HEALTHCARE ADMINISTRATION CHAPTER 3 OF THE HOSPITAL CORPSMAN MANUAL NAVEDTRA 14295A HM1 VIDAL

HEALTHCARE ADMINISTRATION

CHAPTER 3 OF THEHOSPITAL CORPSMAN MANUAL

NAVEDTRA 14295AHM1 VIDAL

TOPICS Provides information on the function of healthcare

programs HMs may be involved in. Discuss legal implications in medical care

Various aspects of consent Incident reports Release of medical information under the Privacy and FOI

acts Provides guidance concerning our relationship

with law enforcement personnel and the legal community

ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE

Defense Enrollment Eligibility Reporting System (DEERS) Improved distribution and control of military healthcare

services Assists in the projection and allocation of costs for healthcare

programs Minimizes fraudulent healthcare claims Enrollment in DEERS:

Active duty? Automatic

Dependents? Accomplished by submitting a DD 1172, Application for Uniformed

Services and Privilege Card


****Patients who show up for care without a valid ID WILL NOT be provided care without signing a document stating they are eligible and a reason why they do not have an ID card. A valid ID card must be presented within 30

calendar days following care to avoid being billed.


REASONS FOR INELIGIBILITY – non emergency care will be denied!!!!!!!!

Sponsor not Enrolled in DEERS Dependent not enrolled in DEERS Passed terminal eligibility date Sponsor has separated from AD Spouse is divorced from sponsor and is not

entitled to benefits as a former spouse Dependent child is married


UNDER NO CIRCUMSTANCES WILL THE CLERK PERFORMING THE ELIGIBILITY CHECK DENY THE REQUESTED CARE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

ONLY COMMAND DESIGNATED SUPERVISORY PERSONNEL CAN PERFORM THIS FUNCTION.

ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CAREDEERS ELIGIBILITY OVERRIDES:1.DD 1172: must present original copy used for DEERS enrollment.2.All Other Dependents Recently Becoming Eligible for Benefits

New mothers, babies, recent adoption and dependent parents Must be within 120 days For children under 10, valid ID of parent or guardian is

acceptable

3.New ID Card Must be issued within previous 120 days

4.Ineligible Due to ID Card Expiration5.Sponsors Entering AD for a Period of Greater than 30 Days


DEERS ELIGIBILITY OVERRIDES6. Newborns

Newborns will not be denied care up to 60 days following birth.

If not enrolled by the 61st day, newborn will shift to Tricare Standardd

7. Emergency Care8. Sponsor’s Duty Station is OCONUS or has an

FPO/APO address9. Survivors


DEERS ELIGIBILITY EXCEPTIONS Secretary of the Navy Designees Foreign Military Personnel

NATO military personnel and their dependents Crew and passengers of visiting military aircraft Crews of ships of NATO nations that come into port

Red Cross Workers Secret Service Agents FAA Personnel Some non-retiree veterans

TRICARE TRICARE is an enhancement of the Civilian

Health and Medical Program of the Uniformed Services (CHAMPUS).

It is a medical benefits program established to manage the care in military MTFs.

It also manages cost sharing charges for medically necessary civilian services and supplies required in the diagnosis and treatment of illnesses.

TRICARE Information pertaining to eligibility, extent of

care, providers, cost and claims is contained in the booklet SAILING WITH TRICARE, FOR SAILORS AND THEIR FAMILIES.

Information on the TRICARE dental program can be found in TRICARE DENTAL PROGRAM BENEFIT PROGRAM.

DENTAL CARE ELIGIBILITY Active duty and reservists recalled to active

duty for a period of more than 30 days are eligible for all services.

Family members must be enrolled in the TRICARE Dental Plan and can only do so if the sponsor has at least 12 months remaining on active duty.

DENTAL CARE ELIGIBILITYPRIORITY OF CARE:CAT 1A Active DutyCAT 1B Reserve/National GuardCAT 2 Family members of AD/DeadCAT 3 ROTCCAT 4 Retired members/familyCAT 5 GS employeesCAT 6 All others

THE ACRONYM DEERS STANDS FOR WHAT?

DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM

HOW MANY “DEERS ELIGIBILITY OVERRIDE” CODES ARE THERE?

