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.