3.2 In order for an RTC to be authorized,
the RTC shall comply with the following requirements:
3.2.1 An RTC shall be currently accredited
by the Joint Commission (TJC), the Commission on Accreditation of
Rehabilitation Facilities (CARF), the Council on Accreditation (CoA),
or an accrediting organization approved by the Defense Health Agency
(DHA). The contractor may submit additional accrediting organizations
for TRICARE authorization, subject to approval by the Government
Designated Authority (GDA).
3.2.2 The RTC
must be licensed as an RTC to provide RTC services within the applicable
jurisdiction in which it operates.
Note: Where different certification,
accreditation, or licensing standards exist, the more exacting standard applies.
Regulations take precedence over standards, and standards take precedence
over participation agreements.
3.2.3 The RTC
shall accept the allowable RTC rate, as provided in
32 CFR 199.14(f) and the TRICARE Reimbursement
Manual (TRM),
Chapter 7, Section 4 as payment in full for
services provided.
3.2.4 The RTC
shall comply with all requirements applicable to institutional providers
generally concerning preauthorization, concurrent care review, claims
processing, beneficiary liability, double coverage, utilization
and quality review, and other matters.
3.2.5 The RTC
shall not be considered an authorized provider nor shall any benefits
be paid to the facility for any services provided prior to the date
the facility is approved by the DHA, or designee.
3.2.6 All RTC services and supplies
shall be provided by trained, licensed staff. All mental health
services must be provided by an authorized mental health provider.
This includes all diagnostic services, psychotherapy, psychological
testing, and patient assessment. Assessments will include documentation
of the outcomes of standardized assessment measures for Post-Traumatic
Stress Disorder (PTSD), anxiety disorders, and depressive disorders
using the PTSD Checklist (PCL-5), Generalized Anxiety Disorder (GAD-7),
and Patient Health Questionnaire (PHQ-9 or A), respectively, at
baseline, at 60 calendar day intervals, and at discharge (see
Chapter 1, Section 5.1 for details).
3.2.7 The RTC must enter into a written
participation agreement with the DHA, or designee. (See
Section 12.3 and
Addendum E.)
3.2.8 The RTC agrees to notify the
referring military provider or Market/Military Medical Treatment
Facility (MTF) 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.