Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Existing law provides for the licensure of hospice agencies by the State Department of Public Health to provide hospice services to an individual who is experiencing the last phase of life due to a terminal illness, as defined. Under existing law, hospice services are covered under the Medi-Cal program, subject to utilization controls and the availability of federal financial participation, as specified.

The State Department of Health Care Services administratively requires, effective March 2, 2026, a hospice provider to use a certain online attestation form to notify the department when a Medi-Cal fee-for-service member has elected to receive hospice services, as specified.

This bill would codify and recast those departmental procedures relating to the online form. The bill would require the hospice provider to submit the online form within 5 calendar days after the members election to receive hospice services, and to submit the form in conjunction with counseling, receipt of informed consent, and completion of a separate election notice form, as specified.

The bill would make these provisions applicable only to the Medi-Cal fee-for-service delivery system. In the case of Medi-Cal managed care, the bill would require a hospice provider to instead follow its assigned Medi-Cal managed care plans submission requirements, as specified.

Existing law establishes the Office of Problem Gambling in the State Department of Public Health and requires the office to develop a gambling disorder prevention program that includes, among other components, a toll-free telephone service for immediate crisis management, public awareness campaigns, and training of gambling industry personnel in identifying customers who are at risk for gambling disorders. Existing law also requires the office to develop a treatment program for those purposes, which may include, among other things, state-funded treatment services in the form of telephone counseling. Existing law requires the office to make information available regarding this program as requested by the Governor and the Legislature.

This bill would delete the authorization for telephone counseling treatment services and instead authorize telehealth counseling. The bill would also require the office to make the information available if it is requested by a county health officer.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2538

Author:(Macedo)

As Amended Ver:June 29, 2026

Majority vote

SUMMARY

Codifies current Department of Health Care Services (DHCS) requirements related to online forms to notify DHCS when a Medi-Cal fee-for-service member elects to receive hospice services.

Senate Amendments

Clarify the bill's provisions do not limit DHCS's authority to implement any additional fraud-prevention measures as authorized or required by state or federal law, and add coauthors.

COMMENTS

Hospice. As explained by the State Auditor in a seminal audit requested by the Joint Legislative Audit Committee in 2021, "The State's Weak Oversight of Hospice Agencies Has Created Opportunities for Large-Scale Fraud and Abuse," hospice is a specialized form of interdisciplinary health care primarily designed to provide palliative care and alleviate the physical, emotional, social, and spiritual discomforts of a person who is experiencing the last phases of life because of a terminal disease. Palliative care optimizes the quality of life of a patient with a terminal illness by anticipating, preventing, and treating suffering. Hospice care treats pain and other symptoms associated with a terminal disease, rather than attempting to cure the disease when a cure is no longer possible or when the burdens of curative treatment outweigh the benefits. Individuals who receive hospice care are commonly facing terminal cancer, heart disease, or neurological diagnoses, such as Alzheimer's disease. Hospice patients rely heavily on caregivers and are one of the state's most vulnerable populations.

Although care for the seriously ill and dying has a long history, the modern concept of hospice was introduced to the United States in the 1970s and the federal Medicare program started covering hospice services as a benefit in the 1980s. Medi-Cal coverage mirrors the Medicare hospice benefit. Any Medi-Cal recipient certified by a physician as having a life expectancy of six months or less can elect to receive hospice care in lieu of normal Medi-Cal coverage for services related to the terminal condition. To begin hospice care, a patient or their representative must file an election statement with a hospice provider. This statement acknowledges that the patient understands that the hospice care relating to the illness is intended to alleviate pain and suffering rather than to cure the illness, and that certain Medi-Cal benefits are waived by the election of hospice.

State Audit, Fraud, and Recent State Activity. In December of 2020, The Los Angeles Times published a lengthy investigative series on the hospice industry, focused on the rapid growth in the number of agencies in southern California. In March 2022, the California State Auditor released the audit report mentioned above, which noted that over the prior 10 years, the number of hospice agencies in Los Angeles County had outpaced the need for hospice services. The report found numerous indicators to suggest that many of these hospice agencies had been created to fraudulently bill Medicare and Medi-Cal for services rendered to ineligible patients, or services not provided at all. The report also found that the Department of Public Health (DPH), the agency primarily responsible for the licensing and oversight of hospice agencies, had failed to take adequate action in the face of widespread problems. The report also found that DHCS and the California Department of Justice (DOJ) had not sufficiently coordinated their efforts with DPH. Since the audit, there has been significant legislative, administrative, and enforcement activity, including:

1. Numerous bills were passed, including AB 2673 (Irwin), Chapter 797, Statutes of 2022, which enacted many of the reforms suggested by the Auditor;
2. A moratorium on new hospice licensees was put into place in 2021, which remains in place;
3. Over 280 hospice licenses have been revoked over the past two years, an additional 300 providers are under investigation, and 109 individuals have been charged with hospice-related offenses;
4. The state created a multi-agency Hospice Fraud Task Force coordinated by DPH that includes representation from the California Health & Human Services Agency, DHCS, Department of Social Services, and DOJ; 
5. DHCS has updated its hospice claims systems and managed care requirements to block any hospice payments unless a valid provider/enrollee authorization form is verified, ensuring members have elected hospice care and preventing unauthorized billing;
6. DHCS is strengthening utilization management for hospice care, including prior authorization requirements; and,
7. DPH is in the process of adopting emergency regulations that will lead to permanent regulations that increase DPH's ongoing fraud and oversight protection efforts. DPH submitted then withdrew emergency regulations in December 2025.

Fallout from bad actors in the hospice industry continues to reverberate. As recently as this month, on April 9, 2026, California Attorney General Rob Bonta and DHCS announced charges filed against 21 suspects and the dismantling of a major hospice fraud scheme that defrauded California of $267 million. According to the DOJ, the operation resulted in the arrests of five people after ten different locations were searched in southern California.

DHCS Forms Related to Hospice Election. DHCS maintains two forms related to hospice election: the DHCS 8052 Notice of Election (NOE) form and the recently released Online Medi-Cal Hospice Program Attestation Form. According to DHCS, the two forms serve different but related purposes in the Medi-Cal hospice election process:

1. DHCS 8052 – Hospice Notice of Election (NOE) Form. This form documents the Medi-Cal fee-for-service member's election of hospice services and captures their informed consent and original signature, or that of their legal guardian/authorized representative. It must be completed by qualified hospice personnel after counseling the member and must be retained in the member's medical record. It is not submitted to DHCS, but must be available upon DHCS request or during state/federal audits.
2. Medi-Cal Hospice Program Attestation Form. This form serves as the official notification to DHCS that the member has elected hospice services. It must be completed online by the hospice provider within five calendar days of the election date. The provider must attest that all requirements were met, including obtaining informed consent using the DHCS 8052 form. This form is required starting March 2026; DHCS notes that emailed and paper submissions will no longer be accepted.

This bill codifies the above requirements related to the submission of the Attestation Form and the Hospice Notice of Election form that documents the patient's consent.

