Last updated: November 2026
TRICARE authorized provider readiness helps residential treatment centers and substance use disorder rehabilitation facilities assess their compliance with 32 CFR 199.6 before applying for authorization. Integral Healthcare Solutions (IHS) maps your operation to that rule, drafts the missing policies and program descriptions for you and your counsel to approve, and builds the checklist for your application packet.
IHS works in three practice lines: accreditation consulting, compliance services and program development. This page is the compliance services line.
What is TRICARE authorized provider status?
It is the standing a provider needs under the Department of Defense rule before TRICARE cost-shares its services. The governing text is 32 CFR 199.6, TRICARE—authorized providers (official GPO eCFR XML opened 2026-11-05; file built 18 August 2026). The rule still uses the older name CHAMPUS beside TRICARE.
Paragraph (a) puts a duty on every provider that seeks payment to learn the program requirements and comply with them. Paragraph (a)(1) says that being a listed type of provider does not mean TRICARE will automatically pay a claim. The provider that furnishes the service must meet all licensing and other requirements in the part, must not be under a sanction under § 199.9, and must not be barred from cost-sharing by the part. The patient must be an eligible beneficiary, and the services must be authorized and medically necessary, whatever the provider's standing.
TRICARE manuals and contractor forms also apply. IHS did not open them for this page; the gap assessment checks your policies against the current editions and forms you obtain.
Who needs it and what triggers it
IHS offers this work to residential treatment centers and substance use disorder rehabilitation facilities preparing for authorization or an agreement review under § 199.6(b)(4)(vii) and (xiv). Possible starting points:
- A new residential or substance use program plans to serve TRICARE beneficiaries.
- An existing program adds a distinct part or a new site and needs to know whether its agreement covers it.
- An agreement nears the end of its period, which the rule says will generally be not more than five years.
Partial hospitalization programs ((b)(4)(xii)), intensive outpatient programs ((b)(4)(xviii)), opioid treatment programs ((b)(4)(xix)) and corporate services providers (paragraph (f)) each have their own paragraph and conditions.
What does the rule require of a residential treatment center?
The rule defines a residential treatment center as a facility, or a distinct part of one, that gives beneficiaries under 21 years of age a medically supervised, interdisciplinary program of mental health treatment. It is appropriate for patients whose main symptoms are essentially stabilized, although not resolved, and who have persistent dysfunction in major life areas. The rule separates it from acute psychiatric care, partial hospitalization, group homes, therapeutic schools and facilities treating a primary diagnosis of substance use disorder, intellectual disability or developmental disability (§ 199.6(b)(4)(vii)(A)(1)).
To qualify, the center must meet the minimum standards in paragraphs (A) through (C) plus any further criteria the Director determines necessary. It must be licensed and operate in substantial compliance with state and federal regulations, be currently accredited by an organization the Director approves, and have a written participation agreement with OCHAMPUS. Until the Director signs that agreement, the center is not an authorized provider and no benefits are paid for its services. Retroactive approval is not given, and OCHAMPUS may require an on-site inspection before signing (§ 199.6(b)(4)(vii)(A)(2) and (B)).
The agreement requires compliance with the RTC paragraph. The separate certification of continuing compliance with the CHAMPUS Standards for Residential Treatment Centers Serving Children and Adolescents with Mental Disorders excepts standards for which the center notifies the Director of noncompliance. It must report its designated liaison to OCHAMPUS in writing. Claims are due at least every 30 days, except when collection from other health insurance necessitates delay; if claims are not submitted at least every 30 days, the center may not bill the beneficiary or family for disallowed amounts. Audits may be unannounced (§ 199.6(b)(4)(vii)(B)(6) through (11)).
What does the rule require of a substance use disorder rehabilitation facility?
A substance use disorder rehabilitation facility (SUDRF) provides medically monitored, interdisciplinary addiction treatment for beneficiaries with psychoactive substance use disorders, with qualified health care professionals assessing, treating and evaluating patients 24 hours a day, seven days a week. It may be a distinct part of a facility; its patients have persistent dysfunction in several major life areas from addiction-related symptoms or accompanying physical or emotional/behavioral problems (§ 199.6(b)(4)(xiv)(A)(1)).
