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TRICARE Policy Manual 6010.60-M, April 1, 2015
Providers
Chapter 11
Section 2.9
Residential Treatment Center (RTC) Standards
Issue Date:  June 13, 2017
Revision:  C-13, November 15, 2017
1.0  ISSUE
RTC Standards.
2.0  DESCRIPTION
An RTC is a facility or a distinct part of a facility that provides to beneficiaries under 21 years of age a medically supervised, interdisciplinary program of mental health treatment. An RTC is appropriate for patients whose predominant symptom presentation is essentially stabilized, although not resolved, and who have persistent dysfunction in major life areas. Residential treatment may be complemented by family therapy and case management for community based resources. Discharge planning should support transitional care for the patient and family, to include resources available in the geographic area where the patient will be residing. The extent and pervasiveness of the patient’s problems require a protected and highly structured therapeutic environment.
3.0  POLICY
3.1  The RTC program must be under the general direction of a licensed TRICARE authorized physician employed by the RTC to ensure medication and physical needs of all the patients are considered.
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.
3.2.3  The RTC shall accept the allowable RTC rate, as provided in 32 CFR 199.14(f) and the TRICARE Reimbursement Manual (TRM), Chapter 7, Section 4, paragraph 3.5 as payment in full for services provided.
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.
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