According to the Author

This bill helps protect some of the most vulnerable Medi-Cal patients by codifying a commonsense accountability measure already being used by DHCS. The author indicates clear statutory direction is warranted regarding how hospice elections are documented, when the form must be submitted, and how that attestation relates to counseling and informed consent.

Arguments in Support

The California Baptist Capitol Ministry writes in support that this bill ensures proper documentation requirements are applied and reflects a commitment to caring for the vulnerable.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

VOTES:

ASM HEALTH: 16-0-0

YES: Bonta, Chen, Addis, Aguiar-Curry, Ahrens, Caloza, Carrillo, Mark González, Johnson, Patel, Patterson, Rogers, Sanchez, Schiavo, Sharp-Collins, Stefani

ASM APPROPRIATIONS: 14-0-1

YES: Wicks, Hoover, Aguiar-Curry, Caloza, Dixon, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache, Ta, Tangipa

ABS, ABST OR NV: Arambula

ASSEMBLY FLOOR: 77-0-3

YES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Elhawary, Ellis, Fong, Gabriel, Gallagher, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Jackson, Johnson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Tangipa, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

ABS, ABST OR NV: Arambula, Flora, Celeste Rodriguez

SENATE FLOOR: 40-0-0

YES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Reyes, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

UPDATED

VERSION: June 29, 2026

CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0003746

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2538

Author:(Macedo)

As Amended Ver:June 29, 2026

Majority vote

SUMMARY

Codifies current Department of Health Care Services (DHCS) requirements related to online forms to notify DHCS when a Medi-Cal fee-for-service member elects to receive hospice services.

Senate Amendments

Clarify the bill's provisions do not limit DHCS's authority to implement any additional fraud-prevention measures as authorized or required by state or federal law, and add coauthors.

COMMENTS

Hospice. As explained by the State Auditor in a seminal audit requested by the Joint Legislative Audit Committee in 2021, "The State's Weak Oversight of Hospice Agencies Has Created Opportunities for Large-Scale Fraud and Abuse," hospice is a specialized form of interdisciplinary health care primarily designed to provide palliative care and alleviate the physical, emotional, social, and spiritual discomforts of a person who is experiencing the last phases of life because of a terminal disease. Palliative care optimizes the quality of life of a patient with a terminal illness by anticipating, preventing, and treating suffering. Hospice care treats pain and other symptoms associated with a terminal disease, rather than attempting to cure the disease when a cure is no longer possible or when the burdens of curative treatment outweigh the benefits. Individuals who receive hospice care are commonly facing terminal cancer, heart disease, or neurological diagnoses, such as Alzheimer's disease. Hospice patients rely heavily on caregivers and are one of the state's most vulnerable populations.

Although care for the seriously ill and dying has a long history, the modern concept of hospice was introduced to the United States in the 1970s and the federal Medicare program started covering hospice services as a benefit in the 1980s. Medi-Cal coverage mirrors the Medicare hospice benefit. Any Medi-Cal recipient certified by a physician as having a life expectancy of six months or less can elect to receive hospice care in lieu of normal Medi-Cal coverage for services related to the terminal condition. To begin hospice care, a patient or their representative must file an election statement with a hospice provider. This statement acknowledges that the patient understands that the hospice care relating to the illness is intended to alleviate pain and suffering rather than to cure the illness, and that certain Medi-Cal benefits are waived by the election of hospice.

State Audit, Fraud, and Recent State Activity. In December of 2020, The Los Angeles Times published a lengthy investigative series on the hospice industry, focused on the rapid growth in the number of agencies in southern California. In March 2022, the California State Auditor released the audit report mentioned above, which noted that over the prior 10 years, the number of hospice agencies in Los Angeles County had outpaced the need for hospice services. The report found numerous indicators to suggest that many of these hospice agencies had been created to fraudulently bill Medicare and Medi-Cal for services rendered to ineligible patients, or services not provided at all. The report also found that the Department of Public Health (DPH), the agency primarily responsible for the licensing and oversight of hospice agencies, had failed to take adequate action in the face of widespread problems. The report also found that DHCS and the California Department of Justice (DOJ) had not sufficiently coordinated their efforts with DPH. Since the audit, there has been significant legislative, administrative, and enforcement activity, including:

1. Numerous bills were passed, including AB 2673 (Irwin), Chapter 797, Statutes of 2022, which enacted many of the reforms suggested by the Auditor;
2. A moratorium on new hospice licensees was put into place in 2021, which remains in place;
3. Over 280 hospice licenses have been revoked over the past two years, an additional 300 providers are under investigation, and 109 individuals have been charged with hospice-related offenses;
4. The state created a multi-agency Hospice Fraud Task Force coordinated by DPH that includes representation from the California Health & Human Services Agency, DHCS, Department of Social Services, and DOJ; 
5. DHCS has updated its hospice claims systems and managed care requirements to block any hospice payments unless a valid provider/enrollee authorization form is verified, ensuring members have elected hospice care and preventing unauthorized billing;
6. DHCS is strengthening utilization management for hospice care, including prior authorization requirements; and,
7. DPH is in the process of adopting emergency regulations that will lead to permanent regulations that increase DPH's ongoing fraud and oversight protection efforts. DPH submitted then withdrew emergency regulations in December 2025.

Fallout from bad actors in the hospice industry continues to reverberate. As recently as this month, on April 9, 2026, California Attorney General Rob Bonta and DHCS announced charges filed against 21 suspects and the dismantling of a major hospice fraud scheme that defrauded California of $267 million. According to the DOJ, the operation resulted in the arrests of five people after ten different locations were searched in southern California.

DHCS Forms Related to Hospice Election. DHCS maintains two forms related to hospice election: the DHCS 8052 Notice of Election (NOE) form and the recently released Online Medi-Cal Hospice Program Attestation Form. According to DHCS, the two forms serve different but related purposes in the Medi-Cal hospice election process:

1. DHCS 8052 – Hospice Notice of Election (NOE) Form. This form documents the Medi-Cal fee-for-service member's election of hospice services and captures their informed consent and original signature, or that of their legal guardian/authorized representative. It must be completed by qualified hospice personnel after counseling the member and must be retained in the member's medical record. It is not submitted to DHCS, but must be available upon DHCS request or during state/federal audits.
2. Medi-Cal Hospice Program Attestation Form. This form serves as the official notification to DHCS that the member has elected hospice services. It must be completed online by the hospice provider within five calendar days of the election date. The provider must attest that all requirements were met, including obtaining informed consent using the DHCS 8052 form. This form is required starting March 2026; DHCS notes that emailed and paper submissions will no longer be accepted.

This bill codifies the above requirements related to the submission of the Attestation Form and the Hospice Notice of Election form that documents the patient's consent.

According to the Author

This bill helps protect some of the most vulnerable Medi-Cal patients by codifying a commonsense accountability measure already being used by DHCS. The author indicates clear statutory direction is warranted regarding how hospice elections are documented, when the form must be submitted, and how that attestation relates to counseling and informed consent.

