CHA News Article

DHCS Seeks Volunteer Hospitals for TAR-Free Process

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

  • Use an evidence-based standardized utilization review (UR) criteria for acute inpatient hospital stays for any payer
  • 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 use standardized medical review criteria — such as InterQual or MCG (formerly Milliman Care Guidelines) — to perform their own utilization reviews. DHCS would provide monitoring and oversight post-payment.

This process would apply to acute inpatient stays, excluding those for beneficiaries with restricted aid codes, and would 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.

Hospitals interested in being a part of the second phase of this transition should respond to DHCS at DRGTARFree@dhcs.ca.gov. Depending on the number of volunteers, some may be offered participation in a subsequent phase. Additional information on the new process is available on the DHCS website.

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