2.8.5.6.8
MOA
Between DVA and DoD for Medical Treatment Provided to Service Members
With SCI, TBI, Blindness, or Polytraumatic InjuriesAddendum D contains the MOA
Between DVA And DoD For Medical Treatment Provided To Service Members
With SCI, TBI, Blindness, Or Polytraumatic Injuries. Acquired conditions
referred to DVA/VHA medical facilities/programs referenced in the
MOA or similar private sector programs are exempt from the SHCP
waiver process and the contractor shall reimburse under normal TRICARE
reimbursement policy. DHA-Great Lakes (DHA-GL) will not process
referrals for programs, DME, or other authorized treatment for acquired
conditions, but the contractor shall process referrals in alignment
with the conditions of the MOA. Acquired conditions include:
2.8.5.6.8.1 Acquired Brain Injuries (ABIs)
(e.g., cardiovascular accident, brain cancer, aneurysm, brain arteriovenous
malformation). This includes ABIs due to International Classification
of Diseases, 10th Revision (ICD-10) codes including S06 (other than
those already covered under the MOA as TBI), A87.9, F01.50, F02.80,
F02.81, F03.90, F03.91, F07.81, G00.9, G03.0, G03.1, G03.9, G04.00,
G05.3, G05.4, G06.0, G06.1, G06.2, G08, G09, G92, G93.0, G93.1,
I60.00, I60.01, I60.02, I60.10, I60.11, I60.12, I60.2, I60.30, I60.31,
I60.32, I60.4, I60.50, I60.51, I60.52, I60.6, I60.7, I60.8, I60.9,
I61.9, I62.00, I62.1, I63.019, I63.119, I63.139, I63.20, I63.219,
I63.22, I63.239, I63.30, I63.40, I63.50, I63.59, I67.89, I69.810,
I69.811, I69.812, I69.813, I69.814, I69.815, I69.818, I69.819, I69.898,
I69.910, I69.911, I69.912, I69.913, I69.914, I69.915, I69.918, I69.919,
I69.928, P10.1, P10.3, P10.8, P10.9, P52.4, P52.5, P52.6, P52.8,
P52.9, R09.0, R09.01, R09.02, R41.2, R41.3, R41.82, T75.1, T75.1XXA,
T75.1XXD, T75.1XXS.
2.8.5.6.8.2 Acquired blindness (e.g., blindness
caused by diabetes, infections, glaucoma or other non-traumatic
injury). This includes ICD-10 codes under Blindness and Low Vision
(H54).
2.8.5.6.8.3 Non-traumatic spinal cord disorders
(e.g., conditions due to infection, loss of blood supply, compression
caused by cancer, or degeneration of the spinal vertebrae). This
includes ICD-10 codes under deforming dorsopathies (M40-M43), spondylopathies
(M45-49) and other dorsopathies (M50-M54).