Arguments in Support

The California Baptist Capitol Ministry writes in support that this bill ensures proper documentation requirements are applied and reflects a commitment to caring for the vulnerable.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

VOTES:

ASM HEALTH: 16-0-0

YES: Bonta, Chen, Addis, Aguiar-Curry, Ahrens, Caloza, Carrillo, Mark González, Johnson, Patel, Patterson, Rogers, Sanchez, Schiavo, Sharp-Collins, Stefani

ASM APPROPRIATIONS: 14-0-1

YES: Wicks, Hoover, Aguiar-Curry, Caloza, Dixon, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache, Ta, Tangipa

ABS, ABST OR NV: Arambula

ASSEMBLY FLOOR: 77-0-3

YES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Elhawary, Ellis, Fong, Gabriel, Gallagher, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Jackson, Johnson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Tangipa, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

ABS, ABST OR NV: Arambula, Flora, Celeste Rodriguez

SENATE FLOOR: 40-0-0

YES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Reyes, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

UPDATED

VERSION: June 29, 2026

CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0003746

 THIRD READING  

Bill No: AB 2538

Author: Macedo (R), et al.

Amended: 6/29/26 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 6/24/26

AYES: Weber Pierson, Valladares, Caballero, Durazo, Gonzalez, Grove, Menjivar, Padilla, Pérez, Rubio, Smallwood-Cuevas

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 77-0, 5/14/26 (Consent) - See last page for vote

SUBJECT: Medi-Cal: hospice providers: forms

SOURCE: Author

DIGEST:

This bill codifies current Department of Health Care Services (DHCS) requirements for hospice providers to notify DHCS when a Medi-Cal fee-for-service recipient elects hospice services prior to seeking reimbursement for services.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. Establishes a schedule of benefits under the Medi-Cal program, which includes hospice benefits in accordance with Medicare requirements, subject to utilization controls. [Welfare and Institutions Code (WIC) §14000, et seq. and §14132]
2. Authorizes DHCS to take a variety of anti-fraud measures, including limiting codes for which any provider may bill if DHCS determines excessive services or billings or abuse has occurred; suspend payment to providers for all services upon receipt of a credible fraud allegation; automatically suspend or refuse to enroll providers who have been revoked or suspended from a federal, California or another state’s licensing, certification, or approval authority or convicted of any fraud or abuse in any government program; issue Medi-Cal cards to Medi-Cal fraud investigators for purposes of investigating Medi-Cal fraud; seek confirmation from Medi-Cal recipients that covered services were actually received; and, adopt, repeal, or amend additional measures to prevent or curtail fraud and abuse via emergency regulations or guidance in specified cases. [WIC §14044, §14107.11, §14043.6, §14043.36, §14026.5, §14107.13, and §14043.75]
3. Establishes the Hospice Licensure Act of 1990 (Act) which provides the California Department of Public Health (CDPH) with the authority to license and regulate hospice agencies. [Health and Safety Code (HSC) §1745, et seq.]
   
4. Defines “hospice” as a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets specified criteria. [HSC §1746]
5. Imposes a moratorium on new hospice licensure until January 1, 2027, or one year after the date emergency regulations are adopted, as specified. [HSC §1751.70, et seq.]

This bill:

• 1. Requires DHCS to develop an online-only form for hospice providers to use to notify DHCS when a Medi-Cal fee-for-service member elects to receive hospice services. Authorizes DHCS to designate the existing Medi-Cal Hospice Program Attestation Form, its successor, or a different form, as this form.
  2. Requires a hospice provider to submit the online form within five calendar days after the Medi-Cal fee-for-service member’s election to receive hospice services, in conjunction with counseling the Medi-Cal member, obtaining informed consent, and completing and obtaining a signature on the Medi-Cal Hospice Program Election Notice Form (DHCS 8052) or its successor.
  3. Requires the provider to maintain the election notice form in the Medi-Cal member’s medical records and make the election notice form available to DHCS upon request or in the event of a state or federal audit.
  4. Requires submission of the online form for reimbursement eligibility, but specifies that the submission itself does not guarantee that reimbursement.
  5. Requires a reimbursement claim by a hospice provider to be processed only after DHCS validates the information and applies relevant hospice billing codes.
  6. Specifies that this bill applies only to the Medi-Cal fee-for-service delivery system. Clarifies that in the case of Medi-Cal managed care, a hospice provider must instead follow its assigned Medi-Cal managed care plan’s submission requirements, including, but not limited to, the submission of a Medi-Cal hospice program election notice as set forth in All Plan Letter 25-008 or its successor.
  7. Specifies that this bill does not limit DHCS’s authority to implement any additional fraud-prevention measures as authorized or required by state or federal law

Background

According to the author of this bill:

This bill helps protect some of the most vulnerable Medi-Cal patients by making sure hospices are actually providing the services they are claiming. Most people have never had to choose hospice before; they do not know what questions to ask, what warning signs to look for, or who to trust. That is why state oversight matters, and right now the system is broken. This bill codifies a commonsense accountability measure already being used by DHCS and helps ensure the hospice benefit is used appropriately and transparently.

Background on hospice. At the center of hospice care is the belief that individuals have the right to die pain-free and with dignity, and that families will receive necessary support. Hospice care is available to patients who no longer wish treatment directed at curing their disease. Patients are usually referred to hospice by their personal physician, although they can be referred by their families or even by themselves. Initially, a physician certifies that the patient has a life expectancy of six months or less if the disease follows its normal course. Hospice usually begins within 48 hours after a referral, but can begin sooner based on the circumstances. A hospice nurse evaluates what the person and family needs and develops a plan of care. The plan addresses the entire family’s needs: medical; emotional; psychological; spiritual; and, support services. The nurse then coordinates the care with a physician and the full team of health professionals.

State Audit. California State Auditor Report 2021-123 on California Hospice Licensure and Oversight was published on March 29, 2022, and found multiple indicators of fraud and abuse, in particular in Los Angeles County: a rapid increase in the number of hospice agencies with no clear correlation to increased need; excessive geographic clustering of hospices with sometimes dozens of separately licensed agencies located in the same building; unusually long durations of hospice services provided to individual patients; abnormally high rates of still-living patients discharged from hospice care; and, hospice agencies using possibly stolen identities of medical personnel. The state audit found that the state agencies responsible for overseeing hospice care in California have failed to take adequate measures to prevent such fraudulent billing of Medicare or Medi-Cal or to protect patients from unqualified and unscrupulous providers. The report focused primarily on CDPH’s weak licensing and investigative procedures, but also pointed to the need for coordination with DHCS, as the provider of Medi-Cal hospice services with its own investigative authority, and the Department of Justice (DOJ).

