3.3 In
addition, in order for a freestanding inpatient/residential SUDRF
to be authorized, the SUDRF shall comply with the following requirements:3.3.1 An
SUDRF shall be currently accredited by TJC, CARF, CoA, or an accrediting
organization approved by the Director, DHA. The regional contractor
may submit, via the TRO, additional accrediting organizations for
TRICARE authorization, subject to approval by the Director, DHA.
3.3.2 The
SUDRF shall be licensed as an SUDRF to provide SUD services within
the applicable jurisdiction in which it operates.
3.3.4 The
SUDRF shall comply with all requirements applicable to institutional
providers generally concerning accreditation requirements, preauthorization,
concurrent care review, claims processing, beneficiary liability,
double coverage, utilization and quality review, and other matters.
3.3.5 The
SUDRF shall not be considered an authorized provider, nor may any
benefits be paid to, the facility for any services provided prior
to the date the facility is approved by the Director, DHA, or designee.
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
SUDRFs. All mental health services must be provided by the TRICARE
authorized individual professional provider of mental health services.
Assessments will include documentation of the outcomes of standardized
assessment measures for Post-Traumatic Stress Disorder (PTSD), Generalized
Anxiety Disorder (GAD), and Major Depressive Disorder (MDD) using
the PTSD Checklist (PCL), GAD-7, and Patient Health Questionnaire
(PHQ)-8, respectively, at baseline, at 60-120 day intervals, and
at discharge (see Chapter 1, Section 5.1 for details). [Exception:
Residential treatment programs 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
services required. The facility must provide case management services that
help assure the patient’s appropriate living arrangements after
treatment hours, transportation to and from the facility, arrangement
of community based support services, referral of suspected child abuse
to the appropriate state agencies, and effective care arrangements,
at a minimum.
3.3.8 The SUDRF shall
enter into a written participation agreement with the Director,
DHA, or designee. (See Section 12.3 and Addendum D.)
3.3.9 The SUDRF agrees
to notify the referring military provider or Military Treatment
Facility (MTF)/Enhanced Multi-Service Market (eMSM) referral management
office (on behalf of the 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.