[Title 32 CFR 728]
[Code of Federal Regulations (annual edition) - July 1, 2002 Edition]
[Title 32 - NATIONAL DEFENSE]
[Subtitle A - Department of Defense (Continued)]
[Chapter Vi - DEPARTMENT OF THE NAVY]
[Subchapter C - PERSONNEL]
[Part 728 - MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES]
[From the U.S. Government Printing Office]
32NATIONAL DEFENSE52002-07-012002-07-01falseMEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES728PART 728NATIONAL DEFENSEDepartment of Defense (Continued)DEPARTMENT OF THE NAVYPERSONNEL
PART 728--MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES--Table of Contents
Subpart A--General
Sec.
728.1 Mission of Navy Medical Department facilities.
728.2 Definitions.
728.3 General restrictions and priorities.
728.4 Policies.
Subpart B--Members of the Uniformed Services on Active Duty
728.11 Eligible beneficiaries.
728.12 Extent of care.
728.13 Application for care.
728.14 Pay patients.
Subpart C--Members of Reserve Components, Reserve Officers' Training
Corps, Navy and Marine Corps Officer Candidate Programs, and National
Guard Personnel
728.21 Navy and Marine Corps reservists.
728.22 Members of other reserve components of the uniformed services.
728.23 Reserve Officers' Training Corps (ROTC).
728.24 Navy and Marine Corps Officer Candidate Programs.
728.25 Army and Air Force National Guard personnel.
Subpart D--Retired Members and Dependents of the Uniformed Services
728.31 Eligible beneficiaries and health benefits authorized.
728.32 Application for care.
728.33 Nonavailability statement (DD 1251).
728.34 Care beyond the capabilities of a naval MTF.
728.35 Coordination of benefits--third party payers.
728.36 Pay patients.
Subpart E--Members of Foreign Military Services and Their Dependents
728.41 General provisions.
728.42 NATO.
728.43 Members of other foreign military services and their dependents.
728.44 Members of security assistance training programs, foreign
military sales, and their ITO authorized dependents.
728.45 Civilian components (employees of foreign military services) and
their dependents.
728.46 Charges and collection.
Subpart F--Beneficiaries of Other Federal Agencies
728.51 General provisions--the ``Economy Act.''
728.52 Veterans Administration beneficiaries (VAB).
728.53 Department of Labor, Office of Workers' Compensation Programs
(OWCP) beneficiaries.
728.54 U.S. Public Health Service (USPHS), other than members of the
uniformed services.
728.55 Department of Justice beneficiaries.
728.56 Treasury Department beneficiaries.
728.57 Department of State and associated agencies.
728.58 Federal Aviation Agency (FAA) beneficiaries.
728.59 Peace Corps beneficiaries.
728.60 Job Corps and Volunteers in Service to America (VISTA)
beneficiaries.
728.61 Medicare beneficiaries.
Subpart G--Other Persons
728.71 Ex-service maternity care.
728.72 Applicants for enrollment in the Senior Reserve Officers'
Training Program.
728.73 Applicants for enlistment or reenlistment in the Armed Forces,
and applicants for enlistment in the reserve components.
728.74 Applicants for appointment in the regular Navy or Marine Corps
and reserve components, including members of the reserve
components who apply for active duty.
728.75 Applicants for cadetship at service academies and applicants for
the Uniformed Services University of Health Sciences (USUHS).
728.76 Naval Home residents.
728.77 Secretarial designees.
728.78 American Red Cross representatives and their dependents.
728.79 Employees of Federal contractors and subcontractors.
728.80 U.S. Government employees.
728.81 Other civilians.
728.82 Individuals whose military records are being considered for
correction.
728.83 Persons in military custody and nonmilitary Federal prisoners.
Subpart H--Adjuncts to Medical Care
728.91 General.
728.92 Policy.
728.93 Chart of adjuncts.
Subpart I--Reservists--Continued Treatment, Return to Limited Duty,
Separation, or Retirement for Physical Disability
728.101 General.
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728.102 Care from other than Federal sources.
Subpart J--Initiating Collection Action on Pay Patients
728.111 General.
728.112 Responsibilities.
728.113 Categories of pay patients.
Authority: 5 U.S.C. 301 and 8101; 10 U.S.C. 1071-1095, 1201-1221,
2104, 2107, 2109, 2110, 5031, 5537, 6011, 6201-6203; 22 U.S.C. 1158,
2357, 2504, 2505, 2507, 2522; 24 U.S.C. 15, 34, 35; 31 U.S.C. 1535; 42
U.S.C. 249, 253; and 32 CFR 700.1202.
Source: 52 FR 33718, Sept. 4, 1987, unless otherwise noted.
Subpart A--General
Sec. 728.1 Mission of Navy Medical Department facilities.
The primary mission of Navy Medical Department facilities is to
provide medical and dental care for members of the Navy and Marine Corps
and for members of the other uniformed services who may be sick,
injured, or disabled. In addition, Navy Medical Department facilities
may provide medical and dental care to dependents of military personnel,
to members not on active duty, and to such other persons as authorized
by law, U.S. Navy regulations, and Department of Defense directives.
These authorizations also provide that Navy Medical Department
facilities may be called upon to furnish medical and dental care, under
laws of humanity or principles of international courtesy, to civilians
and to other persons not otherwise entitled to medical and dental care.
Sec. 728.2 Definitions.
Unless otherwise qualified in this part, the following terms, when
used throughout, are defined as follows:
(a) Active duty. Full-time duty in the active military service of
the United States. This includes full-time training duty; annual
training duty; and attendance, while in the active military service, at
a school designated as a service school by law or by the Secretary of
the military department concerned. It does not include full-time
National Guard duty.
(b) Active duty for training. A tour of active duty for reserves for
training under orders that provide for automatic reversion to non-active
status when the specified period of active duty is completed. It
includes annual training, special tours, and the initial tour performed
by enlistees without prior military service.
(c) CHAMPUS. Civilian Health and Medical Program of the Uniformed
Services.
(d) Catchment area. A specified geographic area surrounding each
Uniformed Services Medical Treatment Facility (USMTF) or designated
Uniformed Services Treatment Facility (USTF). In the United States,
catchment areas are defined by zip codes and are based on an area of
approximately 40 miles in radius for inpatient care and 20 miles in
radius for ambulatory care. Zip codes designating such areas in the
United States are specified in Volumes I and II of the Military Health
Services System (MHSS) Catchment Area Directory. Catchment areas for
facilities outside the United States are defined in Volume III of the
MHSS Catchment Area Directory. These directories exclude certain areas
because of geographic barriers.
(e) Chronic condition. Any medical or surgical condition marked by
long duration or frequent recurrence--or likely to be so marked--which,
in light of medical information available, will ordinarily resist
efforts to eradicate it completely; a condition which needs health
benefits to achieve or maintain stability that can be provided safely
only by, or under the supervision of, physicians, nurses, or persons
authorized by physicians.
(f) Civilian employee. Under 5 U.S.C. 2105, a nonmilitary individual
(1) appointed in the civil service, (2) engaged in the performance of a
Federal function, or (3) engaged in the performance of his or her duties
while subject to the supervision of The President, a Member or Members
of Congress, or the Congress, a member of a uniformed service, an
individual who is an employee under 5 U.S.C. 2105, the head of a
Government controlled corporation, or an adjutant general designated by
the Secretary concerned under section 709c of title 32. Included are
justices and judges of the United States, appointed and engaging
[[Page 286]]
in the performance of duties per 5 U.S.C. 2104.
(g) Cooperative care. Medical services and supplies for which
CHAMPUS will share in the cost under circumstances specified in
Sec. 728.4(z), even though the patient remains under the primary control
of a USMTF.
(h) Cooperative care coordinator. Designated individual in a CHAMPUS
contractor's office who serves as the point of contact for health
benefits advisors on all matters related to supplemental-cooperative
care or services provided or ordered for CHAMPUS-eligible beneficiaries
by USMTF providers.
(i) Dental care. Treatment which will prevent or remedy diseases,
disabilities, and injuries to the teeth, jaws, and related structures
and thereby contribute to maintenance or restoration of the dental
health of an individual.
(j) Dependent. A spouse, an unremarried widow or widower, a child,
or a parent who bears that legal relationship to his or her sponsor. For
the purpose of rendering care under title 10, U.S.C., chapter 55, this
category may also include an unremarried former spouse. However, each
beneficiary must also meet the eligibility criteria in Sec. 728.31(b)
and Sec. 728.31(c).
(k) Designated USTFs. The following former U.S. Public Health
Service (USPHS) facilities operate as ``designated USTFs'' for the
purpose of rendering medical and dental care to active duty members and
to all CHAMPUS-eligible individuals.
(1) Sisters of Charity of the Incarnate Word Health Care System,
6400 Lawndale, Houston, TX 77058 (713) 928-2931 operates the following
facilities:
(i) St. John Hospital, 2050 Space Park Drive, Nassau Bay, TX 77058,
telephone (713) 333-5503. Inpatient and outpatient services.
(ii) St. Mary's Hospital Outpatient Clinic, 404 St. Mary's
Boulevard, Galveston, TX 77550, telephone (409) 763-5301. Outpatient
services only.
(iii) St. Joseph Hospital Ambulatory Care Center, 1919 La Branch,
Houston, TX 77002, telephone (713) 757-1000. Outpatient services only.
(iv) St. Mary's Hospital Ambulatory Care Center, 3600 Gates
Boulevard, Port Arthur, TX 77640 (409) 985-7431. Outpatient services
only.
(2) Inpatient and outpatient services. (i) Wyman Park Health System,
Inc., 3100 Wyman Park Drive, Baltimore, MD 21211, telephone (301) 338-
3693.
(ii) Alston-Brighton Aid and Health Group, Inc., Brighton Marine
Public Health Center, 77 Warren Street, Boston, MA 02135, telephone
(617) 782-3400.
(iii) Bayley Seton Hospital, Bay Street and Vanderbilt Avenue,
Staten Island, NY 10304, telephone (718) 390-5547 or 6007.
(iv) Pacific Medical Center, 1200 12th Avenue South, Seattle, WA
98144, telephone (206) 326-4100.
(3) Outpatient services only. (i) Coastal Health Service, 331
Veranda Street, Portland, ME 04103, telephone (207) 774-5805.
(ii) Lutheran Medical Center, Downtown Health Care Services, 1313
Superior Avenue, Cleveland, OH 44113, telephone (216) 363-2065.
(l) Disability retirement or separation. Temporary or permanent
retirement or separation for physical disability as provided in title
10, U.S.C., 1201-1221.
(m) Elective care. Medical, surgical, or dental care desired or
requested by the individual or recommended by the physician or dentist
which, in the opinion of other cognizant professional authority, can be
performed at another place or time without jeopardizing life, limb,
health, or well-being of the patient, e.g., surgery for cosmetic
purposes and nonessential dental prosthetic appliances.
(n) Emergency care. Medical treatment of patients with severe, life-
threatening, or potentially disabling conditions that require immediate
intervention to prevent undue suffering or loss of life or limb and
dental treatment of painful or acute conditions.
(o) Health benefits advisors (HBA). Designated individuals at naval
facilities who are responsible for advising and assisting beneficiaries
covered in this part concerning medica1 and dental benefits in uniformed
services facilities and under CHAMPUS. They also provide information
regarding Veterans' Administration, Medicare, MEDICAID, and such other
local health programs known to be available to beneficiaries (see
Sec. 728.4(n)).
(p) Hospitalization. Inpatient care in a medical treatment facility.
[[Page 287]]
(q) Inactive duty training. Duty prescribed for Reserves by the
Secretary concerned under section 206 of title 37, U.S.C. or any other
provision of law. Also includes special additional duties authorized for
Reserves by an authority designated by the Secretary concerned and
performed on a voluntary basis in connection with the prescribed
training or maintenance activities of the units to which they are
assigned. It includes those duties when performed by Reserves in their
status as members of the National Guard.
(r) Legitimate care. Those medical and dental services under the
cooperative/supplemental care program of CHAMPUS that are legally
performed and not contrary to governing statutes.
(s) Maximum hospital benefit. That point during inpatient treatment
when the patient's progress appears to have stabilized and it can be
anticipated that additional hospitalization will not directly contribute
to any further substantial recovery. A patient who will continue to
improve slowly over a long period without specific therapy or medical
supervision, or with only a moderate amount of treatment on an
outpatient basis, may be considered as having attained maximum hospital
benefit.
(t) Medical care. Treatment required to maintain or restore the
health of an individual. Medical care may include, but is not limited
to, the furnishing of inpatient treatment, outpatient treatment, nursing
service, medical examinations, immunizations, drugs, subsistence,
transportation, and other adjuncts such as prosthetic devices,
spectacles, hearing aids, orthopedic footwear, and other medically
indicated appliances or services.
(u) Medically inappropriate. A situation arising when denial of a
Nonavailability Statement could result in significant risk to the health
of a patient or significant limitation to the patient's reasonable
access to needed health care.
(v) Medically necessary. The level of services and supplies (i.e.,
frequency, extent, and kinds) adequate for the diagnosis and treatment
of illness or injury, including maternity care. Medically necessary,
includes the concept of appropriate medical care.
(w) Medical treatment facility (MTF). Any duly authorized medical
department center, hospital, clinic, or other facility that provides
medical, surgical, or dental care.
(x) Member or former member. Includes:
(1) Members of the uniformed services ordered to active duty for
more than 30 days.
(2) Retired members as defined in Sec. 728.2(bb).
(3) Members of a uniformed service ordered to active duty for more
than 30 days who died while on that duty.
(4) Deceased retired members.
(y) Military patient. A member of a United States uniformed service
on active duty, active duty for training, or inactive duty training, or
an active duty member of the armed forces of a foreign government who is
receiving inpatient or outpatient care.
(z) Occupational health services. Includes medical examinations and
tests related to preemployment, preplacement, periodic, and
pretermination; tests required for protecting the health and safety of
naval personnel; job-related immunizations and chemoprophylaxis;
education and training related to occupational health; and other
services provided to avoid lost time or to improve effectiveness of
employees. The latter will include the furnishing of emergency treatment
of illnesses or injuries occurring at work. Furnish such health services
to both active duty military personnel and naval civilian employees per
current directives.
(aa) Retired member. A member or former member of a uniformed
service who is entitled to retired or retainer pay, or equivalent pay,
as a result of service in a uniformed service. This includes a member or
former member who is: (1) Retired for length of service; (2) permanently
or temporarily retired for physical disability; (3) on the emergency
officers' retired list and is entitled to retired pay for physical
disability; or (4) otherwise in receipt of retired pay under chapter 67
of title 10.
(bb) Routine care. Medica1 and dental care necessary to maintain
health or dental functions other than care of an emergency or elective
nature.
(cc) Supplemental care or services. When medical or dental
management is
[[Page 288]]
retained by a naval MTF and required care is not available at the
facility retaining management, any additional material, professional
diagnostic or consultative services, or other personal services ordered
by qualified uniformed service providers, and obtained for the care of
that patient are supplemental. See Sec. 728.12 concerning the management
of active duty member patients.
(dd) Uniformed services. The Navy, Marine Corps, Air Force, Army,
Coast Guard, Commissioned Corps of the Public Health Service, and the
Commissioned Corps of the National Oceanic and Atmospheric
Administration.
(ee) USMTF. Uniformed services medical treatment facility.
(ff) Visit, outpatient. Appearance by an eligible beneficiary at a
separate, organized clinic or specialty service for: Examination,
diagnosis, treatment, evaluation, consultation, counseling, or medical
advice; or treatment of an eligible beneficiary in quarters; and a
signed and dated entry is made in the patient's health record.
Specifically excluded are personnel in an inpatient status at the time
of such a visit.
Sec. 728.3 General restrictions and priorities.
(a) Restrictions. (1) Naval MTFs provide care to all eligible
beneficiaries subject to the capabilities of the professional staff and
the availability of space and facilities.
(2) Hospitalization and outpatient services may be provided outside
the continental limits of the United States and in Alaska to officers
and employees of any department or agency of the Federal Government, to
employees of a contractor with the United States or the contractor's
subcontractor, to accompanying dependents of such persons, and in
emergencies to such other persons as the Secretary of the Navy may
prescribe: Provided, such services are not otherwise available in
reasonably accessible and appropriate non-Federal facilities.
Hospitalization of such individuals in a naval MTF is limited to the
treatment of acute medical and surgical conditions, exclusive of
nervous, mental, or contagious diseases, or those requiring domiciliary
care. Routine dental care, other than dental prosthesis or orthodontia,
may be rendered on a space available basis outside the continental
limits of the United States and in Alaska, Provided, such services are
not otherwise available in reasonably accessible and appropriate non-
Federal facilities.
(b) Priorities. When care cannot be rendered to all eligible
beneficiaries, the priorities in the following chart will prevail. Make
no distinction as to the sponsoring uniformed service when providing
care or deciding priorities.
Priorities for the Various Categories of Personnel Eligible for Care in Navy Medical Department Facilities
----------------------------------------------------------------------------------------------------------------
Priority Category Degree of entitlement
----------------------------------------------------------------------------------------------------------------
1...................................... A. Members of the uniformed See subpart B.
services on active duty (including
active duty for training and
inactive duty training) and
comparable personnel of the NATO
nations meeting the conditions
prescribed in this part.
