Common use of ACCREDITATION AND STANDARDS Clause in Contracts

ACCREDITATION AND STANDARDS. The SUDRF hereby agrees to: (a) Comply with the TRICARE/CHAMPUS Standards for Substance Use Disorder Rehabilitation Facilities, as promulgated by the Director, DHA or designee. (b) Be licensed to provide substance use treatment within the applicable jurisdiction in which it operates, if licensure is available. (c) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission on Accreditation of Health Care Organizations under the Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/ Developmental Disabilities Services, or by the Commission on Accreditation of Rehabilitation Facilities as an alcoholism and other drug dependency rehabilitation program under the Standards Manual for Organizations Serving People with Disabilities. (d) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, and 32 CFR 199.14(a)(2)(v)(C) for partial hospitalization services, as payment in full for services provided. (e) 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. (f ) Be fully operational and treating patients for a period of at least six months (with at least 30% minimum patient census) before it submits an application for approval. (g) Ensure that any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE requirements for individual professional providers. (Exception: SUDRFs 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 all-inclusive DRG rate for inpatient services, or the per-diem rate for partial hospitalization services, but the individual must work under the documented direct clinical supervision of a fully qualified mental health provider employed by the SUDRF). All other program services will be provided by trained, licensed staff. (h) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (i) Have a written agreement with at least one backup TRICARE-authorized hospital, which specifies that the hospital will accept any and all TRICARE beneficiaries transferred for emergency mental health or medical/surgical care. The SUDRF must have a written emergency transportation agreement with at least one ambulance company, which specifies the estimated transportation time to each backup hospital. (j) 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 for preauthorization. (k) Not bill the beneficiary for services excluded on the basis of 32 CFR 199.4(g)(1) (not medically 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 had been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (l) Prior to initiation of this agreement, and annually thereafter, conduct a self assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of Substance Use Disorders as issued by the Director, DHA or designee, and notify the Director, DHA or designee, of any matter regarding which the facility is not in compliance with such standards.

ACCREDITATION AND STANDARDS. The SUDRF RTC hereby agrees to: (a) Comply with the TRICARE/CHAMPUS Standards for Substance Use Disorder Rehabilitation FacilitiesRTCs Serving Children and Adolescents with Mental Disorders, as promulgated by the Director, DHA or designee. (b) Be licensed to provide substance use treatment RTC services within the applicable jurisdiction in which it operates, if licensure is available. (c) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission on Accreditation of Health Care Organizations under the Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/ Retardation/Developmental Disabilities Services, or by Services (formerly the Commission on Accreditation of Rehabilitation Facilities as an alcoholism and other drug dependency rehabilitation program under the Consolidated Standards Manual for Organizations Serving People with DisabilitiesManual). (d) Accept the TRICARETRICARE all-determined inclusive per diem rate, as provided in 32 CFR 199.14(a)(1)(ii)(F199.14(f) for inpatient services, and 32 CFR 199.14(a)(2)(v)(C) for partial hospitalization services, as payment in full for services provided. (e) 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. (f ) Be fully operational and treating patients for a period of at least six months (with at least 30% minimum patient census) before it submits an application for approval. (g) Ensure that any individual, group, or family psychotherapy, or psychological testing and assessment, is all mental health services listed in 32 CFR 199.4(b)(3)(ix) are provided by a qualified mental health provider providers who meets meet TRICARE requirements for individual professional providers. (Exception: SUDRFs 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, but are actively working toward licensure or certification, may provide mental health services within the all-inclusive DRG rate for inpatient services, or the per-per diem rate for partial hospitalization services, but the individual must work under the documented direct clinical supervision of a fully qualified mental health provider employed by the SUDRFRTC). All other program services will be provided by trained, licensed staff. (h) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (i) Have a written agreement with at least one backup TRICARE-authorized hospital, which specifies that the hospital will accept any and all TRICARE beneficiaries transferred for emergency mental health or medical/surgical care. The SUDRF RTC must have a written emergency transportation agreement with at least one ambulance company, which specifies the estimated transportation time to each backup hospital. (ji) 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 for preauthorization. (kj) Not bill the beneficiary for services excluded on the basis of 32 CFR 199.4(g)(1) (not medically 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 had has been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (lk) Prior to initiation of this agreement, and annually thereafter, conduct a self assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation RTCs Serving Children and Partial Hospitalization for the Treatment of Substance Use Adolescents with Mental Disorders as issued by the Director, DHA DHA, or designee, and notify the Director, DHA or designee, of any matter regarding which the facility is not in compliance with such standards.

ACCREDITATION AND STANDARDS. The SUDRF hereby agrees to: (a) Comply with the TRICARE/CHAMPUS Standards for Substance Use Disorder Rehabilitation Facilities, as promulgated by the Director, DHA or designee. (b) Be licensed to provide substance use treatment within the applicable jurisdiction in which it operates, if licensure is available. (c) Be specifically accredited by and remain in compliance with standards issued by the Joint Commission on Accreditation of Health Care Organizations under the Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/ Developmental Disabilities Services, or by the Commission on Accreditation of Rehabilitation Facilities as an alcoholism and other drug dependency rehabilitation program under the Standards Manual for Organizations Serving People with Disabilities. (d) Accept the TRICARE-determined rate, as provided in 32 CFR 199.14(a)(1)(ii)(F) for inpatient services, and 32 CFR 199.14(a)(2)(v)(C199.14(a)(2)(ix)(C) for partial hospitalization services, as payment in full for services provided. (e) 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. (f ) Be fully operational and treating patients for a period of at least six months (with at least 30% minimum patient census) before it submits an application for approval. (g) Ensure that any individual, group, or family psychotherapy, or psychological testing and assessment, is provided by a qualified mental health provider who meets TRICARE requirements for individual professional providers. (Exception: SUDRFs 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 all-inclusive DRG rate for inpatient services, or the per-diem rate for partial hospitalization services, but the individual must work under the documented direct clinical supervision of a fully qualified mental health provider employed by the SUDRF). All other program services will be provided by trained, licensed staff. (h) Ensure the provision of individual, group, and family psychotherapy and addiction counseling services that are consistent with each patient’s treatment plan. (i) Have a written agreement with at least one backup TRICARE-authorized hospital, which specifies that the hospital will accept any and all TRICARE beneficiaries transferred for emergency mental health or medical/surgical care. The SUDRF must have a written emergency transportation agreement with at least one ambulance company, which specifies the estimated transportation time to each backup hospital. (j) 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 for preauthorization. (k) Not bill the beneficiary for services excluded on the basis of 32 CFR 199.4(g)(1) (not medically 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 had been determined to be noncovered by TRICARE. (A general statement signed at admission relative to financial liability does not fill this requirement.) (l) Prior to initiation of this agreement, and annually thereafter, conduct a self assessment of its compliance with the TRICARE/CHAMPUS Standards for Inpatient Rehabilitation and Partial Hospitalization for the Treatment of Substance Use Disorders as issued by the Director, DHA or designee, and notify the Director, DHA or designee, of any matter regarding which the facility is not in compliance with such standards.