Complete medical records and all supporting documentation must be submitted to the CHAMPUS contractor inside 30 days of the date of its request. If data usually are not acquired inside the designated timeframe, authorization of the hospice benefit will be denied and any prior payments made will be recouped. A denial issued for this reason is not an initial dedication beneath ยง 199.10, and is not appealable. Under the Basic Program, advantages may be prolonged for medically essential prescribed drugs required within the treatment of an illness or harm or in reference to maternity care (refer to paragraph of this section). However, TRICARE advantages cannot be approved to support or maintain an existing or potential drug abuse situation whether or not the medicine are eligible for profit consideration and whether or not obtained by authorized means.
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