Recent state actions. Prior to the release of the report, the Legislature passed SB 664 (Allen, Chapter 494, Statutes of 2021) to instill a moratorium on new hospice licenses. AB 2673 (Irwin, Chapter 797, Statutes of 2022) extended the moratorium, added a new moratorium on license transfers (which remains in place), and required CDPH to conduct surveys of accredited hospices and adopt emergency regulations, along with other oversight requirements. According to the Governor’s office, the state has revoked the licenses of more than 280 hospices over the past two years and is evaluating an additional 300 hospices. The state has also created a multi-agency Hospice Fraud Task Force coordinated by CDPH, that also includes DHCS, the California Health and Human Services Agency, and the DOJ. In April 2026 the Attorney General and DHCS announced charges filed against 21 suspects and the arrest of five people in a hospice fraud scheme that defrauded California of $267 million. Finally, CDPH just released proposed emergency regulations that would establish a comprehensive licensing framework for hospice agencies on June 1, 2026.

Trump administration focus on fraud in Medicaid. The Trump Administration has begun intensely focusing on fraud in the Medicaid program. On January 27, 2026, the Center for Medicare & Medicaid Services (CMS) Director Mehmet Oz posted a video on social media highlighting hospice fraud in Los Angeles. However, in a January 27, 2026 letter from CMS to Governor Newsom, CMS identified 14 services as “high-risk” services that were the focus of fraud investigations in Minnesota and questioned what activities California has undertaken related to these services. Hospice services were not mentioned in this letter. Nonetheless, in DHCS’ response to this letter, it highlighted its efforts to combat fraud, waste, and abuse. DHCS stated that the largest number of credible allegations of fraud that it has investigated involve hospice providers, with allegations including billing for services not rendered, medically unnecessary services, and upcoding. In the past two years, DHCS’s fraud unit had 48 hospice-related credible fraud referrals involving 189 subjects.

The President also formed a fraud task force via executive order on March 16, 2026, chaired by the Vice President, to look at fraud across the federal government. Most recently, on May 13, 2026, CMS announced a six-month moratorium on new Medicare enrollment for hospices; and in the press release, pointed to heightened oversight of newly enrolled Medicare hospice providers in states with elevated fraud risk, including California. CMS also stated that it was conducting nationwide hospice site visits, proposing new regulations involving a new public hospice scoring system, and suspending payments to hundreds of hospice providers in Los Angeles.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/3/26)

The California Baptist Capitol Ministry

OPPOSITION: (Verified 8/3/26)

None received

ARGUMENTS IN SUPPORT: The California Baptist Capitol Ministry, representing 11 California Baptist Churches, writes in support stating that this bill is a commitment to caring for the most vulnerable among us. They state that the bible requires extending proper care and accountability for those in their final days.

ASSEMBLY FLOOR: 77-0, 5/14/26

AYES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Elhawary, Ellis, Fong, Gabriel, Gallagher, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Jackson, Johnson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Tangipa, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NO VOTE RECORDED: Arambula, Flora, Celeste Rodriguez

Prepared by: Jen Flory / HEALTH / (916) 651-4111

8/5/26 15:12:49

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Akilah Weber Pierson, Chair

BILL NO: AB 2538

SUBJECT: Medi-Cal: hospice providers: forms.

SUMMARY:

Codifies current Department of Health Care Services (DHCS) requirements for hospice providers to notify DHCS when a Medi-Cal fee-for-service recipient elects hospice services prior to seeking reimbursement for services.

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. Establishes a schedule of benefits under the Medi-Cal program, which includes hospice benefits in accordance with Medicare requirements, subject to utilization controls. [WIC §14000, et seq. and §14132]
2. Authorizes DHCS to take a variety of anti-fraud measures, including limiting codes for which any provider may bill if DHCS determines excessive services or billings or abuse has occurred; suspend payment to providers for all services upon receipt of a credible fraud allegation; automatically suspend or refuse to enroll providers who have been revoked or suspended from a federal, California or another state’s licensing, certification, or approval authority or convicted of any fraud or abuse in any government program; issue Medi-Cal cards to Medi-Cal fraud investigators for purposes of investigating Medi-Cal fraud; seek confirmation from Medi-Cal recipients that covered services were actually received; and, adopt, repeal, or amend additional measures to prevent or curtail fraud and abuse via emergency regulations or guidance in specified cases. [WIC §14044, §14107.11, §14043.6, §14043.36, §14026.5, §14107.13, and §14043.75]
3. Establishes the Hospice Licensure Act of 1990 (Act) which provides the California Department of Public Health (CDPH) with the authority to license and regulate hospice agencies. [HSC §1745, et seq.]
   
4. Defines “hospice” as a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets specified criteria. [HSC §1746]
5. Imposes a moratorium on new hospice licensure until January 1, 2027, or one year after the date emergency regulations are adopted, as specified. [HSC §1751.70, et seq.]

This bill:

• 1. Requires DHCS to develop an online-only form for hospice providers to use to notify DHCS when a Medi-Cal fee-for-service member elects to receive hospice services. Authorizes DHCS to designate the existing Medi-Cal Hospice Program Attestation Form, its successor, or a different form, as this form.
  2. Requires a hospice provider to submit the online form within five calendar days after the Medi-Cal fee-for-service member’s election to receive hospice services, in conjunction with counseling the Medi-Cal member, obtaining informed consent, and completing and obtaining a signature on the Medi-Cal Hospice Program Election Notice Form (DHCS 8052) or its successor.
  3. Requires the provider to maintain the election notice form in the Medi-Cal member’s medical records and make the election notice form available to DHCS upon request or in the event of a state or federal audit.
  4. Requires submission of the online form for reimbursement eligibility, but specifies that the submission itself does not guarantee that reimbursement.
  5. Requires a reimbursement claim to be processed only after DHCS validates the information and applies relevant hospice billing codes.
  6. Specifies that this bill applies only to the Medi-Cal fee-for-service delivery system. Clarifies that in the case of Medi-Cal managed care, a hospice provider must instead follow its assigned Medi-Cal managed care plan’s submission requirements, including, but not limited to, the submission of a Medi-Cal hospice program election notice as set forth in All Plan Letter 25-008 or its successor.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, this bill has no state costs.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill helps protect some of the most vulnerable Medi-Cal patients by making sure hospices are actually providing the services they are claiming. Most people have never had to choose hospice before; they do not know what questions to ask, what warning signs to look for, or who to trust. That is why state oversight matters, and right now the system is broken. This bill codifies a commonsense accountability measure already being used by DHCS and helps ensure the hospice benefit is used appropriately and transparently.
2. Background on hospice. At the center of hospice care is the belief that individuals have the right to die pain-free and with dignity, and that families will receive necessary support. Hospice care is available to patients who no longer wish treatment directed at curing their disease. Patients are usually referred to hospice by their personal physician, although they can be referred by their families or even by themselves. Initially, a physician certifies that the patient has a life expectancy of six months or less if the disease follows its normal course. Hospice usually begins within 48 hours after a referral, but can begin sooner based on the circumstances. A hospice nurse evaluates what the person and family needs and develops a plan of care. The plan addresses the entire family’s needs: medical; emotional; psychological; spiritual; and, support services. The nurse then coordinates the care with a physician and the full team of health professionals.
   
