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TRICARE Operations Manual 6010.59-M, April 1, 2015
TRICARE Regional Offices (TROs)/Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM) and Contractor Interfaces
Chapter 15
Section 3
Clinical Support Agreement (CSA) Program
Revision:  C-92, July 14, 2021
1.0  General
The CSA Program represents a requirement for the contractor to provide needed clinical personnel to the Market Directors/Military Treatment Facility (MTF) Directors in those situations where the Market Director/MTF Director has determined that it is in the Government’s best interest. The requesting organization is responsible for funding all actions issued under the CSA Program.
2.0  Limits
2.1  CSA Program resource availability is limited to individuals in the following categories:
•  Personnel of the type set forth in 32 CFR 199.6(c)(3) as an independent professional provider who meet both the criteria contained in 32 CFR 199 and credentialing requirements delineated in this chapter; or
•  Personnel who provide general clinical support, including but not limited to, nurses, x-ray technicians, laboratory technicians, pharmacists, etc.
2.2  Under the authority of 10 United States Code (USC) 1095 and 32 CFR 220.8, CSA providers shall not bill for any form of third party payment. The Market/MTF participating in the CSA Program will bill for and retain all funds available from a third party.
2.3  The contractor shall not charge a copayment, cost-share, and/or deductible to any beneficiary receiving services from a CSA provider.
2.4  The contractor shall not include CSA Program costs as underwritten health care costs or supplemental health care costs.
2.5  The contractor shall ensure personnel obtained by CSAs on a personal services basis comply with DoD Instruction 6025.5, “Personal Services Contracts for Health Care Providers,” January 6, 1995.
3.0  Program Requirements
3.1  Personnel
The contractor shall prepare and submit a detailed technical and cost proposal within the time frame specified in the Government request. The contractor shall not provide services under this section until a formal contract action is executed by a Defense Health Agency (DHA) Contracting Officer (CO).
3.1.1  Individual Professional Providers
The contractor shall furnish individual professional providers who meet or exceed the criteria contained in 32 CFR 199.6, TRICARE Policy Manual (TPM), Chapter 11, and the requirements of this chapter. The contractor shall provide personnel accepted and credentialed by the Market/MTF within 90 days of receiving the executed contract action, or within the time frame otherwise established between the parties and identified within the Performance Work Statement (PWS)/Statement of Work (SOW)/Specification.
3.1.2  Clinical Support Personnel
3.1.2.1  The contractor shall furnish clinical support personnel who are licensed or certified to practice in the state and in their specialty where such licensing or certification are available and meet facility requirements of where the individual will practice. The contractor shall ensure clinical support personnel obtained on a personal services basis meet the licensure requirements of 10 USC Section 1094. The specific facility requirements will be contained in each PWS/SOW.
3.1.2.2  The contractor shall provide clinical support personnel accepted and credentialed by the Market/MTF within 60 days of receiving the executed contract action, or within the time frame otherwise established between the parties and identified within the PWS/SOW. The contractor shall furnish qualified health care personnel with the necessary credentials to meet the Market/MTF privileging requirements in accordance with the specifications contained in the PWS/SOW. The contractor shall provide the documentation supporting the fulfillment of the requirements to the Market/MTF credentialing office where the individual will work 30 days prior to the individual’s first day of work.
3.1.3  Supervision Of CSA Personnel
3.1.3.1  The contractor may obtain CSA personnel on a personal services basis or a non-personal services basis as specified in the PWS/SOW. The contractor shall supervise all CSA personnel obtained on a non-personal services basis for the purposes of directing the terms and conditions of employment. This does not preclude Market/MTF oversight on administrative aspects of patient care activities, such as scheduling, peer review, quality assessment, etc. Contractor furnished personnel shall comply with privileging requirements, utilization review/management criteria, quality assessment, criteria, and peer review and quality of care reviews in accordance with the policy, procedures, and regulatory provisions established for Government practitioners (32 CFR 199.15, 199.16, and TPM, Chapter 11).
3.1.3.2  The contractor shall ensure all CSA personnel comply with all Market/MTF specific requirements including all local Employee Health Program (EHP), Federal Occupational Safety Act and Health Act (OSHA), Bloodborn Pathogens Program (BBP) requirements, and Market/MTF training requirements.
3.1.4  Credentialing of CSA Program Personnel
3.1.4.1  The contractor shall provide individual professional providers who meet the credentialing and privileging requirements of 32 CFR 199.6 to the Market/MTF. In addition, contractor shall ensure the staff members agree to comply with the licensing and credentialing directives of the Market/MTF and to fully participate in Market/MTF quality assessment and improvement activities required by the Market/MTF. DoD requirements for the basic credentials and privileging of health care providers are set forth in 32 CFR 199.6 and DoD Directives (DoDD) 6025.6, 6025.11, and 6024.14. The contractor shall provide the Market Directors/MTF Directors with all documentation required by these and all applicable Army, Navy, Air Force, or Space Force directives at least 30 days prior to the provider’s first day of work in a Market/MTF. The contractor shall provide the Market Director/MTF Director with the original and one copy of all information on credentials for civilian providers working in the Market/MTF. (The Market/MTF will return the original document upon the completion of the Market/MTF credentialing process.) The contractor shall query the National Practitioner Data Bank (NPDB) about each provider upon initial appointment and every two years thereafter and provide the Market Director/MTF Director with copies of the NPDB report each time the contractor receives one on a CSA professional provider.
3.1.4.2  The contractor shall credential all clinical support personnel in accordance with the PWS/SOW. The contractor shall provide the documentation supporting the fulfillment of the requirements to the Market/MTF where the individual will work at least 30 calendar days prior to the individual’s first day of work.
3.1.5  Contractor Liability for CSA Program Personnel
The contractor shall be solely liable for negligent acts or omissions of personnel supplied by the contractor on a non-personal services basis. The contractor shall ensure that all individual professional providers and clinical support personnel provided on a non-personal services basis maintain full professional liability insurance as required by the contract.
3.2  Reports
The contractor shall provide monthly CSA reports according to contract requirements.
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