Eligibility requires the minimum standards in § 199.6(b)(4)(xiv)(A) through (C) and additional criteria the Director determines necessary, licensing, substantial compliance with state and federal regulations, Director-approved accreditation for the treatment level, and a written participation agreement. Benefits are not paid for services before the Director signs. One consolidated agreement may cover all units of the TRICARE-authorized facility, and an on-site visit may be part of authorization. The facility also certifies that it conducted a self-assessment against the CHAMPUS standards for these facilities and told the Director of any matter on which it does not comply (§ 199.6(b)(4)(xiv)(A)(2) and (B)).
How does the approval route work?
Section 199.6(b)(3)(ii) expects facilities seeking approval to meet applicable (b)(4) criteria and requires CHAMPUS Form 200 and additional information OCHAMPUS requests. The Director or designee may order a scheduled or unscheduled on-site evaluation; the determination goes in writing to the facility and fiscal intermediary. Resurveying continues, and noncompliance requires immediate steps toward compliance or termination under § 199.9(f)(2) ((b)(3)(iv) through (v)).
How IHS helps
IHS tests the operation against the standards for its category:
- Gap assessment of your licenses, accreditation, policies, staffing and program description against the paragraph for your category.
- Evidence map that ties each requirement to the document that shows it.
- Drafts of policies and program descriptions, for your clinicians, leaders and counsel to approve.
- A comparison of your draft agreement with what the rule says it must include, with questions for your counsel.
- An application packet checklist, mock review and readiness support before you submit, using the current forms you obtain.
Your organization supplies its licenses, current policies, staffing and clinical program descriptions, accreditation records and the TRICARE forms and manual text it obtains.
The limit: IHS does not submit to TRICARE or its contractors, does not contact them for you and does not act as your liaison. Your organization signs, submits and communicates with the agency. This page is not legal advice, and your counsel reviews the policies and the agreement.
What to have ready
Each item ties to 32 CFR 199.6, TRICARE—authorized providers (official GPO eCFR XML built 18 August 2026, opened 2026-11-05; source linked above).
| Item | Section | What the rule asks |
|---|---|---|
| State license | (b)(4)(vii)(A)(2); (b)(4)(xiv)(A)(2) | The facility is licensed and operates in substantial compliance with state and federal regulations. |
| Current accreditation record | (b)(4)(vii)(A)(2); (b)(4)(xiv)(A)(2) | The facility is currently accredited by an organization the Director approves, and a SUDRF is accredited for the level of treatment it provides. |
| Program description matching the category | (b)(4)(vii)(A)(1); (b)(4)(xiv)(A)(1) | Population, age range, supervision and treatment model fit the rule's definition for the category. |
| Written participation agreement | (b)(4)(vii)(A)(2) and (B); (b)(4)(xiv)(A)(2) and (B) | Signed by the Director before benefits are paid. |
| Compliance certifications and self-assessment | (b)(4)(vii)(B)(7) through (8); (b)(4)(xiv)(B)(7) through (8) | Regulatory compliance; continuing CHAMPUS-standards compliance except standards notified to the Director as unmet; SUDRF self-assessment and notice of noncompliance; liaison designation reported to OCHAMPUS in writing. |
| Claims and billing procedure | (b)(4)(vii)(B)(5) and (6); (a)(13) | Bill insurance primary to CHAMPUS first. Submit RTC claims at least every 30 days except for necessary insurance-collection delays; do not bill beneficiaries or families for disallowed amounts when claims are not submitted every 30 days. Observe § 199.6(a)(13)(i) billing prohibitions. |
| Records and audit access | (a)(12); (a)(13)(v), (ix) and (x); (b)(4)(vii)(B)(11); (b)(4)(xiv)(B)(11) | Contemporaneous records identify caregivers and substantiate care, necessity, appropriateness, rationale, efficacy and outcomes. Keep clinical and other records for CHAMPUS-paid services, including arranged services, for 60 months from service. Audits may be unannounced and include patients and non-CHAMPUS patient records. |
Also have the TRICARE manual text and contractor forms you hold, since the Director issues implementing instructions ((a)(14)). To have IHS walk the list against your operation, start with the introductory call.
