3.3 In addition,
in order for a freestanding
PHP to
be authorized, the PHP shall comply with the following requirements:
3.3.1 The PHP shall be currently accredited by the
Joint Commission (TJC) under the
Commission on Accreditation of Rehabilitation Facilities (CARF),
the Council on Accreditation (CoA), or an accrediting organization
approved by the Director, DHA. The
regional contractor may submit, via the TRICARE Regional Office
(TRO), additional accrediting organizations for TRICARE authorization,
subject to approval by the Director, DHA.
3.3.2 The PHP shall be licensed as a PHP to provide
PHP services within the applicable jurisdiction in which it operates.
3.3.4 The PHP shall comply with all requirements applicable
to institutional providers generally concerning accreditation
requirements, concurrent care review, claims processing,
beneficiary liability, double coverage, utilization and quality
review, and other matters.
3.3.5 The PHP shall
not be considered an authorized provider nor will any
benefits be paid to the facility for any services provided prior
to the date the facility is approved by the Director, Defense Health
Agency (DHA), or designee.
3.3.6 All diagnostic and therapeutic mental health
and
SUD services must be provided by an authorized mental
health provider. This includes all psychotherapy (individual, group,
family or conjoint, psychoanalysis, collateral), psychological testing
and assessment to include documentation of the outcomes of standardized
assessment measures for Post-Traumatic Stress Disorder (PTSD), Generalized
Anxiety Disorder (GAD), and Major Depressive Disorder (MDD) using
the PTSD Checklist (PCL), GAD-7, and Patient Health Questionnaire
(PHQ)-8, respectively, at baseline, at 60-120 day intervals, and
at discharge (
see
Chapter 1, Section 5.1 for
details).
[Exception: PHPs that employ individuals with master’s or doctoral
level degrees in a mental health discipline who do not meet the licensure,
certification
, and experience requirements
for a qualified mental health provider but are actively working
toward licensure or certification, may provide services within the
all-inclusive per diem rate but the individual must work under the
clinical supervision of a fully qualified mental health provider
employed by the PHP.] All other program services shall be provided
by trained, licensed staff.
3.3.7 Family
therapy
is an integral part of the treatment of children and adolescents
and must be included in
their mental
health treatment plans. If the family is not in the area, the
child
or adolescent patient is probably not a candidate
for partial care as individuals in this program return to their
home setting daily, and effective family interaction is essential.
If the family or patient is not cooperative in participating in
family therapy, they may not be viable candidates for a partial
program. By accepting a child or adolescent under the age of 21
for admission, a partial program is acknowledging that it can provide
the specific treatment appropriate to that individual’s needs and
is responsible for taking only those individuals whom it feels it
can help through the development of an appropriate treatment program
designed to encompass family therapy and maximize the patient’s
ability to function in one or more major life activities. The requirement
for family therapy is not considered met by telephonic therapy or
multifamily group therapy.
(See Chapter 7, Section 3.12.) If
family therapy is clinically contraindicated, an exception to this
requirement may be granted
on a case-by-case basis by
the
clinical director, or designee.
3.3.8 Case management services
required. The facility must provide case management services that
help assure the patient appropriate living arrangements
after treatment hours, transportation to and from the facility,
arrangement of community based support services, referral of suspected
child abuse to the appropriate state agencies, and effective after
care arrangements, at a minimum.
3.3.9 Educational services required. Programs treating
children and adolescents must ensure the provision of a state certified
educational component which assures that patients do not fall behind
in educational placement while receiving partial hospital treatment.
The cost of educational services will not be funded separately from
the per diem rate. The hours devoted to education do not count toward the
therapeutic program.
3.3.10 The PHP shall enter into a
written participation
agreement with the Director, DHA
, or designee. (See Section 12.3 and Addendum F.)
3.3.11 The PHP agrees to notify the referring military
provider or Military Treatment Facility (MTF)/Enhanced Multi-Service
Market (eMSM) referral management office (on behalf of the military
provider) when a Service member or beneficiary, in the provider’s
clinical judgment, meets any of the following criteria:
• Harm
to self - The provider believes there is a serious risk of self-harm
by the Service member either as a result of the condition itself
or medical treatment of the condition;
• Harm to others - There
is a serious risk of harm to others either as a result of the condition
itself or medical treatment of the condition. This includes any
disclosures concerning child abuse or domestic violence;
• Harm to mission -
There is a serious risk of harm to a specific military operational mission.
Such a serious risk may include disorders that significantly impact
impulsivity, insight, reliability, and judgment;
• Inpatient care - Admitted
or discharged from any inpatient mental health or substance use
treatment facility as these are considered critical points in treatment
and support nationally recognized patient safety standards;
• Acute medical conditions
interfering with duty - Experiencing an acute mental health condition
or is engaged in an acute medical treatment regimen that impairs
the beneficiary’s ability to perform assigned duties;
• Substance abuse treatment
program - Entered into, or is being discharged from, a formal outpatient
or inpatient treatment program.