Substance Use Disorders in the U.S. Armed Forces (2013) / Chapter Skim
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3 The Military Health System
3 The Military Health System
Pages 69-84
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From page 69... ...
In the National Capital Region, for example, the services provided by the former Army Walter Reed Hospital and the National Naval Medical Center have been integrated into the new Walter Reed National Medical Center on the grounds of the former National Naval Medical Center. This consolidated site is staffed by providers from both the Army and Navy and provides care for service members from different branches of the military.
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From page 70... ...
, has a statutory responsibility to provide health care to identified beneficiaries. This care is provided through the direct care system at military treatment facilities and through the purchased care system by reimbursement to authorized providers via the TRICARE insurance plans (see Figure 3-2)
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From page 71... ...
Active Duty Service Members and Their Dependents ADSMs generally receive medical care at military treatment facilities or field health stations. ADSMs are automatically enrolled in TRICARE Prime
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From page 72... ...
purchased civilian care in each region and coordinates the care in military treatment faciliƟes with DoD and the services TRICARE Regions Regional Contractor: The contractor that manages the purchased care system for a TRICARE region Authorized Providers: Providers who have been approved by TRICARE to see TRICARE beneficiaries; may be network or non network Network Providers: Non-Network Providers: Providers who are in the managed care Authorized providers who are contractor network and agree to not part of a network; can accept TRICARE charges for charge their usual fees; can see reimbursement TRICARE Standard paƟents FIGURE 3-2 TRICARE organization of services. Military Services Nonmilitary Services • Air Force • U.S.
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From page 73... ...
TRICARE for Life also provides an enhanced benefit package over Medicare. Most TRICARE for Life benefits are provided by civilian TRICARE contractors; however, military treatment facilities provide care to these beneficiaries on a space-available basis as well.
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From page 74... ...
DIRECT CARE: MILITARY TREATMENT FACILITIES The direct care system includes the providers and facilities that are directly managed by the military services. They are organized by service (i.e., Army, Navy, Air Force)
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From page 75... ...
Extra Prime/TPR Extra Prime/TPR Extra Prime Extra Prime Participating Inactive duty training Delayed effective Active duty orders Contingency orders • Consolidated Omnibus Selected Reserve (IDT) /active duty date orders ≥31 days Budget Reconciliation Act training (ADT)
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From page 76... ...
Continued Coverage Medical -- Guard/ Treatment for line of Full TRICARE coverage Full TRICARE Transition Assistance TRS or Continued Reserve Member duty (LOD) conditions, as active duty service coverage as active Management Program Health Care Benefits TRICARE Reserve members duty service (TAMP)
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From page 77... ...
This provider manages their overall care and most referrals, including those for substance abuse treatment. Because of capacity limitations, military treatment facilities are unable to provide care to all eligible beneficiaries.
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From page 78... ...
PURCHASED CARE: TRICARE As noted, to augment care provided by military treatment facilities, health care services are purchased from civilian providers. Overall, there are nearly 400,000 network individual providers for primary care, behavioral health, and specialty care.
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From page 79... ...
ADSMs are automatically enrolled in TRICARE Prime. TRICARE Extra options utilize preferred provider organizations, which domestically are typically networks managed by one of the three national TRICARE contractors.
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From page 80... ...
This section explains how each of these groups accesses SUD care in particular. SUD Care Provided Through the Direct Care System The SUD care available in the direct care system for service members and their dependents varies by service branch and location.
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From page 81... ...
TRICARE provides a lifetime limit of three SUD treatment benefit periods (each benefit period is 365 days from the first visit) , although this limit can be waived by the managed care support contractor that oversees the TRICARE plans for the region.
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From page 82... ...
An additional avenue is Military OneSource, which includes a website and nonclinical counseling that offer referral information on a wide range of topics, including substance abuse. Service members and their families may also receive care through Warrior Transition Units, the Soldier 360 Program, the Veterans Health Administration, and community programs such as Give an Hour.
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From page 83... ...
For the treatment of SUDs, service members and their dependents can access care both in military treatment facilities and through TRICARE network providers. The TRICARE SUD benefit notably does not reimburse for office-based outpatient treatment.
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