Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 168Appendix C - DefinitionsVersion 3.0Medical Management GuideExtended Care Health Option (ECHO)See also Program for Persons with Disabilities (PFPWD)A supplemental program to the basic TRICARE program. ECHO provides financial assistance for an integratedset of services and supplies to eligible active duty family members (including family members of activatedNational Guard or Reserve members). There is no enrollment fee for ECHO; however, family members must:• Have an ECHO-qualifying condition.• Enroll in the Exceptional Family Member Program (EFMP) as provided by the sponsor's Service Branch.• Register in ECHO through ECHO case managers in each TRICARE region.Resources:Code of Federal Regulations (CFR), Title 32 — National Defense, Section 199, Part 5 (199.5):www.tricare.mil/cfr/C5.PDF.See CD-ROM Resource AppendixC-Def5TRICARE: www.tricare.mil/mybenefit/Download/Forms/ECHO_Flyer_v3_09_L.pdf.Factual Determinations (nonmedical necessity)Determinations issued in cases involving coverage issues, provider authorization (status) requests, hospice care,foreign claims, denials based on sections other than National Defense Civilian Health and Medical Programof the Uniformed Services (CHAMPUS), Title 32, Section 199, Part 4 (199.4), and both medical necessity andfactual determinations.Resources:TRICARE Operations Manual 6010.51-M, Chapter 13, Section 5, Appeal of Factual (Nonmedical Necessity)Determinations: http://www.tricare.mil/TO02/C13S5.pdf.Code of Federal Regulations (CFR), Title 32 — National Defense, Section 199, Part 4 (199.4):www.tricare.mil/cfr/C4.PDF.See CD-ROM Resource AppendixC-Def4Federal Recovery Coordinator (FRC)The DoD/VA federal Recovery Coordination Program (RCP) provides senior-level clinical nurses and socialworkers through the VA designated as Federal Recovery Coordinators (FRCs). These staff provide oversight ofthe recovery plan for catastrophically injured Service members. The FRC works with the Service member, his/herfamily, and the recovery team to develop a Federal Individual Recovery Plan (FIRP). The FRC continues to workwith the Service member and his/her family throughout the recovery, rehabilitation, and transition process tomeet their needs. The FRC remains available to the Service member and his/her family for life as long as theyneed.Resources:Department of Veterans Affairs (VA): http://www.oefoif.va.gov/.
Medical Management Guide Version 3.0 Appendix C - DefinitionsPage 169Federal Individual Recovery Plan (FIRP)See Federal Recovery Coordinator (FRC)Resources:Department of Veterans Affairs (VA): http://www.oefoif.va.gov/.Global War on Terrorism (GWOT)/Overseas Contingency Operations (OCO)Following the terrorists attacks of Sept. 11, 2001, the U.S. began military operations to combat terrorism bothin the United States and overseas. Military operations to defend the United States against further attacks areknown as Operation Noble Eagle. Ongoing military operations in Afghanistan and Iraq are known as OperationEnduring Freedom (OEF) and Operation Iraqi Freedom (OIF), respectively. Together, these three militaryoperations are identified as the Global War on Terrorism (GWOT).In a memorandum from the Office of Management and Budget (OMB) in March 2009, which was forwardedto Pentagon staff members from the Defense Department's Office of Security Review, the Obamaadministration noted that it “prefers to avoid using the term 'Long War' or 'Global War on Terror' [GWOT].” Itasked that the term “Overseas Contingency Operation” be used instead.Resources:Government Accountability Office (GAO) publication GAO-05-822, Global War on Terrorism — DoD Needs toImprove the Reliability of Cost Data and Provide Additional Guidance to Control Costs, p. 1: http://www.gao.gov/new.items/d05882.pdf.U.S. Department of Defense, Officer of the Inspector General: http://www.dodig.mil/gwot_iraq/index.htm.Wilson, S., Kamen, A. “Global War On Terror” Is Given New Name — Bush's Phrase Is Out, Pentagon Says.The Washington Post, March 25, 2009: http://www.washingtonpost.com/wp-dyn/content/article/2009/03/24/AR2009032402818.html.GrievanceIn the DCS, filing a grievance is the proper method for addressing beneficiary concerns (i.e., complaint) whenthere is a perceived inequity of the benefit, rather than a question of medical necessity.Resources:DoDD 6000.14, Patient Bill of Rights and Responsibilities in the Military Health System (July 30, 1998): http://www.dtic.mil/whs/directives/corres/pdf/600014p.pdf.See also Section II, Utilization ManagementGroup VisitA relatively new model in healthcare delivery where a number of patients meet on a prescribed basis in anexpanded office visit that includes care delivery, education, socialization, and one-to-one physician-patienttime, as needed. Group visits offer staff a new and more satisfying way to interact with patients that makesefficient use of resources, improves access, and uses group process to help motivate behavior change and
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Medical Management Guide, 2009, Version 3.0 - Tricare

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