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 Superior Systems Waiver (SSW)

The federal Centers for Medicare & Medicaid Services has approved the Superior Systems Waiver (SSW) renewal application, effective for a two-year period, October 1, 2015 through September 30, 2017.  The approved waiver is located in the section below.
The SSW describes the utilization review process for acute inpatient hospitals that serve fee-for-service Medi-Cal patients.  It specifies how the non-designated public hospitals and private hospitals will transition from the current use of treatment authorization requests (TAR) for most hospital stays to the use of their own utilization management systems using nationally recognized, evidence-based medical criteria. 
In this new approach, DHCS will conduct post-payment clinical and administrative monitoring and oversight.  This utilization management method is being used by California’s 21 designated public hospitals, which DHCS has already transitioned from the TAR process.
DHCS plans to roll out the new process incrementally, in a pilot project fashion, beginning with a small group of 11 hospitals.  This measured implementation plan will help DHCS ensure that appropriate processes and system changes are in place so that hospital claims can be paid in a timely manner.  DHCS anticipates that the implementation will begin in February 2016.
Please direct your comments, questions, and suggestions regarding the SSW renewal to the following Clinical Assurance and Administrative Support Division (CAASD) email address:  DRGTARFree@dhcs.ca.gov

Superior Systems Waiver (SSW) Renewal

Superior Systems Waiver (SSW) Approval Letter (PDF) 

Superior Systems Waiver (SSW) October 1, 2017 - September 30, 2019 Submitted to CMS June 14, 2017 (PDF)​

Superior Systems Waiver Renewal Stakeholder Meeting Agenda - May 25th, 2017​ 

Superior Systems Waiver Renewal Fact Sheet​ 

Current Superior Systems Waiver (SSW) 

Superior Systems Waiver (SSW) October 1, 2015 - September 30, 2017 

Meeting Archive

Superior Systems Waiver Renewal Stakeholder Meeting               

Thursday, April 16, 2015                                                                

10:00 a.m. - 12:00 p.m.

Webinar Agenda

Webinar PowerPoint

Q & A

 

Superior Systems Waiver Renewal Stakeholder Meeting                                

Wednesday, March 18, 2015                                                                                                     

1:00 p.m. - 3:00 p.m. 

Webinar Agenda

Webinar PowerPoint

Q & A

Links to Current and Draft Superior Systems Waivers

 

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Last modified on: 9/14/2017 3:26 PM