Common use of ACCREDITATION AND STANDARDS The Clause in Contracts

ACCREDITATION AND STANDARDS The. SUDRF hereby agrees to: (a) Be licensed to provide substance use treatment 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), 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 Regional Office (TRO), the TRICARE Overseas Program Office (TOPO), or the Contracting Officer’s Representative (COR) for the Uniformed Services Family Health Plan (USFHP)) additional organizations for TRICARE authorization. (c) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, 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 any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE 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 per-diem rate, but the individual must work under the 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. (f ) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (g) Not xxxx the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirements for preauthorization. (h) Not xxxx 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 had been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (i) Prior to initiation of this agreement, and annually thereafter, conduct a self-assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of SUDs as issued by the Director, DHA or designee, and notify the Director, DHA or designee, of any matter in which the facility is not in compliance with such standards.

ACCREDITATION AND STANDARDS The. SUDRF hereby agrees to: (a) Be licensed to provide substance use treatment 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), 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 Regional Office (TRO), the TRICARE Overseas Program Office (TOPO), or the Contracting Officer’s Representative (COR) for the Uniformed Services Family Health Plan (USFHP)) additional organizations for TRICARE authorization. (c) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, 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 any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE 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 per-diem rate, but the individual must work under the 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. (f ) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (g) Not xxxx bill the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirements for preauthorization. (h) Not xxxx 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 had been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (i) Prior to initiation of this agreement, and annually thereafter, conduct a self-assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of SUDs as issued by the Director, DHA or designee, and notify the Director, DHA or designee, of any matter in which the facility is not in compliance with such standards.

ACCREDITATION AND STANDARDS The. SUDRF hereby agrees to: (a) Be licensed to provide substance use treatment 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), 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 Regional Office (TRO), the TRICARE Overseas Program Office (TOPO), or the Contracting Officer’s Representative (COR) for the Uniformed Services Family Health Plan (USFHP)) additional organizations for TRICARE authorization. (c) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, 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 any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE 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 per-diem rate, but the individual must work under the 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. (f ) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (g) Not xxxx the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirements for preauthorization. (h) Not xxxx 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 had been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (i) Prior to initiation of this agreement, and annually thereafter, conduct a self-assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of SUDs as issued by the Director, DHA or designee, and notify the Director, DHA or designee, of any matter in which the facility is not in compliance with such standards.3.4

ACCREDITATION AND STANDARDS The. SUDRF hereby agrees to: (a) Be licensed to provide substance use treatment 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), 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 Regional Office (TRO), the TRICARE Overseas Program Office (TOPO), or the Contracting Officer’s Representative (COR) for the Uniformed Services Family Health Plan (USFHP)) additional organizations for TRICARE authorization. (c) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, 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 any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE 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 per-diem rate, but the individual must work under the 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. (f ) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (g) Not xxxx the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirements for preauthorization. (h) Not xxxx 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 had been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (i) Prior to initiation of this agreement, and annually thereafter, conduct a self-assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of SUDs as issued by the Director, DHA or designee, and notify the Director, DHA or designee, of any matter in which the facility is not in compliance with such standards.)

ACCREDITATION AND STANDARDS The. SUDRF hereby agrees to: (a) Be licensed to provide substance use treatment 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), 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 Regional Office (TRO), the TRICARE Overseas Program Office (TOPO), or the Contracting Officer’s Representative (COR) for the Uniformed Services Family Health Plan (USFHP)) additional organizations for TRICARE authorization. (c) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, 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 any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE 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 per-diem rate, but the individual must work under the 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. (f ) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (g) Not xxxx the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirements for preauthorization. (h) Not xxxx 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 had been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (i) Prior to initiation of this agreement, and annually thereafter, conduct a self-assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of SUDs as issued by the Director, DHA or designee, and notify the Director, DHA or designee, of any matter in which the facility is not in compliance with such standards.. 3.4