Title 32 National Defense Civilian Health And Medical Program Of The Uniformed Services (CHAMPUS) Part 199.6 TRICARE-Authorized Providers Revision: C-12, November 17, 2020 Rule: Final Rule/FR Vol 85, No 222 (a) General. (1) Listing of provider does not guarantee payment of benefits. (2) Outside the United States or emergency situations within the United States. (3) Dual Compensation/Conflict of Interest. (4) [Reserved] (5) Utilization review and quality assurance. (6) Exclusion of beneficiary liability. (7) Provider required. (8) Participating providers. (i) Mandatory participation. (ii) Voluntary participation-- (A) Total claims participation: The participating provider program. (B) Claim-specific participation. (iii) Claim-by-claim participation. (9) Limitation to authorized institutional provider designation. (10) Authorized provider. (11) Balance billing limits. (i) In general. (ii) Waiver. (iii) Compliance. (12) Medical records. (13) Participation agreements. (14) Implementing instructions. (15) Exclusion. (b) Institutional providers-- (1) General. (i) Preauthorization. (ii) Billing practices. (2) Nondiscrimination policy. (i) Emergency care. (ii) Care rendered before finding of a violation. (iii) Other facility not available. (3) Procedures for qualifying as a CHAMPUS-approved institutional provider. (i) JCAH accreditation status. (ii) Required to comply with criteria. (iii) Notice of peer review rights. (iv) Surveying of facilities. (v) Institutions not in compliance with CHAMPUS standards. (vi) Participation agreements required for some hospitals which are not Medicare-participating. (4) Categories of institutional providers. (i) Hospitals, acute care, general and special. (ii) Organ transplant centers. (iii) Organ transplant consortia. (iv) Hospitals, psychiatric. (v) Long Term Care Hospital (LTCH). (vi) Skilled nursing facility. (vii) Residential treatment centers. (A) Organization and administration-- (B) Participation agreement requirements. (C) Other requirements applicable to RTCs. (viii) Christian Science sanatoriums. (ix) Infirmaries. (x) Other special institution providers. (A) General. (B) Types of providers. (xi) Birthing centers. (A) Certification requirements. (B) CHAMPUS birthing center standards. (xii) Psychiatric and substance use disorder partial hospitalization programs. (A) Organization and administration-- (B) Participation agreement requirements. (C) Other requirements applicable to PHPs. (xiii) Hospice programs. (xiv) Substance use disorder rehabilitation facilities. (A) Organization and administration-- (B) Participation agreement requirements. (8) Designate an individual who will act as liaison for CHAMPUS inquiries. The SUDRF shall inform OCHAMPUS in writing of the designated individual; (C) Other requirements applicable to substance use disorder rehabilitation facilities. (xv) Home health agencies (HHAs). (xvi) Critical Access Hospitals (CAHs). (xvii) Sole community hospitals (SCHs). (xviii) Intensive outpatient programs. (A) Organization and administration-- (B) Participation agreement requirements. (C) Other requirements applicable to Intensive Outpatient Programs (IOP). (xix) Opioid Treatment Programs (OTPs). (A) Organization and administration. (B) Participation agreement requirements. (C) Other requirements applicable to OTPs. (xx) Inpatient Rehabilitation Facility (IRF). (c) Individual professional providers of care-- (1) General-- (i) Purpose. (ii) Professional corporation affiliation or association membership permitted. (iii) Scope of practice limitation. (iv) Employee status exclusion. (v) Training status exclusion. (2) Conditions of authorization-- (i) Professional license requirement. (ii) Professional certification requirement. (iii) Education, training and experience requirement. (iv) Physician referral and supervision. (3) Types of providers. (i) Physicians. (B) Doctors of Osteopathy (D.O.). (ii) Dentists. (A) Doctors of Dental Medicine (D.M.D.). (B) Doctors of Dental Surgery (D.D.S.). (iii) Other allied health professionals. (A) Clinical psychologist. (B) Doctors of Optometry. (C) Doctors of Podiatric Medicine or Podiatrists. (D) Certified nurse midwives. (E) Certified nurse practitioner. (F) Certified Clinical Social Worker. (G) Certified psychiatric nurse specialist. (H) Certified physician assistant. (I) Anesthesiologist Assistant. (J) Certified Registered Nurse Anesthetist (CRNA). (K) Other individual paramedical providers. (L) Nutritionist. (M) Registered dietician. (N) TRICARE certified mental health counselor. (iv) Extramedical individual providers. (A) Certified marriage and family therapists. (B) Pastoral counselors. (C) Supervised mental health counselor. (E) Christian Science practitioners and Christian Science nurses. (d) Other providers. (1) Independent laboratory. (2) Suppliers of portable x-ray services. (3) Pharmacies. (4) Ambulance companies. (5) Medical equipment firms, medical supply firms, and Durable Medical Equipment, Prosthetic, Orthotic, Supplies providers/suppliers. (6) Mammography suppliers. (e) Extended Care Health Option Providers.-- (1) General. (2) ECHO provider categories-- (i) ECHO inpatient care provider. (ii) ECHO outpatient care provider. (iii) ECHO vendor. (3) ECHO provider exclusion or suspension. (f) Corporate services providers-- (1) General. (2) Conditions of authorization. (3) Transfer of participation agreement. (4) Pricing and payment methodology: (5) Termination of participation agreement.