3.3 In addition,
in order for a freestanding IOP to be authorized, the IOP shall
comply with the following requirements:
3.3.1 The IOP shall be currently
accredited by the Joint Commission (TJC), 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, additional accrediting organizations for TRICARE authorization,
subject to approval by the Director, DHA.
3.3.2 The IOP shall be licensed
as an IOP to provide IOP services within the applicable jurisdiction in
which it operates.
Note: Where different
certification, accreditation, or licensing standards exist, the
more exacting standard applies. Regulations take precedence over
standards, and standards take precedence over participation agreements.
3.3.4 The IOP 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 IOP 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
and the participation agreement is signed by the Director, DHA,
or designee. Retroactive approval is not given.
3.3.6 All services,
supplies, equipment, and space necessary to fulfill the requirements
of each patient’s individualized diagnosis and treatment plan are
included in the reimbursement approved for an authorized IOP. All
mental health services must be provided by a TRICARE authorized
individual qualified mental health provider. Assessments will 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:
IOPs 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 such individuals
must work under the clinical supervision of a fully qualified mental
health provider employed by the facility.]
3.3.7 Case management. When appropriate,
and with the consent of the person served, the IOP should coordinate
the care, treatment, or services, including providing coordinated
treatment with other services.
3.3.8 The IOP must enter into a
participation agreement with the Director, DHA, or designee. (See
Section 12.3 and
Addendum G.)
3.3.9 The IOP
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.