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

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Presentation on theme: "HEALTHCARE ADMINISTRATION CHAPTER 3 OF THE HOSPITAL CORPSMAN MANUAL NAVEDTRA 14295A HM1 VIDAL."— Presentation transcript:

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: 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 Expiration 5.Sponsors Entering AD for a Period of Greater than 30 Days

8 ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE DEERS ELIGIBILITY OVERRIDES 6.Newborns Newborns will not be denied care up to 60 days following birth. If not enrolled by the 61 st day, newborn will shift to Tricare Standardd 7.Emergency Care 8.Sponsor’s Duty Station is OCONUS or has an FPO/APO address 9.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.

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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 ? QUALITY ASSURANCE PROGRAM

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

29 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: 1. Freedom of Information Act 2. 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. FALSE

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

50 QUESTIONS??????


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