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.
Appears in 8 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
ACCREDITATION AND STANDARDS. The RTC SUDRF hereby agrees to:
(a) Be licensed to provide RTC services 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), 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 allTRICARE-inclusive per diem determined rate, as provided in 32 CFR 199.14(f199.14(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 all mental health services are any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health providers provider who meet meets TRICARE requirements for individual professional providers. (Exception: RTCs 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 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 RTCSUDRF). All other program services will be provided by trained, licensed staff.
Appears in 6 contracts
Samples: Participation Agreement for Inpatient/Residential Substance Use Disorder Rehabilitation Facility (Sudrf) Services, Participation Agreement, Participation Agreement
ACCREDITATION AND STANDARDS. The RTC hereby agrees to:to:
(a) Comply with the TRICARE/CHAMPUS Standards for Residential Treatment Centers Serving Children and Adolescents with Mental Disorders, as promulgated by the Executive Director, TMA.
(b) Be licensed to provide RTC services within the applicable jurisdiction in which it operates, if licensure is available.
(bc) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission (TJC), the Commission on Accreditation of Rehabilitation Facilities Health Care Organizations under the Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/ Developmental Disabilities Services (CARFformerly the Consolidated Standards Manual), 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.
(cd) Accept the TRICARE TRICARE/CHAMPUS all-inclusive per diem rate, as provided in 32 CFR 199.14(f) as payment in full for services provided.
(de) 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.
(ef) 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 all mental health services listed in 32 CFR 199.4(c)(3)(ix) are provided by qualified mental health providers who meet TRICARE TRICARE/CHAMPUS 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.staff.
(h) Have a written agreement with at least one backup TRICARE/CHAMPUS- authorized hospital, which specifies that the hospital will accept any and all TRICARE/ CHAMPUS beneficiaries transferred for emergency mental health or medical/surgical care. The RTC must have a written emergency transportation agreement with at least one ambulance company, which specifies the estimated transportation time to each backup hospital.
(i) 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.
(j) Not xxxx the beneficiary for services excluded on the basis of 32 CFR 199.4(g)(1)(not medically 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 to be noncovered by TRICARE/CHAMPUS. (A general statement signed at admission relative to financial liability does not fill this requirement.)
(k) Prior to initiation of this agreement, and annually thereafter, conduct a self assessment of its compliance with the TRICARE/CHAMPUS
Appears in 6 contracts
Samples: Participation Agreement for Residential Treatment Center (Rtc), Participation Agreement for Residential Treatment Center (Rtc), Participation Agreement for Residential Treatment Center (Rtc)
