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.