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TRICARE Operations Manual 6010.62-M, April 2021
Telehealth
Chapter 27
Section 1
Telehealth Services
Revision:  
1.0  General
1.1  The National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2017, Section 718 signed into law on December 23, 2016 requires the Secretary of Defense to incorporate throughout the Direct Care (DC) and purchased care components of the Military Health System (MHS) the use of telehealth services, including mobile health applications to:
1.1.1  Improve access to primary care, urgent care, behavioral health care, and specialty care;
1.1.2  Perform health assessments;
1.1.3  Provide diagnoses, interventions, and supervision;
1.1.4  To monitor individual health outcomes of covered beneficiaries with chronic diseases or conditions;
1.1.5  Improve communication between health care providers and patients, and
1.1.6  Reduce health care costs for covered beneficiaries and the Department of Defense (DoD).
1.2  Additionally, Section 705 of NDAA FY 2017 requires the Secretary to ensure the Managed Care Support (MCS) contract under the TRICARE program will establish networks in rural, remote, and isolated areas to provide timely access to care for covered beneficiaries. For policy guidance on telemedicine see the TRICARE Policy Manual (TPM), Chapter 7, Section 22.1. Definitions can be found at https://manuals.health.mil/pages/v3/DownloadManualFile.aspx?Filename=Definitions.pdf.
2.0  TELEHEALTH PROGRAM REQUIREMENTS
2.1  The contractor’s network shall include secure telehealth services accessible to all TRICARE plan enrollees without Medicare Part B in the contractor’s geographic area of responsibility.
2.1.1  The contractor shall develop a plan for implementation of its telehealth program in coordination with its network implementation plan to include detailing all phases of program implementation. For plan reporting requirements, see DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract.
2.1.2  The contractor shall provide an outreach and education program on telehealth requirements, incentives, and implementation support for all network and TRICARE-authorized providers. The program shall include education on applicable telehealth policies, and procedures to allow providers to carry out the requirements of this contract in an efficient and effective manner, which promotes beneficiary satisfaction and the use of telehealth services. The outreach program shall include information on best practices for selecting and implementing secure, Health Insurance Portability and Accountability Act (HIPAA) compliant telehealth platforms.
2.1.3  The contractor shall provide a report on the ability of beneficiaries to access telehealth services in rural, remote and isolated areas for the performance assessment of the telehealth network. For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract.
2.1.4  The contractor shall obtain and maintain nationally recognized accrediting organization accreditation for its telehealth network of virtual-only telehealth providers. The offeror’s Health Network accreditation is sufficient for providers who deliver care via physical office locations and who have integrated a HIPAA-compliant virtual care delivery option into their practices. For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract.
2.1.5  The contractor shall ensure the beneficiaries are able to receive telehealth appointments in accordance with TRICARE access standards in 32 CFR 199.17(p)(5).
2.1.6  The contractor shall implement quality improvement interventions when access to telehealth appointments is below access standards in 32 CFR 199.17(p)(5). For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract.
2.1.7  The contractor shall ensure the delivery of the following telehealth services in all coverage areas within the contractor’s region: teleconsultation capability; scheduled and unscheduled visits; secure asynchronous and audio or visual synchronous encounters which can support physical exams and remote health monitoring.
2.1.8  The contractor shall ensure telemedicine is offered as a modality of care for routine and urgent encounters to include primary care, specialty care, and behavioral health.
2.1.9  The contractor shall develop, implement, and maintain secure mobile applications that enable the beneficiary to virtually interact with telehealth network providers for the provision of secure telemedicine and facilitate delivery of telehealth services to complement the Population Health (PH) program. Access to telehealth urgent care services shall include, but not be limited to, access via a secure smart phone application.
2.1.10  The contractor shall ensure mobile applications for the delivery of care integrate with the MHS electronic medical record to the maximum extent practicable.
2.1.11  The contractor shall provide network specialists the ability to perform teleconsultation services through an asynchronous teleconsultation capability, ensuring providers are educated on its operation and availability.
2.1.11.1  The asynchronous teleconsultation capability shall provide a response within one business day, capture whether the consulting provider recommended a referral, and offer synchronous technical assistance (person-to-person) during business hours.
2.1.11.2  The contractor shall make available to network and Market/Military Medical Treatment Facility (MTF) providers for challenging cases, teleconsultation with expert specialists at institutions with nationally recognized specialty-specific accreditation in the appropriate medical field.
2.1.12  The contractor shall ensure telehealth services are available 24 hours a day, seven days a week, and 365 days a year for urgent care services. The patient wait time between request for unscheduled synchronous care (i.e., not requiring a physical exam) and initiation of services shall be in accordance with TRICARE urgent care access standards in 32 CFR 199.17(p)(5)(i) through (v).
