Persons eligible for Basic Program advantages. Persons eligible to receive the Basic Program advantages are set forth in § 199.three of this part. Any person decided to be an eligible CHAMPUS beneficiary is eligible for Basic Program benefits.
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(Also throughout the remainder of the subsection, “services” includes items and “provider” contains supplier). This paragraph does not apply to protection determinations made by OCHAMPUS or the fiscal intermediaries which are not based on medical necessity determinations made underneath the PRO program. Annual calendar yr deductible for outpatient companies or supplies. An eligible former partner is responsible for the cost of the first $150.00 of the CHAMPUS-determined cheap costs or expenses for otherwise coated outpatient services or provides offered in anybody calendar yr. (Except for providers obtained prior to April 1, 1991, the deductible amount is $50.00).
Inpatient acute take care of medical or surgical therapy of an acute illness, or of an acute exacerbation of the qualifying condition, is excluded. Reasonable repairs and upkeep of the beneficiary owned or rented DE or AT gadgets offered by this part shall be allowed while a beneficiary is registered in the ECHO Program. Repairs of DE and/or AT devices broken while utilizing the merchandise in a fashion inconsistent with its widespread use, and alternative of misplaced or stolen rental DE usually are not authorized coverage as an ECHO profit. In addition, repairs and maintenance of deluxe, luxury, or immaterial features of DE or AT gadgets are not licensed coverage as an ECHO benefit. The allowable equipment and an AT device purchase shall include such companies and modifications to the tools as essential to make the equipment usable for a particular ECHO beneficiary. The Government’s cost-share incurred for these services accrues to the program year profit restrict of $36,000.