3. State Audit. California State Auditor Report 2021-123 on California Hospice Licensure and Oversight was published on March 29, 2022, and found multiple indicators of fraud and abuse, in particular in Los Angeles County: a rapid increase in the number of hospice agencies with no clear correlation to increased need; excessive geographic clustering of hospices with sometimes dozens of separately licensed agencies located in the same building; unusually long durations of hospice services provided to individual patients; abnormally high rates of still-living patients discharged from hospice care; and, hospice agencies using possibly stolen identities of medical personnel. The state audit found that the state agencies responsible for overseeing hospice care in California have failed to take adequate measures to prevent such fraudulent billing of Medicare or Medi-Cal or to protect patients from unqualified and unscrupulous providers. The report focused primarily on CDPH’s weak licensing and investigative procedures, but also pointed to the need for coordination with DHCS, as the provider of Medi-Cal hospice services with its own investigative authority, and the Department of Justice (DOJ).
4. Recent state actions. Prior to the release of the report, the Legislature passed SB 664 (Allen, Chapter 494, Statutes of 2021) to instill a moratorium on new hospice licenses. AB 2673 (Irwin, Chapter 797, Statutes of 2022) extended the moratorium, added a new moratorium on license transfers (which remains in place), and required CDPH to conduct surveys of accredited hospices and adopt emergency regulations, along with other oversight requirements. According to the Governor’s office, the state has revoked the licenses of more than 280 hospices over the past two years and is evaluating an additional 300 hospices. The state has also created a multi-agency Hospice Fraud Task Force coordinated by CDPH, that also includes DHCS, the California Health and Human Services Agency, and the DOJ. In April 2026 the Attorney General and DHCS announced charges filed against 21 suspects and the arrest of five people in a hospice fraud scheme that defrauded California of $267 million. Finally, CDPH just released proposed emergency regulations that would establish a comprehensive licensing framework for hospice agencies on June 1, 2026.
5. Trump administration focus on fraud in Medicaid. The Trump Administration has begun intensely focusing on fraud in the Medicaid program. On January 27, 2026, the Center for Medicare & Medicaid Services (CMS) Director Mehmet Oz posted a video on social media highlighting hospice fraud in Los Angeles. However, in a January 27, 2026 letter from CMS to Governor Newsom, CMS identified 14 services as “high-risk” services that were the focus of fraud investigations in Minnesota and questioned what activities California has undertaken related to these services. Hospice services were not mentioned in this letter. Nonetheless, in DHCS’ response to this letter, it highlighted its efforts to combat fraud, waste, and abuse. DHCS stated that the largest number of credible allegations of fraud that it has investigated involve hospice providers, with allegations including billing for services not rendered, medically unnecessary services, and upcoding. In the past two years, DHCS’s fraud unit had 48 hospice-related credible fraud referrals involving 189 subjects.

The President also formed a fraud task force via executive order on March 16, 2026, chaired by the Vice President, to look at fraud across the federal government. Most recently, on May 13, 2026, CMS announced a six-month moratorium on new Medicare enrollment for hospices; and in the press release, pointed to heightened oversight of newly enrolled Medicare hospice providers in states with elevated fraud risk, including California. CMS also stated that it was conducting nationwide hospice site visits, proposing new regulations involving a new public hospice scoring system, and suspending payments to hundreds of hospice providers in Los Angeles.

1. Related legislation. AB 2670 (Castillo) would require DHCS to convene a task force to assess fraud risks in the Medi-Cal program. AB 2670 was not heard in the Assembly Health Committee.
2. Prior legislation. AB 177 (Committee on Budget, Chapter 999, Statutes of 2024) extends the moratorium on new hospice agency licenses until January 1, 2027, or one year after the date CDPH adopts emergency regulations.

SB 137 (Committee on Budget and Fiscal Review, Chapter 191, Statutes of 2023) extends the deadline by which CDPH must adopt emergency regulations to implement audit recommendations for the licensure and oversight of hospice agencies.

AB 1117 (Irwin of 2023) would have required any hospice agency obtaining a license to obtain certification to participate in the federal Medicare program within 12 months of licensure, and to continuously serve patients, or to forfeit its license. AB 1117 was not heard in the Senate Health Committee.

AB 2673 (Irwin, Chapter 797, Statutes of 2022) extends the moratorium on new hospice agency licenses and enacts numerous recommendations from the Auditor's report on hospice licensure.

AB 1280 (Irwin, Chapter 478, Statutes of 2021) prohibits a hospice provider from paying referral sources for referring a patient to the hospice. AB 1280 requires a hospice to provide verbal and written notice of the patient's rights and responsibilities in a language and manner the person understands, before providing care.

SB 664 (Allen, Chapter 494, Statutes of 2021) imposes a moratorium on new hospice licenses until one year from the date that the California State Auditor publishes a report on hospice licensure.

1. Support. The California Baptist Capitol Ministry, representing 11 California Baptist Churches, writes in support stating that this bill is a commitment to caring for the most vulnerable among us. They state that the bible requires extending proper care and accountability for those in their final days.
2. Policy comment. Although hospice fraud has clearly caught the attention of both state and federal officials, codifying a recently adopted mandated hospice election form will likely not alter the landscape. Should this be codified in statute, the author may also want to include language that clarifies that DHCS is not precluded in any way from implementing other anti-fraud measures as it sees fit or as required by federal law. For example, providers currently do not need to submit the patient’s signed election form under this bill. At some stage DHCS or CMS may decide this is necessary.
3. Amendments. The author and committee have agreed to the following amendments.

Make a technical correction as noted below as the section mentioned does not actually provide for any services:

(d)(2) A claim for reimbursement under this section by a hospice provider shall be processed only after the department validates the information and applies the relevant hospice billing code.

Add catch-all language to ensure that the specific requirements for the hospice election form do not hinder additional fraud-prevention efforts:

(g) Nothing in this section shall limit the department’s authority to implement any additional fraud-prevention measures as authorized or required by state or federal law.

SUPPORT AND OPPOSITION:

Support: The California Baptist Capitol Ministry

Oppose: None received.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Akilah Weber Pierson, Chair

BILL NO: AB 2538

SUBJECT: Medi-Cal: hospice providers: forms.

SUMMARY:

Codifies current Department of Health Care Services (DHCS) requirements for hospice providers to notify DHCS when a Medi-Cal fee-for-service recipient elects hospice services prior to seeking reimbursement for services.

