关于临床保障部门
Clinical Assurance Division (CAD) is comprised of five branches. CAD provides strong, cost-effective utilization controls by reviewing and adjudicating Treatment Authorization Requests (TARs) for certain medical procedures, services and drugs for fee-for-service Medi-Cal beneficiaries prior to payment for services. CAD also responds to all TAR appeals submitted by providers and offers program support to the Office of Legal Services for all litigation resulting from denied TAR appeals. In addition, CAD is responsible for the Designated Public Hospital Project (DPHP), which allows public hospitals in California to use an evidence-based standardized tool to determine medical necessity for hospital days and services for Medi-Cal beneficiaries in lieu of submitting a TAR to the field office.
该部门由遍布加利福尼亚州的办事处以及以下项目组成：
- 治疗授权请求 (TAR)
- 150 名临床专业人员驻扎在加州各地
- 2019年，Med-Cal按服务收费（FFS）受益人提交的独立服务申请超过685,000份，并已进行裁决。
- 上诉和诉讼
- 自 2013 年以来，TAR 上诉数量下降了 86%
- 2013 年，上诉案件数量超过 200 起，而 2019 年则不到 10 起
- 更多 CAD 程序
- 指定公立医院项目 (PHP) 免收 TAR 费用计划
- 州囚犯计划 (SIP) 监督
- 入学前筛选和审查 (PASAR)
- 遗传残疾人士计划（GHPP）