Medical Management Guide, 2009, Version 3.0 - Tricare

Page 88Case Management Version 3.0Medical Management GuideRecovery Coordination ProgramRecovery, Rehabilitation, Reintegration (R3)FOUR CORNERSTONESNew Roles for CM in the NDAARecovery Care Coordinators– Responsible for assistance to Service member (i.e., access)– Employed by Military BranchRecoveryPlanRecoveryCoordinatorMedical Care Case Managers (MCCMs)– Licensed, healthcare professional– Understand Rx and receive appropriate careNon-Medical Care Managers (NMCMs)– Finance, personnel, admin, transitional, family supportRecoveryTeamNational ResourceDirectoryFederal Recovery Coordinators– Primary responsibility/oversight for R3– Employed by Veterans Administration: LCSW or RNsSource: National Defense Authorization ActFig. 24 – Recovery Coordination ProgramFig. 25 – New Roles for CM in the NDAAThe FIRP plan should track with the plan of caredeveloped by the recovery team as a whole.The RCC continues to work with the ADSM and his/her family throughout the recovery, rehabilitation,and transition process to meet their needs. For bestoutcomes, the RCC is treated as a member of theoverall outpatient recovery team that includes clinicaland non-clinical staff. The RCC participates in teamdiscussions and plan-of-care development.Additional resources specific to wounded warriorcare are found in the June 2008 provision of theNDAA (H.R. 5658 — see Appendix D, Resources).Figs. 24 and 25 describe aspects of woundedwarrior care coordination under the NDAA.TRANSITION/COORDINATION OF CARETransition of CareIn the military, unique transitions of care (TOCs)occur when patients move:• From the DCS to the PCS.• From MHS care to VA care.• Among multiple Service-level settings— for example: An injured Marine receivesemergency care in an Air Force ED, istransferred to a Navy medical center for limbsavingsurgery, is rehabilitated in an Armysetting, and is moved jointly between his/herhome base primary care and the VA for PEBpurposes.• From one TRICARE regional case manager toanother.