優質系統豁免
聯邦醫療保險中心 & 醫療補助服務已批准了高級系統豁免（SSW）續期申請，該申請為期五年生效，從 10 月 1, 2024 至 9 月 30, 2029。已核准的豁免及相關文件如下載於「現行高級制度豁免續約」10 月 1, 2024 至 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.
- 治療授權請求 (TAR) 流程： TAR 流程要求 DHCS 在批准報銷之前授權住院醫院服務。 醫院將 TAR 提交給 DHCS 進行入院審查和批准，以確保在申請服務之前滿足醫療需求。
- 時間 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) 指定公立醫院參與協議
- （附件5）非指定公立及私立醫院TAR免參加協議
先前高級制度豁免的鏈接
- 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)
- 高級系統豁免續約 2019 年資料簡介
- Superior Systems Waiver (SSW) October 1, 2017 – September 30, 2019 Submitted to CMS June 14, 2017 (PDF)
- 高級制度豁免 (SSW) 批准函件 (PDF)
- Superior Systems Waiver (SSW) October 1, 2015 – September 30, 2017
- 聯邦醫療保險和醫療補助服務中心 (CMS) 批准函，日期為 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)
- 聯邦醫療保險和醫療補助服務中心 (CMS) 批准函，日期為 2013 年 6 月 28 日(PDF)
- 於二零一三年七月三十一日向 CMS 提出高級制度豁免綜合續約申請 (PDF)
- 於二零一三年九月二十六日收到高級制度豁免綜合續約批准函件 (PDF)
- 高級系統豁免（SSW）綜合續約批准函-ADA 合規（PDF）