Common use of ACCREDITATION AND STANDARDS Clause in Contracts

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 IOP OTP hereby agrees to: (a) Be licensed to provide IOP OTP 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 a SAMHSA recognized state-certified program (via the TRO, the TOPO, or the COR see: xxxx://xxx0.xxxxxx.xxx/treatment/directory.aspx for the USFHP) additional accrediting organizations for TRICARE authorization, subject to approval by the Director, DHASAMHSA directory of OTPs). (c) Accept the allowable IOP OTP rate, as provided in 32 CFR 199.14(a)(2)(ix199.14(a)(2)(ix)(A)(3), 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 OTPs 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 IOPOTP.) 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 IOP RTC hereby agrees to: (a) Be licensed to provide IOP 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 for IOPs 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 COR 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). (c) Accept the allowable IOP TRICARE all-inclusive per diem rate, as provided in 32 CFR 199.14(a)(2)(ix), 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 listed are provided by qualified mental health providers who meet the TRICARE requirements for individual professional providers. (Exception: IOPs 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 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 IOP.) RTC). 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 requirementsrequirements for preauthorization. (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 noncoveredto be noncovered by TRICARE. (A general statement signed at admission as relative to financial liability does not fill this requirement.)

ACCREDITATION AND STANDARDS. The IOP hereby agrees to: to:‌ (a) a)‌ Be licensed to provide IOP services within the applicable jurisdiction in which it operates. (b) 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) c)‌ Accept the allowable IOP rate, as provided in 32 CFR 199.14(a)(2)(ix), as payment in full for services provided. provided.‌‌ (d) 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. matters.‌‌ (e) 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) 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.)requirement.)‌‌‌‌

ACCREDITATION AND STANDARDS. The IOP PHP hereby agrees to: (a) Be licensed to provide IOP PHP services within the applicable jurisdiction in which it operates. (b) Be specifically PHPs shall be currently 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 PHP 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: IOPs 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 IOPPHP.) All other program services will be provided by trained, licensed staff. (f ) Ensure the provision of an active family therapy component which ensures that each patient and family participate at least weekly in family therapy provided by the institution and rendered by an authorized mental health provider. (g) Not bill the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirementsrequirements for preauthorization. (gh) 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 IOP RTC hereby agrees to: (a) Be licensed to provide IOP 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 for IOPs 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 COR 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). (c) Accept the allowable IOP TRICARE all-inclusive per diem rate, as provided in 32 CFR 199.14(a)(2)(ix), 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 listed are provided by qualified mental health providers who meet the TRICARE requirements for individual professional providers. (Exception: IOPs 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 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 IOP.) RTC). 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 requirementsrequirements for preauthorization. (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 noncoveredto be noncovered by TRICARE. (A general statement signed at admission as relative to financial liability does not fill this requirement.)) 3.4

ACCREDITATION AND STANDARDS. The IOP PHP hereby agrees to: (a) Be licensed to provide IOP PHP services within the applicable jurisdiction in which it operates. (b) Be specifically PHPs shall be currently 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 PHP 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: IOPs 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 IOPPHP.) All other program services will be provided by trained, licensed staff. (f ) Ensure the provision of an active family therapy component which ensures that each patient and family participate at least weekly in family therapy provided by the institution and rendered by an authorized mental health provider. (g) Not bill the beneficiary for services in excess of the cost-share or services for which payment is disallowed for failure to comply with requirementsrequirements for preauthorization. (gh) 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.)) 3.4