Residential Treatment Centers
Residential treatment centers (RTCs) provide treatment for children and adolescents (some centers may provide treatment up to age 21) who require behavioral health care due to a serious behavioral health disorder. Children who only have disciplinary problems or primary substance use disorders do not qualify for treatment in an RTC setting.
All RTCs must be TRICARE-authorized by the NQMC, Maximus, to provide residential treatment to TRICARE-eligible beneficiaries. Providers may contact Maximus by one of the following means:
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Mail
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NQMC—Maximus
1600 E. Northern Avenue
Suite 100
Phoenix, AZ 85020 |
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Phone
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1-602-308-7160 |
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E-mail
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nqmc@maximus.com |
A psychiatrist or other clinical psychologist must recommend the child be admitted to the RTC, and a psychiatrist or clinical psychologist must direct the development of a treatment plan. Documentation must be submitted to support each request, and the behavioral health disorder must meet clinical review criteria before admission can be authorized.
Additional RTC details include:
- RTC care is covered to a maximum of 150 days in a fiscal year or for a single admission, if medically necessary. These limits are subject to waiver in certain cases.
- Prior authorization is required.
- Concurrent reviews are conducted during the course of the RTC stay.
TRICARE reimbursement for RTC care is an all-inclusive per diem rate. The only three charges considered outside the all-inclusive RTC rate are defined below:
- Geographically distant family therapy—The family therapist may bill and be reimbursed separately from the RTC if the therapy is provided to one or both of the child’s parents residing a minimum of 250 miles from the RTC.
- RTC educational services—Educational services will be covered only in cases when appropriate education is not available from or not payable by local, state, or federal governments. TRICARE is always the payer of last resort. For network providers, this coverage limitation applies only if educational services are not part of the contracted per diem rate.
- Non-behavioral health care services—Services provided to the beneficiary not related to behavioral health care, such as medical treatments for asthma or diabetes, may be reimbursed separately from the RTC.
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