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.)
Appears in 6 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
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.)
3.4 QUALITY OF CARE (a) The IOP shall assure that any and all eligible beneficiaries receive intensive outpatient services which comply with standards in Article 3.3.
Appears in 5 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
