优越系统豁免
联邦医疗保险和医疗补助服务中心已批准了高级系统豁免 (SSW) 续签申请，有效期五年，自1年 2024 月日起至30年 2029 月日止。已批准的豁免和相关文件位于下面的当前上级系统豁免续签 10 月1 、 2024 - 9 月30 、 2029部分。
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.
- 治疗授权请求 (TAR) 流程： TAR 流程要求 DHCS 在批准报销之前授权住院医院服务。 医院向 DHCS 提交 TAR 以供审核和批准入院，以确保在申请服务之前满足医疗需要。
- 电视 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
- （附件4）指定公立医院参与协议
- （附件5）非指定公立及私立医院免收TAR参与协议
先前优越系统豁免的链接
- 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 豁免续签 2019 情况说明书
- Superior Systems Waiver (SSW) October 1, 2017 – September 30, 2019 Submitted to CMS June 14, 2017 (PDF)
- 上级系统豁免 (SSW) 批准函 (PDF)
- Superior Systems Waiver (SSW) October 1, 2015 – September 30, 2017
- 医疗保险和医疗补助服务中心 (CMS) 批准函（2015 年 9 月 30 日） （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)
- 医疗保险和医疗补助服务中心 (CMS) 批准函（2013 年 6 月 28 日） （PDF）
- 2013 年 7 月 31 日向 CMS 提出的高级系统豁免 (SSW) 综合续订请求(PDF)
- 2013 年 9 月 26 日收到高级系统豁免 (SSW) 综合续订批准函(PDF)
- 高级系统豁免 (SSW) 综合续订批准书 - ADA 合规性(PDF)