How it compares
RTCs and SUDRFs have distinct definitions under § 199.6(b)(4)(vii)(A)(1) and (xiv)(A)(1), set out above. Partial hospitalization, intensive outpatient and opioid treatment programs have separate criteria. IHS does not tell you which category to choose.
TRICARE authorization is separate from the Director-approved accreditation required for RTCs and SUDRFs. IHS has pages on CARF partial hospitalization accreditation, ACHC behavioral health accreditation and 42 CFR Part 2 substance use records compliance.
What it costs
The reviewed § 199.6 text does not specify an application fee. Confirm current fees with TRICARE or your contractor.
IHS scopes each engagement after a free introductory call.
What this is not
IHS is not TRICARE, a TRICARE contractor or an accrediting body, and it does not grant authorized provider status.
This page is not legal advice. IHS is a consulting firm, not a law firm.
IHS does not guarantee authorization or payment, does not write clinical content without your clinicians' approval and does not submit anything to TRICARE or its contractors. Your organization submits.
Frequently asked questions
What is a residential treatment center under the rule?
An RTC provides medically supervised, interdisciplinary mental health treatment to beneficiaries under 21. It serves patients whose main symptoms are essentially stabilized but unresolved and who have persistent dysfunction in major life areas (§ 199.6(b)(4)(vii)(A)(1)).
What is a substance use disorder rehabilitation facility under the rule?
A SUDRF provides medically monitored, interdisciplinary addiction treatment for beneficiaries with psychoactive substance use disorders. Qualified health care professionals provide assessment, treatment and evaluation 24 hours a day, seven days a week (§ 199.6(b)(4)(xiv)(A)(1)).
Does being a listed provider type guarantee payment?
No. The provider must meet licensing and other requirements, be free of § 199.9 sanctions, and face no other cost-sharing prohibition under this part; the patient must be eligible and the billed services or supplies authorized and medically necessary (§ 199.6(a)(1)).
Does TRICARE pay for services before the participation agreement is signed?
The RTC and SUDRF provisions withhold authorized status and benefits for services before the Director signs the agreement (§ 199.6(b)(4)(vii) and (xiv)). The RTC provision also expressly prohibits retroactive approval. Separately, § 199.6(a)(2) lets the Director, OCHAMPUS, or a designee, after review of the facts, pay for otherwise covered services from a provider that does not meet the part's standards, when the care is outside the United States or an emergency within the United States and Puerto Rico. The note to that paragraph says only the Secretary of Defense, the Secretary of Health and Human Services, the Secretary of Transportation, or their designees may authorize emergency payment to a civilian U.S. facility that does not comply with title VI of the Civil Rights Act of 1964.
What is a participation agreement and who must sign one?
For RTCs and SUDRFs, it is the written agreement with OCHAMPUS signed by the Director. Section 199.6(a)(8)(i) requires institutional providers to participate on all claims, SNFs and HHAs to have agreements for all claims, and paragraph (f) corporate services providers to have agreements as the Director or designee provides.
Does accreditation replace TRICARE authorization?
No. RTCs and SUDRFs need Director-approved accreditation and a written participation agreement; SUDRF accreditation must cover the required treatment level (§ 199.6(b)(4)(vii)(A)(2) and (xiv)(A)(2)).
What does IHS draft and what does the provider submit?
IHS drafts the gap assessment, policies, program descriptions and the packet checklist. Your organization signs and submits the application and communicates with TRICARE and its contractors.
Does readiness work guarantee authorization?
No. For RTCs and SUDRFs, inaccurate information or withheld material facts in obtaining or retaining authorization brings denial or termination and two years of ineligibility for consideration (§ 199.6(b)(4)(vii)(C)(3) and (xiv)(C)(3)).