3.0  TELEHEALTH PLATFORM STANDARDS AND DELIVERY OF CARE
3.1  Platform Standards and Requirements
3.1.1  The contractor shall comply with state and federal laws governing delivery of care via telehealth and ensure that delivery platforms incorporate standards mandated by the HIPAA Privacy, Security, and Breach Rules, 45 CFR Parts 160 and 164 (collectively, “HIPAA Rules”), and the DoD HIPAA Issuances. Contractor compliance with the HIPAA Rules and DoD HIPAA Issuances and related privacy requirements are addressed in the Chapter 1, Section 5 and Chapter 19, Section 3.
3.1.2  The contractor shall inform the beneficiaries as to conditions and benefits included and excluded from telehealth services.
3.1.3   The contractor shall list the availability of telehealth services online for beneficiaries with clear instructions on how to access telehealth services.
3.1.4  The contractor shall list the availability of telehealth services in its online provider directory.
3.1.5  The contractor shall enable patients to validate current contact number(s) at time of request for care.
3.1.6  The contractor shall provide the beneficiary with real-time information regarding estimated telephone wait time and/or number of callers ahead of them in the queue.
3.1.7  The contractor shall ensure TRICARE nurse advice lines, if provided by the Government through a different contractor, are clearly advertised on the platform as an option for instant consultation.
3.1.8  The contractor shall ensure that telehealth services have platform technical support 24 hours a day, seven days a week, 365 days a year for the providers and patients. The platforms shall include mobile access to care, clearly displayed contact phone number for assistance, and secure messaging.
3.1.9  The contractor shall provide User Guides that are clear and accessible for all users.
3.1.10  The contractor shall provide an application program interface to allow mobile applications to open the telehealth application through single sign on.
3.1.11  The contractor shall ensure Market/MTF providers are able to utilize the telehealth platforms to provide or facilitate care between a Market/MTF origination (or distant) site and a private sector origination (or distant) site.
3.1.12  The contractor shall ensure application(s) (mobile or desktop) enable the treating provider to view information shared by eligible patients regarding symptoms, medical history, allergies, patient medications, problem history, primary care team contact information, patient location and personal emergency contact information for means of contacting local emergency services.
3.1.13  The contractor shall ensure through the application providers have the ability to visualize the patient, share information with the patient, review results, document the encounter, and transfer information securely into the patient’s Electronic Health Record (EHR) (as applicable).
3.1.14  The contractor shall ensure the telehealth providers have the ability to electronically prescribe ancillary tests, medications, and durable medical equipment in the patient’s local network.
3.1.15  The contractor shall ensure the telehealth platform specifications shall not impose technical requirements upon the beneficiary beyond consumer accessible broadband and commercially available consumer audio and video devices.
3.1.16  The contractor shall configure its networks to support access to Government systems (e.g., configure ports and protocols for access) and shall support HyperText Transfer (Transport) Protocol (HTTP), HyperText Transfer (Transport) Protocol Secure (HTTPS), web-derived Java Applets, and Secure File Transfer Protocols (SFTPs) (e.g., STFP, Secure Socket Layer (SSL)/Transport Layer Security (TLS)), for software that the contractor proposes to use to interconnect with DoD facilities.
3.2  Delivery of Care
3.2.1  The contractor shall ensure that telehealth providers and presenters are licensed or certified in accordance with appropriate state laws, federal regulations, and nationally recognized organizations governing provision of care via telemedicine. See TPM, Chapter 7, Section 22.1.
3.2.2  The contractor shall verify patients are enrolled in TRICARE health plans in accordance with provisions set forth in Chapter 6, and ensure referrals/preauthorizations/authorizations for care are processed when applicable in accordance with Chapter 7, prior to receipt of care via telehealth services provided within the benefit.
3.2.3  The contractor shall ensure and validate that any provision of telecritical care operating in network facilities is governed by a Telehealth Continuity of Care Plan. The continuity of care plan shall address triage of the telehealth service during a national emergency.
3.2.4  The contractor shall develop and maintain a telehealth crisis action protocol to address transition of care from telehealth to in-person care in accordance with the TPM, Chapter 7, Section 22.1.
3.2.5  The contractor shall include remote health monitoring and chronic care remote physiologic monitoring in the telehealth program as feasible to complement its PH program when a covered benefit.
3.2.6  The contractor shall ensure telehealth providers follow the same referral processes in accordance with Chapter 7, Section 5 and TPM, Chapter 1, Section 7.1, as applicable.
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