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.
3.2.4 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.