Medical Management Guide, 2009, Version 3.0 - Tricare

Page 92Case Management Version 3.0Medical Management GuidePatient movement has advanced to support criticalcare capabilities via the AE system. Patients returningto CONUS MTFs with complex and catastrophicinjuries and/or complicated medical sequelae(abnormal condition resulting from a previousdisease) will likely require CM services and maybenefit from enrollment into one of the Services’warrior care programs. Case managers need a basicunderstanding of patient movement through the AEsystem, as it offers perspective on patients’ medicaland psychosocial health needs from onset of injuryor illness to definitive treatment in stateside MTFs.For more information, contact your MTF PatientAdministration office.Coordination of CareCoordination from the MHS to the Departmentof Veterans AffairsDepending on eligibility (i.e., Service-connectedcondition or disability), Active Duty, retired, orseparated Service members may receive health carefrom the VA’s Veterans Health Administration (VHA).In 1996, Congress established Public Law 104-262,the Veterans Health Care Eligibility Reform Act, inwhich enrolled veterans are entitled to a medicalbenefits package that emphasizes preventive andprimary care. For more information on eligibilityand enrollment, refer to the VA website: http://www.va.gov/healtheligibility/coveredservices/StandardBenefits.asp.The DoD and VA (VHA and Veterans BenefitsAdministration [VBA]) continue to partner toimprove the dialogue and collaboration between thetwo departments at all levels, focusing on the abilityto identify and serve all ADSMs who have sustainedinjuries or illnesses in combat operations.When the transition of healthcare services isrequired between an MTF and a VA medicalcenter (VAMC), the MTF case manager (or patientadministrative staff, as appropriate) is responsiblefor coordinating the transfer with the VHA Liaisonlocated at the MTF and/or the OEF/OIF CareManagement Team located at the VAMC. To locatethe appropriate VHA Liaison for referral, refer to thecontact list table on CD-ROM Resource CM-36(this list is continuously updated).When the MTF case manager identifies the requirementto transfer care to the VA, he/she completesa referral packet to include the DoD/VA LiaisonReferral Form ( CD-ROM Resource CM-37) witha discharge plan and medical record documentation.Once the VHA Liaison receives the referral form andmedical record documentation, he/she initiates thereferral with the accepting VAMC. Depending onthe urgency and request for healthcare services, thetransition time may occur as quickly as a few days.Coordination for Active Duty Service Membersin the TRICARE Prime Remote ProgramThe Military Medical Support Office (MMSO) is aTri-Service agency providing CM services for the followingpopulations:• ADSMs enrolled in the TRICARE Prime Remote(TPR) program.• Reserve and National Guard members injured inthe line of duty (LOD).• New accessions awaiting the start of training.