About Clinical Assurance Division
Clinical Assurance Division (CAD) is comprised of five branches. CAD provides strong, cost-effective utilization controls by reviewing and adjudicating Treatment Authorization Requests (TARs) for certain medical procedures, services and drugs for fee-for-service Medi-Cal beneficiaries prior to payment for services. CAD also responds to all TAR appeals submitted by providers and offers program support to the Office of Legal Services for all litigation resulting from denied TAR appeals. In addition, CAD is responsible for the Designated Public Hospital Project (DPHP), which allows public hospitals in California to use an evidence-based standardized tool to determine medical necessity for hospital days and services for Medi-Cal beneficiaries in lieu of submitting a TAR to the field office.
The division is comprised of offices across California along with programs that include:
- Treatment Authorization Request (TAR)
- 150 Clinical Professionals stationed across California
- Over 685,000 unique service requests adjudicated for Med-Cal fee-for-service (FFS) beneficiaries in 2019
- Appeals and Litigation
- TAR appeals have decreased 86% since 2013
- An active caseload of over 200 appeals in 2013 compared to 2019 where the number is under 10
- More Programs Within CAD
- Designated Public Hospital Project (PHP) TAR-Free Program
- State Inmate Program (SIP) Oversight
- Pre-Admission Screening and Review (PASAR)
- Genetically Handicapped Persons Program (GHPP)
