CHA News Article

DHCS Seeks Hospital Volunteers to Transition to TAR-Free Utilization Review

The California Department of Health Care Services (DHCS) seeks private and district/municipal hospital volunteers for the second phase transition to a treatment authorization request (TAR) free process for fee-for-service Medi-Cal beneficiaries. To participate in the TAR-free process, hospitals must:

  • Utilize an evidence-based standardized utilization review (UR) criteria for acute inpatient hospital stays for any payer; and
  • Have the ability to provide DHCS electronic access to medical records and UR reviews/decisions.

In the TAR-free process, hospitals would no longer submit a TAR for most acute inpatient stays, and instead would utilize standardized medical review criteria — such as InterQual or Milliman Care Guidelines — to perform their own utilization review. DHCS would provide monitoring and oversight post-payment.

The process would apply to acute inpatient stays, excluding those for beneficiaries with restricted aid codes, and would also exclude acute rehabilitation, acute administrative days and acute hospice for all fee-for-service Medi-Cal beneficiaries. DHCS estimates that approximately 85 percent of the current TAR volume for acute inpatient stays would instead be handled by the new process.

Interested hospitals should respond to DHCS at DRGTAR-Free@dhcs.ca.gov. Depending on the number of volunteers, some may be offered participation in a subsequent phase.

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