B. Members of a Reserve Component See subpart C.
of the Armed Forces and National
Guard personnel under orders.
2...................................... Dependents of active duty members See subparts D and E.
of the uniformed services,
dependents of persons who died
while in such a status, and the
dependents of active duty members
of NATO nations meeting the
conditions prescribed in subpart E
of this part.
3...................................... Members ot the Senior Reserve See Sec. 728.23.
Officers' Training Corps of the
Armed Forces.
4...................................... Retired members of the uniformed See subpart D.
services and their dependents and
dependents of deceased retired
members.
5...................................... Civilian employees of the Federal See Sec. 728.80.
Government under the limited
circumstances covered by the
Federal Employees' Health Service
program.
6...................................... All others, including ex-service See subparts F and G.
maternity eligibles.
----------------------------------------------------------------------------------------------------------------
[[Page 289]]
Sec. 728.4 Policies.
(a) Admissions to closed psychiatric wards. Admit patients to closed
psychiatric wards only when they have a psychiatric or emotional
disorder which renders them dangerous to themselves or others, or when a
period of careful closed psychiatric observation is necessary to
determine whether such a condition exists. When a patient is admitted to
a closed psychiatric ward, the reason for admission must be clearly
stated in the patient's clinical record by the physician admitting the
patient to the ward. These same policies apply equally in those
instances when it becomes necessary to place a patient under constant
surveillance while in an open ward.
(b) Absence from the sick list. See Sec. 728.4 (d), (x), and (y).
(c) Charges and collection. Charges for services rendered vary and
are set by the Office of the Assistant Secretary of Defense
(Comptroller) and published in a yearly NAVMEDCOMNOTE 6320, (Cost
elements of medical, dental, subsistence rates, and hospitalization
bills). Billing and collection actions also vary according to
entitlement or eligibility and are governed by the provisions of NAVMED
P-5020, Resource Management Handbook. See subpart J on the initiation of
collection action on pay patients.
(d) Convalescent leave. Convalescent leave, a period of authorized
absence of active duty members under medical care when such persons are
not yet fit for duty, may be granted by a member's commanding officer
(CO) or the hospital's CO per the following:
(1) Unless otherwise indicated, grant such leave only when
recommended by COMNAVMEDCOM through action taken upon a report by a
medical board, or the recommended findings of a physical evaluation
board or higher authority.
(2) Member's commanding officer (upon advice of attending
physician); commanding officers of Navy, Army, or Air Force medical
facilities; commanders of regional medical commands for persons
hospitalized in designated USTFs or in civilian facilities within their
respective areas of authority; and managers of Veterans Administration
hospitals within the 50 United States or in puerto Rico may grant
convalescent leave to active duty naval patients, with or without
reference to a medical board, physical evaluation board, or higher
authority provided the:
(i) Convalescent leave is being granted subsequent to a period of
hospitalization.
(ii) Member is not awaiting disciplinary action or separation from
the service for medical or administrative reasons.
(iii) Medical officer in charge:
(A) Considers the convalescent leave beneficial to the patient's
health.
(B) Certifies that the patient is not fit for duty, will not need
hospital treatment during the contemplated convalescent leave period,
and that such leave will not delay final disposition of the patient.
(3) When considered necessary by the attending physician and
approved on an individual basis by the commander of the respective
geographic regional medical command, convalescent leave in excess of 30
days may be granted. The authority to grant convalescent leave in excess
of 30 days may not be redelegated to hospital commanding officers.
Member's permanent command must be notified of such extensions (see
MILPERSMAN 3020360).
(4) Exercise care in granting convalescent leave to limit the
duration of such leave to that which is essential in relation to
diagnosis, prognosis, estimated duration of treatment, and patient's
probable final disposition.
(5) Upon return from convalescent leave;
(i) Forward one copy of original orders of officers, bearing all
endorsements, to the Commander, Naval Military Personnel Command
(COMNAVMILPERSCOM) (NMPC-4) or the Commandant of the Marine Corps (CMC),
as appropriate.
(ii) Make an entry on the administrative remarks page (page 13 for
Navy personnel) of the service records of enlisted personnel indicating
that convalescent leave was granted and the dates of departure and
return.
(6) lf considered beneficial to the patient's health, commanding
officers of hospitals may grant convalescent leave
[[Page 290]]
as a delay in reporting back to the parent command.
(e) Cosmetic surgery. (1) Defined as that surgery which is done to
revise or change the texture, configuration, or relationship of
contiguous structures of any feature of the human body which would be
considered by the average prudent observer to be within the broad range
of ``normal'' and acceptable variation for age or ethnic origin, and in
addition, is performed for a condition which is judged by competent
medical opinion to be without potential for jeopardy to physical or
mental health of an individual.
(2) Commanding officers will monitor, control, and assure compliance
with the following cosmetic surgery policy:
(i) Certain cosmetic procedures are a necessary part of training and
retention of skills to meet the requirements of certification and
recertification.
(ii) Insofar as they meet minimum requirements and serve to improve
the skills and techniques needed for reconstructive surgery, the
following cosmetic procedures may be performed as low priority surgery
on active duty members only when time and space are available.
(A) Cosmetic facial rhytidectomies (face lifts) will be a part of
all training programs required by certifying boards.
(B) Cosmetic augmentation mammaplasties will be done only by
properly credentialed surgeons and residents within surgical training
programs to meet requirements of certifying boards.
(f) Cross-utilization of uniformed services facilities. To provide
effective cross-utilization of medical and dental facilities of the
uniformed services, eligible persons, regardless of service affiliation,
will be given equal opportunity for health benefits. Catchment areas
have been established by the Department of Defense for each USMTF (see
Sec. 728.2(d)). Eligible beneficiaries residing within such a catchment
area are expected to use that inpatient facility for care. Make
provisions to assure that:
(1) Eligible beneficiaries residing in a catchment area served by a
USMTF not of the sponsor's own service may obtain care at that facility
or at a facility of the sponsor's service located in another catchment
area.
(2) If the facility to which an eligible beneficiary applies cannot
furnish needed care, the other facility or facilities in overlapping
catchment areas are contacted to determine whether care can be provided
thereat.
(g) Disengagement. Discontinuance of medical management by a naval
MTF for only a specific episode of care.
(1) General. Disengagement is accomplished only after alternative
sources of care (i.e., transfer to another USMTF, a USTF, or other
Federal source via the aeromedical evacuation system, if appropriate)
and attendant costs, if applicable, have been fully explained to patient
or responsible family member. Counselors may arrange for counseling by
other appropriate sources when the patient is or may be eligible for VA,
Medicare, MEDICAID, etc. benefits. With the individual's permission,
counselors may also contact State programs, local health organizations,
or health foundations to determine if care is available for the
condition upon which disengagement is based. After the disengagement
decision is made, the patient to be disengaged or the responsible family
member should be advised to return to the naval MTF for any care
required subsequent to receiving the care that necessitated
disengagement.
(2) CHAMPUS-eligible individuals. (i) Issue a Nonavailability
Statement (DD 1251) per Sec. 728.33, when appropriate, to patients
released to civilian sources for total care (disengaged) under CHAMPUS.
CHAMPUS-eligible patients disengaged for total care, who do not
otherwise require a DD 1251 (released for outpatient care or those
released whose residence is outside the inpatient catchment area of all
USMTFs and USTFs) will be given the original of a properly completed DD
2161, Referral For Civilian Medical Care, which clearly indicates that
the patient is released for total care under CHAMPUS. CHAMPUS-eligible
beneficiaries will be disengaged for services under CHAMPUS when:
(A) Required services are beyond your capability and these services
cannot be appropriately provided through
[[Page 291]]
one of the alternatives listed in Sec. 728.4(z), or
(B) You cannot effectively provide required services or manage the
overall course of care even if augmented by services procured from other
Government or civilian sources using naval MTF operation and maintenance
funds as authorized in subpart Sec. 728.4(z).
(ii) When a decision is made to disengage a CHAMPUS-eligible
individual, commanding officers (CO) or officers-in-charge (OIC) are
responsible for assuring that counseling and documentation of counseling
are appropriately accomplished. Complete a NAVMED 6320/30. Disengagement
for Civilian Medical Care, to document that all appropriate
disengagement procedures have been accomplished.
(iii) After obtaining the signature of the patient or responsible
family member, the counselor will file a copy of the DD 2161 and the
original of the NAVMED 6320/30 in the patient's Health Record.
(3) Patients other than active duty or CHAMPUS-eligible individuals-
-(i) Categories of patients. The following are categories of individuals
who also may be disengaged:
(A) Medicare-eligible individuals.
(B) MEDICAID-eligible individuals.
(C) Civilians (U.S. and foreign) admitted or treated as civilian
humanitarians.
(D) Secretarial designees.
(E) All other individuals, with or without private insurance, who
are not eligible for care at the expense of the Government.
(ii) Disengagement decision. Disengage such individuals when:
(A) Required services are beyond the capability of the MTF, and
services necessary for continued treatment in the MTF cannot be
appropriately provided by another USMTF, a USTF, or another Federal
source. (Explore alternative sources, for individuals eligible for care
from these sources, before making the disengagement decision.)
(B) The MTF cannot, within the facility's capability, effectively
provide required care or manage the overall course of treatment even if
augmented by services procured from other Government sources or through
procurement from civilian sources using supplemental care funding.
(iii) Counseling. The initial step in the disengagement process is
appropriate counseling and documentation. In an emergency, or when the
individual cannot be appropriately counseled prior to leaving the MTF,
establish procedures to ensure counseling and documentation are
accomplished during the next working day. Such ``follow-up'' counseling
may be in person or via a witnessed telephone conversation. In either
instance, the counselor will document counseling on a NAVMED 6320/30,
Disengagement for Civilian Medical Care. The disengagement decision
making authority must assure the accomplishment of counseling by
personally initiating this service or by referring the patient or
responsible family member to the HBA for counseling. As a minimum,
counseling will consist of:
(A) Explaining that the patient is being disengaged from treatment
at the facility and the reason therefor. Assure that the individual
understands the meaning of ``disengagement'' by explaining that the MTF
is unable to provide for the patient's present needs and must therefore
relinquish medical management of the patient to a health care provider
of the individual's choice.
(B) Assuring the individual that the disengagement action is taken
to provide for the patient's immediate medical needs. Also assure that
the individual understands that the disengagement is not indicative of
whether care is or will be available in the MTF for other aspects of
past, current, or future medical conditions.
(C) Explaining Medicare, MEDICAID, or other known programs as they
relate to the particular circumstance of the patient, including cost-
sharing, deductibles, allowable charges, participating and authorized
providers, physicians accepting assignment, claim filing procedures,
etc. Explain that once disengagement is accomplished, the Navy, is not
responsible for any costs for care received from a health care provider
of the patient's or responsible family member's choice.
(iv) Documentation. Commanding officers are responsible for ensuring
that proper documentation procedures are
[[Page 292]]
started and that providers and counselors under their commands are
apprised of their individual responsibilities for counseling and
documenting each disengagement. Failure to properly counsel and document
counseling may result in the naval MTF having to absorb the cost of the
entire episode of care. Document counseling on a NAVMED 6320/30.
Disengagement for Civilian Medical Care. Completion of all items on the
form assures documentation and written acknowledgement of appropriate
disengagement and counseling. If the patient or responsible family
member refuses to acknowledge receipt of counseling by signing the form,
state this fact on the bottom of the form and have it witnessed by an
officer. Give the patient or responsible family member a copy and
immediately file the original in the patient's Health Record.
(4) Active duty members. When an active duty member seeks care at a
USMTF, that USMTF retains some responsibility (e.g., notification,
medical cognizance, supplemental care, etc.) for that member even when
the member must be transferred to another facility for care. Therefore,
relinquishment of total management of an active duty member
(disengagement) cannot be accomplished.
(h) Domiciliary/custodial care. The type of care designed
essentially to assist an individual in meeting the normal activities of
daily living, i.e., services which constitute personal care such as help
in walking and getting in or out of bed, help in bathing, dressing,
feeding, preparation of special diets, and supervision over medications
which can usually be self-administered and which does not entail or
require the continuing attention of trained medical or paramedical
personnel. The essential characteristics to be considered are the level
of care and medical supervision that the patient requires, rather than
such factors as diagnosis, type of condition, or the degree of
functional limitation. Such care will not be provided in naval MTFs
except when required for active duty members of the uniformed services.
(i) Emergency care. Treat patients authorized only emergency care
and those admitted as civilian emergencies only during the period of the
emergency. Initiate action to effect appropriate disposition of such
patients as soon as the emergency period ends.
(j) Evaluation after admission. Evaluate each patient as soon as
possible after admission and continue reevaluation until disposition is
made. Anticipate each patient's probable type and date of disposition.
Necessary processing by the various medical and administrative entities
will take place concurrently with treatment of the patient. Make the
medical disposition decision as early as possible for U.S. military
patients inasmuch as immediate transfer to a specialized VA center or to
a VA spinal cord injury center may be in their best interest (see
NAVMEDCOMINST 6320.1.2). Make disposition decisions for military
personnel of NATO nations in conformance with Sec. 728.42(d).
(k) Extent of care. Subject to the restrictions and priorities in
Sec. 728.3, eligible persons will be provided medical and dental care to
the extent authorized, required, and available. When an individual is
accepted for care, all care and adjuncts thereto, such as nonstandard
supplies, as determined by the CO to be necessary, will be provided from
resources available to the CO unless specifically prohibited elsewhere
in this part. When a patient has been accepted and required care is
beyond the capability of the accepting MTF, the CO thereof will arrange
for the required care by one of the means shown below. The method of
choice will be based upon professional considerations and travel
economy.
(1) Transfer the patient per Sec. 728.4(bb).
(2) Procure from civilian sources the necessary material or
professional personal services required for the patient's proper care
and treatment.
(3) Care authorized in Sec. 728.4(k)(2) will normally be
accomplished in the naval MTF. However, when such action is not
feasible, supplementation may be obtained outside the facility. Patients
may be sent to other Federal or civilian facilities for specific
treatment or services under Sec. 728.4(k)(3) provided they remain under
medical management of the CO of the sending facility during the entire
period of care.
[[Page 293]]
(l) Family planning services. Provide family planning services
following the provisions of SECNAVINST 6300.2A.
(m) Grouping of patients. Group hospitalized patients according to
their requirements for housing, medical, or dental care. Provide gender
identified quarters, facilities, and professional supervision on that
basis when appropriate. Individuals who must be retained under limited
medical supervision (medical hold) solely for administrative reasons or
for medical conditions which can be treated on a clinic basis will be
provided quarters and messing facilities, where practicable, separately
from those hospitalized. Provide medical care for such patients on a
periodic clinic appointment basis (see Sec. 728.4(p) for handling
enlisted convalescent patients). Make maximum use of administrative
versus medical personnel in the supervision of such patients.
(n) Health benefits advising--(1) General. A Health Benefits
Advising program must be started at all shore commands having one or
more medical officers. While health benefits advisors are not required
aboard every ship with a medical officer, the medical department
representative can usually provide services to personnel requiring help.
The number of health benefits advisors (HBAs) of a command will be
commensurate with counseling and assistance requirements. The program
provides health benefits information and counseling to beneficiaries of
the Uniformed Services Health Benefits Program (USHBP) and to others who
may or may not qualify for care in USMTFs. Office location of HBAs,
their names, and telephone numbers will be widely publicized locally. If
additional help is required, contact MEDCOM-333 on AUTOVON 294-1127 or
commercial (202) 653-1127. In addition to the duties described in
Sec. 728.4(n)(2), HBAs will:
(i) Maintain a depository of up-to-date officially supplied health
benefits information for availability to all beneficiaries.
(ii) Provide information and guidance to beneficiaries and generally
support the medical and dental staff by providing help to eligible
beneficiaries seeking or obtaining services from USMTFs, civilian
facilities, VA facilities, Medicare, MEDICAID, and other health
programs.
(iii) Assure that when a referral or disengagement is required,
patients or responsible family members are:
(A) Fully informed that such action is taken to provide for their
immediate medical or dental requirements and that the disengagement or
referral has no bearing on whether care may be available in the naval
MTF for other aspects of current or other future medical conditions.
(B) Provided the services and counseling outlined in
Sec. 728.4(n)(2) or Sec. 728.3(g)(3)(ii), as appropriate, prior to their
departure from the facility when such beneficiaries are referred or
disengaged because care required is beyond the naval MTF's capability.
In an emergency, or when the patient or sponsor cannot be seen by the
HBA prior to leaving, provide these benefits as soon thereafter as
possible.
(2) Counseling and assisting CHAMPUS-eligible individuals. HBAs, as
a minimum, will:
(i) Explain alternatives available to the patient.
(ii) If appropriate, explain CHAMPUS as it relates to the particular
circumstance, including the cost-sharing provisions applicable to the
patient, allowable charges, provider participation, and claim filing
procedures. Fully inform the patient or responsible family member that
when a patient is disengaged for care under CHAMPUS or when cooperative
care is to be considered for payment under the provisions of
Sec. 728.4(z) (5) and (6), the naval MTF is not responsible for monetary
amounts above the CHAMPUS-determined allowable charge or for charges
CHAMPUS does not allow.
