(B) the requirements for the participation agreement. In addition to the other requirements in this paragraph, b) (4) (xiv), the Centre must have entered into a participation agreement with OCHAMPUS to authorize the services of a hospital rehabilitation centre for the treatment of substance use disorders. A single consolidated participation agreement is acceptable to all entities of the facility approved by TRICARE. The duration of a participation agreement is set out in the agreement and generally does not exceed five years. SUDRF is not considered a CHAMPUS-approved supplier and CHAMPUS payments are only made for services provided by SUDRF at the time of the signing of the participation agreement by the Director. In addition to reviewing the SUDRF application and supporting documents, an on-site visit by OCHAMPUS representatives may be part of the authorisation process. The participation agreement must include at least the following requirements: qualified care services. Qualified care services include the use of professional care and skills services by an RN, LPN or LVN, which must be performed under the supervision/general direction of a TRICARE licensed physician in order to ensure patient safety and obtain the medically desired result according to recognized standards of practice. (xv) Health Services (HHA). HHAs must be approved by Medicare and comply with all conditions of participation in Medicare, in accordance with paragraphs 1861 (o) and 1891 of the Social Security Act (42 U.C 1395x (o) and 1395bb) and 42 CFR Part 484 for tricare beneficiaries, in order to obtain payments under the TRICARE program.
It may be found that an HHA does not comply with a specific condition of participation in Medicare and that it nevertheless participates in the TRICARE program as long as HHA is allowed to continue participating in Medicare, while correcting the condition of non-compliance. an HHA is a public agency or sub-division of an agency or agency that meets the following requirements: (2) up to 35 hours per week for qualified and home health care services provided less day by day and verified on a case-by-case basis by care management contractors, and on the basis of a record justifying the need and adequacy of this additional care; or (1) to provide hospital treatment centres in hospital, in accordance with the participation agreement and the CHAMPUS regulation, for eligible CHAMPUS beneficiaries who need such services; iii) The facility is currently accredited by an accreditation body accredited by the director. (1) Definition. SUDRF is a residential or rehabilitation facility or a self-contained part of an institution that provides psychoactive patients with treatment under medical supervision and focused on interdisciplinary addiction. Qualified health professionals offer 24 hours, seven days a week, assessment, treatment and evaluation. A SUDRF is suitable for patients whose symptoms related to addiction or physical and emotional/behavioural dysfunction problems that accompany persistent disorders in several important areas of life. Hospital or hospital rehabilitation is different: this rule has been reviewed by the Office of Management and Household in accordance with executive order 12866. This is an important rule under the Congressional Review Act. This rule is economically significant, as it would result in a reduction in TRICARE payments to skilled care facilities (NFS) of more than $100 million per year.