Home
infusion services must be preauthorized and provided in accordance
with the TRICARE Policy Manual (TPM),
Chapter 8, Section 20.1. Home infusion companies
eligible for Corporate Services Provider (CSP) status as set forth
in the TPM,
Chapter 11, Section 12.1 will be paid under
the CHAMPUS Maximum Allowable Charge (CMAC) reimbursement system
on a fee-for-service basis for otherwise-covered professional services
provided by TRICARE-authorized individual providers employed by
or under contract with a freestanding corporate entity. Reimbursement
of covered services, along with related drugs and supplies, will
be made directly to the TRICARE-authorized corporate services provider under
its own tax identification number. Payment will be allowable for
services rendered in the authorized CSP’s place of business, or
in the beneficiary’s home, under such circumstances as the contractor
determines to be necessary for the efficient delivery of such in-home
services. The corporate entity will not be allowed additional facility
charges that are not already incorporated into the professional
service structure; i.e., facility charges that are not already included
in the overhead and malpractice cost indices used in establishing
locally-adjusted CMAC rates. Additional expenses by providers due
to travel will also not be covered.