The transportation benefit obtainable under ECHO is specified elsewhere on this part. Drugs, devices, medical therapies, diagnostic, and therapeutic procedures for which the safety and efficacy have not been established in accordance with § 199.4 are excluded. The difference between the worth for journey or accommodations that present services or options that exceed the necessities of the beneficiary’s condition and the price for journey or accommodations without those providers or options is excluded. Training that teaches the use of assistive know-how devices or to accumulate expertise that are needed for the management of the qualifying condition. Such coaching can be approved for the beneficiary’s instant family.
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The standardized costs shall be calculated by multiplying the total costs by the issue described in paragraph of this section and adjusting this amount for indirect medical training prices. Cost outliers for providers in youngsters’s hospitals and for neonatal providers shall be reimbursed the DRG-based quantity plus a proportion of all costs exceeding the brink. Effective with admissions occurring on or after October 1, 1998, standardized costs are no longer adjusted for indirect medical education costs. In addition, CHAMPUS will calculate the outlier funds that would have occurred at each of the 59 Children’s hospitals beneath the FY99 outlier policy for all circumstances that may have been outliers underneath the FY94 policies utilizing essentially the most accurate information obtainable in September 1998. A ratio will be calculated which equals the extent of outlier funds that may have been made beneath the FY94 outlier insurance policies and the outlier funds that may be made if the FY99 outlier policies had applied to each of these potential outlier circumstances for these hospitals. The ratio might be calculated across all outlier claims for the fifty nine hospitals and will not be hospital specific.
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The primary technique of processing CHAMPUS claims within the United States is thru competitively procured, fixed-price contracts. The Director, OCHAMPUS, or a designee, is responsible for negotiating, beneath the provisions of the FAR, contracts for the aim of adjudicating and processing CHAMPUS claims . Collect, keep, and analyze program value and utilization information acceptable for preparation of budgets, fiscal planning, and as otherwise needed to hold out CHAMPUS programs and missions. Enter into agreements via the Department of Defense with respect to the Military Departments or other U.S.