Tsev Cov Kev Pabcuam Cov Kev Pabcuam Medi-Cal Kev Tso Cai Rau Superior Systems​​ 

Superior Systems Waiver​​ 

Tsoom Fwv Teb Chaws Chaw rau Medicare & Medicaid Cov Kev Pabcuam tau pom zoo rau Superior Systems Waiver (SSW) daim ntawv thov rov ua dua tshiab, siv tau rau tsib xyoos, Lub Kaum Hli 1, 2024 txog lub Cuaj Hli 30, 2029. Daim ntawv tso cai zam thiab cov ntaub ntawv cuam tshuam muaj nyob hauv qab no hauv Cov Txheej Txheem Zoo Tshaj Plaws Tam Sim No Rov Ua Dua Tshiab Lub Kaum Hli 1, 2024 - Cuaj Hlis 30, 2029 ntu.​​ 

The SSW describes the utilization review (UR) process for acute inpatient hospitals that serve fee-for-service Medi-Cal patients.  Under SSW authority, the Department of Health Care Services (DHCS) employs the following UR approaches, depending on the type of acute inpatient service, the hospital type, and the characteristics of the beneficiary’s health care coverage.​​  

  • Kev Thov Kev Tso Cai Kho Mob (TAR) txheej txheem: TAR txheej txheem xav kom DHCS tso cai rau cov neeg mob hauv tsev kho mob ua ntej pom zoo them nyiaj rov qab. Cov tsev kho mob xa TARs rau DHCS rau kev tshuaj xyuas thiab kev pom zoo ntawm kev tso npe nkag los xyuas kom meej tias kev kho mob tau ua tiav ua ntej thov kev pabcuam.​​  
  • T​​ AR-Free process: The TAR-Free process requires hospitals to use evidence-based, standardized medical review criteria to determine medical necessity and claim for inpatient hospital services, while DHCS performs post-payment clinical and administrative compliance reviews using statistically valid samples of paid inpatient hospital claims.​​  

Please direct your questions regarding the SSW to the following Clinical Assurance Division (CAD) email address: SSWRenewal@dhcs.ca.gov.​​ 

Current Superior Systems Waiver Renewal October 1, 2024 – September 30, 2029​​                           

Txuas rau Ua Ntej Superior Systems Waivers​​