AllThe
TMEP contractor shall comply with all TRICARE requirements
in
Chapter 18 regarding
Demonstrations and Pilot Projects
shall apply to the
TMEP unless specifically changed, waived, or superseded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
The
provisions
of TMEP contractor shall comply with the
requirements in Chapter 18 are
applicable to TMEP with the following exceptions:
1.1 The
provisions
of requirements in Chapter 18, Section 3,
paragraphs
8.8.1 through 8.8.3.2, referral and authorizations requirements
will be conducted by the regional contractors 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 3, paragraph 8.6.
The regional contractor
will submit shall
share the authorization
s for
TRICARE/Medicare dual eligible beneficiaries
to with the
TMEP contractor as established in the Memorandum of Understanding
(MOU). The TMEP contractor
will shall contact
the
appropriate regional contractor regarding
referral
and authorizations for claims
received with
ACD services without an authorization.
1.2 The provisions
of Chapter 18, Section 4, paragraphs 15.1, 15.6, and 15.8 are not
applicable to TMEP.
1.2 The
provisions
of requirements in Chapter 18, Section 94, paragraphs
3.0 and 6.0 do not apply
to
TMEP.
All other requirements for this
Pilot Project do not apply.