NINE

TRUE OR FALSE? AN AFGHAN ARMY OFFICER PARTICIPATING IN A PERSONNEL EXCHANGE PROGRAM IN THE U.S. IS ELIGIBLE FOR CARE.

TRUE

WHAT MEDICAL BENEFITS PROGRAM WAS ESTABLISHED TO ENHANCE MANAGEMENT OF CARE SERVICES IN MILITARY MEDICAL TREATMENT FACILITIES?

TRICARE

NAVY MEDICINE’S QA PROGRAM

Used to evaluate the degree of excellence of care

Reflect what patients and providers expect of each other

BUMEDINST 6010.13, Quality Assurance Program, lists required elements for process improvement

PATIENT RELATIONS AND COMMAND CONTACT PROGRAMSPatient Relations Program Implemented through BUMEDINST 6300.10, Health Care

Relations Program Primary goal – provide assistance by intervention in and

resolution of a patient’s complaints are problemsPatient Contact Program A subset of the Patient Relations Program Ensures an effective means of resolving issues before the

patient leaves the hospital

****Both programs strive to enhance channels of communication between the hospital and patient.

FAMILY ADVOCACY PROGRAM Purpose - ID, treat and monitor

Navy personnel engaging in spouse or child abuse/neglect and sexual abuse

A responsibility of the Navy Military Personnel Command

Guided by SECNAVINST 1752.3 BUMEDINST 6320.70

Established cases are reported at the central registry at BUMED where:

Statistics are compiled Future assignments of established

abusers is monitored and controlled.

DRUG AND ALCOHOL ABUSE PREVENTION AND CONTROL PROGRAM

Guidance provided by OPNAVINST 5350.4, Drug and Alcohol Abuse

Prevention and Control SECNAVINST 5300.28, Military Substance

Abuse Prevention and Control

PREVENTIONDAPA (Drug and Alcohol Program Advisor)

Provide liaison between law enforcement, medical, family service center and CO

Coordinates on-site training Facilitates anonymous meetings Provides referrals for outside intervention and inpatient

treatment Personnel can be indentified to the DAPA through

Aberrant behavioral patterns Suspicious medical findings Self-referral

CONTROL

Medical personnel become professionally involved in substance abuse programs when called upon to withdraw blood or urine from an individual suspected of drug and alcohol

Circumstances where withdrawal of blood or urine is authorized

Consensual withdrawal Valid medical purpose Competence for duty examinations

CONTROLCompetence for Duty Examination Request form is NAVMED 6120/1 Contains a block for the submitting authority to

request lab analysis The following procedures should be used in

handling competency for duty requests Command initiating the request should complete items 1

through 12. Normally Cos, XOs or CDOs are authorized to make requests

Medical Officer or other authorized healthcare provider completes blocks 13 through 49

If lab analysis is requested, patient should give written consent. If the patient does not give consent, but will allow extraction, the sample should be taken. If the patient refuses consent and will physically resist extraction, the requesting command should be notified and no extraction should be attempted.

PHYSICAL READINESS PROGRAM

Outlined in OPNAVINST 6110.1 series

Medical Department responsibilities are Providing technical

assistance to BUPERS Conducting lifestyle, fitness,

and obesity research Review health status and

granting waivers Assisting in development of

exercise prescriptions

WHAT NAVY MEDICINE PROGRAM IS OUTLINED IN BUMEDINST 6010.13?

QUALITY ASSURANCE PROGRAM

WHAT PROGRAM ENSURES EFFECTIVE MEANS OF RESOLVING ISSUES BEFORE A PATIENT DEPARTS OUR FACILITY?

PATIENT CONTACT PROGRAM

WHAT PROGRAM IDENTIFIES, TREATS AND MONITORS NAVY PERSONNEL ENGAGING IN SPOUSE OR CHILD ABUSE, OR SEXUAL ABUSE?

FAMILY ADVOCACY PROGRAM

WHAT FORM IS TO USED TO REQUEST FOR A COMPETENCY FOR DUTY EXAMINATION?

NAVMED 6120/1

ON THE NAVMED 6120/1, WHAT BLOCKS ARE COMPLETED BY THE COMMAND INTIATING THE REQUEST?

1 THROUGH 12

LEGAL IMPLICATIONS IN MEDICAL CARE

CONSENT REQUIREMENTS FOR MEDICAL TREATMENT Every person has the right

not to be touched without giving permission.

