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DHCS Announces Flexibility on Medi-Cal Inpatient Rehabilitation Facility Requirements

For rehabilitation leaders, reimbursement directors, compliance officers

The Department of Health Care Services (DHCS) has announced temporary regulatory flexibility for the amount of therapy required for Medi-Cal beneficiaries admitted for inpatient acute rehabilitation services, or 18 hours of therapy per week. 

During the public health emergency, inpatient rehabilitation days will be reviewed for consideration of authorization when therapy hours may not have met prior criteria.  This flexibility is retroactive to March 18 and aligns with a Medicare waiver of the three hours per day guideline for the provision of an interdisciplinary program of intensive therapy services.  

DHCS notes that if an inpatient rehabilitation facility (IRF) receives a denial it believes conflicts with this temporary flexibility guidance, the IRF may submit a new treatment authorization request with a message in the miscellaneous treatment authorization request information field stating, “Please reconsider — COVID-19 flexibility.”