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 Fee-For-Service
(FFS) 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 Tax
Identification Number (TIN). 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 required 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.