Market Directors/Military Medical Treatment Facility (MTF) Directors, And Contractor Interfaces
1.0 RESOURCE SHARING AUTHORITY
2.0 RESOURCE
SHARING PROGRAM AGREEMENTS
2.1 Resource Sharing Agreements
(RSAs) consists of Internal Resource Sharing Agreements (IRSAs),
where the purpose of the RSA is to supplement the services provided
at Markets/MTFs, and External Resource Sharing Agreements (ERSAs),
where the purpose of the external RSA enables military health care
personnel, active duty and civilian, to provide covered medical
services to active duty and TRICARE beneficiaries in a network facility.
The following procedures apply to both IRSAs and ERSAs:
2.2 The contractor
shall develop and implement a resource sharing program for seeking
agreements with individual Market Directors/MTF Directors for the
provision of medical personnel. The contractor’s resource sharing program
medical personnel shall comply with Department of Defense (DoD)
directives for licensure, clinical appointment with the MTF, and
participation in quality assurance reviews.
2.3 The contractor’s
resource sharing program shall also address opportunities for military
health care personnel and support personnel to provide covered medical
services to Military Health System (MHS) beneficiaries in a network
facility.
3.0 RESOURCE
SHARING PROGRAM REQUIREMENTS
The contractor shall meet the
following resource sharing program requirements:
3.1 Develop
a draft plan for identifying advantageous resource sharing opportunities
in conjunction with the Government Designated Authority (GDA) and
Market Director/MTF Director.
3.2 Submit
the resource sharing plan to the GDA for approval no later than
60 calendar days prior to the start of healthcare delivery and 60
calendar days prior to the start of each new option period. For
plan submission requirements, see DD Form 1423, Contract Data Requirements
List (CDRL), located in Section J of the applicable contract.
3.2.1 The contractor’s
plan shall include the contractor’s general approach and methods
for facilitating the identification of resource sharing opportunities
throughout the geographic area of responsibility, an evaluation
of the overall costs and savings potential agreements should generate
for the MHS, and the contractor’s approach to the development of
agreements which adhere to resource sharing guidelines in
paragraph 2.0.
3.2.2 The contractor’s
plan will also include a proposal for how the IRSA will improve
quality of care and beneficiary experience. The contractor’s plan
for IRSAs, shall include a description of the contractor’s proposed methodology
for developing a detailed cost analysis for each resource sharing
proposal. The cost analysis shall include the contractor’s actual
cost of providing the personnel, equipment, equipment maintenance,
and supplies, the anticipated increase in services provided within
the Markets/MTFs, the anticipated support required from the Markets/MTFs
(labor, supplies, etc.) and the net savings to the Government and
the contractor.
3.2.3 The contractor’s plan will
also include a proposal for how the ERSA will improve quality of
care and beneficiary experience. The contractor’s plan for ERSAs
shall include a description of the contractor’s proposed methodology
for developing a detailed cost analysis for each resource sharing
proposal. The cost analysis shall include the Markets/MTF’s actual
cost of providing the services, the monetary benefits received by
the contractor, projected workload, administrative costs, and the
contractor’s actual cost of providing services in support of external
resource sharing providers.
3.3 The contractor
shall comply with the DoD Health Insurance Portability and Accountability
Act (HIPAA).
3.3.1 The contractor shall develop,
document and incorporate into its resource sharing program functions policies
and procedures ensuring compliance with Health and Human Services
(HHS) Privacy Regulations.
3.3.2 The contractor
shall require its resource sharing providers to use the DoD HIPAA
Notice of Privacy Practices (NoPP) and HHS Privacy Regulation compliant
authorization forms, when applicable.
3.3.3 The contractor
shall coordinate with the appropriate GDA to determine how they
may assist the MHS with dissemination of the Notice of Privacy Practices
to applicable TRICARE beneficiaries whenever there is a material
revision to the DoD NoPP.
3.4 The contractor
shall, not later than 60 calendar days after contract award, provide
the Market Director/MTF Director a complete cost analysis within
30 calendar days of a written request for consideration of a potential resource
sharing opportunity by the Market Director/MTF Director, provided
that the MTF is able to provide the Market/MTF-specific cost and
workload information necessary to perform the analysis within 15
calendar days of making the written request.
3.5 The Government
may extend the 30 calendar day requirement on a day-to-day basis
if all of the necessary data is not provided by the 15th calendar
day after the written request.
3.6 The contractor
shall develop and implement procedures for monitoring RSA performances.
3.7 The contractor
shall submit the Market/MTF Optimization Support Plan to the GDA
no later than 60 calendar days prior to start of health care delivery
(SHCD) for review and approval. For plan submission requirements,
see DD Form 1423, CDRL, located in Section J of the applicable contract.
