Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 172Appendix C - DefinitionsVersion 3.0Medical Management Guideperiods not to exceed 30 days to ensure appropriate patient clinical oversight. Consecutive light duty forany “new condition” up to 90 days may be ordered by the provider (in maximum 30-day periods), but inno case will light duty exceed 90 consecutive days, inclusive of any convalescent leave periods. The FederalEmployees' Compensation Program (FECA) for the Army requires that light duty assignments be provided toemployees faced with job-related injuries or occupational illnesses or diseases. When medical care is authorizedunder the Federal Employees' Compensation Act (FECA), the supervisor, in coordination with the CivilianPersonnel Assistance Center (CPAC), offers the employee light duty work in his/her assigned position, or inanother position, compatible with medically imposed restrictions/limitations. Any position offers made mustbe evaluated by the employee's attending physician to ensure the modified work assignment can safely beperformed by the employee based upon the limitations of his/her medical condition.Resources:Department of Labor, Wage and Hour Division, Final Rule under the Family and Medical Leave Act (FMLA)(effective Jan. 16, 2009):• http://www.dol.gov/esa/whd/fmla/• http://www.dol.gov/esa/whd/fmla/finalrule.htmArmy Civilian Personnel Onlinehttp://www.cpol.army.mil/library/permiss/2904e.htmlhttp://www.cpol.army.mil/library/permiss/2904.htmlLimited Duty (LIMDU)See also Temporary Limited Duty (TLD)/Permanent Limited Duty (IPLD)Limited Duty status allows a Marine to remain on Active Duty when they are not currently fit for full duty, butthere is high likelihood that, with appropriate treatment, they can be restored to ongoing full and productiveduty in a reasonable amount of time (defined as 6-14 months). This status will usually prevent them from beingdeployable and has some other administrative ramifications.Resources:U.S. Marine Corps (USMC): http://www.usmc-mccs.org/LEADERSGUIDE/keyterm_display.cfm?anchor=LimitedDuty.Line of Duty (LOD)An inquiry into the circumstances surrounding the injury or disease of an Active Duty Service member (ADSM).LOD is used to determine the status of an ADSM for indemnity and compensation purposes. LOD investigationsanswer three primary questions:1. Did the member’s injury or disease occur while performing military duty in a duty status?2. If not, was it aggravated by military duty?3. Was the occurrence or aggravation due to the ADSM’s intentional injury or willful negligence?
Medical Management Guide Version 3.0 Appendix C - DefinitionsPage 173Resources:Army: AR 635-40, Physical Evaluation for Retention, Retirement, and Separation:http://www.army.mil/usapa/epubs/pdf/r635_40.pdf.Air Force: AFI 36-2910, Line of Duty (Misconduct) Determinations: http://www.e-publishing.af.mil/.Air Force: AFI 48-123, Medical Examinations and Standards: http://www.e-publishing.af.mil/.Managed Care Support Contractor (MCSC)The 50 United States are divided into three TRICARE regions. Each of the regions has a regional contractorthat helps administer the TRICARE benefit plan. These roles are defined as Managed Care Support Contractors(MCSCs). The regional contractors provide a variety of functions, including:• Establishing TRICARE provider networks.• Operating TRICARE service centers.• Providing customer service call centers.• Providing administrative support, such as enrollment, care authorization, and claims processing.• Communicating and distributing educational information to beneficiaries and providers.MCSCs work with their TRICARE Regional Offices to manage the benefit at the local level, and receive overallguidance from TMA headquarters.Resources:TRICARE:• http://www.tricare.mil/factsheets/viewfactsheet.cfm?id=92• http://www.tricare.mil/tp02/C12S11_1.PDFSee Section I, Medical Management Essentials.McKesson ® InterQual ® Evidence-based Clinical Decision Support CriteriaCriteria that assist in determining the appropriate level of clinical care for adult and pediatric patients inthe acute, long-term, rehabilitation, subacute, home care, and skilled nursing facility settings. They provideevidence-based clinically appropriate decision-making support to promote care management and facilitation,quality improvement, and beneficiary satisfaction.The criteria are designed to screen for cases that warrant medical review. Used as a UM tool for managing care,it is not intended to deny care, but can function as a decision support tool. TMA purchases an enterprise-widelicense annually for a variety of McKesson InterQual criteria sets for use within MTFs.Resources:McKesson: http://www.mckesson.com/.
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Medical Management Guide, 2009, Version 3.0 - Tricare

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