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TRICARE Operations Manual 6010.59-M, April 1, 2015
TRICARE Medicare Eligible Program (TMEP)
Chapter 20
Section 18
Demonstrations And Pilot Projects (Except Value-Based Initiatives)
Revision:  C-108, May 18, 2022
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TRICARE requirements in Chapter 18 regarding Demonstrations and Pilot Projects unless specifically changed, waived, or superseded by this section (as indicated below), the TRICARE Policy Manual (TPM), TRICARE Reimbursement Manual (TRM), TRICARE Systems Manual (TSM), or TMEP contract.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.
1.3  The requirements in Chapter 18, Section 8 do not apply.
1.4  The requirements in Chapter 18, Section 10 not apply.
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