PREREQUISITES FOR PAYMENT. The following applicable requirements shall be fulfilled in order to establish an employee's eligibility for sick leave benefits.
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with procedures, the PHP shall be paid based upon the allowance of the rate determined in accordance with the prevailing 32 CFR 199.14 (see Article 4.1), and contingent upon certain conditions provided in the 32 CFR 199, and in particular the following:
(a) The patient seeking admission is suffering from a mental disorder, to include SUD, which meets the diagnostic criteria of the current edition of the DSM and meets the TRICARE definition of a mental disorder.
(b) The patient meets the criteria for admission to a PHP issued by the Director, DHA.
(c) A qualified mental health professional who meets requirements for individual professional providers and who is permitted by law and by the PHP recommends that the patient be admitted to the PHP.
(d) A qualified mental health professional with admitting privileges who meets the requirements for individual professional providers will be responsible for the development, supervision, implementation, and assessment of a written, individualized, interdisciplinary clinical formulation and plan of treatment.
(e) All services are provided by or under the supervision of an authorized mental health provider (see Article 3.3(e)).
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE/CHAMPUS procedures, the RTC shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE/CHAMPUS regulation (see Article 4.1) contingent upon certain conditions provided in the TRICARE/CHAMPUS regulation, the TRICARE/CHAMPUS Standards for Residential Treatment Centers Serving Children and Adolescents with Mental Disorders, and in particular the following:
(a) The patient seeking admission is suffering from a mental disorder that meets both the diagnostic criteria of the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association and the TRICARE/CHAMPUS definition of a mental disorder.
(b) The patient seeking admission does not have a primary diagnosis of chemical abuse or dependence.
(c) The patient seeking admission does not have a primary diagnosis of mental retardation or developmental disability.
(d) The patient meets the criteria for admission to an RTC issued by the Executive Director, TMA.
(e) The medical and/or psychological necessity of the patient’s admission is determined by a qualified mental health professional who meets TRICARE/CHAMPUS requirements for individual professional providers, and who is permitted by law and by the facility to refer patients for admission.
(f) A qualified mental health professional who meets TRICARE/CHAMPUS requirements for individual professional providers will be responsible for the development, supervision, implementation, and assessment of a written, individualized, interdisciplinary clinical formulation and plan of treatment.
(g) All services in 32 CFR 199.4(c)(3)(ix) are provided by or under the supervision of a TRICARE/CHAMPUS-authorized mental health provider (see Article 3.3(h) above).
(h) TMA or a designee has preauthorized all care rendered to the patient.
(i) The patient meets eligibility requirements for TRICARE/CHAMPUS coverage.
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with procedures, the OTP shall be paid based upon the allowance of the rate determined in accordance with the prevailing 32 CFR 199.14 (see Article 4.1), and contingent upon certain conditions provided in the 32 CFR 199, and in particular the following: (a) The patient seeking admission is suffering from a mental disorder, to include substance use disorder, which meets the diagnostic criteria of the current edition of the DSM and meets the TRICARE definition of a mental disorder.
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE procedures, the SUDRF shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE regulation (see Article
4.1) contingent upon certain conditions provided in the TRICARE regulation, and in particular, the following: (a) The patient seeking admission is suffering from a mental disorder, to include SUD, that meets both the diagnostic criteria of the current edition of the DSM and the TRICARE definition of a mental disorder.
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE procedures, the SUDRF shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE regulation (see Article 4.1) contingent upon certain conditions provided in the TRICARE regulation, the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of Substance Use Disorders, and in particular the following:
(a) The patient seeking admission is suffering from a mental disorder that meets both the diagnostic criteria of the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association and the TRICARE definition of a mental disorder.
(b) The patient meets the criteria for admission to an SUDRF issued by the Deputy Director, TMA.
(c) The medical and/or psychological necessity of the patient’s admission is determined by a qualified mental health provider who meets TRICARE requirements as an individual professional provider, and who is permitted by law and by the facility to refer patients for admission.
(d) A qualified mental health professional who meets TRICARE requirements for individual professional providers will be responsible for the development, supervision, implementation, and assessment of a written, individualized, interdisciplinary clinical formulation and plan of treatment.
(e) All individual, group, or family psychotherapy, and psychological testing and assessment are provided by or under the supervision of a qualified mental health provider who meets TRICARE requirements as an individual professional provider (see Article 3.3(h) above).
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE procedures, the RTC shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE regulation (see Article
4.1) contingent upon certain conditions provided in the TRICARE regulation, and in particular the following: (a) The patient seeking admission is suffering from a mental disorder that meets both the diagnostic criteria of the current edition of the DSM and the TRICARE definition of a mental disorder.
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE procedures, the SUDRF shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE regulation (see Article
4.1) contingent upon certain conditions provided in the TRICARE regulation, and in particular, the following:
(a) The patient seeking admission is suffering from a mental disorder, to include SUD, that meets both the diagnostic criteria of the current edition of the DSM and the TRICARE definition of a mental disorder.
(b) The patient meets the criteria for admission to an SUDRF issued by the Director, DHA.
(c) The medical and/or psychological necessity of the patient’s admission is determined by a qualified mental health provider who meets TRICARE requirements as an individual professional provider, and who is permitted by law and by the facility to refer patients for admission.
(d) A qualified mental health professional who meets TRICARE requirements for individual professional providers will be responsible for the development, supervision, implementation, and assessment of a written, individualized, interdisciplinary clinical formulation and plan of treatment.
(e) All individual, group, or family psychotherapy, and psychological testing and assessment are provided by or under the supervision of a qualified mental health provider who meets TRICARE requirements as an individual professional provider (see Article 3.3(e)).
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with procedures, the PHP shall be paid based upon the allowance of the rate determined in accordance with the prevailing 32 CFR 199.14 (see Article 4.1), and contingent upon certain conditions provided in the 32 CFR 199, the Standards for Psychiatric Partial Hospitalization Programs, and in particular the following:
(a) The patient seeking admission is suffering from a mental disorder which meets the diagnostic criteria of the current edition of the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association and meets the TRICARE/ CHAMPUS definition of a mental disorder.
(b) The patient meets the criteria for admission to a PHP issued by the Executive Director, TMA.
(c) A qualified mental health professional who meets requirements for individual professional providers and who is permitted by law and by the PHP recommends that the patient be admitted to the PHP.
(d) A qualified mental health professional with admitting privileges who meets the requirements for individual professional providers will be responsible for the development, supervision, implementation, and assessment of a written, individualized, interdisciplinary clinical formulation and plan of treatment.
(e) All services are provided by or under the supervision of an authorized mental health provider (see Article 3.3(g) above).
(f) The Executive Director, TMA, or a designee has precertified all care rendered to the patient.
(g) The patient meets eligibility requirements for coverage.
PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE procedures, the SUDRF shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE regulation (see Article 4.1) contingent upon certain conditions provided in the TRICARE regulation, the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of Substance Use Disorders, and in particular the following: (a) The patient seeking admission is suffering from a mental disorder that meets both the diagnostic criteria of the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association and the TRICARE definition of a mental disorder.
