Medical Management Guide, 2009, Version 3.0 - Tricare

Medical Management Guide Version 3.0 Appendix C - DefinitionsPage 175Medical Retention Processing (MRP) - Medical holdover soldiers mobilized under Title 10 USC 12302 ISOGWOT. All RC soldiers with medical conditions that require more than 60 days for resolution will be asked tovolunteer to transition to a Medical Retention Processing Unit (MRPU). Soldiers who do not volunteer will bereleased from active duty and briefed on follow-on medical entitlements such as VA hospitals.Resources:Fort Carson the Mountain Post: http://www.carson.army.mil/Moblas/Medical%20Hold.htm.Medical Management (MM)An integrated managed care model that promotes Utilization Management (UM), Case Management (CM),and Disease Management (DM) programs as a hybrid approach to managing patient care. It includes a shift toevidence-based, outcome-oriented UM, and a greater emphasis on integrating clinical practice guidelines intothe MM process, thereby holding the system accountable for patient outcomes.Resources: DoD Instruction 6025.20, Medical Management (MM) Programs in the Direct Care System (DCS)and Remote Areas (Jan. 5, 2006): http://www.dtic.mil/whs/directives/corres/pdf/602520p.pdf.Medical NecessityAccepted healthcare services and supplies provided by healthcare entities, appropriate to the evaluation andtreatment of a disease, condition, illness, or injury and consistent with the applicable standard of care. Whetherservices or supplies are deemed “medically or psychologically necessary,” depends on the frequency, extent,and types of medical services or supplies which represent appropriate medical care and that are generallyaccepted by qualified professionals to be reasonable and adequate for the diagnosis and treatment of illness,injury, pregnancy, and mental disorders or that are reasonable and adequate for well-baby care.Resources:American College of Medical Quality (ACMQ), Policy 8: Definition and Application of Medical Necessity: http://www.acmq.org/policies/policy8.pdf.Code of Federal Regulations (CFR), Title 32 — National Defense, Section 199, Part 2 (199.2):http://www.tricare.mil/CFR/C2.PDF. See CD-ROM Resource AppendixC-Def3MedicareA health insurance program for people age 65 or older, people under age 65 with certain disabilities, andpeople of all ages with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).Medicare has Part A (Hospital Insurance), Part B (Medical Insurance), and Prescription Drug Coverage.Resources:Centers for Medicare & Medicaid Services (CMS):• http://www.cms.hhs.gov/MedicareGenInfo/• http://www.cms.hhs.gov/home/medicare.aspMedicare: http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_alp.php.