TAR-Free Process for Designated Public Hospitals
Background
In 2008, the Department of Health Care Services’ (DHCS) launched a two-year pilot project under the California Superior Systems Waiver (SSW), allowing selected Designated Public Hospitals (DPHs) to use an evidence based standardized medical review criteria tool in lieu of the Treatment Authorization Request (TAR) process for Fee-For-Service (FFS) Medi-Cal stays.
The pilot project, known as the Designated Public Hospital Project (DPHP), concluded in 2010 and allowed DHCS to evaluate the fiscal impact of standardized utilization review criteria on acute inpatient days, length of stay, levels of care, approval and denial rates, and program costs.
Following the pilot, the project expanded to all DPHs, evolving into what is now known as the DPH TAR-Free Process where participating hospitals operate under a Participation Agreement.
Resources
- Participation Agreement for Designated Public Hospitals
- Participating Hospitals
- Frequently Asked Questions (FAQs) – DPH TAR-Free Process
DHCS Variance Authority
For the TAR-Free process, the Clinical Assurance Division (CAD) reports utilization oversight findings by means of a set of variance (reason) codes. These codes reflect variances from Medi-Cal policy and TAR-Free process requirements. Sources of authority for these variance 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.
- Variance Descriptions and Authority
- Medi-Cal Aid Codes
- Medi-Cal Provider Manual
- Manual of Criteria for Medi-Cal Authorization
Dispute Resolution Process
A dispute resolution process is in place to provide participating hospitals with an opportunity to appeal DHCS findings.
Technical Workgroup Teleconference Minutes
- Technical Workgroup Teleconference Minutes May 13, 2024
- Technical Workgroup Teleconference Minutes March 6, 2023
Links
- TAR-Free Process for Non-Designated Public Hospitals and Private Hospitals
- California Superior Systems Waiver
Contact Information
The TAR-Free process is supported by DHCS CAD Headquarters staff based in West Sacramento, CA as well as DHCS Medi-Cal clinicians 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 CAD Staff: PublicHospitalProject@dhcs.ca.gov.
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