3.3 In addition,
in order for a freestanding IOP to be authorized, the IOP shall
comply with the following requirements:
3.3.1 The IOP
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 DHA. The contractor may submit additional accrediting
organizations for TRICARE authorization, subject to approval by
the Government Designated Authority (GDA).
3.3.2 The IOP
shall be licensed as an IOP to provide IOP 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.
3.3.4 The IOP
shall comply with all requirements applicable to institutional providers
generally concerning accreditation requirements, concurrent care
review, claims processing, beneficiary liability, double coverage, utilization
and quality review, and other matters.
3.3.5 The IOP
shall not be considered an authorized provider nor will any benefits
be paid to the facility for any services provided prior to the date
the facility is approved and the participation agreement is signed
by the DHA, or designee. Retroactive approval is not given.
3.3.6 All services, supplies, equipment,
and space necessary to fulfill the requirements of each patient’s individualized
diagnosis and treatment plan are included in the reimbursement approved
for an authorized IOP. All mental health services must be provided
by a TRICARE authorized individual qualified mental health provider. Assessments
will include documentation of the outcomes of standardized assessment
measures for Post-Traumatic Stress Disorder (PTSD), anxiety disorders,
and depressive disorders using the PTSD Checklist (PCL-5), Generalized Anxiety
Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9 or A),
respectively, at baseline, at 60 calendar day intervals, and at
discharge (see
Chapter 1, Section 5.1 for details). [Exception:
IOPs that employ individuals with master’s or doctoral level degrees
in a mental health discipline who do not meet the licensure, certification,
and experience requirements for a qualified mental health provider
but are actively working toward licensure or certification, may
provide services within the all-inclusive per diem rate but such
individuals must work under the clinical supervision of a fully
qualified mental health provider employed by the facility.]
3.3.7 Case management. When appropriate,
and with the consent of the person served, the IOP should coordinate
the care, treatment, or services, including providing coordinated
treatment with other services.
3.3.8 The IOP
must enter into a participation agreement with the DHA, or designee.
(See
Section 12.3 and
Addendum G.)
3.3.9 The IOP agrees to notify the
referring military provider or Market/Military Medical Treatment
Facility (MTF) referral management office (on behalf of a 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.