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.