4.0 RSA
GUIDELINES
4.1 Internal Resource Sharing
4.1.1 The contractor’s
IRSAs shall be based upon written agreements between the contractor
and the Market Director/MTF Director, with GDA concurrence, and
between the contractor its resource sharing provider(s).
4.1.2 Before
a provider is permitted to practice in the Market/MTF, he or she
must be granted privileges by the Market Director/MTF Director to
do so, based upon his or her credentials, in accordance with applicable regulations.
4.1.2.1 The contractor’s IRSAs shall
fully set forth the terms, conditions, and limitations of the resource sharing
arrangements.
4.1.2.2 The contractor’s IRSAs may
include professional and support personnel, equipment and equipment maintenance,
and supplies.
4.1.2.3 The contractor shall forward
copies of all proposed IRSAs to the GDA for approval.
4.1.2.4 The GDA will provide the contractor
written approval or disapproval within 30 calendar days of receipt.
4.1.2.5 The contractor shall forward
copies of all proposed approved IRSAs and all supporting pricing information
for the agreement to the DHA Contracting Officer (CO) no later than
10 calendar days following written notification by the GDA of the
approval of the agreement.
4.1.2.6 The CO will evaluate the agreement
and supporting documentation and request from the contractor any
necessary information to make a determination that the agreed to
amount for the agreement is fair and reasonable.
4.1.2.6.1 The CO, once he or she has
determined that the agreement is fair and reasonable, will execute
a contract action obligating funds for the agreement and authorizing
the contractor to proceed with performance of the agreement.
4.1.2.6.2 The contractor shall provide
resource sharing clinical personnel for the Market/MTF credential review
within 90 calendar days of the execution of a contract action, within
the time frame otherwise established between the parties and identified
within the Performance Work Statement (PWS) or the Statement of
Work (SOW)/Specifications.
4.1.2.6.3 The contractor shall accomplish
the following activities from issuance of a modification through contractor
performance: recruit, place and manage IRSA Provider(s) as well
as resolve IRSA Provider(’s) performance issues as follows:
• Recruit: In response
to a contract modification, or during contractor performance when
replacing and substituting the IRSA Provider(s), the contractor
shall recruit qualified IRSA Provider(s) from outside of the Government
to fulfill the duties, qualifications, and requirements in the performance
work statement. The contractor shall find, conduct competency-based
screening against preliminary Government minimum requirements, obtain
initial background checks, and submit qualifying documentation on
the IRSA Provider(s) as part of the recruiting requirement.
• Place: In response
to a contract modification or during contractor performance when
replacing or substituting IRSA Provider(s), the contractor shall
place the qualified IRSA Provider(s) in DHA Markets/MTFs to provide clinical
services. The contractor shall: verify IRSA Provider(s’) qualifications
against subsequent Government minimum requirements; submit complete
and accurate credentials packages on all IRSA Providers requiring privileges
in the Market/MTF; establish appointments with the Market/MTF Unit
Security Managers on the first duty day; ensure the IRSA Provider(s)
complete the necessary security investigation package.
• Manage: During
contractor performance, the contractor shall manage the workforce
by maintaining fill and retention rates, maintaining continual IRSA
Provider(s) qualifications without Government involvement, and managing
replacements and substitution requirements that ensure no vacancy
exceeds 90 consecutive calendar days for credentialed FTEs.
• Resolve Performance Issues: During
contractor performance, the contractor shall resolve all performance issues
identified by the Government.
4.2 External
Resource Sharing
4.2.1 External resource sharing shall
be based upon written agreements between the contractor, the Market Director/MTF
Director, and the network facility, with the GDA’s concurrence.
4.2.2 The Market
Director/MTF Director will ensure that the military provider has
active clinical privileges with the network facility before a military
provider is permitted to practice in the network facility.
4.2.3 The Market
Director/MTF Director will ensure that ERSA providers are licensed
to practice medicine in a United States jurisdiction during the
term of the agreement.
4.2.3.1 The contractor’s ERSA shall
set forth all the terms, conditions and limitations of the resource
sharing arrangement.
4.2.3.2 The Market Director/MTF Director
will forward copies of all completed ERSAs to the GDA for approval prior
to the implementation of any RSA.
4.2.3.3 The GDA will provide the contractor
written approval or disapproval within 30 calendar days of receipt.
4.2.3.4 The Market Director/MTF Director
will forward copies of all approved RSAs to the CO no later than
10 calendar days following written notification by the GDA of the
approval of the agreement.
