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.