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The Department of Health Care Services has provided updated information on treatment authorization request (TAR) criteria for acute inpatient rehabilitation.
The document clarifies Medi-Cal policy regarding medical necessity for admission, including eligible diagnoses, intensive rehabilitation therapy program, and the interdisciplinary team. Overall, the updated guidance aligns closely with established Medicare criteria, including the provision that an intensive therapy program is demonstrated by the provision of 15 hours of therapy per week, a change from the prior threshold of 18 hours per week.
The guidance also lists the minimum documents that must be submitted with the TAR to document medical necessity.
