3.2 In order
for an RTC to be authorized, the RTC shall comply with the following
requirements:
3.2.1 An RTC 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, Defense Health Agency (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.
3.2.2 The RTC must be licensed as
an RTC to provide RTC 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.
3.2.4 The RTC shall comply with
all requirements applicable to institutional providers generally concerning
preauthorization, concurrent care review, claims processing, beneficiary
liability, double coverage, utilization and quality review, and
other matters.
3.2.5 The RTC shall not be considered
an authorized provider nor shall 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.
3.2.6 All RTC services and supplies
shall be provided by trained, licensed staff. All mental health services
must be provided by an authorized mental health provider. This includes
all diagnostic services, psychotherapy, psychological testing, and
patient assessment. 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).
3.2.7 The RTC
must enter into a written participation agreement with the Director,
DHA, or designee. (See
Section 12.3 and
Addendum E.)
3.2.8 The RTC 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.