If the preauthorized service or supplies are not obtained or commenced throughout the specified time restrict, a new preauthorization is required earlier than advantages could additionally be extended. For organ and stem cell transplants, the preauthorization shall remain in effect so long as the beneficiary continues to satisfy the specific transplant standards set forth within the TRICARE/CHAMPUS Policy Manual, or until the approved transplant happens. Exclusion of beneficiary legal responsibility. In connection with sure utilization evaluation, quality assurance and preauthorization necessities of part 199.4 of this part, suppliers could not maintain sufferers responsible for payment for sure providers for which CHAMPUS payment is disallowed.
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The listening to officer could problem invites and requests to people to seem and testify with out cost to the Government, so that the total information within the case may be offered. Any celebration to the listening to could appoint a representative to behave on behalf of the celebration at the hearing, except such particular person at present is disqualified or suspended from acting in another Federal administrative proceeding, or except otherwise prohibited by law, this half, or another DoD regulation (see paragraph of this section). A hearing officer may refuse to permit any particular person to characterize a party at the hearing when such individual engages in unethical, disruptive, or contemptuous conduct, or deliberately fails to adjust to correct instructions or requests of the hearing officer, or the provisions of this part. The consultant shall have the same authority as the interesting celebration and see given to the consultant shall constitute discover required to be given to the appealing party. Appeal rights have been provided but a request for hearing is not received by OCHAMPUS inside 60 days of the date of the discover of the formal review willpower. The request shall be mailed inside 60 days after the date of the notice of the reconsideration determination or OCHAMPUS initial determination being appealed.