Superior Systems Waiver
The federal Centers for Medicare & Medicaid Services has approved the Superior Systems Waiver (SSW) renewal application, effective for a five-year period, October 1, 2024 through September 30, 2029. The approved waiver and related documents are located below in the Current Superior Systems Waiver Renewal October 1, 2024 – September 30, 2029 section.
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.
- Treatment Authorization Request (TAR) process: The TAR process requires DHCS to authorize inpatient hospital services prior to approving reimbursement. Hospitals submit TARs to DHCS for review and approval of admissions to ensure medical necessity is met prior to claiming for services.
- TAR-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
Links to Prior Superior Systems Waivers
- 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 Fact Sheet
- Superior Systems Waiver (SSW) October 1, 2017 - September 30, 2019 Submitted to CMS June 14, 2017 (PDF)
- Superior Systems Waiver (SSW) Approval Letter (PDF)
- Superior Systems Waiver (SSW) October 1, 2015 - September 30, 2017
- Centers for Medicare and Medicaid Services (CMS) Approval Letter dated September 30, 2015 (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)
- Centers for Medicare and Medicaid Services (CMS) Approval Letter dated June 28, 2013 (PDF)
- Superior Systems Waiver (SSW) Comprehensive Renewal Request to CMS dated July 31, 2013 (PDF)
- Superior Systems Waiver (SSW) Comprehensive Renewal Approval Letter Received on September 26, 2013 (PDF)
- Superior Systems Waiver (SSW) Comprehensive Renewal Approval Letter- ADA Compliance (PDF)