Existing law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. [WIC §14000, et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program, which includes hospice benefits in accordance with Medicare requirements, subject to utilization controls. [WIC §14132]
3. Authorizes DHCS to take a variety of anti-fraud measures, including limiting codes for which any provider may bill if DHCS determines excessive services or billings or abuse has occurred; suspend payment to providers for all services upon receipt of a credible fraud allegation; automatically suspending or refuse to enroll providers who have been revoked or suspended from a federal, California or another state’s licensing, certification, or approval authority or convicted of any fraud or abuse in any government program; issue Medi-Cal cards to Medi-Cal fraud investigators for purposes of investigating Medi-Cal fraud; seek confirmation from Medi-Cal recipients that covered services were actually received; and adopt, repeal, or amend additional measures to prevent or curtail fraud and abuse via emergency regulations or guidance in specified cases. [WIC §14044, §14107.11, §14043.6, §14043.36, §14026.5, §14107.13, and §14043.75]
4. Establishes the Hospice Licensure Act of 1990 (Act) which provides the California Department of Public Health (CDPH) with the authority to license and regulate hospice agencies. [HSC §1745, et seq.]
   
5. Defines hospice as a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets specified criteria. [HSC §1746]
6. Imposes a moratorium on new hospice licensure until January 1, 2027, or one year after the date emergency regulations are adopted, as specified. [HSC §1751.70, et seq.]

This bill:

• 1. Requires DHCS to develop an online-only form for hospice providers to use to notify DHCS when a Medi-Cal fee-for-service member elects to receive hospice services while authorizing DHCS to designate the existing Medi-Cal Hospice Program Attestation Form, its successor, or a different form, as this form.
  2. Requires a hospice provider to submit the online form within five calendar days after the Medi-Cal fee-for-service member’s election to receive hospice services, in conjunction with counseling the Medi-Cal member, obtaining informed consent, and completing and obtaining a signature on the Medi-Cal Hospice Program Election Notice Form (DHCS 8052) or its successor.
  3. Requires the provider to maintain the election notice form in the Medi-Cal member’s medical records and make the election notice form available to DHCS upon request or in the event of a state or federal audit.
  4. Specifies that submission of the online form described in a) is required for reimbursement eligibility, but the submission itself does not guarantee that reimbursement.
  5. Prohibits DHCS from processing a claim for reimbursement only after validating the information and applying the relevant hospice billing code.
  6. Specifies that this bill applies only to the Medi-Cal fee-for-service delivery system. Clarifies that in the case of Medi-Cal managed care, a hospice provider must instead follow its assigned Medi-Cal managed care plan’s submission requirements, including, but not limited to, the submission of a Medi-Cal hospice program election notice as set forth in All Plan Letter 25-008 or its successor.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, this bill has no state costs.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill helps protect some of the most vulnerable Medi-Cal patients by making sure hospices are actually providing the services they are claiming. Most people have never had to choose hospice before; they do not know what questions to ask, what warning signs to look for, or who to trust. That is why state oversight matters, and right now the system is broken. This bill codifies a commonsense accountability measure already being used by DHCS and helps ensure the hospice benefit is used appropriately and transparently.
2. Background on hospice. At the center of hospice care is the belief that individuals have the right to die pain-free and with dignity, and that families will receive necessary support. Hospice care is available to patients who no longer wish treatment directed at curing their disease. Patients are usually referred to hospice by their personal physician, although they can be referred by their families or even by themselves. Initially, a physician certifies that the patient has a life expectancy of six months or less if the disease follows its normal course. Hospice usually begins within 48 hours after a referral, but can begin sooner based on the circumstances. A hospice nurse evaluates what the person and family needs and develops a plan of care. The plan addresses the entire family’s needs: medical; emotional; psychological; spiritual; and, support services. The nurse then coordinates the care with a physician and the full team of health professionals.
   
3. State Audit. California State Auditor Report 2021-123 on California Hospice Licensure and Oversight was published on March 29, 2022, and found multiple indicators of fraud and abuse, in particular in Los Angeles County: a rapid increase in the number of hospice agencies with no clear correlation to increased need; excessive geographic clustering of hospices with sometimes dozens of separately licensed agencies located in the same building; unusually long durations of hospice services provided to individual patients; abnormally high rates of still-living patients discharged from hospice care; and hospice agencies using possibly stolen identities of medical personnel. The state audit found that the state agencies responsible for overseeing hospice care in California have failed to take adequate measures to prevent such fraudulent billing of Medicare or Medi-Cal or to protect patients from unqualified and unscrupulous providers. The report focused primarily on CDPH’s weak licensing and investigative procedures, but also pointed to the need for coordination with DHCS, as the provider of Medi-Cal hospice services with its own investigative authority, and the Department of Justice.
4. Recent state actions. Prior to the release of the report, the Legislature passed SB 664 (Allen, Chapter 494, Statutes of 2021) to instill a moratorium on new hospice licenses. AB 2673 (Irwin, Chapter 797, Statutes of 2022) extended the moratorium, added a new moratorium on license transfers (which remains in place), required CDPH to conduct surveys of accredited hospices and adopt emergency regulations, along with other oversight requirements. CDPH submitted emergency regulations in December 2025, but withdrew them. According to the Governor’s office, the state has revoked the licenses of more than 280 hospices over the past two years and is evaluating an additional 300 hospices. The state has also created a multi-agency Hospice Fraud Task Force coordinated by CDPH, that also includes DHCS, the California Health and Human Services Agency, and the Department of Justice. Finally, the Attorney General and DHCS also recently announced charges filed against 21 suspects and the arrest of five people in a hospice fraud scheme that defrauded California of $267 million.
5. Trump administration focus on fraud in Medicaid. The Trump Administration has begun intensely focusing on fraud in the Medicaid program. On January 27, 2026, the Center for Medicare & Medicaid Services (CMS) Director Mehmet Oz posted a video on social media highlighting hospice fraud in Los Angeles. However, in a January 27, 2026 letter from CMS to Governor Newsom, CMS identified 14 services as “high-risk” services that were the focus of fraud investigations in Minnesota and questioned what activities California has undertaken related to these services. Hospice services were not mentioned in this letter. Nonetheless, in DHCS’ response to this letter, it highlighted its efforts to combat fraud, waste, and abuse. DHCS stated that the largest number of credible allegations of fraud that it has investigated involve hospice providers, with allegations including billing for services not rendered, medically unnecessary services, and upcoding. In the past two years, DHCS’s fraud unit had 48 hospice-related credible fraud referrals involving 189 subjects.

The President also formed a fraud task force via executive order on March 16, 2026, chaired by the Vice President, to look at fraud across the federal government. Most recently, on May 13, 2026, CMS announced a six-month moratorium on new Medicare enrollment for hospices; and in the press release, pointed to heightened oversight of newly enrolled Medicare hospice providers in states with elevated fraud risk, including California. CMS also stated that it was conducting nationwide hospice site visits, proposing new regulations involving a new public hospice scoring system, and suspending payments to hundreds of hospice providers in Los Angeles.

1. Related legislation. AB 2670 (Castillo) would require DHCS to convene a task force to assess fraud risks in the Medi-Cal program. AB 2670 was not heard in the Assembly Health Committee.
2. Prior legislation. AB 177 (Committee on Budget, Chapter 999, Statutes of 2024) extends the existing moratorium on new hospice agency licenses until January 1, 2027, or one year after the date CDPH adopts emergency regulations.

