TRICARE Regional Offices (TROs)/Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM) and Contractor Interfaces
1.0 Resource
Sharing Authority
2.0 Resource
Sharing Program Agreements
Resource sharing
consists only of external resource sharing (where the purpose of
the external resource sharing agreement enables military health
care personnel, active duty and civilian, to provide covered medical
services to active duty and TRICARE beneficiaries in a network facility.)
Although both Internal and External Resource Sharing is authorized
by Regulation, current policy is that only External Resource Sharing
will be implemented.
3.0 Resource
Sharing Program Requirements
The contractor
shall meet the following resource sharing program requirements:
3.1 Develop
a plan for identifying advantageous resource sharing opportunities
in conjunction with the TRICARE Regional Office (TRO) Chief Operating
Officer (COO) and the Military Treatment Facility (MTF) Commanders/Enhanced
Multi-Service Market (eMSM) Managers.
3.2 Develop and implement procedures
and measures for monitoring resource sharing agreement performances.
4.0 Resource
Sharing Agreement Guidelines
External resource
sharing shall be based upon written agreements between the contractor,
the MTF Commander/eMSM Manager, and the network facility, with the
TRO Regional COO concurrence. Before a military provider is permitted
to practice in a network facility, the MTF Commander/eMSM Manager
will ensure the military provider has active clinical privileges
with the network facility. The MTF Commander/eMSM Manager will also
ensure external resource sharing providers are licensed to practice
medicine in the United States (U.S.) jurisdiction during the term
of the resource sharing agreement. The resource sharing agreement
shall set forth all the terms, conditions and limitations of the
resource sharing arrangements. MTF Commanders/eMSM Managers may
only authorized Medicare dual eligible beneficiaries to be seen
under External Resource Sharing Agreements for care that is not covered
under Medicare. Active duty members and Active Duty
Family Members (ADFMs) with end stage renal disease or disability
eligible for Medicare Part A and not enrolled in Medicare Part B
may be authorized to be seen under External Resource Sharing Agreements. The
MTF Commander/eMSM Manager shall forward copies of all completed
external resource sharing agreements to the TRO Regional COO for
approval prior to the implementation of any resource sharing agreement.
The TRO Regional COO will provide the contractor written approval/disapproval
within 30 calendar days of receipt. The MTF Commander/eMSM Manager will forward
copies of all approved resource sharing agreements to the Procuring
Contracting Officer (PCO) no later than 10 calendar days following
written notification by the TRO Regional COO of the approval of
the agreement.
5.0 Professional
Liability
This clause is mandatory and will
be inserted in all External Resource Sharing Agreements, unless
a wavier is obtained from the Defense Health Agency (DHA) Office
of General Counsel (OGC) and the service legal advisor:
“While performing health care functions
authorized by the MTF/eMSM, designated health care personnel will
be acting within the scope of their duties as determined by the
Department of Justice (DOJ). The United States Government will be
responsible for their actions within the scope of their duties.
As such, any remedy for damages for personal injury, including death,
caused by their negligence or wrongful acts or omissions shall be
exclusively against the United States under provisions of the Federal Torts
Claims Act (Title 28 USC, Sections 1346(b), 2671-2680) and not against
the individual military health care provider. In the event any Department
of Defense (DoD) health care provider is asked to respond to an
emergency involving a non-DoD beneficiary, the state’s borrowed
servant defense and any other applicable defenses and immunities
available to the United States will apply to allegations of negligence
or wrongful acts or omissions arising from care rendered by the
provider.”
6.0 Credentials,
Privileging, And Other Provider Requirements
MTF
Commanders/eMSM Managers will ensure that the military health care
personnel are appropriately licensed and have active clinical privileges
within the network facility. The external resource sharing health
care personnel’s military command is responsible for the supervision
of the external resource sharing health care personnel.
7.0 Record
Keeping
The contractor shall maintain accurate
records to document actions related to resource sharing agreements.
These records shall include accurate recording of the personnel
performing services in network facilities, identifying each individuals
name, Social Security Number (SSN), type of provider or staff, and
the hours worked in the facility.
8.0 Audits
Contractor resource sharing expenditures are
subject to audit by the Government.