(iii) Explain why the naval MTF is paying for the supplemental care,
if appropriate (see Sec. 728.4(z) (3) and (4)), and how the bill will be
handled. Then:
(A) Complete a DD 2161, Referral For Civilian Medical Care, marking
the appropriate source of payment with the concurrence of the naval MTF
commanding officer or CO's designee.
(B) If referred for a specified procedure with a consultation report
to be returned to the naval MTF retaining medical management, annotate
the DD 2161 in the consultation report section
[[Page 294]]
to state this requirement. Advise patient or responsible family member
to arrange for a completed copy of the DD 2161 to be returned to the
naval MTF for payment, if appropriate, and inclusion in patient's
medical record.
(iv) Brief patient or responsible family member on the use of the DD
2161 in USMTF payment procedures and CHAMPUS claims processing, as
appropriate. Provide sufficient copies of DD 2161 and explain that
CHAMPUS contractors will return claims submitted without a required DD
2161. Obtain signature of patient or responsible family member on the
form.
(v) Arrange for counseling from appropriate sources when the patient
is eligible for VA, Medicare, or MEDICAID benefits.
(vi) Serve as liaison between civilian providers and naval MTF on
administrative matters related to the referral and disengagement
process.
(vii) Serve as liaison between naval MTF and cooperative care
coordinators on matters relating to care provided or recommended by
naval MTF providers, as appropriate.
(viii) Explain why the patient is being disengaged and, per
Sec. 728.4(g)(2), provide a DD 1251, Nonavailability Statement, or DD
2161, Referral For Civilian Medical Care, as appropriate.
(o) Immunizations. Administer immunizations per BUMED INST 6230.1H.
(p) Medical holding companies. Medical holding companies (MHC) have
been established at certain activities to facilitate handling of
enlisted convalescent patients whose medical conditions are such that,
although they cannot be returned to full duty, they can perform light
duty ashore commensurate with their condition while completing their
medical care on an outpatient basis. Where feasible, process such
patients for transfer.
(q) Notifications. The interests of the Navy, Marine Corps, and DOD
have been adversely affected by past procedures which emphasized making
notifications only when an active duty member's condition was classed as
either seriously ill or injured or classed as very seriously ill or
injured. However, even temporary disabilities which preclude
communication with the next of kin have generated understandable concern
and criticism, especially when emergency hospitalization has resulted.
Accordingly, naval MTFs will effect procedures to make notifications
required in Sec. 728.4(q) (2), (3), and (4) upon admission or diagnosis
of individuals specified. The provisions of Sec. 728.4(q) supplement
articles 1810520 and 4210100 of the Naval Military Personnel Manual and
chapter 1 of Marine Corps Order P3040.4B, Marine Corps Casualty
Procedures Manual; they do not supersede them.
(1) Privacy Act. The right to privacy of individuals for whom
hospitalization reports and other notifications are made will be
safeguarded as required by the Privacy Act, implemented in the
Department of the Navy by SECNAVINST 5211.5C, U.S. Navy Regulations, the
Manual of the Judge Advocate General, the Marine Corps Casualty
Procedures Manual, and the Manual of the Medical Department.
(2) Active duty flag or general officers and retired Marine Corps
general officers. Upon admission of subject officers, make telephonic
contact with MEDCOM-33 on AUTOVON 294-1179 or commercial (202) 653-1179
(after duty hours, contact the command duty officer on AUTOVON 294-1327
or commercial (202) 653-1327) to provide the following information:
(i) Initial. Include in the initial report:
(A) Officer's name, grade, social security number, and designator.
(B) Duty assignment in ship or station, or other status.
(C) Date of admission.
(D) Present condition, stating if serious or very serious.
(E) Diagnosis, prognosis, and estimated period of hospitalization.
To prevent possible invasion of privacy, report the diagnosis only in
International Classification of Diseases--9th Edition (ICD-9-CM) code
designator.
(ii) Progress reports. Call frequency and content will be at the
discretion of the commanding officer. However, promptly report changes
in condition or status.
(iii) Termination report. Make a termination of hospitalization
report to provide appropriate details for informational purposes.
[[Page 295]]
(iv) Additional commands to apprise. The geographic naval medical
region serving the hospital and, if different, the one serving the
officer's command will also be apprised of such admissions.
(3) Active duty members--(i) Notification of member's command. The
commanding officer of naval medical treatment facilities has
responsibility for notifying each member's commanding officer under the
conditions listed below. Make COMNAVMILPERS COM or CMC, as appropriate,
information addressees on their respective personnel:
(A) Direct admissions. Upon direct admission of an active duty
member, with or without orders regardless of expected length of stay.
The patient administration department (administrative watch officer
after hours) is responsible for preparation, per Sec. 728.4(q)(4), and
release of these messages. If the patient is attached to a local command
(CO's determination), initial notification may be made telephonically.
Record the name, grade or rate, and position of the person receiving the
call at the member's command on the back of the NAVMED 6300/5, Inpatient
Admission/Disposition Record and include the name and telephone number
of the MTF's point of contact as given to the patient's command.
(B) Change in medical condition. Upon becoming aware of any medical
condition, including pregnancy, which will now or in the foreseeable
future result in the loss of a member's full duty services in excess of
72 hours. Transmit this information in a message, prepared per
Sec. 728.4(q)(4), marked ``Commanding Officer's Eyes Only.''
(ii) Notification of next of kin (NOK)--(A) Admitted members. As
part of the admission procedure, encourage all patients to communicate
expeditiously and regularly with their NOK. When an active duty member's
incapacity makes timely personal communication impractical, i.e.,
fractures, burns, eye pathology, psychiatric or emotional disorders,
etc., MTF personnel will initiate the notification process. Do not start
the process if the patient specifically declines such notification or it
is clear that the NOK already has knowledge of the admission (commands
should develop a local form for such patients to sign attesting their
desire or refusal to have their NOK notified). Once notification has
been made, the facility will make progress reports, at least weekly,
until the patient is again able to communicate with the NOK.
(1) Navy personnel. Upon admission of Navy personnel, effect the
following notification procedures.
(i) In the contiguous 48 states. Patient administration department
personnel will notify the NOK in person, by telephone, telegraph, or by
other expeditious means. Included are notifications of the NOK upon
arrival of all Navy patients received in the medical air-evacuation
system.
(ii) Outside the contiguous 48 states. If the next of kin has
accompanied the patient on the tour of duty and is in the immediate
area, hospital personnel will notify the next of kin in person, by
telephone, telegraph, or by other expeditious means. If the next of kin
is located in the 48 contiguous United States, use telegraphic means to
notify COMNAVMILPERSCOM who will provide notification to the NOK.
(2) Marine Corps personnel. When Marine Corps personnel are
admitted, effect the following notification procedures.
(i) In the contiguous 48 states. The commander of the unit or
activity to which the casualty member is assigned is responsible for
initiating notification procedures to the NOK of seriously or very
seriously ill or injured Marine Corps personnel. Patient administration
department personnel will assure that liaison is established with the
appropriate command or activity when such personnel are admitted.
Patient administration personnel will notify the Marine's command by
telephone and request that cognizance be assumed for in-person initial
notification of the NOK of Marine Corps patients admitted with an
incapacity that makes personal and timely communication impractical and
for those arriving via the medical air-evacuation system. If a member's
command is unknown or cannot be contacted, inform CMC (MHP-10) on
AUTOVON 224-1787 or commercial (202) 694-1787.
(ii) Outside the contiguous 48 states. Make casualty notification
for Marine
[[Page 296]]
Corps personnel hospitalized in naval MTFs outside the contiguous 48
States to the individual's command. If the command is unknown or not
located in close proximity to the MTF, notify CMC (MHP-10). When initial
notification to the individual's command is made via message, make CMC
(MHP-10) an information addressee.
(iii) In and outside the United States. In life-threatening
situations, the Commandant of the Marine Corps desires and encourages
medical officers to communicate with the next of kin. In other
circumstances, request that the Marine Corps member communicate with the
NOK if able. If unable, the medical officer should communicate with the
NOK after personal notification has been effected.
(B) Terminally ill patients. As soon as a diagnosis is made and
confirmed (on inpatients or outpatients) that a Navy member is
terminally ill, MILPERSMAN 4210100 requires notification of the primary
and secondary next of kin. Accomplish notification the same as for Navy
members admitted as seriously or very seriously ill or injured, i.e., by
priority message to the Commander, Naval Military Personnel Command and
to the Casualty Assistance Calls/Funeral Honors Support Program
Coordinator, as appropriate, who has cognizance over the geographical
area in which the primary and secondary NOK resides (see OPNAVINST
1770.1). Submit followup reports when appropriate. See MILPERSMAN
4210100 for further amplification and for information addressees.
(1) In the contiguous 48 states. Notification responsibility is
assigned to the USMTF making the diagnosis and to the member's duty
station if diagnosed in a civilian facility.
(2) Outside the contiguous 48 states. Notification responsibility is
assigned to the naval medical facility making the diagnosis. When
diagnosed in nonnaval facilities or aboard deployed naval vessels,
notification responsibility belongs to the Commander, Naval Military
Personnel Command.
(C) Other uniformed services patients. Establish liaison with other
uniformed services to assure proper notification upon admission or
diagnosis of active duty members of other services.
(D) Nonactive duty patients. At the discretion of individual
commanding officers, the provisions of Sec. 728.4(q)(3)(ii) on providing
notification to the NOK may be extended to admissions or diagnosis of
nonactive duty patients; e.g., admission of dependents of members on
duty overseas.
(4) Messages--(i) Content. Phrase contents of messages (and
telephonic notifications) in lay terms and provide sufficient details
concerning the patient's condition, prognosis, and diagnosis. Messages
will also contain the name and telephone number of the facility's point
of contact. When appropriate for addressal, psychiatric and other
sensitive diagnoses will be related with discretion. When indicated,
also include specific comment as to whether the presence of the next of
kin is medically warranted. Note: In making notification to the NOK of
patients diagnosed as having Acquired Immune Deficiency Syndrome (AIDS)
or Human Immunodeficiency Virus (HIV), use one of the symptoms of the
disease as the diagnosis (e.g., pneumonia) rather than ``HIV'',
``AIDS'', or the diagnostic code for AIDS.
(ii) Information addressees. Make the commander of the geographic
naval medical region servicing the member's command and the one
servicing the hospital, if different, information addressees on all
messages. For Marine Corps personnel, also include CMC (MHP-10) and the
appropriate Marine Corps district headquarters as information
addressees, COMNAVMEDCOM WASHINGTON DC requires information copies of
messages only when a patient has been placed on the seriously ill or
injured or very seriously ill or injured list or diagnosed as terminally
ill.
(r) Outpatient care. Whenever possible, perform diagnostic
procedures and provide preoperative and post operative care, surgical
care, convalescence, and followup observations and treatment on an
outpatient basis.
(s) Performance of duties while in an inpatient status. U.S.
military patients may be assigned duties in and around naval MTFs when
such duties will be,
[[Page 297]]
in the judgement of the attending physician, of a therapeutic value.
Physical condition, past training, and other acquired skills must all be
considered before assigning any patient a given task. Do not assign
patients duties which are not within their capabilities or which require
more than a very brief period of orientation.
(t) Prolonged definitive medical care. Prolonged definitive medical
care in naval MTFs will not be provided for U.S. military patients who
are unlikely to return to duty. The time at which a patient should be
processed for disability separation must be determined on an individual
basis, taking into consideration the interests of the patient as well as
those of the Government. A long-term patient roster will be maintained
and updated at least once monthly to enable commanding officers and
other appropriate staff members to monitor the progress of all patients
with 30 or more continuous days of hospitalization. Include on the
roster basic patient identification data (name, grade or rate, register
number, ward or absent status, clinic service, and whether assigned to a
medical holding company), projected disposition (date, type, and
profile), diagnosis, and cumulative hospital days (present facility and
total).
(u) Remediable physical defects of active duty members--(1) General.
When a medical evaluation reveals that a Navy or Marine Corps patient on
active duty has developed a remediable defect while on active duty, the
patient will be offered the opportunity of operative repair or other
appropriate remediable treatment, if medically indicated.
(2) Refusal of treatment. Per MANMED art. 18-15, when a member
refuses to submit to recommended therapeutic measures for a remediable
defect or condition which has interfered with the member's performance
of duty and following prescribed therapy, the member is expected to be
fit for full duty, the following procedures will apply:
(i) Transfer the member to a naval MTF for further evaluation and
appearance before a medical board. After counseling per MANMED art. 18-
15, any member of the naval service who refuses to submit to recommended
medical, surgical, dental, or diagnostic measures, other than routine
treatment for minor or temporary disabilities, will be asked to sign a
completed NAVMED 6100/4, Medical Board Certificate Relative to
Counseling on Refusal of Surgery and/or Treatment, attesting to the
counseling.
(ii) The board will study all pertinent information, inquire into
the merits of the individual's refusal to submit to treatment, and
report the facts with appropriate recommendations.
(iii) As a general rule, refusal of minor surgery should be
considered unreasonable in the absence of substantial contraindications.
Refusal of major surgical operations may be reasonable or unreasonable,
according to the circumstances, The age of the patient, previous
unsuccessful operations, existing physical or mental contraindications,
and any special risks should all be taken into consideration.
(iv) Where surgical procedures are involved, the board's report will
contain answers to the following questions:
(A) Is surgical treatment required to relieve the incapacity and
restore the individual to a duty status, and may it be expected to do
so?
(B) Is the proposed surgery an established procedure that qualified
and experienced surgeons ordinarily would recommend and undertake?
(C) Considering the risks ordinarily associated with surgical
treatment, the patient's age and general physical condition, and the
member's reason for refusing treatment, is the refusal reasonable or
unreasonable? (Fear of surgery or religious scruples may be considered,
along with all the other evidence, for whatever weight may appear
appropriate.)
(v) If a member needing surgery is mentally competent, do not
perform surgery over the member's protestation.
(vi) In medical, dental, or diagnostic situations, the board should
show the need and risk of the recommended procedure(s).
(vii) If a medical board decides that a diagnostic, medical, dental,
or surgical procedure is indicated, these findings must be made known to
the patient. The board's report will show that the patient was afforded
an opportunity to submit a written statement explaining
[[Page 298]]
the grounds for refusal. Forward any statement with the board's report.
Advise the patient that even if the disability originally arose in line
of duty, its continuance may be attributable to the member's
unreasonable refusal to cooperate in its correction; and that the
continuance of the disability might, therefore, result in the member's
separation without benefits.
(viii) Also advise the patient that:
(A) Title 10 U.S.C. 1207 precludes disposition under chapter 61 of
10 U.S.C. if such a member's disability is due to intentional
misconduct, willful neglect, or if it was incurred during a period of
unauthorized absence. A member's refusal to complete a recommended
therapy regimen or diagnostic procedure may be interpreted as willful
neglect.
(B) Benefits from the Veterans Administration will be dependent upon
a finding that the disability was incurred in line of duty and is not
due to the member's willful misconduct.
(ix) The Social Security Act contains special provisions relating to
benefits for ``disabled'' persons and certain provisions relating to
persons disabled ``in line of duty'' during service in the Armed Forces.
In many instances persons deemed to have ``remediable'' disorders have
been held not ``disabled'' within the meaning of that term as used in
the statute, and Federal courts have upheld that interpretation. One who
is deemed unreasonably to have refused to undergo available surgical
procedures may be deemed both ``not disabled'' and to have incurred the
condition ``not in the line of duty.''
(x) Forward the board's report directly to the Central Physical
Evaluation Board with a copy to MEDCOM-25 except in those instances when
the convening authority desires referral of the medical board report for
Departmental review.
(xi) Per MANMED art. 18-15, a member who refuses medical, dental, or
surgical treatment for a condition that existed prior to entry into the
service (EPTE defect), not aggravated by a period of active service but
which interferes with the performance of duties, should be processed for
reason of physical disability, convenience to the Government, or
enlisted in error rather than under the refusal of treatment provisions.
Procedures are delineated in BUMEDINST 1910.2G and SECNAVINST 1910.4A.
(3) Other uniformed services patients. When a patient of another
service is found to have a remediable physical defect developed in the
military service, refer the matter to the nearest headquarters of the
service concerned.
(v) Responsibilities of the commanding officer. In connection with
the provisions of this part, commanding officers of naval MTFs will:
(1) Determine which persons within the various categories authorized
care in a facility will receive treatment in, be admitted to, and be
discharged from that specific facility.
(2) Supervise care and treatment, including the employment of
recognized professional procedures.
(3) Provide each patient with the best possible care in keeping with
accepted professional standards and the assigned primary mission of the
facility.
(4) Provide for counseling patients and naval MTF providers when
care required is beyond the naval MTF's capability. This includes:
(i) Establishing training programs to acquaint naval MTF providers
and HBAs with the uniformed services' referral for supplemental/
cooperative care or services policy outlined in Sec. 728.4(z).
(ii) Implementing control measures to ensure that:
(A) Providers requesting care under the provisions Sec. 728.4(z) are
qualified to maintain physician case management when required.
(B) Care requested under the supplemental/cooperative care criteria
is medically necessary, legitimate, and otherwise permissible under the
terms of that part of the USHBP under which it will be considered for
payment.
(C) Providers explain to patients the reason for a referral and the
type of referral being made.
(D) Attending physicians properly refer beneficiaries to the HBA for
counseling and services per Sec. 728.4(n).
(E) Uniform criteria are applied in determining cooperative care
situations without consideration of rate, grade, or uniformed service
affiliation.
