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

2. 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

3. 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

4. ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE
****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.

5. ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE
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

6. ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE
UNDER NO CIRCUMSTANCES WILL THE CLERK PERFORMING THE ELIGIBILITY CHECK DENY THE REQUESTED CARE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
ONLY COMMAND DESIGNATED SUPERVISORY PERSONNEL CAN PERFORM THIS FUNCTION.

7. ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE
DEERS ELIGIBILITY OVERRIDES:
DD 1172: must present original copy used for DEERS enrollment.
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
New ID Card
Must be issued within previous 120 days
Ineligible Due to ID Card Expiration
Sponsors Entering AD for a Period of Greater than 30 Days

8. ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE
DEERS ELIGIBILITY OVERRIDES
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
Emergency Care
Sponsor’s Duty Station is OCONUS or has an FPO/APO address
Survivors

9. ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE
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

10. 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.

12. 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.

13. 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.

14. DENTAL CARE ELIGIBILITY
PRIORITY OF CARE: CAT 1A Active Duty CAT 1B Reserve/National Guard CAT 2 Family members of AD/Dead CAT 3 ROTC CAT 4 Retired members/family CAT 5 GS employees CAT 6 All others

15. THE ACRONYM DEERS STANDS FOR WHAT?
DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM

16. HOW MANY “DEERS ELIGIBILITY OVERRIDE” CODES ARE THERE?
NINE

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

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

19. NAVY MEDICINE’S QA PROGRAM
Used to evaluate the degree of excellence of care
Reflect what patients and providers expect of each other
BUMEDINST , Quality Assurance Program, lists required elements for process improvement

20. PATIENT RELATIONS AND COMMAND CONTACT PROGRAMS
Patient Relations Program
Implemented through BUMEDINST , Health Care Relations Program
Primary goal – provide assistance by intervention in and resolution of a patient’s complaints are problems
Patient 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.

21. 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
BUMEDINST
Established cases are reported at the central registry at BUMED where:
Statistics are compiled
Future assignments of established abusers is monitored and controlled.

22. DRUG AND ALCOHOL ABUSE PREVENTION AND CONTROL PROGRAM
Guidance provided by
OPNAVINST , Drug and Alcohol Abuse Prevention and Control
SECNAVINST , Military Substance Abuse Prevention and Control

23. PREVENTION DAPA (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

24. 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

25. CONTROL Competence 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.

26. PHYSICAL READINESS PROGRAM
Outlined in OPNAVINST 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

27. WHAT NAVY MEDICINE PROGRAM IS OUTLINED IN BUMEDINST 6010.13?
QUALITY ASSURANCE PROGRAM

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

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

30. WHAT FORM IS TO USED TO REQUEST FOR A COMPETENCY FOR DUTY EXAMINATION?
NAVMED 6120/1

31. ON THE NAVMED 6120/1, WHAT BLOCKS ARE COMPLETED BY THE COMMAND INTIATING THE REQUEST?
1 THROUGH 12

32. LEGAL IMPLICATIONS IN MEDICAL CARE

33. 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

34. 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!!!!

35. CONSENT REQUIREMENTS FOR MEDICAL TREATMENT
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

36. CONSENT REQUIREMENTS FOR MEDICAL TREATMENT
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

37. CONSENT REQUIREMENTS FOR MEDICAL TREATMENT
WHO 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”

38. CONSENT REQUIREMENTS FOR MEDICAL TREATMENT
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

39. CONSENT REQUIREMENTS FOR MEDICAL TREATMENT
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

40. CONSENT REQUIREMENTS FOR MEDICAL TREATMENT
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

41. 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

42. 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

43. RELEASE OF MEDICAL INFORMATION
There are two federal statutes:
Freedom of Information Act
Privacy ct of 1974

44. MEDICAL CONDITIONS AND LAW ENFORCMENT PERSONNEL

45. MEDICAL CONDITIONS LAW ENFORCEMENT PERSONNEL
DELIVERY OF A PATIENT UNDER WARRANT OF ARREST
Nonactive Duty Patients
Active Duty Patients
Consult a JAG officer
PRISONER 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

46. MEDICAL CONDITIONS LAW ENFORCEMENT PERSONNEL
SEXUAL ASSAULT AND RAPE
NAVMEDCOMINST (Management of Alleged or Suspected Sexual Assault and Rape Cases) provides guidance for:
Care
Evaluation
Medico-legal documentation
OPNAVINST (Sexual Assault Victim Intervention Program), and SECNAVINST , (Victim and Witness Program) provide guidance for the care and support of victimes

47. WHEN IS CONSENT NECESSARY BEFORE RENDERING ROUTINE TREATMENT?
ALWAYS!!!!!

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

49. FREEDOM ON INFORMATION ACT
WHAT TWO FEDERAL STATUTES ESTABLISH CRITERIA FOR COLLECTING, MAINTAINING, AND RELEASING MEDICAL TREATMENT RECORDS?
PRIVACY ACT
FREEDOM ON INFORMATION ACT

50. QUESTIONS??????