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.