[[Page 299]]
(F) All DD 2161's are properly completed and approved by the
commanding officer or designee.
(G) A copy of the completed DD 2161 is returned to the naval MTF for
inclusion in the medical record of the patient.
(w) Sick call. A regularly scheduled assembly of sick and injured
military personnel established to provide routine medical care.
Subsequent to examination, personnel medically unfit for duty will be
admitted to an MTF or placed sick in quarters; personnel not admitted or
placed sick in quarters will be given such treatment as is deemed
necessary. When excused from duty for medical reasons which do not
require hospitalization, military personnel may be authorized to remain
in quarters, not to exceed 72 hours.
(x) Sicklist--authorized absence from. Commanding officers of naval
MTFs may authorize absences of up to 72 hours for dependents and retired
personnel without formal discharge from the sicklist. When absences are
authorized in excess of 24 hours, subsistence charges or dependent's
rate, as applicable, for that period will not be collected and the
number of reportable occupied bed days will be appropriately reduced.
Prior to authorizing such absences, the attending physician will advise
patients of their physical limitations and of any necessary safety
precautions, and will annotate the clinical record that patients have
been so advised. For treatment under the Medical Care Recovery Act, make
reporting consistent with Sec. 728.4(aa).
(y) Subsisting out. A category in which officer and enlisted
patients on the sicklist of a naval MTF may be placed when their daily
presence is not required for treatment nor examination, but who are not
yet ready for return to duty. As a general rule, patients placed in this
category should reside in the area of the facility and should be
examined by the attending physician at least weekly. Enlisted personnel
in a subsisting out status should be granted commuted rations.
(1) Granting of subsisting out privileges is one of many disposition
alternatives; however, recommend that other avenues (medical holding
company, convalescent leave, limited duty, etc.) be considered before
granting this privilege.
(2) Naval MTF patients in a subsisting out status should not be
confused with those enlisted personnel in a rehabilitation program who
are granted liberty and are drawing commuted rations, but are required
to be present at the treating facility during normal working hours.
These personnel are not subsisting out and must have a bed assigned at
the naval MTF.
(3) Naval MTF patients who are required to report for examinations
or treatment more often than every 48 hours should not be placed in a
subsisting out status.
(z) Supplemental/cooperative care or services--(1) General. When
such services as defined in Sec. 728.2(cc) are rendered to other than
CHAMPUS-eligible individuals, the cost thereof is chargeable to
operation and maintenance funds available for operation of the facility
requesting care or services. Cooperative care applies to CHAMPUS-
eligible patients receiving inpatient or outpatient care in a USMTF who
require care or services beyond the capability of that USMTF. The
following general principles apply to such CHAMPUS-eligible patients:
(i) Cooperation of uniformed services physicians. USMTF physicians
are required to cooperate in providing CHAMPUS contractors and OCHAMPUS
additional medical information. SECNAVINST 5211.5C delineates policies,
conditions, and procedures that govern safeguarding, using, accessing,
and disseminating personal information kept in a system of records.
Providing information to CHAMPUS contractors and OCHAMPUS will be
governed thereby.
(ii) Physician case management. Where required by NAVMEDCOMINST
6320.18 (CHAMPUS Regulation; implementation of), uniformed services
physicians are required to provide case management (oversight) as would
an attending or supervising civilian physician.
(iii) CHAMPUS-authorized providers. CHAMPUS contractors are
responsible for determining whether a civilian provider is CHAMPUS-
authorized and for providing such information, upon request, to USMTFs.
[[Page 300]]
(iv) Phychiatric or psychotherapeutic services. If psychiatric care
is being rendered by a psychiatric or clinical social worker, a
psychiatric nurse, or a marriage and family counselor, and the uniformed
services facility has made a determination that it does not have the
professional staff competent to provide required physician case
management, the patient may be (partially) disengaged for the
psychiatric or psychotherapeutic service, yet have the remainder of
required medical care provided by the naval MTF.
(v) Forms and documentation. A DD 2161, Referral For Civilian
Medical Care, will be provided to each patient who is to receive
supplemental or cooperative care or services. When supplemental care is
required under the provisions of Sec. 728.4(z) (3) and (4), the
provisions of Sec. 728.4(z)(3)(iii) apply. When cooperative care or
services are required under the provisions of Sec. 728.4(z) (5) and (6),
the provisions of Sec. 728.4(z)(5)(iv) apply.
(vi) Clarification of unusual circumstances. Commanding officers of
naval MTFs will submit requests for clarification of unusual
circumstances to OCHAMPUS or CHAMPUS contractors via the Commander,
Naval Medical Command (MEDCOM-33) for consideration.
(2) Care beyond a naval MTF's capability. When, either during
initial evaluation or during the course of treatment of CHAMPUS-eligible
beneficiaries, required services are beyond the capability of the naval
MTF, the commanding officer will arrange for the services from an
alternate source in the following order, subject to restrictions
specified. The provisions of Sec. 728.4(z)(2)(i) through (iii) must be
followed before either supplemental care, authorized in
Sec. 728.4(z)(4), is considered for payment from Navy Operations and
Maintenance funds, or cooperative care, authorized in Sec. 728.4(z)(6),
is to be considered for payment under the terms of CHAMPUS.
(i) Obtain from another USMTF or other Federal MTF the authorized
care necessary for continued treatment of the patient within the naval
MTF, when such action is medically feasible and economically
advantageous to the Government.
(ii) When the patient is a retired member or dependent, transfer per
Sec. 728.4(bb)(3) (i), (ii), (iii), or (iv), in that order. When the
patient is a dependent of a member of a NATO nation, transfer per
Sec. 728.4(bb)(4) (i), (ii), or (iii), in that order.
(iii) With the patient's permission, the naval MTF may contact State
programs, local health agencies, or health foundations to determine if
benefits are available.
(iv) Obtain such supplemental care or services as delineated in
Sec. 728.4(z)(4) from a civilian source using local operation and
maintenance funds, or
(v) Obtain such cooperative care or services as delineated in
Sec. 728.4(z)(6) from a civilian source under the terms of CHAMPUS.
(3) Operation and maintenance funds. When local operation and
maintenance funds are to be used to obtain supplemental care or
services, the following guidelines are applicable:
(i) Care or services must be legitimate, medically necessary, and
ordered by a qualified USMTF provider.
(ii) The naval MTF must make the necessary arrangements for
obtaining required care or services from a specific source of care.
(iii) Upon approval of the naval MTF commanding officer or designee,
provide the patient or sponsor with a properly completed DD 2161,
Referral For Civilian Medical Care. The DD 2161 will be marked by the
health benefits advisor or other designated individual to show the naval
MTF as the source of payment. Forward a copy to the MTF's contracting or
supply officer who is the point of contact for coordinating obligations
with the comptroller and thus is responsible for assuring proper
processing for payment.
(iv) Authorize care on an inpatient or outpatient basis for the
minimum period necessary for the civilian provider to perform the
specific test, procedure, treatment, or consultation requested. Patients
receiving inpatient services in civilian medical facilities will not be
counted as an occupied bed in the naval MTF, but will be continued on
the naval MTF's inpatient census. Continue to charge pay patients the
USMTF inpatient rate appropriate for their patient category.
[[Page 301]]
(v) Naval MTF physicians will maintain professional contact with
civilian providers.
(4) Care and services authorized. Use local operation and
maintenance funds to defray the cost of the following when CHAMPUS-
eligible patients are referred to civilian sources for the following
types of care or services;
(i) All specialty consultations for the purpose of establishing or
confirming diagnoses or recommending a course of treatment.
(ii) All diagnostic tests, diagnostic examinations, and diagnostic
procedures (including genetic tests and CAT scans), ordered by qualified
USMTF providers.
(iii) Prescription drugs and medical supplies.
(iv) Civilian ambulance service ordered by USMTF personnel.
(5) CHAMPUS funds. When payment is to be considered under the terms
of CHAMPUS for cooperative care, even though the beneficiary remains
under naval MTF control, the following guidelines are applicable:
(i) Process charges for care under the terms of CHAMPUS.
(A) If the charge for a covered service or supply is above the
CHAMPUS-determined reasonable charge, the direct care system will not
assume any liability on behalf of the patient where a civilian provider
is concerned, although a USMTF physician recommended or prescribed the
service or supply.
(B) Payment consideration for all care or services meeting
cooperative care criteria will be under the terms of CHAMPUS and payment
for such care or services will not be made from naval MTF funds.
Conversely, any care or services meeting naval MTF supplemental care or
services payment criteria will not be considered under the terms of
CHAMPUS.
(ii) Care must be legitimate and otherwise permissible under the
terms of CHAMPUS and must be ordered by a qualified USMTF provider.
(iii) Provide assistance to beneficiaries referred or disengaged
under CHAMPUS. Although USMTF personnel are not authorized to refer
beneficiaries to a specific civilian provider for care under CHAMPUS,
health benefits advisors are authorized to contact the cooperative care
coordinator of the appropriate CHAMPUS contractor for aid in determining
authorized providers with the capability of rendering required services.
Such information may be given to beneficiaries. Also encourage
beneficiaries to obtain required services only from providers willing to
participate in CHAMPUS. Subject to the availability of space,
facilities, and capabilities of the staff, USMTFs may provide
consultative and such other ancillary aid as required by the civilian
provider selected by the beneficiary.
(iv) Provide a properly completed DD 2161, Referral For Civilian
Medical Care, to patients who are referred (versus disengaged) to
civilian sources under the terms of CHAMPUS for cooperative care. (A
Nonavailability Statement (DD 1251) may also be required. Provide this
form when required under Sec. 728.33.) The DD 2161 will be marked by the
health benefits advisor, or other designated individual, to show CHAMPUS
as the source of payment consideration. All such DD 2161's must be
approved by the commanding officer or designee. Give the patient
sufficient copies to ensure a copy of the DD 2161 accompanies each
CHAMPUS claim. Advise patients that CHAMPUS contractors will return
claims received without the DD 2161. Also advise patients to arrange for
return of a completed copy of the DD 2161 to the naval MTF for inclusion
in their medical record.
(v) Such patients receiving inpatient or outpatient care or services
will pay the patient's share of the costs as specified under the terms
of CHAMPUS for their beneficiary category. Patients receiving inpatient
services will not be continued on the naval MTF's census and will not be
charged the USMTF inpatient rate.
(vi) Certain ancillary services authorized under CHAMPUS require
physician case management during the course of treatment. USMTF
physicians will manage the provision of ancillary services by civilian
providers when such services are obtained under the terms of CHAMPUS.
Examples include physical therapy, private duty (special) nursing,
rental or lease/purchase of durable medical equipment,
[[Page 302]]
and services under the CHAMPUS Program for the Handicapped. USMTF
providers exercising physician case management responsibility for
ancillary services under CHAMPUS are subject to the same benefit
limitations and certification of need requirements applicable to
civilian providers under the terms of CHAMPUS for the same types of
care. USMTF physicians exercising physician case management
responsibility will maintain professional contact with civilian
providers of care.
(6) Care and services authorized. Refer CHAMPUS-eligible patients to
civilian sources for the following under the terms of CHAMPUS:
(i) Authorized nondiagnostic medical services such as physical
therapy, speech therapy, radiation therapy, and private duty (special)
nursing.
(ii) Preauthorized (by OCHAMPUS) adjunctive dental care, including
orthodontia related to surgical correction of cleft palate.
(iii) Durable medical equipment. (CHAMPUS payment will be considered
only if the equipment is not available on a loan basis from the naval
MTF.)
(iv) Prosthetic devices (limited benefit), orthopedic braces and
appliances.
(v) Optical devices (limited benefit).
(vi) Civilian ambulance service to a USMTF when service is ordered
by other than direct care personnel.
(vii) All CHAMPUS Program for the Handicapped care.
(viii) Psychotherapeutic or psychiatric care.
(ix) Except for those types of care or services delineated in
Sec. 728.4(z)(4), all other CHAMPUS authorized medical services not
available in the naval MTF (for example, neonatal intensive care).
(aa) Third party liability case. Per chapter 24, section 2403, JAG
Manual, use the following guidelines to complete and submit a NAVJAG
5890/12, Hospital and Medical Care, 3rd Party Liability Case, when a
third party may be liable for the injury or disease being treated:
(1) Preparation. All naval MTFs will use the front of NAVJAG 5890/12
to report the value of medical care furnished to any patient when (i) a
third party may be legally liable for causing the injury or disease, or
(ii) when a Government claim is possible under workmen's compensation,
no-fault insurance (see responsibilities for apprising the insurance
carrier in Sec. 728.4(aa)(5)), uninsured motorist insurance, or under
medical payments insurance (e.g., in all automobile accident cases).
Block 4 of this form requires an appended statement of the patient or an
accident report, if available. Prior to requesting such a statement from
a patient, the person preparing the front side of NAVJAG 5890/12 will
show the patient the Privacy Act statement printed at the bottom of the
form and have the patient sign his or her name beneath the statement.
(2) Submission--(i) Naval patients. For naval patients, submit the
completed front side of the NAVJAG 5890/12 to the appropriate action JAG
designee listed in section 2401 of the JAG Manual at the following
times:
(A) Initial. Make an initial submission as soon as practicable after
a patient is admitted for any period of inpatient care, or if it appears
that more than 7 outpatient treatments will be furnished. This
submission should not be delayed pending the accumulation of all
potential charges from the treating facility. This submission need not
be based upon an extensive investigation of the cause of the injury or
disease, but it should include all known facts. Statements by the
patient, police reports, and similar information (if available), should
be appended to the form.
(B) Interim. Make an interim submission every 4 months after the
initial submission until the patient is transferred or released from the
facility, or changed from an inpatient status to an outpatient status.
(C) Final. Make a final submission upon completion of treatment or
upon transfer of the patient to another facility. The facility to which
the patient is transferred should be noted on the form. Report control
symbol NAVJAG 5890-1 is assigned to this report.
(ii) Nonnaval patients. When care is provided to personnel of
another Federal agency or department, that agency or department
generally will assert any claim in behalf of the United States. In such
instances, submit the NAVJAG 5890/12's (initial, interim, and
[[Page 303]]
final) directly to the appropriate of the following:
(A) U.S. Army. Commanding general of the Army or comparable area
commander in which the incident occurred.
(B) U.S. Air Force. Staff judge advocate of the Air Force
installation nearest the location where the initial medical care was
provided.
(C) U.S. Coast Guard. Commandant (G-K-2). U.S. Coast Guard,
Washington, DC 20593-0001.
(D) Department of Labor. The appropriate Office of Workers'
Compensation Programs (OWCP).
(E) Veterans Administration. Director of the Veterans Administration
hospital responsible for medical care of the patient being provided
treatment.
(F) Department of Health and Human Services (DHHS). Regional
attorney's office in the area were the incident occurred.
(3) Supplementary documents. An SF 502 should accompany the final
submission in all cases involving inpatient care. Additionally, when
Government care exceeds $1,000, inpatient facilities should complete and
submit the back side of NAVJAG 5890/12 to the action JAG designee. On
this side of the form, the determination of ``patient status'' may be
used on local hospital usage.
(4) Health record entries. Retain copies of all NAVJAG 5890/12's in
the Health Record of the patient. Immediately notify action JAG
designees when a patient receives additional treatment subsequent to the
issuance of a final NAVJAG 5890/12 if the subsequent treatment is
related to the condition which gave rise to the claim.
(5) No-fault insurance. When no-fault insurance is or may be
involved, the naval legal service office at which the JAG designee is
located is responsible for apprising the insurance carrier that the
Federal payment for the benefits of this part is secondary to any no-
fault insurance coverage available to the injured individual.
(6) Additional guidance. Chapter 24 of the JAG Manual and BUMEDINST
5890.1A contain supplemental information.
(bb) Transfer of patients--(1) General. Treat all patients at the
lowest echelon equipped and staffed to provide necessary care; however,
when transfer to another MTF is considered necessary, use Government
transportation when available. Accomplish medical regulating per the
provisions of OPNAVINST 4630.25B and BUMEDINST 6320.1D.
(2) U.S. military patients. Do not retain U.S. military patients in
acute care MTFs longer than the minimum time necessary to attain the
mental or physical state required for return to duty or separation from
the service. When required care is not available at the facility
providing area inpatient care, transfer patients to the most readily
accessible USMTF or designated USTF possessing the required capability.
Transportation of the patient and a medical attendant or attendants, if
required, is authorized at Government expense. Since the VA is staffed
and equipped to provide care in the most expeditious manner, follow the
administrative procedures outlined in NAVMEDCOMINST 6320.12 when:
(i) A patient has received the maximum benefit of hospitalization in
a naval MTF but requires a protracted period of nursing home type care.
The VA can provide this type care or arrange for it from a civilian
source for individuals so entitled.
(ii) Determined that there is or may be spinal cord injury
necessitating immediate medical and psychological attention.
(iii) A patient has sustained an apparently severe head injury or
has been blinded necessitating immediate intervention beyond the
capabilities of naval MTFs.
(iv) A determination has been made by the Secretary concerned that a
member on active duty has an alcohol or drug dependency or drug abuse
disability.
(3) Retired members and dependents. When a retired member of a
dependent requires care beyond the capabilities of a facility and a
transfer is necessary, the commanding officer of that facility may:
(i) Arrange for transfer to another USMTF or designated USTF located
in an overlapping inpatient catchment area of the transferring facility
if either has the required capability.
(ii) If the patient or sponsor agrees, arrange for transfer to the
nearest
[[Page 304]]
USMTF or designated USTF with required capability, regardless of its
location.
(iii) Arrange for transfer of retired members to the Veterans
Administration MTF nearest the patient's residence.
(iv) Provide aid in releasing the patient to a civilian provider of
the patient's choice under the terms of Medicare, if the patient is
entitled. Beneficiaries entitled to Medicare, Part A, because they are
65 years of age or older or because of a disability or chronic renal
disease, lose CHAMPUS eligibility but remain eligible for care in USMTFs
and designated USTFs.
(v) If the patient is authorized benefits under CHAMPUS, disengage
from medical management and issue a Non-availability Statement (DD 1251)
per the provisions of Sec. 728.33, for care under CHAMPUS. This step
should only be taken after due consideration is made of the
supplemental/cooperative care policy addressed in Sec. 728.4(z).
(4) Dependents of members of NATO nations. When a dependent, as
defined in Sec. 728.41, of a member of a NATO nation requires care
beyond the capabilities of a facility and a transfer is necessary, the
commanding officer of that facility may:
(i) Arrange for transfer to another USMTF or designated USTF with
required capability if either is located in an overlapping inpatient
catchment area of the transferring facility.
(ii) If the patient or sponsor agrees, arrange for transfer to the
nearest USMTF or designated USTF with required capability, regardless of
its location.
(iii) Effect disposition per Sec. 728.42(d).
(5) Others--(i) Medical care. Section 34 of title 24, United States
Code, provides that hospitalization and outpatient services may be
provided outside the continental limits of the United States and in
Alaska to officers and employees of any department or agency of the
Federal Government, to employees of a contractor with the United States
or the contractor's subcontractor, to dependents of such persons, and in
emergencies to such other persons as the Secretary of the Navy may
prescribe: Provided, such services are not otherwise available in
reasonably accessible and appropriate non-Federal facilities.
Hospitalization of such persons in a naval MTF is further limited by 24
U.S.C. 35 to the treatment of acute medical and surgical conditions,
exclusive of nervous, mental, or contagious diseases, or those requiring
domiciliary care.
(ii) Dental care. Section 35 of title 24 provides for space
available routine dental care, other than dental prosthesis and
orthodontia, for the categories of individuals enumerated in
Sec. 728.4(bb)(5)(i): Provided, that such services are not otherwise
available in reasonably accessible and appropriate non-Federal
facilities.
(iii) Transfer. Accomplish transfer and subsequent treatment of
individuals in Sec. 728.4(bb)(5)(i) per the provisions of law enumerated
in Sec. 728.4(bb)(5) (i) and (ii).
(cc) Verification of patient eligibility--(1) DEERS. (i) The Defense
Enrollment Eligibility Reporting System (DEERS) was implemented by
OPNAVINST 1750.2. Where DEERS has been started at naval medical and
dental treatment facilities, commanding officers will appoint, in
writing, a DEERS project officer to perform at the base level. The
project officer's responsibilities and functions include coordinating,
executing, and maintaining base-level DEERS policies and procedures;
providing liaison with line activities, base-level personnel project
officers, and base-level public affairs project officers; meeting and
helping the contractor field representative on site visits to each
facility under the project officer's cognizance; and compiling and
submitting reports required within the command and by higher authority.
(ii) Commanding officers of afloat and deployable units are
encouraged to appoint a unit DEERS medical project officer as a liaison
with the hospital project officer providing services to local medical
and dental treatment facilities. Distribute notice of such appointments
to all concerned facilities.
(iii) When a DEERS project officer has been appointed by a naval MTF
or DTF, submit a message (report control symbol MED 6320-42) to
COMNAVMEDCOM, with information
[[Page 305]]
copies to appropriate chain of command activities, no later than 10
October annually, and situationally when changes occur. As a minimum,
the report will provide:
(A) Name of reporting facility. If the project officer is
responsible for more than one facility, list all such facilities.
(B) Mailing address including complete zip code (zip + 4) and unit
identification code (UIC). Include this information for all facilities
listed in Sec. 728.4(cc)(1)(iii)(A).
(C) Name, grade, and corps of the DEERS project officer designated.
(D) Position title within parent facility.
(E) AUTOVON and commercial telephone numbers.
(2) DEERS and the identification card. This subpart includes DEERS
procedures for eligibility verification checks to be used in conjunction
with the identification card system as a basis for verifying eligibility
for medical and dental care in USMTFs and uniformed services dental
treatment facilities (USDTFs). For other than emergency care, certain
patients are required to have a valid ID card in their possession and,
under the circumstances described in Sec. 728.4(cc)(3), are also
required to meet DEERS criteria before treatment or services are
rendered. Although DEERS and the ID card system are interrelated, there
will be instances where a beneficiary is in possession of an apparently
valid ID card and the DEERS verification check shows that eligibility
has terminated or vice versa. Eligibility verification via an ID card
does not override an indication of ineligibility in DEERS without some
other collateral documentation. Dependents (in possession of or without
ID cards) who undergo DEERS checking will be considered ineligible for
the reasons stated in Sec. 728.4(cc)(4)(v) (A) through (G). For problem
resolution, refer dependents of active duty members to the personnel
support detachment (PSD) servicing the sponsor's command; refer
retirees, their dependents, and survivors to the local PSD.
(3) Identification cards and procedures. All individuals, including
members of uniformed services in uniform, must provide valid
identification when requesting health benefits. Although the most widely
recognized and acceptable forms of identification are DD 1173, DD 2,
Form PHS-1866-1, and Form PHS-1866-3 (Ret), individuals presenting for
care without such identification may be rendered care upon presentation
of other identification as outlined in this part. Under the
circumstances indicated, the following procedures will be followed when
individuals present without the required ID card.
(i) Children under 10. Although a DD 1173 (Uniformed Services
Identification and Privilege Card) may be issued to children under 10
years of age, under normal circumstances they are not. Accordingly,
certification and identification of children under 10 years of age are
the responsibility of the member, retired member, accompanying parent,
legal guardian, or acting guardian. Either the DD 1173 issued the spouse
of a member or former member or the identification card of the member or
former member (DD 2, DD 2 (Ret), Form PHS-1866-1, or Form PHS-1866-3
(Ret)) is acceptable for the purpose of verifying eligibility of a child
under 10 years of age.
(ii) Indefinite expiration. The fact that the word ``indefinite''
may appear in the space for the expiration date on a member's card does
not lessen its acceptability for identification of a child. See
Sec. 728.4(cc)(3)(iii) for dependent's cards with an indefinite
expiration date.
(iii) Expiration date. To be valid, a dependent's DD 1173 must have
an expiration date. Do not honor a dependent's DD 1173 with an
expiration date of ``indefinite''. Furthermore, such a card should be
confiscated, per NAVMILPERSCOMINST 1750.1A, and forwarded to the local
PSD. The PSD may then forward it to the Commander, Naval Military
Personnel Command, (NMPC (641D)/Pers 7312), Department of the Navy,
Washington, DC 20370-5000 for investigation and final disposition.
Render necessary emergency treatment to such a person. The patient
administration department must determine such a patient's beneficiary
status within 30 calendar days and forward such determination to the
fiscal department. If indicated, billing
[[Page 306]]
action for treatment will then proceed following NAVMED P-5020.
(iv) Without cards or with expired cards. (A) When parents or
parents-in-law (including step-parents and step-parents-in-law) request
care in naval MTFs or DTFs without a DD 1173 in their possession or with
expired DD 1173's, render care if they or their sponsor sign a statement
that the individual requiring care has a valid ID card or that an
application has been submitted for a renewal DD 1173. In the latter
instance, include in the statement the allegation that: (1) The
beneficiary is dependent upon the service member for over one-half of
his or her support, and (2) that there has been no material change in
the beneficiary's circumstances since the previous determination of
dependency and issuance of the expired card. Place the statement in the
beneficiary's medical record. Inform the patient or sponsor that if
eligibility is not verified by presentation of a valid ID card to the
patient administration department within 30 calendar days, the facility
will initiate action to recoup the cost of care. If indicated, billing
action for the cost of treatment will then proceed following NAVMED P-
5020.
(B) When recent accessions, National Guard, reservists, or Reserve
units are called to active duty for a period greater than 30 days and
neither the members nor their dependents are at yet in receipt of their
identification cards, satisfactory collateral identification may be
accepted in lieu thereof, i.e., official documents such as orders, along
with a marriage license, or birth certificate which establish the
individual's status as a dependent of a member called to duty for a
period which is not specified as 30 days or less. For a child, the
collateral documentation must include satisfactory evidence that the
child is within the age limiting criteria outlined in Sec. 728.31(b)(4).
An eligible dependent's entitlement, under the provisions of this
subpart, starts on the first day of the sponsor's active service and
ends as of midnight on the last day of active service.
(4) DEERS checking. Unless otherwise indicated, all DEERS
verification procedures will be accomplished in conjunction with
possession of a valid ID card.
(i) Prospective DEERS processing--(A) Appointments. To minimize
difficulties for MTFs, DTFs, and patients, DEERS checks are necessary
for prospective patients with future appointments made through a central
or clinic appointment desk. Without advance DEERS checking, patients
could arrive at a facility with valid ID cards but may fail the DEERS
check, or may arrive without ID cards but be identified by the DEERS
check as eligible. Records, including full social security numbers, of
central and clinic appointment systems will be passed daily to the DEERS
representative for a prospective DEERS check. This enables appointment
clerks to notify individuals with appointments of any apparent problem
with the DEERS or ID card system and refer those with problems to
appropriate authorities prior to the appointment.
(B) Prescriptions. Minimum checking requirements of the program
require prospective DEERS checks on all individuals presenting
prescriptions of civilian providers (see Sec. 728.4(cc)(4)(iv)(D)).
(ii) Retrospective DEERS processing. Pass daily logs (for walk-in
patients, patients presenting in emergencies, or patients replacing last
minute appointment cancellations) to the DEERS representative for
retrospective batch processing if necessary for the facility to meet the
minimum checking requirements in Sec. 728.4(cc)(4)(iv). For DEERS
processing, the last four digits of a social security number are
insufficient. Accordingly, when retrospective processing is necessary,
the full social security number of each patient must be included on
daily logs.
(iii) Priorities. With the following initial priorities, conduct
DEERS eligibility checks using a CRT terminal, single-number dialer
telephone, or 800 number access provided for the specific purpose of
DEERS checking to:
(A) Determine whether a beneficiary is enrolled.
(B) Verify beneficiary eligibility. Eastablishment of eligibility is
under the cognizance of personnel support activities and detachments.
[[Page 307]]
(C) Identify any errors on the data base.
(iv) Minimum checking requirements. Process patients presenting at
USMTFs and DTFs in the 50 States for DEERS eligibility verification per
the following minimum checking requirements.
(A) Twenty five percent of all outpatient visits.
(B) One hundred percent of all admissions.
(C) One hundred percent of all dental visits at all DTFs for other
than active duty members, retired members, and dependent.
(1) Active duty members are exempt from DEERS eligibility
verification checking at DTFs.
(2) Retired members will receive a DEERS vertification check at the
initial visit to any DTF and annually thereafter at time of treatment at
the same facility. To qualify for care as a result of the annually
performed verification check, the individual performing the eligibility
check will make a notation to this effect on an SF 603, Health Record--
Dental. Include in the notation the date and result of the check.
(3) Dependents will have a DEERS eligibility verification check upon
initial presentation for evaluation or treatment. This check will be
valid for up to 30 days if, when the check is conducted, the period of
eligibility requested is 30 days. A 30-day eligibility check may be
accomplished online or via telephone by filling in or requesting the
operator to fill in a 30 day period in the requested treatment dates on
the DEERS eligibility inquiry screen. Each service or clinic is expected
to establish auditable procedures to trace the date of the last
eligibility verification on a particular dependent.
(D) One hundred percent of pharmacy outpatients presenting new
prescriptions written by a civilian provider. Prospective DEERS checks
are required for all patients presenting prescriptions of civilian
providers. A DEERS check is not required upon presentation of a request
for refill of a prescription of a civilian provider if the original
prescription was filled by a USMTF within the past 120 days.
(E) One hundred percent of all individuals requesting treatment
without a valid ID card if they represent themselves as individuals who
are eligible to be included in the DEERS data base.
(v) Ineligibility determinations. When a DEERS verification check is
performed and eligibility cannot be verified for any of the following
reasons, deny routine nonemergency care unless the beneficiary meets the
criteria for a DEERS eligibility override as noted in
Sec. 728.4(cc)(4)(viii).
(A) Sponsor not enrolled in DEERS.
(B) Dependent not enrolled in DEERS.
(C) ``End eligibility date'' has passed. Each individual in the
DEERS data base has a date assigned on which eligibility is scheduled to
end.
(D) Sponsor has separated from active duty and is no longer entitled
to benefits.
(E) Spouse has a final divorce decree from sponsor and is not
entitled to continued eligibility as a former spouse.
(F) Dependent child is married.
(G) Dependent becomes an active duty member of a uniformed service.
(Applies only to CHAMPUS benefits since the former dependent becomes
entitled to direct care benefits in his or her own right as an active
duty member and must enroll in DEERS.)
(vi) Emergency situations. When a physician determines that
emergency care is necessary, initiate treatment. If admitted after
emergency treatment has been provided, a retrospective DEERS check is
required. If an emergency admission or emergency outpatient treatment is
accomplished for an individual whose proof of eligibility is in
question, the patient administration department must determine the
individual's beneficiary status within 30 calendar days of treatment and
forward such determination to the fiscal department. Eligibility
verifications will normally consist of presentation of a valid ID card
along with either a positive DEERS check or a DEERS override as noted in
Sec. 728.4(cc)(4)(viii). If indicated, billing action for treatment will
then proceed per NAVMED P-5020.
(vii) Eligibility verification for nonemergency care. When a
prospective patient presents without a valid ID card and:
[[Page 308]]
(A) DEERS does not verify eligibility, deny nonemergency care. Care
denial will only be accomplished by supervisory personnel designated by
the commanding officer.
(B) The individual is on the DEERS data base, do not provide
nonemergency care until a NAVMED 6320/9, Dependent's Eligibility for
Medical Care, is signed by the member, patient, patient's parent, or
patient's legal or acting guardian. This form attests the fact that
eligibility has been established per appropriate directives and includes
the reason a valid ID card is not in the prospective patient's
possession. Apprise the aforementioned responsible individual of the
provisions on the form NAVMED 6320/9 now requiring presentation of a
valid ID card within 30 calendar days. Deny treatment or admission in
physician determined nonemergency situations of persons refusing to sign
the certification on the NAVMED 6320/9. For persons rendered treatment,
patient administration department personnel must determine their
eligibility status within 30 calendar days and forward such
determination to the fiscal department. If indicated, billing action for
treatment will then proceed following NAVMED P-5020.
(viii) DEERS overrides. Possession of an ID card alone does not
constitute sufficient proof of eligibility when the DEERS check does not
verify eligibility. What constitutes sufficient proof will be determined
by the reason the patient failed the DEERS check. For example, groups
most expected to fail DEERS eligibility checks are recent accession
members and their dependents, Guard or Reserve members recently
activated for training periods of greater than 30 days and their
dependents, and parents and parents-in-law with expired ID cards. Upon
presentation of a valid ID card, the following are reasons to
``override'' a DEERS check either showing the individual as ineligible
or when an individual does not appear in the DEERS data base.
(A) DD 1172. Patient presents an original of a copy of a DD 1172,
Application for Uniformed Services Identification and Privilege Card,
which is also used to enroll beneficiaries in DEERS. If the original is
used, the personnel support detachment (PSD) furnishing the original
will list the telephone number of the verifying officer to aid in
verification. Any copy presented must have an original signature in
section III; printed name of verifying officer, his or her grade, title,
and telephone number; and the date the copy was issued. For treatment
purposes, this override expires 120 days from the date issued.
(B) Recently issued identification cards--(1) DD 1173. Patient
presents a recently issued DD 1173, Uniformed Services Identification
and Privilege Card. Examples are spouses recently married to sponsor,
newly eligible stepchildren, family members of sponsors recently
entering on active duty for a period greater than 30 days, parents or
parents-in-law, and unremarried spouses recently determined eligible.
For treatment purposes, this override expires 120 days from the date
issued.
(2) Other ID cards. Patient presents any of the following ID cards
with a date of issue within the previous 120 days: DD 2, DD 2 (Ret),
Form PHS 1866-1, or Form PHs 1866-3 (Ret). When these ID cards are used
for the purpose of verifying eligibility for a child, collateral
documentation is necessary to ensure the child is actually the alleged
sponsor's dependent and in determining whether the child is within the
age limiting criteria outlined in Sec. 728.31(b)(4).
(C) Active duty orders. Patient or sponsor presents recently issued
orders to active duty for a period greater than 30 days. Copies of such
orders may be accepted up to 120 days of their issue date.
(D) Newborn infants. Newborn infants for a period of 1 year after
birth provided the sponsor presents a valid ID card.
(E) Recently expired ID cards. If the DEERS data base shows an
individual as ineligible due to an ID card that has expired within the
previous 120 days (shown on the screen as ``Elig with valid ID card''),
care may be rendered when the patient has a new ID card issued within
the previous 120 days.
(F) Sponsor's duty station has an FPO or APO number or sponsor is
stationed outside the 50 United States. Do not deny
[[Page 309]]
care to bona fide dependents of sponsors assigned to a duty station
outside the 50 United States or assigned to a duty station with an FPO
or APO address as long as the sponsor appears on the DEERS data base.
Before initiating nonemergency care, request collateral documentation
showing relationship to sponsor when the relationship is or may be in
doubt.
(G) Survivors. Dependents of deceased sponsors when the deceased
sponsor failed to enroll in or have his or her dependents enrolled in
DEERS. This situation will be evidenced when an eligibility check on the
surviving widow or widower (or other dependent) finds that the sponsor
does not appear (screen shows ``Sponsor SSN Not Found'') or the
survivor's name appears as the sponsor but the survivor is not listed
separately as a dependent. In any of these situations, if the survivor
has a valid ID card, treat the individual on the first visit and refer
him or her to the local personnel support detachment for correction of
the DEERS data base. For second and subsequent visits prior to
appearance on the DEERS data base, require survivors to present a DD
1172 issued per Sec. 728.4(cc)(4)(viii)(A).
(H) Patients not eligible for DEERS enrollment. (1) Secretarial
designees are not eligible for enrollment in DEERS. Their eligibility
determination is verified by the letter, on one of the service
Secretaries' letterhead, of authorization issued.
(2) When it becomes necessary to make a determination of eligibility
on other individuals not eligible for entry on the DEERS data base,
patient administration department personnel will obtain a determination
from the purported sponsoring agency, if appropriate. When necessary to
treat or admit a person who cannot otherwise present proof of
eligibility for care at the expense of the Government, do not deny care
based only on the fact that the individual is not on the DEERS data
base. In such instances, follow the procedures in NAVMED P-5020 to
minimize, to the fullest extent possible, the write-off of uncollectible
accounts.
Subpart B--Members of the Uniformed Services on Active Duty
Sec. 728.11 Eligible beneficiaries.
(a) A member of a uniformed service, as defined in subpart A, who is
on active duty is entitled to and will be provided medical and dental
care and adjuncts thereto. For the purpose of this part, the following
are also considered on active duty:
(1) Members of the National Guard in active Federal service pursuant
to a ``call'' under 10 U.S.C. 3500 or 8500.
(2) Midshipmen of the U.S. Naval Academy.
(3) Cadets of the U.S. Military Academy.
(4) Cadets of the Air Force Academy.
(5) Cadets of the Coast Guard Academy.
(b) The following categories of personnel who are on active duty are
entitled to and will be provided medical and dental care and adjuncts
thereto to the same extent as is provided for active duty members of the
Regular service (except reservists when on active duty for training as
delineated in Sec. 728.21).
(1) Members of the Reserve components.
(2) Members of the Fleet Reserve.
(3) Members of the Fleet Marine Corps Reserve.
(4) Members of the Reserve Officers' Training Corps.
(5) Members of all officer candidate programs.
(6) Retired members of the uniformed services.
Sec. 728.12 Extent of care.
Members who are away from their duty stations or are on duty where
there is no MTF of their own service may receive care at the nearest
available Federal MTF (including designated USTFs) with the capability
to provide required care. Care will be provided without regard to
whether the condition for which treatment is required was incurred or
contracted in line of duty.
(a) All uniformed services active duty members. (1) All eligible
beneficiaries
[[Page 310]]
covered in this subpart are entitled to and will be rendered the
following treatment and services upon application to a naval MTF whose
mission includes the rendering of the care required. This entitlement
provides that when required care and services are beyond the
capabilities of the facility to which the member applies, the commanding
officer of that facility will arrange for care from another USMTF,
designated USTF, or other Federal source or will authorize and arrange
for direct use of supplemental services and supplies from civilian non-
Federal sources out of operation and maintenance funds.
(i) Necessary hospitalization and other medical care.
(ii) Occupational health services as defined in Sec. 728.2(z).
(iii) Necessary prosthetic devices, prosthetic dental appliances,
hearing aids, spectacles, orthopedic footwear, and other orthopedic
appliances (see subpart H). When these items need repair or replacement
and the items were not damaged or lost through negligence, repair or
replacement is authorized at Goverment expense.
(iv) Routine dental care.
(2) When a USMTF, with a mission of providing the care required,
releases the medical management of an active duty member of the Navy,
Marine Corps, Army, Air Force, or a commissioned corps member of USPHS
or NOAA, the resulting civilian health care costs will be paid by the
referring facility.
(3) The member's uniformed service will be billed for care provided
by the civilian facility only when the referring MTF is not organized
nor authorized to provide needed health care (see part 732 of this
chapter for naval members). Saturation of service or facilities does not
fall within this exception. When a naval MTF retains medical management,
the costs of supplemental care obtained from civilian sources is paid
from funds available to operate the MTF which manages care of the
patient. When it becomes necessary to refer a USPHS or NOAA commissioned
corps member to a non-Federal source of care, place a call to the
Department of Health and Human Services (DHHS), Chief, Patient Care
Services on (301) 443-1943 or FTS 443-1943 if DHHS is to assume
financial responsibility. Patient Care Services is the sole source for
providing authorization for non-Federal care at DHHS expense.
(b) Maternity episode for active duty female members. A pregnant
active duty member who lives outside the MHSS inpatient catchment area
of all USMTFs is permitted to choose whether she wishes to deliver in a
closer civilian hospital or travel to the USMTF for delivery. If such a
member chooses to deliver in a naval MTF, makes application, and
presents at that facility at the time for delivery, the provisions of
paragraph (a) of this section apply with respect to the furnishing of
needed care, including routine newborn care (i.e., nursery, newborn
examination, PKU test, etc.); arrangements for care beyond the
facility's capabilities; or the expenditure of funds for supplemental
care or services. Pay expenses incurred for the infant in USMTFs or
civilian facilities (once the mother has been admitted to the USMTF)
from funds available for care of active duty members, unless the infant
becomes a patient in his or her own right either through an extension of
the birthing hospital stay because of complications, subsequent transfer
to another facility, or subsequent admission. If the Government is to
assume financial responsibility for:
(1) Care of pregnant members residing within the MHSS inpatient
catchment area of a uniformed services hospital or in the inpatient
catchment area of a designated USTF, such members are required to:
(i) Make application to that facility for care, or
(ii) Obtain authorization, per part 732 of this chapter, for
delivery in a civilian facility.
(2) Non-Federal care of pregnant members residing outside inpatient
catchment areas of USMTFs and USTFs, the member must request and receive
authorization per part 732 of this chapter. Part 732 of this chapter
also provides for cases of precipitious labor necessitating emergency
care. OPNAVINST 6000.1, Management of
[[Page 311]]
Pregnant Servicewomen, contains medical-administrative guidelines on
management prior to admission and after discharge from admission for
delivery.
(c) Reserve and National Guard personnel. In addition to those
services covered in paragraphs (a) and (b) of this section, Reserve and
National Guard personnel are authorized the following under conditions
set forth. (See Sec. 728.25 for additional benefits for National Guard
personnel.)
(1) Personnel whose units have an active Army mission of manning
missile sites are authorized spectacle inserts for protective field
masks.
(2) Personnel assigned to units designated for control of civil
disturbances are authorized spectacle inserts for protective field masks
M17.
Sec. 728.13 Application for care.
Possession of an ID card (a green colored DD 2 (with letter suffix
denoting branch of service), Armed Forces Identification Card; a green
colored PHS 1866-1, Identification Card; or a red colored DD 2 Res
(Reservists on active duty for training)) alone does not constitute
sufficient proof of eligibility. Accordingly, make a DEERS check, per
Sec. 728.4(cc), before other than emergency care is rendered to the
extent that may be authorized.
Sec. 728.14 Pay patients.
Care is provided on a reimbursable basis to: Coast Guard active duty
officers, enlisted personnel, and academy cadets; Public Health Service
Commissioned Corps active duty officers; and Commissioned Corps active
duty officers of the National Oceanic and Atmospheric Administration.
Accordingly, patient administration personnel will initiate the
collection action process in subpart J in each instance of inpatient or
outpatient care provided to these categories of patients.
Subpart C--Members of Reserve Components, Reserve Officers' Training
Corps, Navy and Marine Corps Officer Candidate Programs, and National
Guard Personnel
Sec. 728.21 Navy and Marine Corps reservists.
(a) Scope. This section applies to reservists, as those terms are
defined in Sec. 728.2, ordered to active duty for training or inactive
duty training for 30 days or less. Reservists serving under orders
specifying duty in excess of 30 days, such as Sea and Air Mariners
(SAMS) while on initial active duty for training, will be provided care
as members of the Regular service per subpart B.
(b) Entitlement. Per 10 U.S.C. 1074a(a), reservists who incur or
aggravate an injury, illness, or disease in line of duty while on active
duty for training or inactive duty training for a period of 30 days or
less, including travel to and from that duty, are entitled to medical
and dental care appropriate for the treatment of that injury, disease,
or illness until the resulting disability cannot be materially improved
by further hospitalization or treatment. Care is authorized for such an
injury, illness, or disease beyond the period of training to the same
extent as care is authorized for members of the Regular service (see
subpart B) subject to the provisions of Sec. 728.21(e).
(c) Questionable circumstances. If the circumstances are
questionable, referral to the OMA or ODA is appropriate. If necessary,
make referral to the Naval Medical Command (MEDCOM-33 for medical and
MEDCOM-06 for dental) on determinations of entitlements.
(d) Line of duty. For the purpose of providing treatment under laws
entitling reservists to care, an injury, illness, or disease which is
incurred, aggravated, or becomes manifest while a
[[Page 312]]
reservist is employed in the performance of active duty for training or
inactive duty training (including authorized leave, liberty and travel
to and from either duty) will be considered to have been incurred in
line of duty (LOD) unless the condition was incurred as a result of the
reservist's own misconduct or under other circumstances enumerated in
JAG Manual, chapter VIII. While the LOD investigation is being
conducted, such reservists remain entitled to care. If the investigation
determines that the injury or illness was not incurred in line of duty,
the civilian humanitarian nonindigent rate is applicable if further care
is required in naval MTFs. (See DOD Military Pay and Allowances
Entitlement Manual for allowable constructive travel times.)
(e) Treatment and services authorized. In addition to those services
delineated above, the following may be rendered under circumstances
outlined:
(1) Prosthetic devices, including dental appliances, hearing aids,
spectacles, and orthopedic appliances that are lost or have become
damaged during training duty, not through negligence of the individual,
may be repaired or replaced at Government expense.
(2) Reservists covered by this subpart may be provided the following
only if approved by the appropriate OMA or ODA, or by the Commander,
Naval Medical Command (MEDCOM-33 for medical and MEDCOM-06 for dental)
prior to initiation of services.
(i) Treatment for acute exacerbations of conditions that existed
prior to a reservist's period of training duty. Limit care to that
necessary for the prevention of pain or undue suffering until the
patient can reasonably return to control of the member's private
physician or dentist.
(A) Remediable physical defects and remediable treatment for other
conditions.
(B) Elective surgery.
(ii) All dental care other than emergency treatment and that
necessary to correct an injury incurred in the line of duty.
(f) Authorization for care. (1) Reservists covered by this subpart
may be provided inpatient or outpatient care during a period of training
duty without written authorization.
(2) Except in emergencies or when inpatient care initiated during a
period of training duty extends beyond such period, reservists will be
required to furnish written official authorization from their unit
commanding officer, or higher authority, incident to receiving inpatient
or outpatient care beyond the period of training duty. The letter of
authorization will include name, grade or rate, social security number,
and organization of the reservist; type of training duty being performed
or that was being performed when the condition manifested; diagnosis (if
known); and a statement that the condition was incurred in line of duty
and that the reservist is entitled to care. If the reservist has been
issued a notice of eligibility (NOE) (subpart I), the NOE may then be
accepted in lieu of the letter of authorization. When authorization has
not been obtained beforehand, care may be provided on a civilian
humanitarian basis (see subpart G) pending final determination of
eligibility.
Sec. 728.22 Members of other reserve components of the uniformed services.
(a) Members of reserve components of the Coast Guard may be provided
care the same as Navy and Marine Corps reservists.
(b) Members of reserve components of the Army and Air Force may be
provided care in naval MTFs to the same extent that they are eligible
for such care in MTFs of their respective services. Consult current Army
Regulation 40-3, Medical, Dental, and Veterinary Care, or Air Force
Regulation 168-6, Persons Authorized Medical Care, as appropriate, for
particular eligibility requirements or contact the nearest appropriate
service facility.
(c) When the service directive requires written authorization,
obtain such authorization from the reservist's unit commanding officer
or other appropriate higher authority.
(d) Naval MTFs in the United States are authorized to conduct
physical examinations of and administer immunizations to inactive
reserve Public Health Service commissioned officers
[[Page 313]]
upon presentation of a written request from the Commissioned Personnel
Operations Division, OPM/OAM, 5600 Fishers Lane, Rockville, MD 20852.
Sec. 728.23 Reserve Officers' Training Corps (ROTC).
(a) Eligible beneficiaries. (1) Members of the Senior Reserve
Officers' Training Corps of the Armed Forces including students enrolled
in the 4-year Senior ROTC Program or the 2-year Advanced Training Senior
ROTC Program.
(2) Designated applicants for membership in the Navy, Army, and Air
Force Senior ROTC Programs during their initial 6-weeks training period
(practice cruises or field training).
(3) Medical, dental, pharmacy, veterinary or science allied to
medicine students who are commissioned officers of a reserve component
of an Armed Force who have been admitted to and training in a unit of a
Senior Reserve Officers' Training Corps.
(b) Extent of care. (1) While attending or en route to or from field
training or practice cruises:
(i) Medical care for a condition incurred without reference to line
of duty.
(ii) Routine dental care.
(iii) Prosthetic devices, including dental appliances, hearing aids,
spectacles, and orthopedic appliances that have become damaged or lost
during training duty, not through negligence of the individual, may be
repaired or replaced as necessary at government expense.
(iv) Care of remediable physical defects, elective surgery or other
remediable treatment for conditions that existed prior to a period of
training duty are not authorized without approval from the appropriate
OMA or ODA, or from the Commander, Naval Medical Command (MEDCOM-33 for
medical and MEDCOM-06 for dental).
(v) Medical examinations and immunizations.
(vi) ROTC members are authorized continued medical care, including
hospitalization, upon expiration of their field training or practice
cruise period, the same as reservists in Sec. 728.21(b) and Sec. 728.22.
(2) While attending a civilian educational institution:
(i) Medical care in naval MTFs, including hospitalization, for a
condition incurred in line of duty while at or traveling to or from a
military installation for the purpose of undergoing medical or other
examinations or for purposes of making visits of observation, including
participation in service-sponsored sports, recreational, and training
activities.
(ii) Medical examinations, including hospitalization necessary for
the proper conduct thereof.
(iii) Required immunizations, including hospitalization for severe
reactions therefrom.
(c) Authorization. The individual's commanding officer will prepare
a letter of authorization addressed to the commanding officer of the MTF
concerned.
(d) ROTC members as beneficiaries of the Office of Workers'
Compensation Programs (OWCP). Under circumstances described therein,
render care as outlined in Sec. 728.53 to members of the ROTC as
beneficiaries of OWCP.
Sec. 728.24 Navy and Marine Corps Officer Candidate Programs.
Members of the Reserve Officers Candidate Program and Platoon
Leaders Class are entitled to the same medical and dental benefits as
are provided members of the Navy and Marine Corps Reserve Components.
Accordingly, the provisions of Sec. 728.21 are applicable for such
members. Additionally, candidates for, or persons enrolled in such
programs are authorized access to naval MTFs for the purpose of
conducting special physical examination procedures which have been
requested by the Commander, Naval Medical Command to determine their
physical fitness for appointment to, or continuation in such a program.
Upon a request from the individual's commanding officer, the officer in
charge of cognizant Navy and Marine Corps recruiting stations, or
officer selection officer, naval MTFs are authorized to admit such
persons when, in the opinion of the cognizant officer, hospitalization
is necessary for the proper conduct of the special physical
examinations. Hospitalization should be kept
[[Page 314]]
to a minimum and treatment other than for humanitarian reasons, except
as provided in this part, is not authorized.
Sec. 728.25 Army and Air Force National Guard personnel.
(a) Medical and dental care. Upon presentation of a letter of
authorization, render care as set forth in AR 40-3 (Medical, Dental, and
Veterinary Care) and AFR 168-6 (Persons Authorized Medical Care) to
members of the Army and Air Force National Guard who contract a disease
or become ill in line of duty while on full-time National Guard duty,
(including leave and liberty therefrom) or while traveling to or from
that duty. The authorizing letter will include name, social security
number, grade, and organization of the member; type and period of duty
in which engaged (or in which engaged when the injury or illness
occurred); diagnosis (if known); and will indicate that the injury
suffered or disease contracted was in line of duty and that the
individual is entitled to medical or dental care. Limit care to that
appropriate for the injury. disease, or illness until the resulting
disability cannot be materially improved by further hospitalization or
treatment.
(b) Physical examinations. AR 40-3 and AFR 168-6 also authorize
physical examinations for National Guard personnel. Accordingly, when
requested by an Army or Air Force National Guard unit's commanding
officer, naval MTFs may perform the requested physical examination per
the appropriate service directive, subject to the availability of space,
facilities, and the capabilities of the staff.
Subpart D--Retired Members and Dependents of the Uniformed Services
Sec. 728.31 Eligible beneficiaries and health benefits authorized.
(a) Retired members of the uniformed services. Retired members, as
defined in Sec. 728.2(aa), are authorized the same medical and dental
benefits as active duty members subject to the availability of space and
facilities, capabilities of the professional staff, and the priorities
in Sec. 728.3, except that:
(1) Periodic medical examinations for members on the Temporary
Disability Retired List, including hospitalization in connection with
the conduct thereof, will be furnished on the same priority basis as
care to active duty members.
(2) When vision correction is required, one pair of standard issue
spectacles, or one pair of nonstandard spectacles, are authorized when
required to satisfy patient needs. Two pairs of spectacles may be
furnished only when professionally determined to be essential by the
examining officer. Military ophthalmic laboratories will not furnish
occupational type spectacles, such as aviation, industrial safety,
double segment, and mask insert, to retired military personnel
(NAVMEDCOMINST 6810.1 refers).
(b) Dependents of members of former members. Include:
(1) The spouse.
(2) The unremarried widow.
(3) The unremarried widower.
(4) An unmarried legitimate child, including an adopted child or a
stepchild, who either--
(i) Has not passed his or her 21st birthday;
(ii) Is incapable of self-support because of a mental or physical
incapacity that existed before the 21st birthday and is, or was at the
time of the member's or former member's death, in fact dependent on the
member for over one-half of his or her support; or
(iii) Has not passed the 23rd birthday, is enrolled in a full-time
course of study in an institution of higher learning approved by the
administering Secretary and is, or was at the time of the member's or
former member's death, in fact dependent on the member for over one-half
of his or her support. (If such a child suffers a disabling illness or
injury and is unable to return to school, the child remains eligible for
benefits until 6 months after the disability is removed, or until the
23rd birthday is reached, whichever comes first.)
(5) An unmarried illegitimate child or illegitimate step-child who
is, or was at the time of sponsor's death, dependent on the sponsor for
more than one-half of his or her support; residing with or in a home
provided by the
[[Page 315]]
sponsor or the sponsor's spouse, as applicable, and is--
(i) Under 21 years of age; or
(ii) Twenty-one years of age or older but incapable of self-support
because of a mental or physical incapacity that existed prior to the
individual's 21st birthday; or
(iii) Twenty-one or 22 years of age and pursuing a full-time course
of education that is approved per Sec. 728.31(b)(4)(iii).
(6) A parent or parent-in-law, who is, or was at the time of the
member's or former member's death, in fact dependent on the member for
over one-half of such parent's support and residing in the sponsor's
household.
(7) An unremarried former spouse of a member or former member who
does not have medical coverage under an employer-sponsored health plan,
and who:
(i) On the date of the final decree of divorce, dissolution, or
annulment, had been married to the member or former member at least 20
years during which period the member of former member performed at least
20 years of service creditable in determining that member's or former
member's eligibility for retired or retainer pay, or equivalent pay.
(ii) Had been married to the member of former member at least 20
years, at least 15 of which were during the period the member of former
member performed service creditable in determining the member's
eligibility for retired or retainer pay, or equivalent pay. The former
spouse's sponsor must have performed at least 20 years of service
creditable in determining the sponsor's eligibility for retired or
retainer pay, or equivalent pay.
(A) Eligibility for such former spouses continue until remarriage if
the final decree of divorce, dissolution, or annulment occurred before 1
April 1985.
(B) Eligibility terminates the later of: Either 2 years from the
date of the final decree of divorce, dissolution, or annulment; or 1
April 1988 for such former spouses whose final decree occured on or
after 1 April 1985.
(iii) An unremarried former spouse of a deceased member of former
member who meets the requirements of Sec. 728.31(b)(7)(i) or (ii) may be
provided medical and dental care as a dependent when the sponsor:
(A) Died before attaining age 60.
(B) At the time of death would have been eligible for retired pay
under 10 U.S.C. 1331-1337 except that the sponsor was under 60 years of
age; but the former spouse is not eligible for care until the date the
sponsor would have attained age 60;
(C) Whether or not the sponsor elected participation in the Survivor
Benefit Plan of 10 U.S.C. 1447-1455.
(c) Eligibility factors. Care that may be rendered to all dependents
in this subpart D is subject to the availability of space and
facilities, capabilities of the professional staff, and priorities in
Sec. 728.3. Additionally:
(1) Members of the uniformed services must be serving under orders
specifying active duty for more than 30 days before their dependents are
authorized benefits delineated in Sec. 728.31(d).
(2) A dependent's eligibility begins on the date the member enters
on active duty and ends as of midnight of the date the sponsor's period
of active duty ends for any reason other than retirement or death.
Dependents lose eligibility as of midnight of the date a member is
officially place in a deserter status. Eligibility is restored on the
date a deserter is returned to military control.
(3) A dependent (other than a former spouse) of a member or former
member who died before attaining age 60 and at the time of death--
(i) Would have been eligible for retired pay under chapter 67 of
title 10 U.S.C. but for the fact that the member of former member was
under 60 years of age, and
(ii) Had elected to participate in the Survivor Benefit Plan, may
not be rendered medical or dental care under the sponsor's entitlement
until the date on which such member of former member would have attained
age 60.
(4) A spouse, not qualifying as a former spouse, who is divorced
from a member loses eligibility for benefits as of midnight of the date
the divorce becomes final. This includes loss of maternity care benefits
for wives who are pregnant at the time a divorce becomes
[[Page 316]]
final. A spouse does not lose eligibility through issuance of an
interlocutory decree of divorce even when a property settlement has been
approved which releases the member from responsibility for the spouse's
support. A spouse's eligibility depends upon the relationship of the
spouse to the member; so long as the relationship of husband and wife is
not terminated by a final divorce or annulment decree, eligibility
continues.
(5) Eligibility of children is not affected by the divorce of
parents except that a stepchild relationship ceases upon divorce or
annulment of natural parent and step-parent. A child's eligibility for
health benefits is not affected by the remarriage of the divorced spouse
maintaining custody unless the marriage is to an eligible service
member.
(6) A stepchild relationship does not cease upon death of the member
step-parent but does cease if the natural parent subsequently remarries.
(7) A child of an active duty or retired member, adopted after that
member's death, retains eligibility for health benefits. However, the
adoption of a child of a living member (other than by a person whose
dependents are eligible for health benefits at USMTFs) terminates the
child's eligibility.
(8) If a member's child is married before reaching age 21 to a
person whose dependents are not eligible for health benefits in USMTFs,
eligibility ceases as of midnight on the date of marriage. Should the
marriage be terminated, the child again becomes eligible for benefits as
a dependent child if otherwise eligible.
(d) Health benefits authorized. (1) Inpatient care including
services and supplies normally furnished by the MTF.
(2) Outpatient care and services.
(3) Drugs (see chapter 21, MANMED).
(i) Prescriptions written by officers of the Medical and Dental
Corps, civilian physicians and dentists employed by the Navy, designated
officers of the Medical Service Corps and Nurse Corps, independent duty
hospital corpsmen, and others designated to write prescriptions will be
filled subject to the availability of pharmaceuticals, and consistent
with control procedures and applicable laws.
(ii) Prescriptions written by civilian physicians and dentists (non-
Navy employed) for eligible beneficiaries may be filled if:
(A) The commanding officer or CO's designee determines that pharmacy
personnel and funds are available.
(B) The items requested are routinely stocked.
(C) The prescribed quantity is within limitations established by the
command.
(D) The prescriber is in the local area (limits designated by the
commanding officer).
(E) The provisions of chapter 21, MANMED are followed when such
services include the dispensing of controlled substances.
(4) Treatment on an inpatient or outpatient basis of:
(i) Medical and surgical conditions.
(ii) Contagious diseases.
(iii) Nervous, mental, and chronic conditions.
(5) Physical examinations, including eye examinations and hearing
evaluations, and all other tests and procedures necessary for a complete
physical examination.
(6) Immunizations.
(7) Maternity (obstetrical) and infant care, routine care and
examination of the newborn infant, and well-baby care for mothers and
infants meeting the eligibility requirements of Sec. 728.31(b). If a
newborn infant of an unmarried dependent minor daughter becomes a
patient in his or her own right after discharge of the mother, classify
the infant as civilian humanitarian nonindigent inasmuch as
Sec. 728.31(b) does not define the infant as a dependent of the active
duty or retired service member. Therefore, the minor daughter's sponsor
(parent) should be counseled concerning the possibility of Secretarial
designee status for the infant (see Sec. 728.77).
(8) Diagnostic tests and services, including laboratory and x-ray
examinations. Physical therapy, laboratory, x-ray, and other ambulatory
diagnostic or therapeutic measures requeted by non-Navy employed
physicians may be provided upon approval of the commanding officer or
designated department heads. Rendering of such srvices is subordinate to
and will not unduly
[[Page 317]]
interfere with providing inpatient and outpatient care to active duty
personnel and others whose priority to receive care is equal to or
greater than such dependents. Ensure that the release of any information
to non-Navy employed physicians is in consonance with applicable
provisions of SECNAVINST 5211.5C.
(9) Family planning services as delineated in SECNAVINST 6300.2A.
Abortions, at the expense of the Government, may not be performed except
where the life of the mother would be endangered if the fetus were
carried to term.
(10) Dental care worldwide on a space available basis.
(11) Government ambulance services, surface or air, to transport
dependents to, from, or between medical facilities when determined by
the medical officer in charge to be medically necessary.
(12) Home calls when determined by the medical officer in charge to
be medically necessary.
(13) Artificial limbs and artificial eyes, including initial issue,
fitting, repair, replacement, and adjustment.
(14) Durable equipment such as wheelchairs, hospital beds, and
resuscitators may be issued on a loan basis.
(15) Orthopedic aids, braces, crutches, elastic stockings, walking
irons, and similar aids.
(16) Prosthetic devices (other than artificial limbs and eyes),
hearing aids, orthopedic footwear, and spectacles or contact lenses for
the correction of ordinary refractive error may not be provided
dependents. These items, however, may be sold to dependents at cost to
the Government at facilities outside the United States and at specific
installations within the United States where adequate civilian
facilities are unavailable.
(17) Special lenses (including intraocular lenses) or contact lenses
for those eye conditions which require these items for complete medical
or surgical management of the condition.
(18) One wig if the individual has alopecia resulting from treatment
of a malignant disease: Provided the individual has not previously
received a wig at the expense of the United States.
(e) Dependents of reserves. (1) A dependent, as defined in
Sec. 728.31(b), of a deceased member of the Naval Reserve, the Fleet
Reserve, the Marine Corps Reserve, or the Fleet Marine Corps Reserve,
who--
(i) Was ordered to active duty or to perform inactive-duty training
for any period of time.
(ii) Was disabled in the line of duty from an injury while so
employed, and
(iii) Dies from such a specific injury, illness, or disease is
entitled to the same care as provided for dependents in Sec. 728.31(c).
(2) The provisions of this subpart D are not intended to authorize
medical and dental care precluded for dependents of members of Reserve
components who receive involuntary orders to active duty under 10 U.S.C.
270b.
(f) Unauthorized care. In addition to the devices listed in
Sec. 728.31(d)(16) as unauthorized, dependents are not authorized care
for elective correction of minor dermatological blemishes and marks or
minor anatomical anomalies.
Sec. 728.32 Application for care.
Possession of an ID card alone (DD 2 (Retired), PHS-1866-3
(Retired), or DD 1173 (Uniformed Services Identification and Privilege
Card)) does not constitute sufficient proof of eligibility. Accordingly,
a DEERS check will be instituted per Sec. 728.4 (cc) before medical and
dental care may be rendered except in emergencies. When required
inpatient or outpatient care is beyond the capabilities of the naval
MTF, the provisions of Sec. 728.34 apply. When required inpatient care
cannot be rendered and a decision is made to disengage a CHAMPUS-
eligible beneficiary, the provisions of Sec. 728.33 apply.
Sec. 728.33 Nonavailability statement (DD 1251).
(a) General. Per DODINST 6015.19 of 26 Nov. 1984, the following
guidelines are effective as of 1 Jan. 1985. All previously issued
Nonavailability Statement guidelines and reporting requirements are
superseded.
(b) Applicability. The following provisions are applicable to
nonemergency inpatient care only. A DD 1251 is not required:
[[Page 318]]
(1) For emergency care (see paragraph (d)(1)) of this section.
(2) When the beneficiary has other insurance (including Medicare)
that provides primary coverage for a covered service.
(3) For medical services that CHAMPUS clearly does not cover.
(c) Reasons for issuance. DD 1251's may be issued for only the
following reasons:
(1) Proper facilities are not available.
(2) Professional capability is not available.
(3) It would be medically inappropriate (as defined in
Sec. 728.2(u)) to require the beneficiary to use the USMTF and the
attending physician has specific prior approval from the facility's
commanding officer or higher authority to make such determination.
(i) Issuance for this reason should be restricted to those instances
when denial of the DD 1251 could result in a significant risk to the
health of any patient requiring any clinical specialty.
(ii) Issuing authorities have discretionary authority to evaluate
each situation and issue a DD 1251 under the ``medically inappropriate''
reason if:
(A) In consideration of individual medical needs, personal
constraints on an individual's ability to get to the USMTF results in an
unreasonable limitation on that individual's ability to get required
medical care, and
(B) The issuing authority determines that obtaining care from a
civilian source selected by the individual would result in significantly
less limitations on that individual's ability to get required medical
care than would result if the individual was required to obtain care
from a USMTF.
(C) A beneficiary is in a travel status. The commanding officer of
the first facility contacted, in either the beneficiary's home catchment
area or the catchment area where hospital care was obtained, has this
discretionary authority. Travel in this instance means the beneficiary
is temporarily on a trip away from his or her permanent residence. The
reason the patient is traveling, the distance involved in the travel,
and the time away from the permanent residence is not critical to the
principle inherent in the policy. The issuing officer to whom the
request for a Nonavailability Statement is made should reasonably
determine that the trip was not made, and the civilian care is not (was
not) obtained, with the primary intent of avoiding use of a USMTF or
USTF serving the beneficiary's home area.
(d) Guidelines for issuing--(1) Emergency care. Emergency care
claims do not require an NAS; however, the nature of the service or care
must be certified as an emergency by the attending physician, either on
the claim form or in a separate signed and dated statement. Otherwise, a
DD 1251 is required by CHAMPUS-eligible beneficiaries who are subject to
the provisions of this section.
(2) Emergency maternity care. Unless substantiated by medical
documentation and review, a maternity admission would not be deemed as
an emergency since the fact of the pregnancy would have been established
well in advance of the admission. In such an instance, the beneficiary
would have had sufficient opportunity to obtain a DD 1251 if required in
her residence catchment area.
(3) Newborn infant(s) remaining in hospital after discharge of
mother. A newborn infant remaining in the hospital continuously after
discharge of the mother does not require a separate DD 1251 for the
first 15 days after the mother is discharged. Claims for care beyond
this 15-day limitation must be accompanied by a valid DD 1251 issued in
the infant's name. This is due to the fact that the infant becomes a
patient in his or her own right (the episode of care for the infant
after discharge of the mother is not considered part of the initial
reason for admission of the mother (delivery), and is therefore
considered a separate admission under a different diagnosis).
(4) Cooperative care program. When a DD 2161, Referral for Civilian
Medical Care, is issued for inpatient care in connection with the
Cooperative Care Program (Sec. 728.4(z)(5)(iv)) for care under CHAMPUS,
a DD 1251 must also be issued.
(5) Beneficiary responsibilities. Beneficiaries are responsible for
determining whether an NAS is necessary in
[[Page 319]]
the area of their residence and for obtaining one, if required, by first
seeking nonemergency inpatient care in the USMTF or USTF serving the
catchment area. Beneficiaries cannot avoid this requirement by arranging
to be away from their residence when nonemergency inpatient care is
obtained, e.g., staying with a relative or traveling. Individuals
requiring an NAS because they reside in the inpatient catchment area of
a USMTF or USTF also require an NAS for nonemergency care received while
away from their inpatient catchment area.
(e) Issuing authority. Under the direction of the Commander, Naval
Medical Command, exercised through commanders of naval geographic
medical commands, naval MTFs will issue Nonavailability Statements only
when care required is not available from the naval MTF and the
beneficiary's place of residence is within the catchment area (as
defined in Sec. 728.2(d)) of the issuing facility or as otherwise
directed by the Secretary of Defense. When the facility's inpatient
catchment area overlaps the inpatient catchment area of one or more
other USMTFs or USTFs with inpatient capability and the residence of the
beneficiary is within the same catchment area of one or more other
USMTFs or USTFs with inpatient capability, the issuing authority will:
(1) Determine whether required care is available at any other USMTFs
or USTFs whose inpatient catchment area overlaps the beneficiary's
residence. If care is available, refer the beneficiary to that facility
and do not issue a DD 1251.
(2) Implement measures ensuring that an audit trail related to each
check and referral is maintained, including the check required before
retroactive issuance of a DD 1251 as delineated in paragraph (g) of this
section. When other than written communication is made to ascertain
capability, make a record in the log required in paragraph (h) of this
section that ``Telephonic (or other) determination was made on (date)
that required care was not available at (name of other USMTF(s) or
USTF(s) contacted)''. The individual ascertaining this information will
sign this notation.
