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Business Operation Division MTF Optimization Programs

There are several programs available from the TRICARE Management Activity (TMA), TRO South, and Humana Military Health Services (HMHS) that are designed to assist the Services’ military treatment facilities (MTF) improve their operations. The following is a description of these programs along with hyperlinks to documentation describing the requirements of these programs in greater detail.

First, is the contract vehicle called Clinical Support Agreements (CSA). CSAs allow MTFs the ability to effectively acquire contracted clinical personnel through HMHS which allows the MTF to optimize and enhance their services while maintaining beneficiary satisfaction and minimizing out of pocket costs. Under the Third Generation (T-3) managed care contract, MTFs no longer will use their supporting contracting office to award CSAs. In T-3, that responsibility falls to TMA West. Still, the MTF’s Service Headquarters provide a vital coordinating role to assist their MTF in acquiring T-3 CSAs.

The approved TMA T-3 CSA guidance describes in detail the roles and responsibilities for processing and awarding CSAs. Since the publication of the T-3 CSA Guidance, some of the Services’ Medical Departments have issued documentation regarding their role in coordinating the processing of T-3 CSAs. Please click on the appropriate link to see your Services’ CSA guidance.
Navy

Of note, HMHS has their own in-house Recruiting and Credentialing department whose goal is to expedite the acquisition of qualified candidates for clinical positions for the MTF to accept. HMHS must meet the timeframes outlined in the TRICARE Operations Manual (TOM) in presenting qualified candidates to the MTF. TRO South monitors and reports on HMHS’ compliance with these TOM requirements. Finally, TMA West is required per guidance to meet a 45 day processing time from receipt to award of the T-3 CSA. All of this is designed to ensure your MTF gets “boots on the ground” of qualified candidates in a timely manner to assist your MTF in accomplishing its mission.

External Resource Sharing Agreements (ERSA) are another tool the MTF Commander can use. ERSAs allow MTF providers the ability to provide covered medical services to eligible TRICARE beneficiaries in a HMHS participating network facility where sufficient Government facilities or equipment are not readily available. Such a situation can be due to a temporary reduction of operating rooms or clinical space, a reduction of clinical support staff, or even delays in acquiring needed medical equipment. The benefit of using an ERSA when these situations arise is twofold. First, ERSAs allow MTF providers to maintain their medical currency on clinical procedures that cannot be performed at their MTF. Secondly, the government avoids the costs associated with the professional services these MTF providers perform under the ERSA. This has the impact of reducing the overall Private Sector Care cost the government pays. Please note that TRICARE for Life (TFL) beneficiaries are normally not eligible to receive healthcare services under an ERSA. The only exception is when TRICARE covers a benefit that Medicare does not. Instances when that occurs are rare. To appropriately monitor and track the workload derived from an ERSA, it is critically important that the MTF request through their Service POC establishment of a DMIS ID for the network facility the MTF has an ERSA with. This link provides the Service DMIS ID POCs that need to be contacted to establish a network facility DMIS ID. Please note that workload generated from ERSAs contributes to the Services’ Prospective Payment System (PPS) workload and subsequent direct care funding from TMA.

Processing of the approval of ERSAs is rather straight forward. Once the need for an ERSA is determined, the MTF should notify HMHS of the request. The MTF staff will then tailor the standardized ERSA template (template 508-compliant) with the specific services and projected workload they want to perform at the network facility. Once completed, HMHS assists in the routing of the ERSA to obtain the needed signatures. Normally this routing starts with the HMHS CEO, then the MTF Commander, then to the designated senior official at the Network facility and finally to the Regional Director for final approval. HMHS then makes final distribution of the approved ERSA to all signatories of the document.

The Military Health Services Support Initiative (MHSSI) program provides up to two years of funding from TMA. These funds are available provided the proposed MTF initiative either recaptures private sector care back to the MTF or the initiative prevents current MTF work from being sent to the private sector due to a reduction in MTF capability. The MHSSI program operates under the tenants of TMA’s Prospective Payment System, so successful MHSSI initiatives will generate PPS revenue that exceeds the cost of the initiative. Submission of candidate MHSSI initiatives must be made using the MHSSI Business Case Analysis tool. For Army and Navy submissions, your Service Headquarters requires MTFs first use their Service specific BCA tool. The following links provide the Navy BCA tool.
Navy BCA tool 508-compliant

The specific requirements about using the MHSSI program, to include the submission of worthy initiatives, can be found in the MHSSI guidance. Please know that TRO South analysts are also available to assist the MTFs in the development of worthy MHSSI initiatives for submission and approval by the TRO South Regional Director.

The above are several programs that are available to assist your MTF in fulfilling its mission. HMHS is also available, upon request, to provide Optimization briefings to your MTF senior leadership. Questions regarding any of the information provided above can be directed to the Chief, Optimization and Initiatives (O&I) at 210 292-3286 or the O&I Initiatives Manager at 210 292-3241.

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