Consent must be obtained before medical treatment is initiated.

Healthcare provided before consent is given may result in an assault and battery charge upon the patient

CONSENT REQUIREMENTS FOR MEDICAL TREATMENT

INFORMED CONSENT Requires that a provider give all information

for the patient to make a knowledgeable decision

Duty to inform and explain rests with the provider****this responsibility cannot be delegated!!!!


INFORMED CONSENT Risk of the proposed treatment must be

explained Alternative medical options should be

disclosed and discussed Providers are not required to explain

consequences that are considered simple and essentially risk free


EMERGENCY SITUATIONS Consent before treatment is not necessary if

Treatment prevents deterioration or aggravation of a patients condition

Life-threatening situation Not possible to obtain a valid consent

Existence and scope of the emergency should be adequately documented

CONSENT REQUIREMENTS FOR MEDICAL TREATMENTWHO MAY CONSENT???? Based on a competency evaluation of the patient If patient is incompetent due to statutory or

physical/mental reasons, we must turn to whoever has legal capacity to consent for patient

Parent/Guardians of minors Husband or wife of incompetent spouse Law of the state where the hospital is that controls

the question of “substitute consent”


FORMS OF CONSENT Consent for treatment is obtained through

open discussion between patient and provider

Should be documented by having patient sign appropriate forms

In certain limited circumstances, consent to simple medical treatment may be implied


WITNESS TO CONSENT Any competent adult may witness a

patients consent Preferable that a witness be a staff member

of the hospital who is not participating in the procedure

Not advisable for a relative to act as a witness


DURATION OF CONSENT Consent is valid as long as no change has

occurred in the circumstances between the day consent was given and the day of the procedure

New consent should be obtained if a significant time lapse has occurred

INCIDENT REPORTS Risk-management incident has taken place

when an event occurs that Harms an individual Illustrates potential for harm Dissatisfaction by patients, visitors or staff

Examples Excessive silver nitrate is put into a newborn’s eyes and

impairs vision Mother of a child complains about care and informs a staff

member she plans to speak to her lawyer

INCIDENT REPORTS Staff members aware of incidents must

make the hospital command aware Mechanism: Incident Report System. It is

designed to Document circumstances surrounding the event Alert CO, QA coordinator Establish an information base

Incident reports are confidential

RELEASE OF MEDICAL INFORMATION

There are two federal statutes:

1. Freedom of Information Act

2. Privacy ct of 1974

MEDICAL CONDITIONS AND LAW ENFORCMENT

PERSONNEL

MEDICAL CONDITIONS LAW ENFORCEMENT PERSONNELDELIVERY OF A PATIENT UNDER WARRANT OF ARREST Nonactive Duty Patients Active Duty Patients

Consult a JAG officerPRISONER PATIENTS Enemy POWs and other Detained personnel

Entitled to all medical and dental care Nonmilitary Federal Prisoners

Entitled to emergency care only Military Prisoners

Receive care until they have completed their sentence and are discharged

MEDICAL CONDITIONS LAW ENFORCEMENT PERSONNELSEXUAL ASSAULT AND RAPE NAVMEDCOMINST 6310.3 (Management of

Alleged or Suspected Sexual Assault and Rape Cases) provides guidance for: Care Evaluation Medico-legal documentation

OPNAVINST 1752.1 (Sexual Assault Victim Intervention Program), and SECNAVINST 5800.11, (Victim and Witness Program) provide guidance for the care and support of victimes

WHEN IS CONSENT NECESSARY BEFORE RENDERING ROUTINE TREATMENT?

ALWAYS!!!!!

TRUE OR FALSE? ONLY STAFF MEMBERS OF THE HOSPITAL CAN WITNESS A PATIENTS CONSENT.

FALSE

WHAT TWO FEDERAL STATUTES ESTABLISH CRITERIA FOR COLLECTING, MAINTAINING, AND RELEASING MEDICAL TREATMENT RECORDS?

PRIVACY ACT

FREEDOM ON INFORMATION ACT

QUESTIONS??????

Documents

HEALTHCARE ADMINISTRATION CHAPTER 3 OF THE HOSPITAL CORPSMAN MANUAL NAVEDTRA 14295A HM1 VIDAL