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 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. (b) The patient meets the criteria for admission to an OTP 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 OTP recommends that the patient be admitted to the OTP. (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)). (f ) The patient meets eligibility requirements for coverage.