September 8, 2021
Effective for admissions on or after July 1, 2021, the required weekly acute rehabilitation therapy hours have been reduced from 18 hours to 15 hours. Providers must submit the minimum required documentation with the Treatment Authorization Request (TAR) when requesting Acute Inpatient Intensive Rehabilitation (AIIR) services.
Authorization shall be based upon medical necessity substantiated by the documents submitted with the TAR for each date of service requested. The TAR should include the total number of AIIR hospital days in the appropriate Quantity fields, the medical record and at a minimum, the following documentation when submitted along with the TAR form 18-1 or eTAR:
- Pre-Admission Screening documentation
- Individualized Overall Plan of Care
- Centers for Medicare and Medicaid Services (CMS) Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)
This documentation will be used to determine medical necessity at the time of admission, and should identify the following:
- Involvement of Multiple Therapy Disciplines
- Active Patient Participation
- Rehabilitation Physician Supervision
- Intensive Rehabilitation Therapy Program
- Coordinated Interdisciplinary Team (IDT) Approach
Defined explanations of each of these minimum required documents and medical criteria will be available in an upcoming Medi-Cal Update.