3.3 In addition, in order for a
freestanding
PHP to be authorized,
the PHP shall comply with the following requirements:
3.3.1 The PHP shall be currently
accredited by the Joint Commission (TJC)
under the Commission on Accreditation of Rehabilitation
Facilities (CARF), the Council on Accreditation (CoA), or an accrediting
organization approved by the Director, DHA. The
regional contractor may submit, via the TRICARE Regional Office
(TRO), additional accrediting organizations for TRICARE authorization,
subject to approval by the Director, DHA.
3.3.2 The PHP shall be licensed as
a PHP to provide PHP services within the applicable jurisdiction
in which it operates.
3.3.4 The PHP 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 PHP
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 by the Director, Defense Health
Agency (DHA), or designee.
3.3.6 All diagnostic and therapeutic
mental health
and SUD services must
be provided by an authorized mental health provider. This includes
all psychotherapy (individual, group, family or conjoint, psychoanalysis,
collateral), psychological testing and assessment to 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: PHPs 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 the individual must work under the
clinical supervision of a fully qualified mental health provider
employed by the PHP.] All other program services shall be provided
by trained, licensed staff.
3.3.7 Family
therapy
is an integral part of the treatment of children and adolescents
and must be included in
their mental
health treatment plans. If the family is not in the area, the
child
or adolescent patient is probably not a candidate
for partial care as individuals in this program return to their
home setting daily, and effective family interaction is essential.
If the family or patient is not cooperative in participating in
family therapy, they may not be viable candidates for a partial
program. By accepting a child or adolescent under the age of 21
for admission, a partial program is acknowledging that it can provide
the specific treatment appropriate to that individual’s needs and
is responsible for taking only those individuals whom it feels it
can help through the development of an appropriate treatment program
designed to encompass family therapy and maximize the patient’s
ability to function in one or more major life activities. The requirement
for family therapy is not considered met by telephonic therapy or
multifamily group therapy.
(See Chapter 7, Section 3.12.) If
family therapy is clinically contraindicated, an exception to this
requirement may be granted
on a case-by-case basis by
the
clinical director, or designee.
3.3.8 Case management services
required. The facility must provide case management services that
help assure the patient 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 after
care arrangements, at a minimum.
3.3.9 Educational services required.
Programs treating children and adolescents must ensure the provision
of a state certified educational component which assures that patients
do not fall behind in educational placement while receiving partial
hospital treatment. The cost of educational services will not be
funded separately from the per diem rate. The hours devoted to education
do not count toward the therapeutic program.
3.3.10 The PHP shall enter into a
written participation
agreement with the Director, DHA
, or designee. (See Section 12.3 and Addendum F.)
3.3.11 The PHP 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.