This All Facility Letter (AFL) serves as a notification to all general acute care hospitals of the recently released Medi-Cal Provider Bulletin that notifies providers of expanded Medi-Cal benefits for voluntary inpatient detoxification.

In accordance with Senate Bill X1 1 (Chapter 4, Statutes of 2013) and the Patient Protection and Affordable Care Act, medically necessary voluntary inpatient detoxification is now a Medi-Cal benefit for qualifying beneficiaries. This fee-for-service benefit is effective retroactively for services rendered on or after January 1, 2014. The benefit is reimbursed by certified public expenditure (CPE) for designated public hospitals providing inpatient general acute care services, or is reimbursed by diagnosis-related groups methodology for inpatient general acute care hospitals that do not participate in CPE. This expanded benefit does not include chemical dependency recovery hospitals (CDRHs) or institutions for mental disease (IMD) as defined by U.S. Code Title 42 Section 1396d(i).

Medi-Cal Update, Inpatient Services, February 2014, Bulletin 473 also details the criteria for inpatient admission for voluntary inpatient detoxification and contains relevant background information on the expanded benefits. The bulletin is available at Medi-Cal Update:

(http://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/ips201402.asp#a5).

Voluntary inpatient detoxification services will require prior authorization; claims without an approved Treatment Authorization Request (TAR) may be denied. Additional information about TARs is available at the California Department of Health Care Services website:

(http://www.dhcs.ca.gov/provgovpart/pages/tar.aspx).

Please direct any questions regarding the information in this AFL to the California Department of Health Care Services Benefits Division at (916) 552-9400.

Sincerely,

Original signed by Jean Iacino

Jean Iacino
Interim Deputy Director
Center for Health Care Quality