Skip to main content

Military Health System

Utility Navigation Links

TRICARE Operations Manual 6010.62-M, April 2021
Market Directors/Military Medical Treatment Facility (MTF) Directors, And Contractor Interfaces
Chapter 15
Section 2
Resource Sharing
Revision:  
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.
- END -
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery