1.0 BACKGROUND
The National Defense Authorization
Act (NDAA) Fiscal Year (FY) 2019, Section 702, authorizes a pilot
to treat psychological sequelae associated with sexual trauma to
be accomplished through partnerships with public, private, and non-profit
health care organizations and institutions. These partnership institutions
must provide health care to Active Duty Service Members (ADSM) who
are eligible for care under the TRICARE program. The pilot is focused
on treatment of ADSMs suffering from Post-Traumatic Stress Disorder
(PTSD) and other psychological health conditions associated with
sexual trauma.
2.0 DESCRIPTION
AND OVERVIEW
IOPs provide
an outpatient level of care that includes an organized day or evening
program for the treatment of mental health and/or Substance Use
Disorders (SUDs). This pilot will provide specialized IOP-level
services to ADSMs who are suffering from psychological health conditions
associated with sexual trauma. These services will meet the requirements
of the TRICARE Policy Manual (TPM),
Chapter 7, Section 3.16, and
Chapter 11, Section 2.7 but with a specific
focus on the sequelae of sexual trauma. In accordance with the NDAA
FY 2019, Section 702, the intent of this pilot is to determine the “feasibility
and advisability” of using such programs by measuring outcomes and
sharing of lessons learned. This pilot does not change requirements
for treatment provided through the IOP model. These pilot requirements
do not apply to the Designated Providers (DPs) or TRICARE Overseas
contractor.
3.0 POLICY
3.1 IOPs that
offer a specialized focus on sexual trauma as specified in NDAA
FY 2019, Section 702, provide evidence-based or evidence-informed
treatment for psychological conditions that are common among ADSMs
who have disclosed sexual trauma (for example, including PTSD, substance abuse,
depression). Only TRICARE authorized IOPs that meet the TPM,
Chapter 11, Section 2.7 IOP requirements and
are selected by the Defense Health Agency (DHA) upon recommendation
by the contractor are eligible for participation under this program.
Under this program, IOPs will provide mental health care, support,
and other benefits to ADSMs and their family, and will work with
existing case management resources (Market/Military Treatment Facility
(MTF) or contractor case managers, as appropriate) to link beneficiaries
and their families with community-based support systems. In order
to qualify for mental health benefits under this pilot, the patient
must be diagnosed by a TRICARE authorized or MTF mental health provider
with diagnoses associated with a sexual trauma disclosed by the
ADSM.
3.2 IOPs participating in the pilot
must use only evidence-based treatment strategies for the treatment
of diagnoses associated with a disclosed sexual trauma. Treatment
may include, but is not limited to individual and/or group psychotherapy
and psychoeducation. Approval of an IOP site by the Government signifies
compliance with this paragraph.
3.3 A referral
for supplemental health care consistent with
Chapter 17, Section 3 is required for an ADSM
to participate in the Sexual Trauma IOP Pilot.
3.4 Each contractor
shall identify at least two, but not more than five IOPs which meet
the criteria in this Section and agree to participate in the pilot.
3.4.1 In addition
to meeting the criteria included elsewhere in this section to be
eligible for participation, IOPs shall also be within specialty
care access standards for drive time of a Market/MTF which has at
least 5,000 uniformed service personnel enrolled. IOPs selected
for this pilot shall be in-network or agree to join the TRICARE
network and shall provide more than 50% of care (based on hours)
in-person (as opposed to via telehealth). However, the Government
may approver one entirely telehealth IOP per region if they meet
all other criteria and will continue to provide care via telehealth for
the duration of the pilot. Department of Veterans Affairs (DVA)/Veterans
Health Administration (VHA) facilities are not eligible for the
pilot.
3.4.2 To be eligible to participate,
each IOP shall enter into a Participation Agreement,
Addendum B,
approved by the Director, DHA or designee.
3.4.3 The contractor
shall provide a list of proposed IOPs for inclusion in the pilot
to the Government after confirming the recommended programs meet
all criteria and are willing to participate. The Government will
provide a final, approved list to the contractor based on the recommend
list provided by the contractor. If the contractor is unable to
identify sufficient IOPs that meet these criteria, the contractor
shall notify the Government and provide proposed alternate proposed
IOP sites that do not meet all of the criteria.
3.5 Psychological
Assessment
3.5.1 Patient assessment. Includes
the assessment of each ADSM accepted by the facility, and must,
at a minimum, consist of a physical examination; psychiatric evaluation
(to include medication evaluation); psychological assessment; assessment
of physiological, biological and cognitive processes; developmental
assessment; family history and assessment; social history and assessment;
educational or vocational history and assessment; environmental
assessment; screening or assessment and recreational/activities
assessment. Screening or assessment of sexual dysfunction shall
also be performed. Assessments conducted within seven days prior
to admission to an IOP may be used if approved by the facility Medical
Director, and deemed adequate to permit treatment planning by the IOP.
3.5.2 The participating
IOPs with a focus on sexual trauma will assess the core treatment outcomes
at the patient level. These outcomes shall be measured within seven
days of treatment baseline, within three days of discharge (i.e.,
post-treatment), three months post-treatment, six months post-treatment
and one year post-treatment. Data collected within 14 days of the
scheduled follow-up is within allowance.
3.5.3 The core
treatment outcomes measured for every ADSM participating in the
pilot shall include:
• PTSD - PTSD Checklist (PCL)
• Depression - Patient Health
Questionnaire-8 (PHQ-8)
• Alcohol use - Alcohol Use Disorder
Identification Test (AUDIT) or AUDIT-C
• Functioning/Quality of Life
(QOL) - QOL or World Health Organization (WHO) Disability Assessment Schedule
or Veterans’ Rand-12
• Brief narrative of family support/involvement
3.6 Outcome
Reporting
3.6.1 Details for reporting are identified
in DD Form 1423, Contract Data Requirements List (CDRL), located
in Section J of the applicable contract.
3.6.2 A written
treatment discharge summary shall be provided by the participating
IOP to the referring provider within three business days of discharge
or program exit. The treatment summary shall list treatment groups
attended, pre- and post-treatment outcome measures as defined above, information
regarding patient engagement in treatment, and documentation of
any suicidal or homicidal ideation during IOP treatment (along with
any interventions delivered targeting suicidal or homicidal ideation).
3.7 Special
Processing Code (SPC) BH shall be used for claims under
this pilot.
6.0 PARTICIPATION
IN INFORMATION SHARING NETWORK
The contractor shall require
IOPs which participate in the Sexual Trauma IOP pilot to share clinical
and community outreach best practices with other organizations and
institutions participating in the pilot consistent with NDAA FY
2019, Section 702. Participation is specified as staff representation at
minimally 75% of scheduled meetings and/or teleconferences related
to the pilot (such meetings will occur no more frequently than monthly),
timely responses to requests for information regarding best practices,
and actively identifying and providing best practice knowledge generated
from the IOP to the other participating partner IOPs.
7.0 EFFECTIVE
AND TERMINATION DATES
Effective
on September 1, 2020 and terminates August 31, 2021.