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.