The
TMEP contractor shall comply with all TRICARE requirements in
Chapter
18 regarding Demonstrations and Pilot Projects unless
specifically changed, waived, or superseded by this section (as
indicated below), the TRICARE Policy Manual (TPM), TRICARE Reimbursement
Manual (TRM), TRICARE Systems Manual (TSM), or TMEP contract.
1.0 General
1.1 The
TMEP contractor shall comply with the requirements in
Chapter
18 are applicable to TMEP with the following exceptions:
1.2 The
requirements in
Chapter 18, Section 4,
Department of Defense (DoD) Comprehensive Autism Care Demonstration
(ACD) - The regional contractors manage the care for beneficiaries receiving
ACD services Extended Care Health Option (ECHO) for Active Duty
Family Members (ADFMs) which may include TRICARE and Medicare eligible
beneficiaries. The TMEP contractor shall process claims for beneficiaries
authorized benefits under the ACD that are within the TMEP scope.
The regional contractors shall comply with the requirement for referrals
and authorizations in
Chapter 18, Section 4, paragraph 8.6. The
regional contractor shall share the authorizations for TRICARE/Medicare
dual eligible beneficiaries with the TMEP contractor as established
in the Memorandum of Understanding (MOU). The TMEP contractor shall
contact the appropriate regional contractor regarding claims with ACD
services without an authorization.