On June 9, the Department of Health Care Services (DHCS) announced through a Medi-Cal provider bulletin that the criteria for Treatment Authorization Requests (TAR) for inpatient services will be updated effective for admissions on or after June 15.
The authorization shall be based upon medical necessity substantiated by the documents submitted with the TAR for each date of service requested
Included below are the specific changes:
TAR Criteria for Acute Administrative Days
TAR documentation requirements and criteria for fee-for-service acute administrative days (AADs) must be submitted with information regarding:
- Type of AAD
- Facility criteria
- Eligible aid codes
AADs are reimbursable for Medi-Cal recipients within the following types of aid codes:
- Full scope aid codes and certain restricted aid codes with coverage for long-term care services
- Full scope aid codes and certain restricted aid codes with coverage for pregnancy-related services
- Full scope aid codes and certain restricted aid codes with coverage for emergency services
AAD requires authorization with TAR form (18-1) or an electronic TAR (eTAR), unless DHCS has waived the TAR requirement.
Acute Inpatient Intensive Rehabilitation Services
The manual includes updated information on medical necessity criteria for admission to acute inpatient rehabilitation and associated requirements for documentation.
Acute Inpatient Intensive Rehabilitation (AIIR) services require authorization with TAR form 18-1 or an eTAR, unless DHCS has waived the TAR requirement. A TAR for an AIIR admission is submitted by the facility providing AIIR services. It should include the total number of AIIR hospital days and be reflected in the Number of Days field (Box 17), as appropriate.
The updated provider manual sections with the detailed policy will be released in a future Medi-Cal Update.