3.3 In
addition, in order for a freestanding IOP to be authorized, the
IOP shall comply with the following requirements:
3.3.1 The
IOP 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, DHA. The regional contractor may submit,
via the TRICARE Regional Office, additional accrediting organizations
for TRICARE authorization, subject to approval by the Director,
DHA.
3.3.2 The
IOP shall be licensed as an IOP to provide IOP 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.
3.3.4 The
IOP shall comply with all requirements applicable to institutional
providers generally concerning accreditation requirements, concurrent
care review, claims processing, beneficiary liability, double coverage,
utilization and quality review, and other matters.
3.3.5 The IOP shall not be considered
an authorized provider nor will any benefits be paid to the facility
for any services provided prior to the date the facility is approved
and the participation agreement is signed by the Director, DHA,
or designee. Retroactive approval is not given.
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 IOP. All mental health
services must be provided by a TRICARE authorized individual qualified
mental health provider. 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:
IOPs 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.
When appropriate, and with the consent of the person served, the
IOP should coordinate the care, treatment, or services, including
providing coordinated treatment with other services.
3.3.8 The IOP must enter into a participation
agreement with the Director, DHA, or designee. (See
Section 12.3 and
Addendum G.)
3.3.9 The IOP
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.