3.3 In addition, in order for a freestanding
inpatient/residential SUDRF to be authorized, the SUDRF shall comply
with the following requirements:3.3.1 An SUDRF shall be currently accredited
by TJC, CARF, CoA, or an accrediting organization approved by the
Director, DHA. The regional contractor may submit, via the TRO,
additional accrediting organizations for TRICARE authorization,
subject to approval by the Director, DHA.
3.3.2 The SUDRF shall be licensed as
an SUDRF to provide SUD services within the applicable jurisdiction
in which it operates.
3.3.4 The SUDRF shall comply with all
requirements applicable to institutional providers generally concerning
accreditation requirements, preauthorization, concurrent care review,
claims processing, beneficiary liability, double coverage, utilization
and quality review, and other matters.
3.3.5 The SUDRF shall not be considered
an authorized provider, nor may any benefits be paid to, the facility
for any services provided prior to the date the facility is approved
by the Director, DHA, or designee.
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 SUDRFs. All mental health
services must be provided by the TRICARE authorized individual professional
provider of mental health services. 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:
Residential treatment programs 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 services required.
The facility must provide case management services that help assure
the patient’s 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 care arrangements, at
a minimum.
3.3.8 The
SUDRF shall enter into a written participation agreement with the
Director, DHA, or designee. (See Section 12.3 and Addendum D.)
3.3.9 The SUDRF 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.