June 9, 2022
Effective for admissions on or after June 15, 2022, the Treatment Authorization Request (TAR) criteria for inpatient services has been updated.
Authorization shall be based upon medical necessity substantiated by the documents submitted with the TAR for each date of service requested.
TAR criteria for Acute Administrative Days (AAD)
Treatment Authorization Request (TAR) documentation requirements and criteria for fee-for-service AAD submitted with information regarding:
- Type of AAD
- Facility criteria
- Eligible aid codes
Administrative Days 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 (LTC) 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 a TAR (18-1) or an eTAR, unless DHCS has waived the TAR requirement.
Acute Inpatient Intensive Rehabilitation (AIIR) Services
AIIR services require authorization with a Treatment Authorization Request (TAR) form 18-1 or an electronic TAR (eTAR), unless DHCS has waived the TAR requirement. A TAR for an AIIR admission is submitted by the facility providing AIIR services. The TAR should include the total number of acute inpatient intensive rehabilitation hospital days and be reflected in the Number of Days field (Box 17), as appropriate.
The updated provider manual sections with detailed policy will be released in a future Medi-Cal Update.