TRICARE Regional Offices (TROs)/Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM) and Contractor Interfaces
1.0 Resource Sharing Authority
2.0 Resource Sharing Program Agreements
Resource sharing consists only
of external resource sharing (where the purpose of the external
resource sharing agreement enables military health care personnel,
active duty and civilian, to provide covered medical services to
active duty and TRICARE beneficiaries in a network facility.) Although
both Internal and External Resource Sharing is authorized by Regulation,
current policy is that only External Resource Sharing will be implemented.
3.0 Resource Sharing Program Requirements
The contractor shall meet the
following resource sharing program requirements:
3.1 Develop a plan for identifying
advantageous resource sharing opportunities in conjunction with
the TRICARE Regional Office (TRO) Chief Operating Officer (COO)
and the Market/Military Medical Treatment
Facility (MTF) Directors.
3.2 Develop and implement procedures
and measures for monitoring resource sharing agreement performances.
4.0 Resource Sharing Agreement
Guidelines
External
resource sharing shall be based upon written agreements between
the contractor, the Market/MTF Director,
and the network facility, with the TRO Regional COO concurrence.
Before a military provider is permitted to practice in a network
facility, the Market/MTF Director will
ensure the military provider has active clinical privileges with
the network facility. The Market/MTF Director will
also ensure external resource sharing providers are licensed to
practice medicine in the United States (U.S.) jurisdiction during
the term of the resource sharing agreement. The resource sharing
agreement shall set forth all the terms, conditions and limitations
of the resource sharing arrangements. Market/MTF Directors may
only authorized Medicare dual eligible beneficiaries to be seen
under External Resource Sharing Agreements for care that is not
covered under Medicare. Active duty members and Active Duty Family
Members (ADFMs) with end stage renal disease or disability eligible
for Medicare Part A and not enrolled in Medicare Part B may be authorized
to be seen under External Resource Sharing Agreements. The Market/MTF Director shall
forward copies of all completed external resource sharing agreements
to the TRO Regional COO for approval prior to the implementation
of any resource sharing agreement. The TRO Regional COO will provide
the contractor written approval/disapproval within 30 days
of receipt. The Market/MTF Director will
forward copies of all approved resource sharing agreements to the
Procuring Contracting Officer (PCO) no later than 10 days
following written notification by the TRO Regional COO of the approval
of the agreement.
5.0 Professional Liability
This clause is mandatory and
will be inserted in all External Resource Sharing Agreements, unless
a wavier is obtained from the Defense Health Agency (DHA) Office
of General Counsel (OGC) and the service legal advisor:
“While performing health care
functions authorized by the Market/MTF, designated
health care personnel will be acting within the scope of their duties
as determined by the Department of Justice (DOJ). The United States
Government will be responsible for their actions within the scope
of their duties. As such, any remedy for damages for personal injury,
including death, caused by their negligence or wrongful acts or
omissions shall be exclusively against the United States under provisions
of the Federal Torts Claims Act (Title 28 USC, Sections 1346(b),
2671-2680) and not against the individual military health care provider.
In the event any Department of Defense (DoD) health care provider
is asked to respond to an emergency involving a non-DoD beneficiary,
the state’s borrowed servant defense and any other applicable defenses
and immunities available to the United States will apply to allegations
of negligence or wrongful acts or omissions arising from care rendered
by the provider.”
6.0 Credentials, Privileging, And
Other Provider Requirements
Market/MTF Directors will
ensure that the military health care personnel are appropriately
licensed and have active clinical privileges within the network
facility. The external resource sharing health care personnel’s
military command is responsible for the supervision of the external
resource sharing health care personnel.
7.0 Record Keeping
The contractor shall maintain
accurate records to document actions related to resource sharing agreements.
These records shall include accurate recording of the personnel
performing services in network facilities, identifying each individual’s
name, Social Security Number (SSN), type of provider or staff, and
the hours worked in the facility.
8.0 Audits
Contractor resource sharing
expenditures are subject to audit by the Government.