5.0 SELECTION
OF PROVIDERS
5.1 The contractor shall obtain
input from the Market Directors/MTF Directors regarding the requirements
or needs of the Directors IRSA providers.
5.2 The contractor
shall select the resource sharing providers without any further
involvement of the Government in the selection process, except for
the privileging of the providers by the Market/MTF after the selection
has been made.
6.0 COSTS
The contractor’s IRSA providers,
under the authority of 10 United States Code (USC) 1095 and 32 CFR
220.8(k)(2), shall not bill for any form of third party payment.
6.1 The Market/MTF
with which the IRSA was entered into will bill for and retain all
funds available from a third party.
6.2 The resource
sharing provider’s compensation from the contractor, whether by
way of salary, fee-for-service, or other means, is entirely independent
of any claim to, or payment from, any third party payer.
7.0 PROFESSIONAL
LIABILITY
7.1 Internal Resource Sharing
The contractor shall be solely
liable for negligent acts or omissions of the contractor’s agents
and shall ensure that providers maintain full professional liability
insurance.
7.2 External Resource Sharing
7.2.1 While
performing health care functions authorized by the Market/MTF, designated
health care personnel will be acting within the scope of their duties
as determined by the Department of Justice (DOJ). The United States
(US) 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 US 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.
7.2.2 In the
event any 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.
8.0 CREDENTIALS,
PRIVILEGING, AND OTHER PROVIDER REQUIREMENTS
8.1 The contractor’s
IRSA providers shall meet the licensing and privileging requirements
of
32 CFR 199.6.
8.2 The contractor’s
IRSA providers shall comply with the licensing and privileging directives
of the Market/MTF and to fully participate in Market/MTF quality
assessment and improvement activities required by the Market/MTF.
8.3 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. Note: The original document will be returned
upon the completion of the Market/MTF credentialing process.
8.4 The contractor
shall query the National Practitioner Data Bank (NPDB) on 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 one is received on a resource sharing provider.
8.4.1 DoD requirements
for the basic credentials and privileging of health care providers
are set forth in
32 CFR 199.6,
and DoD Directives 6025.6, 6025.11, and 6025.14.
8.4.2 The contractor
shall provide the Market Director/MTF Director with all documentation
all applicable DoD, Army, Navy or Air Force Directives at least
30 calendar days prior to the provider’s first day of work in a
Market/MTF.
8.5 The Market Director/MTF Director
will ensure that the military health care personnel are appropriately licensed
and have active clinical privileges with the network facility for
ERSA military health care personnel. The Market Director/MTF Director
or their designee will notify the contractor as soon as possible
if a proposed IRSA provider does not meet requirements for privileging
at the Market/MTF.
9.0 SUPERVISION
OF RESOURCE SHARING PERSONNEL
The contractor shall supervise
all contractor personnel placed in MTF facilities, including the
terms and conditions of employment.
9.1 This does
not preclude resource sharing personnel from complying with directions
received from Market/MTF professional personnel in the course of
patient care activities.
9.2 The contractor furnished personnel
shall comply with privileging requirements, utilization review and utilization
management criteria and procedures, quality assessment procedures
and criteria, and peer review and quality of care reviews in accordance
with the policy, procedures, and regulatory provisions established
for Government practitioners (
32
CFR 199.6;
32 CFR 199.15;
and TRICARE Policy Manual (TPM),
Chapter
11).
9.3 The ERSA provider’s military
command is responsible for the supervision of the external resource
sharing health care personnel.
10.0 RECORD
KEEPING
The contractor
shall maintain accurate records to document activities related to
RSAs, which include accurate recording of the personnel performing
services in network facilities or Markets/MTFs, identifying for
each individual the name, provider National Practitioner Identification
(NPI) number, type of provider or staff, number of encounters or
cases, and the hours worked in the facility or Market/MTF.
10.1 The contractor’s
records, for IRSAs, shall include the associated workload and claims
data for the individual IRSA Provider(s).
10.2 The contractor
shall insure IRSA Provider(s) log accurate man-hours in the appropriate
Government Time card System for the applicable work period.
10.3 The contractor
shall insure IRSA Provider(s) records and all encounter and clinical
documentation in Market/MTF’s MHS GENESIS or Legacy HR Systems.
10.4 The contractor
shall provide a monthly Resources Sharing Report to the Market Directors/MTF
Directors (or their designees) and the GDA no later than the last
working day of the month following the month in which the reported
workload was performed. For reporting requirements, see DD Form
1423, CDRL, located in Section J of the applicable contract.
11.0 AUDITS
The contractor’s resource sharing
expenditures are subject to audit by the Government.