ACCREDITATION AND STANDARDS. The RTC hereby agrees to:
(a) Be licensed to provide RTC services within the applicable jurisdiction in which it operates, if licensure is available.
(b) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission (TJC), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation (CoA), or an accrediting organization approved by the Director, DHA. The regional contractor may submit, via the TRICARE Regional Office (TRO), additional accrediting organizations for TRICARE authorization, subject to approval by the Director, DHA.
(c) Accept the TRICARE all-inclusive per diem rate, as provided in 32 CFR 199.14(f) as payment in full for services provided.
(d) Comply with all requirements of 32 CFR 199.4 applicable to institutional providers generally concerning preauthorization, concurrent care review, claims processing, beneficiary liability, double coverage, utilization and quality review, and other matters.
(e) Ensure that all mental health services are provided by qualified mental health providers who meet TRICARE requirements for individual professional providers. (Exception: RTCs that employ individuals with master’s or doctoral level degrees in a mental health discipline who do not meet the licensure, certification, and experience requirements for a qualified mental health provider, but are actively working toward licensure or certification, may provide mental health services within the all-inclusive per diem rate but the individual must work under the documented direct clinical supervision of a fully qualified mental health provider employed by the RTC). All other program services will be provided by trained, licensed staff.
ACCREDITATION AND STANDARDS. The IOP hereby agrees to: (a) Be licensed to provide IOP services within the applicable jurisdiction in which it operates.
ACCREDITATION AND STANDARDS. The SUDRF hereby agrees to:
(a) Comply with the TRICARE/CHAMPUS Standards for Substance Use Disorder Rehabilitation Facilities, as promulgated by the Executive Director, TMA.
(b) Be licensed to provide substance use treatment within the applicable jurisdiction in which it operates, if licensure is available.
(c) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission on Accreditation of Health Care Organizations under the Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/ Developmental Disabilities Services, or by the Commission on Accreditation of Rehabilitation Facilities as an alcoholism and other drug dependency rehabilitation program under the Standards Manual for Organizations Serving People with Disabilities.
(d) Accept the TRICARE/CHAMPUS-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, and 32 CFR 199.14(a)(2)(ix)(C) for partial hospitalization services, as payment in full for services provided.
(e) Comply with all requirements of 32 CFR 199.4 applicable to institutional providers generally concerning preauthorization, concurrent care review, claims processing, beneficiary liability, double coverage, utilization and quality review, and other matters.
(f) Be fully operational and treating patients for a period of at least six months (with at least 30 percent minimum patient census) before it submits an application for approval.
(g) Ensure that any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE/CHAMPUS requirements for individual professional providers. (Exception: SUDRFs that employ individuals with master’s or doctoral level degrees in a mental health discipline who do not meet the licensure, certification, and experience requirements for a qualified mental health provider, but are actively working toward licensure or certification, may provide mental health services within the all-inclusive DRG rate for inpatient services, or the per-diem rate for partial hospitalization services, but the individual must work under the documented direct clinical supervision of a fully qualified mental health provider employed by the SUDRF). All other program services will be provided by trained, licensed staff.
(h) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each pa...
ACCREDITATION AND STANDARDS. The RTC hereby agrees to: (a) Be licensed to provide RTC services within the applicable jurisdiction in which it operates, if licensure is available. (b) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission (TJC), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation (CoA), or an accrediting organization approved by the Director, DHA. The contractor may submit (via the TRICARE Office (TRO), the TRICARE Overseas Program Office (TOPO), or the Contracting Officer’s Representative (COR) for the Uniformed Services Family Health Plan (USFHP)) additional accrediting organizations for TRICARE authorization, subject to approval by the Director, DHA).
ACCREDITATION AND STANDARDS. The OTP hereby agrees to: (a) Be licensed to provide OTP services within the applicable jurisdiction in which it operates.
ACCREDITATION AND STANDARDS. The BC hereby certifies that:
(a) It is accredited by a nationally recognized accreditation organization whose standards and procedures have been determined to be acceptable by the Director, DHA, or a designee; and,
(b) It is in compliance with TRICARE Birthing Center Standards; and,
(c) It is licensed as a birthing center where such license is available, or is specifically licensed as a type of ambulatory health care facility where birthing center specific license is not available; and,
(d) It meets all applicable licensing or certification requirements that are extant in the state, county, municipality, or other political jurisdiction in which the center is located.
