«U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Program Support Center Human Resources Service Division of Commissioned Personnel 5600 Fishers Lane, ...»
Officers whose duty station lies within the catchment area of an MTF must use that facility as their source of primary care. If stationed at an IHS facility which provides health care services to officers, that facility may serve as the source of primary care. If Medical Affairs Branch (MAB) has a contract in place near a duty station, officers are obligated to use that contractor as their source for primary care. Wearing of the uniform is always expected and usually required when reporting for care at an MTF.
Routine medical care up to $1,000 per fiscal year from civilian providers requires no prior approval for officers stationed outside a catchment area of an MTF.
In some areas, specialty and inpatient care in MTFs and IHS facilities or with MAB contractors is limited. In more remote areas, these sources of care are often unavailable. In all these cases, care may be supplemented through civilian providers and Department of Veterans Affairs facilities only with prior approval from MAB. Without prior authorization, officers can obtain only emergency care, or routine primary care under circumstances as specified in CCPM Pamphlet No. 65, “Information on Health Care Services for Active-Duty Officers of the Public Health Service and the National Oceanic and Atmospheric Administration.” Only MAB can authorize civilian care and commit funds for payment. If prior authorization from the MAB is not obtained for the recommended civilian care, the officer will become liable for the cost of that care.
C. PROCEDURES FOR OBTAINING SERVICESMAB is responsible for authorizing care for an officer by a civilian provider. Unless authorized, payment for the care will be the responsibility of the officer.
1. Data Required Every Time an Officer Calls MAB for Civilian Care Authorization:
When an officer presents for civilian care and the diagnosis and treatment are significantly different or the estimated cost is increased more than fifty dollars above what was originally reported, the officer should call a Patient Care Coordinator (PCC) in MAB, DCP, immediately for additional authorization and guidance.
2. Referrals for Civilian Medical Care:
Referrals for civilian medical care are often issued by MTFs and IHS facilities. An MTF generally issues a form DD2161 called a Referral for Civilian Care; the IHS issues a standard referral form. In all cases these forms only recommend civilian care, they do not authorize care. It is the officer's responsibility once a referral is issued to call MAB to obtain authorization for care.
3. Emergency Care:
An emergency requires immediate care and, therefore, does not require prior authorization.
However, all emergencies must be reported to a PCC by phoning (800) 368-2777 or (301) 594as soon as possible but not later than 72 hours after care has been received. MAB should be notified immediately if an officer is being admitted as an inpatient from the emergency room. Report emergencies after hours to the same phone number. Leave all necessary information (a-f) below on MAB's answering machine.
Routine dental care of up to $1,000 per fiscal year from civilian providers requires no prior approval for officers stationed outside the catchment area of an MTF, MAB contractor, or IHS facility offering dental care to officers. All non-routine dental care from civilian providers requires prior approval from MAB and always involves presentation of formal treatment plan by the dentist provided to MAB's Chief Dental Consultant for review and approval or referral back to a MTF.
Officers will utilize an MTF or MAB contractor when travel takes them within the catchment areas of such facilities. When these facilities are not available, officers must obtain prior authorization for services from local civilian providers by calling a PCC on (800) 368-2777.
When outside the U.S., officers will utilize an MTF when available. Otherwise, care may be obtained from local sources but must be paid for by the officer. Reimbursement will be made by MAB. Officers should get the medical records translated into English and should document the currency exchange rate for the date of service.
The following services have very specific authorization requirements and limitations: physical therapy, prosthetic/orthopedic devices, allergy testing, psychiatric care, temporomandibular joint (TMJ) treatment, dental implants, and experimental care. Note: This is not an exhaustive list, and there are benefit limitations and restrictions. Contact MAB for additional information before attempting to obtain these services.
8. Health Benefit Restrictions:
The following services currently are not entitlements: cosmetic surgery, contact lenses, abortions, sterilizations, fertility studies and treatment, chiropractic services, acupuncture, sports medicine, eyeglasses from civilian sources, and orthodontic services. While the above noted services are restricted in the private sector, they may be obtained from an MTF when available.
Payment of bills for health care services provided to officers is made as follows:
Civilian Provider Bills: Medical records pertaining to claims (bills) are required for all non-routine care including emergency care, specialty evaluations, and inpatient admissions. Copies of pertinent medical
records and itemized bills should be sent to:
(Note: Records sent to MAB are automatically forwarded to the Medical Evaluations Staff once claims (bills) have been processed. Therefore, it is not necessary to send duplicates of these records to the Medical Evaluations Staff unless time is a critical factor.) Records received by MAB are stored in the officer's central medical file.
