TRICARE Regional Offices (TROs)/Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM) and Contractor Interfaces
1.0 Resource Sharing Authority
2.0 Resource Sharing Program Agreements
Resource
sharing consists only of external resource sharing (where the purpose
of the external resource sharing agreement enables military health
care personnel, active duty and civilian, to provide covered medical
services to active duty and TRICARE beneficiaries in a network facility.)
Although both Internal and External Resource Sharing is authorized
by Regulation, current policy is that only External Resource Sharing
will be implemented.
3.0 Resource Sharing Program Requirements
The
contractor shall meet the following resource sharing program requirements:
3.1 Develop a plan for identifying
advantageous resource sharing opportunities in conjunction with
the TRICARE Regional Office (TRO) Chief Operating Officer (COO)
and the Military Treatment Facility (MTF) Commanders/Enhanced Multi-Service
Market (eMSM) Managers.
3.2 Develop
and implement procedures and measures for monitoring resource sharing
agreement performances.
4.0 Resource Sharing Agreement
Guidelines
External
resource sharing shall be based upon written agreements between
the contractor, the MTF Commander/eMSM Manager, and the network
facility, with the TRO Regional COO concurrence. Before a military
provider is permitted to practice in a network facility, the MTF
Commander/eMSM Manager will ensure the military provider has active
clinical privileges with the network facility. The MTF Commander/eMSM
Manager will also ensure external resource sharing providers are
licensed to practice medicine in the United States (U.S.) jurisdiction
during the term of the resource sharing agreement. The resource
sharing agreement shall set forth all the terms, conditions and
limitations of the resource sharing arrangements. MTF Commanders/eMSM
Managers may only authorized Medicare dual eligible beneficiaries
to be seen under External Resource Sharing Agreements for care that
is not covered under Medicare. Active
duty members and Active Duty Family Members (ADFMs) with end stage
renal disease or disability eligible for Medicare Part A and not
enrolled in Medicare Part B may be authorized to be seen under External
Resource Sharing Agreements. The MTF Commander/eMSM Manager
shall forward copies of all completed external resource sharing
agreements to the TRO Regional COO for approval prior to the implementation
of any resource sharing agreement. The TRO Regional COO will provide
the contractor written approval/disapproval within 30 calendar days
of receipt. The MTF Commander/eMSM Manager will forward copies of
all approved resource sharing agreements to the Procuring Contracting
Officer (PCO) no later than 10 calendar days following written notification
by the TRO Regional COO of the approval of the agreement.
5.0 Professional Liability
This
clause is mandatory and will be inserted in all External Resource
Sharing Agreements, unless a wavier is obtained from the Defense
Health Agency (DHA) Office of General Counsel (OGC) and the service
legal advisor:
“While performing health care
functions authorized by the MTF/eMSM, designated health care personnel
will be acting within the scope of their duties as determined by the
Department of Justice (DOJ). The United States Government will be
responsible for their actions within the scope of their duties.
As such, any remedy for damages for personal injury, including death,
caused by their negligence or wrongful acts or omissions shall be
exclusively against the United States under provisions of the Federal Torts
Claims Act (Title 28 USC, Sections 1346(b), 2671-2680) and not against
the individual military health care provider. In the event any Department
of Defense (DoD) health care provider is asked to respond to an
emergency involving a non-DoD beneficiary, the state’s borrowed
servant defense and any other applicable defenses and immunities
available to the United States will apply to allegations of negligence
or wrongful acts or omissions arising from care rendered by the
provider.”
6.0 Credentials, Privileging, And
Other Provider Requirements
MTF Commanders/eMSM Managers
will ensure that the military health care personnel are appropriately
licensed and have active clinical privileges within the network
facility. The external resource sharing health care personnel’s
military command is responsible for the supervision of the external
resource sharing health care personnel.
7.0 Record Keeping
The
contractor shall maintain accurate records to document actions related
to resource sharing agreements. These records shall include accurate
recording of the personnel performing services in network facilities,
identifying each individuals name, Social Security Number (SSN),
type of provider or staff, and the hours worked in the facility.
8.0 Audits
Contractor resource sharing
expenditures are subject to audit by the Government.