1.0 ISSUE
1.1 In order
to be considered for benefits on a fee-for-service basis, the services
of the following individual professional providers of care may be
provided only if the beneficiary/patient is referred by a physician
for the treatment of a medically-diagnosed condition.
1.2 A physician must also provide
continuing and ongoing oversight and supervision of the program
or episode of treatment provided by the following individual providers:
• Licensed
Registered Nurses (RNs).
• Licensed Practical Nurse (LPN)
or Licensed Vocational Nurse (LVN).
• Audiologist.
• Pastoral Counselors.
• Supervised Mental Health Counselors
(SMHCs).
2.0 POLICY
2.1 A physician
must establish a diagnosis which, in order to be considered for
benefits, must describe a covered condition. This means the physician
must actually see the patient, do an evaluation and arrive at an
initial diagnostic impression prior to referring the patient. Any
change in the referral diagnosis must be coordinated with the referring
physician.
2.2 The overall management of the
patient rests with the physician and, in order to assure appropriate
case management, coordination must be made with the referring physician
on an ongoing basis. Physician supervision means the physician provides
overall medical management of the case. The referring physician
does not have to be physically located on the premises of the provider
to whom the referral is made. Communication back to the referring
physician is an indication of medical management.
2.3 Military physicians may refer
patients to civilian providers. Because of the mobility of military physicians
due to transfers, retirements and discharges, if the original referring
physician has relocated, another military physician may assume responsibility
for the case upon review of the Military Treatment Facility (MTF)/Enhanced
Multi-Service Market (eMSM) clinical record, a narrative of the patient’s
present status and the proposed treatment plan.