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Public Hospital Project (PHP)

Overview

In 2008, the Department of Health Care Services' (DHCS) Clinical Assurance and Administrative Support Division (CAASD) piloted a new process which allowed selected Designated Public Hospitals (DPHs) to use an evidence based standardized medical review criteria tool in lieu of the TAR process for Fee-For-Service (FFS) Medi-Cal admissions. 

The Designated Public Hospital Project (DPHP) pilot ended in 2010 and allowed DHCS to analyze the impact of the DPHs using standardized criteria on acute inpatient days, length of stay, levels of care, approval and denial rates, and program costs. 

The DPHP, also called the Public Hospital Project (PHP) and Tar-Free Project, entered an expansion phase after the pilot period, to transition all DPHs into the project.  Participating hospitals abide by a Participation Agreement and receive training on the TAR-free process for Medi-Cal FFS admissions.  Trainings include an overview of the PHP, Acute Administrative Days, and Medi-Cal Aid Codes.

 

Public Hospital Project Participation Agreement

Frequently Asked Questions (FAQs)  |  Frequently Asked Questions (FAQs) (Acute Rehab)

​Participating Hospitals Technical Workgroup Teleconference Minutes September 11, 2017
Training PowerPoint I : PHP Overview Technical Workgroup Teleconference Minutes June 5, 2017
Training PowerPoint II: Admin Days Technical Workgroup Teleconference Minutes March 6, 2017

Training PowerPoint III: Medi-Cal Aid Codes

Technical Workgroup Teleconference Minutes December 5, 2016
DPH Denied Medi-Cal Days Template

 

Superior Systems Waiver  |  DHCS CAASD Reason Code Authority  |  Dispute Resolution Process

Since 1985, the Superior Systems Waiver (SSW), under the authority of the federal Centers for Medicare and Medicaid Services, has allowed the Clinical Assurance and Administrative Support Division (CAASD) to provide oversight of the utilization of Medi-Cal services.  In the DPHP (PHP) Project, CAASD reports utilization oversight findings by means of a set of reason codes. 

These reason codes reflect variances from Medi-Cal policy.  Sources of authority for these reason codes include the Federal Code of Regulations, California Code of Regulations, California Welfare and Institutions Code, Federal Social Security Act and Manual of Criteria for Medi-Cal Authorization.  A dispute resolution process is in place for participating hospitals to dispute any DHCS UMD findings.

Reason Codes

Reason Codes (Acute Rehab)

Medi-Cal Provider Manual Medi-Cal Aid Codes

Dispute Resolution Form

Reason Code Authority Manual for Medi-Cal Authorization Criteria
Process for Disputes, Claim Adjustments and Recoupment

 

Links

Contact Information

The PHP is supported by DHCS CAASD Headquarters staff based in Sacramento, CA as well as DHCS Medi-Cal Field Offices located throughout the State. The following general email address is available for participating hospitals to submit questions, suggestions, or any other communications to the DHCS CAASD Staff:  PublicHospitalProject@dhcs.ca.gov.

 

DHCS CAASD Staff Phone List

 

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Last modified on: 9/15/2017 2:44 PM