1.0 BACKGROUND
The
National Defense Authorization Act (NDAA) Fiscal Year (FY) 2019,
Section 702, authorizes a pilot to treat psychological sequelae
associated with sexual trauma to be accomplished through partnerships
with public, private, and non-profit health care organizations and
institutions. These partnership institutions must provide health
care to Active Duty Service Members (ADSM) who are eligible for
care under the TRICARE program. The pilot is focused on treatment
of ADSMs suffering from Post-Traumatic Stress Disorder (PTSD) and
other psychological health conditions associated with sexual trauma.
2.0 DESCRIPTION AND OVERVIEW
IOPs provide an outpatient level of
care that includes an organized day or evening program for the treatment
of mental health and/or Substance Use Disorders (SUDs). This pilot
will provide specialized IOP-level services to ADSMs who are suffering
from psychological health conditions associated with sexual trauma.
These services will meet the requirements of the TRICARE Policy
Manual (TPM),
Chapter 7, Section 3.16, and
Chapter 11, Section 2.7 but with a specific
focus on the sequelae of sexual trauma. In accordance with the NDAA
FY 2019, Section 702, the intent of this pilot is to determine the
“feasibility and advisability” of using such programs by measuring
outcomes and sharing of lessons learned. This pilot does not change
requirements for treatment provided through the IOP model. These
pilot requirements do not apply to the Designated Providers (DPs)
or TRICARE Overseas contractor.
3.0 POLICY
3.1 IOPs that offer a specialized focus
on sexual trauma as specified in NDAA FY 2019, Section 702, provide
evidence-based or evidence-informed treatment for psychological
conditions that are common among ADSMs who have disclosed sexual
trauma (for example, including PTSD, substance abuse, depression).
Only TRICARE authorized IOPs that meet the TPM,
Chapter 11, Section 2.7 IOP requirements and
are selected by the Defense Health Agency (DHA) upon recommendation
by the contractor are eligible for participation under this program.
Under this program, IOPs will provide mental health care, support,
and other benefits to ADSMs and their family, and will work with
existing case management resources (Market/Military Treatment Facility
(MTF) or contractor case managers, as appropriate) to link beneficiaries
and their families with community-based support systems. In order
to qualify for mental health benefits under this pilot, the patient
must be diagnosed by a TRICARE authorized or MTF mental health provider
with diagnoses associated with a sexual trauma disclosed by the
ADSM.
3.2 IOPs participating
in the pilot must use only evidence-based treatment strategies for
the treatment of diagnoses associated with a disclosed sexual trauma.
Treatment may include, but is not limited to individual and/or group
psychotherapy and psychoeducation. Approval of an IOP site by the Government
signifies compliance with this paragraph.
3.3 A referral for supplemental health care
consistent with
Chapter 17, Section 3 is
required for an ADSM to participate in the Sexual Trauma IOP Pilot.
3.4 Each contractor shall identify at
least two, but not more than five IOPs which meet the criteria in this
Section and agree to participate in the pilot.
3.4.1 In addition to meeting the criteria
included elsewhere in this section to be eligible for participation,
IOPs shall also be within specialty care access standards for drive
time of a Market/MTF which has at least 5,000 uniformed service
personnel enrolled. IOPs selected for this pilot shall be in-network
or agree to join the TRICARE network and shall provide more than
50% of care (based on hours) in-person (as opposed to via telehealth).
However, the Government may approver one entirely telehealth IOP
per region if they meet all other criteria and will continue to
provide care via telehealth for the duration of the pilot. Department
of Veterans Affairs (DVA)/Veterans Health Administration (VHA) facilities
are not eligible for the pilot.
3.4.2 To be eligible to participate, each
IOP shall enter into a Participation Agreement,
Addendum B,
approved by the Director, DHA or designee.
3.4.3 The contractor shall provide a list
of proposed IOPs for inclusion in the pilot to the Government after
confirming the recommended programs meet all criteria and are willing
to participate. The Government will provide a final, approved list
to the contractor based on the recommend list provided by the contractor.
If the contractor is unable to identify sufficient IOPs that meet
these criteria, the contractor shall notify the Government and provide
proposed alternate proposed IOP sites that do not meet all of the
criteria.
3.5 Psychological
Assessment
3.5.1 Patient
assessment. Includes the assessment of each ADSM accepted by the
facility, and must, at a minimum, consist of a physical examination;
psychiatric evaluation (to include medication evaluation); psychological
assessment; assessment of physiological, biological and cognitive
processes; developmental assessment; family history and assessment;
social history and assessment; educational or vocational history
and assessment; environmental assessment; screening or assessment
and recreational/activities assessment. Screening or assessment
of sexual dysfunction shall also be performed. Assessments conducted
within seven days prior to admission to an IOP may be used if approved
by the facility Medical Director, and deemed adequate to permit
treatment planning by the IOP.
3.5.2 The participating IOPs with a focus
on sexual trauma will assess the core treatment outcomes at the
patient level. These outcomes shall be measured within seven days
of treatment baseline, within three days of discharge (i.e., post-treatment),
three months post-treatment, six months post-treatment and one year
post-treatment. Data collected within 14 days of the scheduled follow-up is
within allowance.
3.5.3 The core treatment outcomes measured
for every ADSM participating in the pilot shall include:
• PTSD - PTSD Checklist (PCL)
• Depression - Patient Health Questionnaire-8
(PHQ-8)
• Alcohol use
- Alcohol Use Disorder Identification Test (AUDIT) or AUDIT-C
• Functioning/Quality of Life (QOL) - QOL
or World Health Organization (WHO) Disability Assessment Schedule
or Veterans’ Rand-12
• Brief narrative of family support/involvement
3.6 Outcome Reporting
3.6.1 Details for reporting are identified in
DD Form 1423, Contract Data Requirements List (CDRL), located in
Section J of the applicable contract.
3.6.2 A written treatment discharge summary
shall be provided by the participating IOP to the referring provider
within three business days of discharge or program exit. The treatment
summary shall list treatment groups attended, pre- and post-treatment
outcome measures as defined above, information regarding patient
engagement in treatment, and documentation of any suicidal or homicidal
ideation during IOP treatment (along with any interventions delivered
targeting suicidal or homicidal ideation).
3.7 Special Processing Code (SPC) BH shall
be used for claims under this pilot.
6.0 PARTICIPATION IN INFORMATION SHARING
NETWORK
The contractor shall require IOPs
which participate in the Sexual Trauma IOP pilot to share clinical
and community outreach best practices with other organizations and
institutions participating in the pilot consistent with NDAA FY
2019, Section 702. Participation is specified as staff representation at
minimally 75% of scheduled meetings and/or teleconferences related
to the pilot (such meetings will occur no more frequently than monthly),
timely responses to requests for information regarding best practices,
and actively identifying and providing best practice knowledge generated
from the IOP to the other participating partner IOPs.
7.0 EFFECTIVE AND TERMINATION DATES
Effective
on September 1, 2020 and terminates August 31, 2021.