When submitting bills to MAB for payment, officers are required to request that providers forward copies of medical records associated with the services. Failure to provide required medical records will delay payment of bills. In addition, officers are required to forward to the Medical Evaluations Staff any medical records concerning care of illnesses or injuries paid for by the officer and for which the officer does not plan to seek reimbursement.
E. THIRD PARTY LIABILITYIf an officer is injured as a result of action involving a third party, a report must be filed by the officer with a PCC to protect the government's interest and permit recovery of any costs due the government.
Medical records not pertaining to a claim (bill):
Copies of pertinent medical records not pertaining to a claim (bill) for services should be sent marked "medical confidential" to the Division of Commissioned Personnel/HRS/PSC, ATTN: Medical Evaluations Staff/MAB, Room 4C-06, 5600 Fishers Lane, Rockville, MD 20857-0001, for the following
1. Documentation of service acquired or aggravated medical condition(s) for which a claim for the VA benefits may be filed just prior to separation or retirement.
G. HEALTH CARE FOR JRCOSTEP OFFICERSPolicies and procedures pertaining to medical services for Junior Commissioned Officer Student Training and Extern Program (JRCOSTEP) officers are different from other active-duty officers of the PHS. Care for JRCOSTEP officers is limited to emergency care. Only emergency care will be authorized from civilian sources. Other emergency care may be obtained from an MTF on a spaceavailable basis.
H. FAMILY MEMBERSFamily members are entitled to health care from an MTF on a space available basis. Most outpatient routine care may be obtained from a civilian provider and reimbursed by the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). To insure dependent eligibility, the officer must confirm that his/her dependents are enrolled in DEERS. The DEERS office in DCP may be reached at (301) 594-3384. NOTE: The military health care system is changing to TRICARE.
TRICARE information may be obtained at local MTFs of MAB.
Dependents dental care can be provided by voluntary enrollment in the Family Member Dental Plan.
Contact Compensation Branch, DCP, (301) 594-2963 for enrollment information and forms. Contact MAB to discuss plan benefits.
I. APPEALS - STARTING THE PROCESSThere is an appeals process for denied claims. Refer to CCPM Pamphlet No. 65 or contact MAB for advice and guidance.
J. REFERENCES AND INFORMATION SOURCESReferences: The following resource material is provided to all active-duty officers upon call to active
CCPM Pamphlet No. 65, “Information on Health Care Services for Active-Duty Officers of the Public Health Service and the National Oceanic and Atmospheric Administration”
A. INTRODUCTIONEach officer should take the time to become familiar with the published Standards of Conduct which apply to all Federal personnel, including commissioned officers. Every year all active-duty officers receive a synopsis of the Standards of Conduct to remind them of their responsibilities, and to inform them of any changes from the previous year. The Commissioned Corps Bulletin also carries articles on the Standards of Conduct. It is the individual officer's responsibility to know and abide by these standards.
Federal personnel must have high standards of integrity, honesty, and impartiality in order to perform government business properly and to earn and maintain the confidence of citizens.
These standards are expressed in a variety of statutory and regulatory forms. Active-duty PHS commissioned officers are expected to abide by all applicable standards at all times. Even the appearance of infraction may cause an officer to be held accountable as if there were an actual violation of the standards.
Violations, both apparent and real, have been the basis of administrative and disciplinary reviews. Substantiated violations are followed by specific disciplinary action.
There has not been a widespread problem among Federal personnel in general or Corps officers in particular. Apart from rare cases of willful violation of standards, most other situations appear to arise from unfamiliarity with ethical responsibilities. This is a review, providing general instruction and guidance. An officer must become familiar with other rules that apply to his/her specific employment or personal situation.
2. To Whom Does This Apply?
All commissioned officers on active duty are covered by specific standards of conduct. These include regulations issued by the HHS on Standards of Conduct, as provided by the CCPM, INSTRUCTION 1, Subchapter CC26.1, CCPM, and the Supplemental Standards of Ethical Conduct for employees of HHS. Several OPDIVs, most noticeably the Food and Drug Administration, have established additional standards that apply to officers assigned to their programs. Corps officers must comply with such additional requirements. These responsibilities also apply to officers assigned to billets outside of HHS. Officers assigned outside of HHS must also comply with all additional standards established by that organization.
In addition to competence, an officer's behavior must reflect the highest degree of integrity and impartiality. Officers must avoid conflicts of private interests with public duties and responsibilities. Officers must not engage in any conduct prejudicial to the government.