SB 137 (Committee on Budget and Fiscal Review, Chapter 191, Statutes of 2023) extends the deadline by which CDPH must adopt emergency regulations to implement audit recommendations for the licensure and oversight of hospice agencies.

AB 1117 (Irwin of 2023) would have required any hospice agency obtaining a license to obtain certification to participate in the federal Medicare program within 12 months of licensure, and to continuously serve patients, or to forfeit its license. AB 1117 was not heard in the Senate Health Committee.

AB 2673 (Irwin, Chapter 797, Statutes of 2022) extends the moratorium on new hospice agency licenses and enacts numerous recommendations from the Auditor's report on hospice licensure.

AB 1280 (Irwin, Chapter 478, Statutes of 2021) prohibits a hospice referral source from paying referral sources for referring a patient to the hospice. Requires a hospice to provide verbal and written notice of the patient's rights and responsibilities in a language and manner the person understands, before providing care.

SB 664 (Allen, Chapter 494, Statutes of 2021) imposes a moratorium on new hospice licenses until one year from the date that the California State Auditor publishes a report on hospice licensure.

1. Policy comment. Although hospice fraud has clearly caught the attention of both state and federal officials, codifying a recently adopted mandated hospice election form will likely not alter the landscape. Should this be codified in statute, the author may also want to include language that clarifies that DHCS is not precluded in any way from implementing other anti-fraud measures as it sees fit or as required by federal law. For example, providers currently do not need to submit the patient’s signed election form under this bill. At some stage DHCS or CMS may decide this is necessary.
2. Amendments. Make a technical correction as noted below as the section mentioned does not actually provide for any services:

(d)(2) A claim for reimbursement under this section by a hospice provider shall be processed only after the department validates the information and applies the relevant hospice billing code.

Add catch-all language to ensure that the specific requirements for the hospice election form due not hinder additional fraud-prevention efforts:

(g) Nothing in this section shall limit the department’s authority to implement any additional fraud-prevention measures as authorized or required by state or federal law.

SUPPORT AND OPPOSITION:

Support: None received.

Oppose: None received.

-- END --

Date of Hearing: May 6, 2026

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2538

Author:(Macedo) – As Amended Ver:March 16, 2026

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill codifies current Department of Health Care Services (DHCS) requirements related to online forms to notify DHCS when a Medi-Cal fee-for-service member elects to receive hospice services.

FISCAL EFFECT:

No state costs.

COMMENTS:

1. Purpose. According to the author:

[This bill] helps protect some of the most vulnerable Medi-Cal patients by making sure hospices are actually providing the services they are claiming. Most people have never had to choose hospice before; they do not know what questions to ask, what warning signs to look for, or who to trust. That is why state oversight matters, and right now the system is broken. This bill codifies a commonsense accountability measure already being used by DHCS and helps ensure the hospice benefit is used appropriately and transparently.

1. Background. Hospice. Hospice is a specialized form of interdisciplinary health care primarily designed to provide palliative care and alleviate the physical, emotional, social, and spiritual discomforts of a person who is experiencing the last phases of life because of a terminal disease. Palliative care optimizes the quality of life of a patient with a terminal illness by anticipating, preventing, and treating suffering. Individuals who receive hospice care are commonly facing terminal cancer, heart disease, or neurological diagnoses, such as Alzheimer’s disease. Hospice patients rely heavily on caregivers and are one of the state’s most vulnerable populations.

Medi-Cal coverage mirrors the Medicare hospice benefit, which began in the 1980s. Any Medi-Cal recipient certified by a physician as having a life expectancy of six months or less can elect to receive hospice care in lieu of normal Medi-Cal coverage for services related to the terminal condition. To begin hospice care, a patient or their representative must file an election statement with a hospice provider. This statement acknowledges that the patient understands that the hospice care relating to the illness is intended to alleviate pain and suffering rather than to cure the illness, and that certain Medi-Cal benefits are waived by the election of hospice.

Hospice Fraud. In December of 2020, The Los Angeles Times published an investigative series on the hospice industry, focused on the rapid growth in the number of agencies in southern California. In March 2022, the California State Auditor (CSA) released an audit report that noted that the number of hospice agencies in Los Angeles County had outpaced the need for hospice services in the preceding 10 years. The report found numerous indicators to suggest that many of these hospice agencies had been created to fraudulently bill Medicare and Medi-Cal for services rendered to ineligible patients, or services not provided at all. The audit found that the California Department of Public Health (CDPH), the agency primarily responsible for the licensing and oversight of hospice agencies, had failed to take adequate action in the face of widespread problems. The CSA report also found that DHCS and the California Department of Justice (DOJ) had not sufficiently coordinated their efforts with CDPH.

DHCS Forms Related to Hospice Election. As one of the many responses to the CSA audit, DHCS updated its hospice claims systems and managed care requirements to block hospice payments unless a valid provider/enrollee authorization form is verified, ensuring members have elected hospice care and preventing unauthorized billing. DHCS maintains two forms related to hospice election: the Notice of Election (NOE) form and the recently released Online Medi-Cal Hospice Program Attestation Form. According to DHCS, the two forms serve different but related purposes in the Medi-Cal hospice election process. The Hospice Notice of Election (NOE) Form documents a Medi-Cal fee-for-service member’s election of hospice services and captures their informed consent and original signature, or that of their legal guardian or authorized representative. It must be completed by qualified hospice personnel after counseling the member and must be retained in the member’s medical record, but is not submitted to DHCS.

The Medi-Cal Hospice Program Attestation Form serves as the official notification to DHCS that the member has elected hospice services. It must be completed online by the hospice provider within five calendar days of the election date. The provider must attest that all requirements were met, including obtaining informed consent using the DHCS NOE form.

This bill codifies the above requirements related to submission of the Attestation Form and the Hospice NOE form that documents the patient’s consent.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 21, 2026

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2538

Author:(Macedo) – As Amended Ver:March 16, 2026

SUBJECT: Medi-Cal: hospice providers: forms.

SUMMARY: Codifies current Department of Health Care Services (DHCS) requirements related to online forms to notify DHCS when a Medi-Cal fee-for-service member elects to receive hospice services.

EXISTING LAW:

1. Establishes the Medi-Cal program, which is administered by DHCS, and under which qualified low-income individuals receive health care services. [Welfare and Institutions Code (WIC) § 14000, et seq.]
2. Establishes a schedule of benefits under the Medi-Cal program, which includes hospice services in accordance with Medicare requirements. [WIC § 14132 (w)]
3. Establishes the Hospice Licensure Act of 1990 which provides the Department of Public Health (DPH) with the authority to license and regulate hospice agencies. [Health & Safety Code (HSC) § 1745, et seq.]
4. Defines hospice as a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets specified criteria. [HSC § 1746]
5. Imposes a moratorium on new hospice licensure until January 1, 2027, or one year after the date emergency regulations are adopted, as specified. [HSC § 1751.70, et seq.]

