Inpatient admissions to a hospital or other authorized institutional provider (refer to § 199.6, together with inpatient admission to a residential therapy middle, substance use dysfunction rehabilitation facility residential treatment program, or skilled nursing facility) shall be cost-shared on an inpatient basis. The cost-sharing for inpatient companies topic to the TRICARE DRG-based fee system and the TRICARE per diem system shall be the lesser of the respective per diem copayment amount multiplied by the entire number of days in the hospital , or 25 p.c of the hospital’s billed costs. For other inpatient providers, the cost-share shall be 25% of the CHAMPUS-determined allowable costs. To be thought-about for advantages under paragraph of this section, covered providers and provides have to be provided and billed for by a certified supplier as set forth in § 199.6 of this part.
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A reason is a transparent and concise statement of legislation, regulation, insurance policies, or tips referring to the assertion of findings that provides the idea for the really helpful determination. The hearing could also be closed, but the document held open to find a way to allow the introduction of further evidence. Any evidence submitted after the shut of the hearing shall be made obtainable to all events to the hearing, and all events to the hearing shall have the chance for comment. The hearing officer could reopen the listening to if any portion of the extra evidence makes additional listening to desirable.
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A listening to officer might proceed a listening to to a different time or place on his or her own movement or, upon exhibiting of good cause, on the request of any party. Written discover of the time and place of the continued listening to, besides as otherwise provided right here, shall be in accordance with this part. When a continuance is ordered throughout a listening to, oral discover of the time and place of the continued hearing could also be given to each get together to the listening to who’s current at the hearing. If the Director, OCHAMPUS, or a designee, dismisses the request for listening to because of abandonment, the formal evaluation dedication in the case shall be deemed to be ultimate, unless the dismissal is vacated in accordance with paragraph of this section. The hearing officer might delay submitting the beneficial choice if, on the close of the listening to, any celebration to the listening to requests that the record remain open for submission of extra info. In such circumstances, the listening to officer may have 30 days following receipt of all such further data together with feedback from the other parties to the hearing concerning the additional data to submit the recommended choice to the Director, OCHAMPUS, or a designee.