スーペリアシステムの免除
連邦メディケア・メディケイド・サービスセンター(Centers for Medicare & Medicaid Services)は、10月1日から202430年9月までの5年間有効となるSuperior Systems Waiver (SSW)更新申請を承認した2029。承認された権利放棄および関連文書は、 以下のCurrent Superior Systems Waiver Renewal October 1、 2024 – September 30、 2029 セクションにあります。
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.
- 治療承認申請(TAR)プロセス: TARプロセスでは、DHCSが償還を承認する前に入院患者サービスを承認する必要があります。 病院は、サービスを請求する前に医療上の必要性が満たされていることを確認するために、入院の審査と承認のためにTARをDHCSに提出します。
- 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
- CA Superior Systems Waiver (SSW) Request October 1 2024 – September 30 2029
- CMS Approval Letter – CA Superior Systems Waiver October 1 2024 – September 30 2029
- SSW Renewal Transmittal Letter – CA Superior Systems Waiver October 1 2024 – September 30 2029
- (Attachment 1) SSW Renewal TAR & TAR-Free Processes – SSW Renewal October 1 2024 – September 30 2029
- (Attachment 2) SSW Renewal Historical Timeline – SSW Renewal October 1 2024 – September 30 2029
- (Attachment 3) SSW Renewal Crosswalk Table – SSW Renewal October 1 2024 – September 30 2029
- (別紙4)指定公立病院参加約款
- (別紙5)指定外公私立病院TARフリー参加規約
過去の上位制度の免除へのリンク
- Centers for Medicare and Medicaid Services (CMS) Approval Letter dated September 24, 2019 (PDF)
- Superior Systems Waiver (SSW) October 1, 2019 – September 30, 2024 (PDF)
- Superior Systems Waiver Renewal 2019ファクトシート
- Superior Systems Waiver (SSW) October 1, 2017 – September 30, 2019 Submitted to CMS June 14, 2017 (PDF)
- Superior Systems Waiver (SSW) 承認書 (PDF)
- Superior Systems Waiver (SSW) October 1, 2015 – September 30, 2017
- 2015年9月30日付のメディケアおよびメディケイドサービスセンター(CMS)承認書 (PDF)
- Medi-Cal Superior Systems Waiver: Comprehensive Renewal October 1, 2015 – September 30, 2017 submitted on June 30, 2015 (PDF)
- Centers for Medicare and Medicaid Services (CMS) Approval Letter dated April 30, 2014 (PDF)
- Superior Systems Waiver (SSW) Adding Acute Intensive Inpatient Rehabilitation, Submitted to CMS April 17, 2014 (PDF)
- Superior Systems Waiver (SSW) Comprehensive Renewal, Approved by Center for Medicare and Medicaid Services (CMS), (PDF)
- Centers for Medicare and Medicaid Services (CMS) Approval Letter dated September 26, 2013 (PDF)
- 2013年6月28日付のメディケアおよびメディケイドサービスセンター(CMS)承認書(PDF)
- 2013年7月31日付CMSに対するSuperior Systems Waiver (SSW) Comprehensive Renewal Request to CMS (PDF)
- 2013年9月26日受領したSuperior Systems Waiver (SSW) Comprehensive Renewal Approval Letter (PDF)
- Superior Systems Waiver (SSW) Comprehensive Renewal Approval Letter - ADA コンプライアンス (PDF)