FISCAL EFFECT: Unknown. This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill helps protect some of the most vulnerable Medi-Cal patients by codifying a commonsense accountability measure already being used by DHCS. The author indicates clear statutory direction is warranted regarding how hospice elections are documented, when the form must be submitted, and how that attestation relates to counseling and informed consent.
2. BACKGROUND.
   1. Hospice. As explained by the State Auditor in a seminal audit requested by the Joint Legislative Audit Committee in 2021, “The State's Weak Oversight of Hospice Agencies Has Created Opportunities for Large-Scale Fraud and Abuse,” hospice is a specialized form of interdisciplinary health care primarily designed to provide palliative care and alleviate the physical, emotional, social, and spiritual discomforts of a person who is experiencing the last phases of life because of a terminal disease. Palliative care optimizes the quality of life of a patient with a terminal illness by anticipating, preventing, and treating suffering. Hospice care treats pain and other symptoms associated with a terminal disease, rather than attempting to cure the disease when a cure is no longer possible or when the burdens of curative treatment outweigh the benefits. Individuals who receive hospice care are commonly facing terminal cancer, heart disease, or neurological diagnoses, such as Alzheimer’s disease. Hospice patients rely heavily on caregivers and are one of the state’s most vulnerable populations.

Although care for the seriously ill and dying has a long history, the modern concept of hospice was introduced to the United States in the 1970s and the federal Medicare program started covering hospice services as a benefit in the 1980s. Medi-Cal coverage mirrors the Medicare hospice benefit. Any Medi-Cal recipient certified by a physician as having a life expectancy of six months or less can elect to receive hospice care in lieu of normal Medi-Cal coverage for services related to the terminal condition. To begin hospice care, a patient or their representative must file an election statement with a hospice provider. This statement acknowledges that the patient understands that the hospice care relating to the illness is intended to alleviate pain and suffering rather than to cure the illness, and that certain Medi-Cal benefits are waived by the election of hospice.

• 1. State Audit, Fraud, and Recent State Activity. In December of 2020, The Los Angeles Times published a lengthy investigative series on the hospice industry, focused on the rapid growth in the number of agencies in southern California. In March 2022, the California State Auditor released the audit report mentioned above, which noted that over the prior 10 years, the number of hospice agencies in Los Angeles County had outpaced the need for hospice services. The report found numerous indicators to suggest that many of these hospice agencies had been created to fraudulently bill Medicare and Medi-Cal for services rendered to ineligible patients, or services not provided at all. The report also found that DPH, the agency primarily responsible for the licensing and oversight of hospice agencies, had failed to take adequate action in the face of widespread problems. The report also found that DHCS and the California Department of Justice (DOJ) had not sufficiently coordinated their efforts with DPH. Since the audit, there has been significant legislative, administrative, and enforcement activity, including:
     1. Numerous bills were passed, including AB 2673 (Irwin), Chapter 797, Statutes of 2022, which enacted many of the reforms suggested by the Auditor;
     2. A moratorium on new hospice licensees was put into place in 2021, which remains in place;
     3. Over 280 hospice licenses have been revoked over the past two years, an additional 300 providers are under investigation, and 109 individuals have been charged with hospice-related offenses;
     4. The state created a multi-agency Hospice Fraud Task Force coordinated by DPH that includes representation from the California Health & Human Services Agency, DHCS, Department of Social Services, and DOJ; 
     5. DHCS has updated its hospice claims systems and managed care requirements to block any hospice payments unless a valid provider/enrollee authorization form is verified, ensuring members have elected hospice care and preventing unauthorized billing;
     6. DHCS is strengthening utilization management for hospice care, including prior authorization requirements; and,
     7. DPH is in the process of adopting emergency regulations that will lead to permanent regulations that increase DPH’s ongoing fraud and oversight protection efforts. DPH submitted then withdrew emergency regulations in December 2025.

Fallout from bad actors in the hospice industry continues to reverberate. As recently as this month, on April 9, 2026, California Attorney General Rob Bonta and DHCS announced charges filed against 21 suspects and the dismantling of a major hospice fraud scheme that defrauded California of $267 million. According to the DOJ, the operation resulted in the arrests of five people after ten different locations were searched in southern California.

• 1. DHCS Forms Related to Hospice Election. DHCS maintains two forms related to hospice election: the DHCS 8052 Notice of Election (NOE) form and the recently released Online Medi-Cal Hospice Program Attestation Form. According to DHCS, the two forms serve different but related purposes in the Medi-Cal hospice election process:
     1. DHCS 8052 – Hospice Notice of Election (NOE) Form. This form documents the Medi-Cal fee-for-service member’s election of hospice services and captures their informed consent and original signature, or that of their legal guardian/authorized representative. It must be completed by qualified hospice personnel after counseling the member and must be retained in the member’s medical record. It is not submitted to DHCS, but must be available upon DHCS request or during state/federal audits.
     2. Medi-Cal Hospice Program Attestation Form. This form serves as the official notification to DHCS that the member has elected hospice services. It must be completed online by the hospice provider within five calendar days of the election date. The provider must attest that all requirements were met, including obtaining informed consent using the DHCS 8052 form. This form is required starting March 2026; DHCS notes that emailed and paper submissions will no longer be accepted.

This bill codifies the above requirements related to the submission of the Attestation Form and the Hospice Notice of Election form that documents the patient’s consent.

1. RELATED LEGISLATION. AB 2670 (Castillo) would require DHCS to convene a task force to assess fraud risks in the Medi-Cal program. AB 2670 is pending in the Assembly Health Committee.
2. PREVIOUS LEGISLATION.
   1. AB 177 (Committee on Budget), Chapter 999, Statutes of 2024, extends the existing moratorium on new hospice agency licenses until January 1, 2027, or one year after the date DPH adopts emergency regulations.
   2. SB 137 (Committee on Budget and Fiscal Review), Chapter 191, Statutes of 2023, extends the deadline by which DPH must adopt emergency regulations to implement audit recommendations for the licensure and oversight of hospice agencies.
   3. AB 1117 (Irwin) of 2023 would have required any hospice agency obtaining a license to obtain certification to participate in the federal Medicare program within 12 months of licensure, and to continuously serve patients, or to forfeit its license. AB 1117 was referred to the Senate Health Committee and not heard.
   4. AB 2673 (Irwin) extended the moratorium on new hospice agency licenses and enacted numerous recommendations from the Auditor's report on hospice licensure.
   5. SB 664 (Allen), Chapter 494, Statutes of 2021, imposed a moratorium on new hospice agency licenses.
   6. AB 1280 (Irwin), Chapter 478, Statutes of 2021, prohibits a hospice referral source from receiving, directly or indirectly, any form of payment in exchange for referring a patient to hospice provider or facility, and requires a hospice to provide verbal and written notice of the patient's rights and responsibilities in a language and manner the person understands, before providing care.

REGISTERED SUPPORT / OPPOSITION:

Support

None on file

Opposition

None on file

Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097