Pagwawaksi ng Superyor na Sistema
Inaprubahan ng federal Centers for Medicare & Medicaid Services ang aplikasyon sa pag-renew ng Superior Systems Waiver (SSW), na epektibo sa loob ng limang taon, Oktubre 1, 2024 hanggang Setyembre 30, 2029. Ang naaprubahang waiver at mga nauugnay na dokumento ay matatagpuan sa ibaba sa Kasalukuyang Superior Systems Waiver Renewal Oktubre 1, 2024 – Setyembre 30, 2029 na seksyon.
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.
- Proseso ng Treatment Authorization Request (TAR): Ang proseso ng TAR ay nangangailangan ng DHCS na pahintulutan ang mga serbisyo ng ospital sa inpatient bago aprubahan ang reimbursement. Ang mga ospital ay nagsusumite ng mga TAR sa DHCS para sa pagsusuri at pag-apruba ng mga admission upang matiyak na ang medikal na pangangailangan ay natutugunan bago ang pag-claim para sa mga serbisyo.
- 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
- (Attachment 4) Designated Public Hospital Participation Agreement
- (Attachment 5) Non-Designed Public and Private Hospital TAR-Free Participation Agreement
Mga Link sa Naunang Mga Pagwawaksi sa Mga Naunang Superior Systems
- 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
- Liham ng Pag-apruba ng Centers for Medicare and Medicaid Services (CMS) na may petsang Setyembre 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)
- Liham ng Pag-apruba ng Centers for Medicare and Medicaid Services (CMS) na may petsang Hunyo 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 na Natanggap noong Setyembre 26, 2013 (PDF)
- Superior Systems Waiver (SSW) Comprehensive Renewal Approval Letter- ADA Compliance (PDF)