ACCREDITATION AND STANDARDS. The BC hereby certifies that: (a) It is accredited by a nationally recognized accreditation organization whose standards and procedures have been determined to be acceptable by the Director, DHA, or designee; and (b) It is in compliance with TRICARE BC Standards; and (c) It is licensed as a BC where such license is available, or is specifically licensed as a type of ambulatory health care facility where BC specific license is not available; and (
ACCREDITATION AND STANDARDS. The PHP hereby agrees to:
(a) Be licensed to provide PHP services within the applicable jurisdiction in which it operates.
(b) PHPs shall be currently accredited by and remain in compliance with standards issued by the TJC, CARF, CoA, or an accrediting organization approved by the Director, DHA. The regional contractor may submit, via the TRO, additional accrediting organizations for TRICARE authorization, subject to approval by the Director, DHA.
(c) Accept the allowable partial hospitalization program rate, as provided in 32 CFR 199.14(a)(2)(ix), as payment in full for services provided.
(d) Comply with all requirements of 32 CFR 199.4 applicable to institutional providers generally concerning preauthorization, concurrent care review, claims processing, beneficiary liability, double coverage, utilization and quality review, and other matters.
(e) Ensure that all mental health services are provided by qualified mental health providers who meet the requirements for individual professional providers. (Exception: PHPs that employ individuals with master’s or doctoral level degrees in a mental health discipline who do not meet the licensure, certification, and experience requirements for a qualified mental health provider but are actively working toward licensure or certification, may provide mental health services within the per diem rate but the individual must work under the direct clinical supervision of a fully qualified mental health provider employed by the PHP.) All other program services will be provided by trained, licensed staff.
ACCREDITATION AND STANDARDS. The IOP hereby agrees to: (a) Be licensed to provide IOP services within the applicable jurisdiction in which it operates. (b) Be specifically accredited by and remain in compliance with standards issued for IOPs by TJC, CARF, CoA, or an accrediting organization approved by the Director, DHA. The contractor may submit (via the TRO, the TOPO, or the COR for the USFHP) additional accrediting organizations for TRICARE authorization, subject to approval by the Director, DHA. (c) Accept the allowable IOP rate, as provided in 32 CFR 199.14(a)(2)(ix), as payment in full for services provided. (d) Comply with all requirements of 32 CFR 199.4 applicable to institutional providers generally concerning concurrent care review, claims processing, beneficiary liability, double coverage, utilization and quality review, and other matters. (e) Ensure that all mental health services are provided by qualified mental health providers who meet the requirements for individual professional providers. (Exception: IOPs that employ individuals with master’s or doctoral level degrees in a mental health discipline who do not meet the licensure, certification, and experience requirements for a qualified mental health provider but are actively working toward licensure or certification, may provide mental health services within the per diem rate but the individual must work under the direct clinical supervision of a fully qualified mental health provider employed by the IOP.) All other program services will be provided by trained, licensed staff. (f ) Not bill the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirements. (g) Not bill the beneficiary for services excluded on the basis of 32 CFR 199.4(g)(1) (not medically or psychologically necessary), (g)(3) (inappropriate level of care), or (g)(7) (custodial care), unless the beneficiary has agreed in writing to pay for the care, knowing the specific care in question has been determined as noncovered. (A general statement signed at admission as to financial liability does not fill this requirement.)
ACCREDITATION AND STANDARDS. The SUDRF hereby agrees to:
(a) Comply with the TRICARE/CHAMPUS Standards for Substance Use Disorder Rehabilitation Facilities, as promulgated by the Deputy Director, TMA.
(b) Be licensed to provide substance use treatment within the applicable jurisdiction in which it operates, if licensure is available.
(c) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission on Accreditation of Health Care Organizations under the Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/Developmental Disabilities Services, or by the Commission on Accreditation of Rehabilitation Facilities as an alcoholism and other drug dependency rehabilitation program under the Standards Manual for Organizations Serving People with Disabilities.
(d) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, and 32 CFR 199.14(a)(2)(ix)(C) for partial hospitalization services, as payment in full for services provided.
(e) Comply with all requirements of 32 CFR 199.4 applicable to institutional providers generally concerning preauthorization, concurrent care review, claims processing, beneficiary liability, double coverage, utilization and quality review, and other matters.
