Common use of PREREQUISITES FOR PAYMENT Clause in Contracts

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 TRICARE/CHAMPUS TRICARE procedures, the RTC shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE/CHAMPUS TRICARE regulation (see Article Article 4.1) contingent upon certain conditions provided in the TRICARE/CHAMPUS TRICARE 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 DSM and the TRICARE/CHAMPUS TRICARE definition of a mental disorder. (b) The patient seeking admission does not have a primary diagnosis of chemical abuse or dependenceSUD including management of withdrawal symptoms (detoxification). (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, TMADHA. (e) The medical and/or psychological necessity of the patient’s admission is determined by a qualified mental health professional who meets TRICARE/CHAMPUS TRICARE 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 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. (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) above3.3(e)). (h) TMA DHA or a designee has preauthorized all care rendered to the patient. (i) The patient meets eligibility requirements for TRICARE/CHAMPUS TRICARE coverage.

PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE/CHAMPUS procedures, the RTC SUDRF 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 Inpatient Rehabilitation and Partial Hospitalization for the Treatment Centers Serving Children and Adolescents with Mental 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/CHAMPUS definition of a mental disorder.of (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 SUDRF issued by the Executive Director, TMA. (ec) The medical and/or psychological necessity of the patient’s admission is determined by a qualified mental health professional provider who meets TRICARE/CHAMPUS requirements for as an individual professional providersprovider, and who is permitted by law and by the facility to refer patients for admission. (fd) 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. (ge) All services in 32 CFR 199.4(c)(3)(ix) 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/CHAMPUS-authorized mental health CHAMPUS requirements as an individual professional provider (see Article 3.3(h) above). (hf) TMA or a designee has preauthorized precertified all inpatient or partial hospitalization care rendered to the patient. (ig) 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 TRICARE/CHAMPUS procedures, the RTC SUDRF 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 Inpatient Rehabilitation and Partial Hospitalization for the Treatment Centers Serving Children and Adolescents with Mental 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/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 SUDRF issued by the Executive Director, TMA. (ec) The medical and/or psychological necessity of the patient’s 's admission is determined by a qualified mental health professional provider who meets TRICARE/CHAMPUS requirements for as an individual professional providersprovider, and who is permitted by law and by the facility to refer patients for admission. (fd) 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. (ge) All services in 32 CFR 199.4(c)(3)(ix) 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/CHAMPUS-authorized mental health CHAMPUS requirements as an individual professional provider (see Article 3.3(h) above). (hf) TMA or a designee has preauthorized precertified all inpatient or partial hospitalization care rendered to the patient. (ig) 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 TRICARE/CHAMPUS TRICARE procedures, the RTC shall be paid on the basis of the allowance of the rate determined in accordance with the controlling TRICARE/CHAMPUS TRICARE regulation (see Article 4.1) contingent upon certain conditions provided in the TRICARE/CHAMPUS TRICARE 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 TRICARE 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 Deputy 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 TRICARE 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 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. (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 TRICARE coverage.

PREREQUISITES FOR PAYMENT. Provided that there shall first have been a submission of claims in accordance with TRICARE/CHAMPUS procedures, the RTC SUDRF 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 Inpatient Rehabilitation and Partial Hospitalization for the Treatment Centers Serving Children and Adolescents with Mental 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/CHAMPUS definition of a mental disorder.of (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 SUDRF issued by the Executive Director, TMA. (ec) The medical and/or psychological necessity of the patient’s 's admission is determined by a qualified mental health professional provider who meets TRICARE/CHAMPUS requirements for as an individual professional providersprovider, and who is permitted by law and by the facility to refer patients for admission. (fd) 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. (ge) All services in 32 CFR 199.4(c)(3)(ix) 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/CHAMPUS-authorized mental health CHAMPUS requirements as an individual professional provider (see Article 3.3(h) above). (hf) TMA or a designee has preauthorized precertified all inpatient or partial hospitalization care rendered to the patient. (ig) 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 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 '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.