(3) Once established that a DD 1251 is authorized and will be
issued, the following will apply:
(i) Do not refer patients to a specific source of care.
(ii) Nonavailability Statements issued at commands outside the
United States are not valid for care received in facilities located
within the United States. Statements issued within the United States are
not valid for care received outside the United States.
(iii) The issuing authority will:
(A) If capability permits, prepare a DD 1251 via the automated
application of DEERS. Where this system is operational, it provides for
transmitting quarterly reports to the Office of the Assistant Secretary
of Defense for Health Affairs (OASD(HA)) by electronic means. System
users should refer to their DEERS/NAS Users Manual for specific guidance
on the use of the automated system. At activities where the DEER/NAS
automated system is not operational, prepare each DD 1251 per
instructions on the reverse of the form. After completion, if authorized
by the facility CO, the issuing authority will sign the DD 1251. Give a
copy to the patient for presentation to a participating civilian
provider, or for submission with the claim of a nonparticipating
provider. Retain a copy for the issuing activity's records. Retain the
original for subsequent transmittal to the Naval Medical Data Services
Center per paragraph (j) of this section.
(B) Explain to the patient or other responsible family member the
validity period of the DD 1251 (see paragraph (f) of this section).
(C) Ensure that beneficiaries are clearly advised of the cost-
sharing provisions of CHAMPUS and of the fact that the issuance of a
Nonavailability Statement does not imply that CHAMPUS will allow any and
all costs incurred through the use of the DD 1251. The issuance of a DD
1251 indicates only that care requested is not available at a USMTF or
USTF serving the beneficiary's residence inpatient catchment area.
(D) Review, with the patient or responsible family member,
instructions 1 through 6 on the face of the DD 1251 and have the patient
or responsible
[[Page 320]]
family member sign acknowledgement that such review has been made and is
understood.
(E) Advise recipients that CHAMPUS fiscal intermediaries may deny
claims of individuals who are not enrolled in the Defense Enrollment
Eligibility Reporting System (DEERS).
(f) Validity period. DD 1251's issued for:
(1) Other than maternity care are valid for a hospital admission
occurring within 30 days of issuance and remain valid from the date of
admission until 15 days after discharge from the facility rendering
inpatient care. This allows for any follow-on treatment related directly
to the original admission.
(2) Maternity episodes are valid if outpatient of inpatient
treatment related to the pregnancy is initiated within 30 days of its
issuance. They remain valid for care of the mother through termination
of the pregnancy and for 42 days thereafter to allow for postnatal care
to be included in the maternity episode. (See paragraph (d)(3) of this
section for the validity period of DD 1251's for infants remaining after
discharge of the mother.)
(g) Retroactive issuance. Issue Nonavailability Statements
retroactively only if required care could not have been rendered in a
USMTF or USTF as specified in paragraph (e) of this section at the time
services were rendered in the civilian sector. At the time a retroactive
issuance is requested, the facility receiving the request will determine
whether capability existed at the USMTF or USTF serving the inpatient
catchment area wherein the beneficiary resides (resided) or at any of
the facilities in the overlapping area described in paragraph (e) of
this section. While the date of service will be recorded on the DD 1251,
send the retained original to the Naval Medical Data Services Center
along with others issued during the week of issuance (paragraph (j) of
this section refers).
(h) Annotating DD 1251's. Before issuance, annotate each DD 1251 per
the instructions for completion on the reverse of the form. DD 1251's
issued under the CO's discretionary authority for the ``medically
inappropriate reason (paragraph (c)(3)(ii) of this section) will be
annotated in the remarks section documenting the special circumstances
necessitating issuance, the name and location of the source of care
selected by the beneficiary, and approximate distance from the source
selected to the nearest USMTF or USTF with capability (see instruction
number 2 on the reverse of the DD 1251). Establish and maintain a
consecutively numbered log to include for each individual to whom a DD
1251 is issued:
(1) Patient's name and identifying data.
(2) The facility unique NAS number (block number 1 on the DD 1251).
(i) Appeal procedures. Beneficiaries may appeal the denial of their
request for a DD 1251. This procedure consists of four levels within
Navy, any one of which may terminate action and order issuance of a
Nonavailability Statement if deemed warranted:
(1) The first level is the chief of service, or director of clinical
services if the chief of service is the cognizant authority denying the
beneficiary's original request.
(2) The second level is the commanding officer of the naval MTF
denying the issuance. Where the appeal is denied and denial is upheld at
the commanding officer's level, inform beneficiaries that their appeal
may be forwarded to the geographic commander having jurisdictional
authority.
(3) The third level is the appropriate geographic commander, if the
appeal is denied at this level, inform beneficiaries that their appeal
may be forwarded to the Commander, Naval Medical Command, Washington, DC
20372-5120.
(4) The Commander, Naval Medical Command, the fourth level of
appeal, will evaluate all documentation submitted and arrive at a
decision. The beneficiary will be notified in writing of this decision
and the reasons therefor.
(j) Data collection and reporting. Do not issue the original of each
DD 1251 prepared at activities where the DEER/NAS automated system is
not operational. Send the retained originals to the Commanding Officer,
Naval Medical Data Services Center (Code-03), Bethesda, MD 20814-5066
for reporting
[[Page 321]]
under report control symbol DD-HA (Q) 1463(6320).
Sec. 728.34 Care beyond the capabilities of a naval MTF.
When either during initial evaluation or during the course of
treatment of an individual authorized care in this subpart, a
determination is made that required care or services are beyond the
capability of the naval MTF, the provisions of Sec. 728.4(z)(2) apply.
Sec. 728.35 Coordination of benefits--third party payers.
Title 10 U.S.C. 1095 directs the services to collect from third-
party payers the reasonable costs of inpatient hospital care incurred by
the United States on behalf of retirees and dependents. Naval hospital
collection agents have been provided instructions relative to this issue
and are responsible for initiating claims to third-party payers for the
cost of such care. Admission office personnel must obtain insurance,
medical service, or health plan (third-party payer) information from
retirees and dependents upon admission and forward this information to
the collection agent.
Sec. 728.36 Pay patients.
Care is provided on a reimbursable basis to retired Coast Guard
officers and enlisted personnel, retired Public Health Service
Commissioned Corps officers, retired Commissioned Corps officers of the
National Oceanic and Atmospheric Administration, and to the dependents
of such personnel. Accordingly, patient administration personnel will
follow the provisions of subpart J to initiate the collection action
process when inpatient or outpatient care is provided to these
categories of beneficiaries.
Subpart E--Members of Foreign Military Services and Their Dependents
Sec. 728.41 General provisions.
(a) Dependent. As used in this subpart, the term ``dependent''
denotes a person who bears one of the following relationships to his or
her sponsor:
(1) A wife.
(2) A husband if dependent on his sponsor for more than one-half of
his support.
(3) An unmarried legitimate child, including an adopted or stepchild
who is dependent on the sponsor for over one-half of his or her support
and who either:
(i) Has not passed the 21st birthday; or
(ii) Is incapable of self-support due to a physical or mental
incapacity that existed prior to reaching the age of 21; or
(iii) Has not passed the 23rd birthday and is enrolled in a full-
time course of study in an accredited institution of higher learning.
(b) Transfer to naval MTFs in the United States. Do not transfer
personnel covered in this subpart to the United States solely for the
purpose of obtaining medical care at naval MTFs. Consideration may be
given however, in special circumstances following laws of humanity or
principles of international courtesy. Transfer to naval MTFs in the
United States of such persons located outside the United States requires
approval of the Secretary of the Navy. Naval commands, therefore, should
not commit the Navy by a promise of treatment in the United States.
Approval generally will not be granted for treatment of those who suffer
from incurable afflictions, who require excessive nursing or custodial
care, or those who have adequate facilities in their own country. When a
request is received concerning transfer for treatment at a naval MTF in
the United States, the following procedures apply:
(1) Forward the request to the Chief of Naval Operations (OP-61),
with a copy to the Commander, Naval Medical Command, Washington, DC
20372-5120 for administrative processing. Include:
(i) Patient's full name and grade or rate (if dependent, the
sponsor's name and grade or rate also).
(ii) Country of which a citizen.
(iii) Results of coordination with the chief of the diplomatic
mission of the country involved.
[[Page 322]]
(iv) Medical report giving the history, diagnosis, clinical
findings, results of diagnostic tests and procedures, and all other
pertinent medical information.
(v) Availability or lack thereof of professional skills and adequacy
of facilities for treatment in the member's own country.
(vi) Who will assume financial responsibility for costs of
hospitalization and travel.
(2) The Chief of Naval Operations (OP-61) will, if appropriate,
obtain State Department clearance and guidance and advise the Secretary
of the Navy accordingly. The Commander, Naval Medical Command will
furnish the Chief of Naval Operations information and recommendations
relative to the medical aspects and the name of the naval MTF with the
capability to provide required care. If approved, the Chief of Naval
Operations will furnish, through the chain of command, the commanding
officer of the designated naval MTF authorization for admission of the
beneficiary for treatment.
Sec. 728.42 NATO.
(a) NATO SOFA nations. Belgium, Canada, Denmark, Federal Republic of
Germany, France, Greece, Iceland, Italy, Luxembourg, the Netherlands,
Norway, Portugal, Spain, Turkey, the United Kingdom, and the United
States.
(b) Beneficiaries. The following personnel are beneficiaries under
the conditions set forth.
(1) Members of NATO military services and their dependents. Military
personnel of NATO nations, who, in connection with their official
duties, are stationed in or passing through the United States, and their
dependents residing in the United States with the sponsor may be
provided care in naval MTFs to the same extent and under the same
conditions as comparable U.S. uniformed services personnel and their
dependents. Accordingly, the provisions of Sec. 728.12 are applicable to
military personnel and Sec. 728.31(d) through Sec. 728.34 to
accompanying dependents.
(2) Military ships and aircraft personnel. Crew and passengers of
visiting military aircraft and crews of ships of NATO nations which land
or come into port at NATO or U.S. military airfields or ports within
NATO countries.
(3) NATO liaison officers. In overseas areas, liaison officers from
NATO Army Forces or members of a liaison detachment from such a Force.
(c) Application for care. Military personnel of NATO nations
stationed in the United States and their dependents will present valid
Uniformed Services Identification and Privilege Cards (DD 1173) when
applying for care. For other eligible persons passing through the United
States on official business and those enumerated in paragraph (b) (2)
and (3) of this section, orders or other official identification may be
accepted in lieu of the DD 1173.
(d) Disposition. When it becomes necessary to return individuals to
their home country for medical reasons, make immediate notification to
the NATO unit sponsoring the member or dependent's sponsor. Include all
pertinent information regarding the physical and mental condition of the
individual concerned. Following are details of agreements among the
Armed Forces of NATO, CENTO, and SEATO Nations on procedures for
disposition of allied country patients by DOD medical installations.
(1) Transfer of patients. (i) The patient's medical welfare must be
the paramount consideration. When deciding upon transfer of a patient,
give due consideration to any increased medical hazard which the
transfer might involve.
(ii) Arrangements for disposition of patients should be capable of
being implemented by existing organizations. Consequently, no new
establishment should be required specially for dealing with the
transferring of allied casualties.
(iii) Transfer patients to their own national organization at the
earliest practicable opportunity consistent with the observance of
principles established in paragraph (d)(1) (i) and (ii) of this section
and under any of the following conditions:
(A) When a medical facility of their own nation is within reasonable
proximity of the facility of the holding nation.
[[Page 323]]
(B) When the patient is determined to require hospitalization in
excess of 30 days.
(C) Where there is any question as to the ability of the patient to
perform duty upon release from the MTF.
(iv) The decision as to whether a patient, other than one requiring
transfer under paragraph (d)(1)(iii) of this section, is fit for release
from the MTF is the responsibility of the facility's commanding officer.
(v) All clinical documents, to include x-rays, relating to the
patient will accompany such patients on transfer to their own national
organization.
(vi) The decision of suitability for transfer and the arrangements
for transfer will be the responsibility of the holding nation.
(vii) Final transfer channels should be arranged by local liaison
before actual movement.
(viii) Patients not suitable for transfer to their own national
organization must be dealt with for treatment and disposition purposes
as patients of the holding nation until they are transferred, i.e., they
will be dealth with in military hospitals, military medical
installations, or in civilian hospitals that are part of the military
medical evacuation system of the holding nation.
(2) Classification of patients. Different channels for disposition
will be required for the following two types of patients:
(i) Patients not requiring admission. Patients not requiring
admission to an MTF will be returned to their nearest national unit
under arrangements to be made locally.
(ii) Patients admitted to medical installations. All such patients
will be dealth with per paragraph (d)(1) of this section.
(e) Care authorized outside the 48 contiguous United States. Major
overseas commanders may authorize care in naval MTFs subject to the
availability of space, facilities, and the capabilities of the
professional staff in emergency situations only, Provided, the required
care cannot reasonably be obtained in medical facilities of the host
country or in facilities of the patient's own country, or if such
facilities are inadequate. Provide hospitalization only for acute
medical and surgical conditions, exclusive of nervous, mental, or
contagious diseases or those requiring domiciliary care. Administer
dental treatment only as an adjunct to authorized inpatient care. Do not
include dental prostheses or orthodontia.
Sec. 728.43 Members of other foreign military services and their dependents.
(a) Foreign military service members. For the purpose of
Sec. 728.43, members of foreign military services include only:
(1) Military personnel carried on the current Diplomatic List (Blue)
or on the List of Employees of Diplomatic Missions (White) published by
the Department of State.
(2) Military personnel assigned or attached to United States
military units for duty; military personnel on foreign military supply
missions accredited to and recognized by one of the military
departments; and military personnel on duty in the United States at the
invitation of the Secretary of Defense or one of the military
departments. For the purpose of Sec. 728.43, members of foreign Security
Assistance Training Programs (SATP) and Foreign Military Sales (FMS) are
not included (see Sec. 728.44).
(3) Foreign military personnel accredited to joint United States
defense boards or commissions when stationed in the United States.
(4) Foreign military personnel covered in agreements entered into by
the Secretary of State, Secretary of Defense, or one of the military
departments to include, but not limited to, United Nations forces
personnel of foreign governments exclusive of NATO nations.
(b) Care authorized in the United States. Military personnel of
foreign nations not covered in Sec. 728.42 and their dependents residing
in the United States with the sponsor may be routinely provided only
outpatient medical care in naval MTFs on a reimbursable basis. Provided,
the sponsor is in the United States in a status officially recognized by
an agency of the Department of Defense. Dental care and hospitalization
for such members and their dependents are limited to emergencies. All
outpatient care and hospitalization in emergencies are subject
[[Page 324]]
to reimbursement as outlined in Sec. 728.46.
(c) Application for care. All personnel covered by Sec. 728.43 will
present orders or other official U.S. identification verifying their
status when applying for care.
(d) Disposition. When it becomes necessary to return individuals
covered by Sec. 728.43 to their home country for medical reasons, make
immediate notification to the sponsoring unit of the patient or
patient's sponsor with a copy to the Chief of Naval Operations (OP-61).
Include all pertinent information regarding the physical and mental
condition of the individual concerned and full identification,
diagnosis, prognosis, estimated period of hospitalization, and
recommended disposition. Additionally, the provisions of Sec. 728.42(d)
(1) and (2) apply.
(e) Care authorized outside the 48 contiguous United States. Major
overseas commanders may authorize care in naval MTFs subject to the
availability of space, facilities, and the capabilities of the
professional staff in emergency situations only. Provided, the required
care cannot reasonably be obtained in medical facilities of the host
country or in facilities of the patient's own country, or if such
facilities are inadequate. Provide hospitalization only for acute
medical and surgical conditions, exclusive of nervous, mental, or
contagious diseases or those requiring domiciliary care. Administer
dental treatment only as an adjunct to authorized inpatient care. Do not
include dental prostheses or orthodontia.
Sec. 728.44 Members of security assistance training programs, foreign military sales, and their ITO authorized dependents.
(a) Policies--(1) Invitational travel orders screening. Prior to
determining the levels of care authorized or the government or person
responsible for payment for care rendered, carefully screen ITOs to
detect variations applicable to certain foreign countries. For example,
unless orders state differently, Kuwait has a civilian health plan to
cover medical expenses of their trainees; trainees from the Federal
Republic of Germany are personally responsible for reimbursing for
inpatient care provided to their dependents; and all inpatient medical
services for trainees from France and their dependents are to be borne
by the individual trainee.
(2) Elective and definitive surgery. The overall policy with respect
to elective and definitive surgery for Security Assistance Training
Program (SATP), Foreign Military Sales (FMS) personnel and their
dependents is that conservatism will at all times prevail, except bona
fide emergency situations which might threaten the life or health of an
individual. Generally, elective care is not authorized nor should be
started. However, when a commanding officer of a naval MTF considers
such care necessary to the early resumption and completion of training,
submit the complete facts to the Chief of Naval Operations (OP-63) for
approval. Include the patient's name (sponsor's also if patient is an
ITO authorized dependent), grade or rate, country of origin, diagnosis,
type of elective care being sought, and prognosis.
(3) Prior to entering training. Upon arrival of an SATP or FMS
trainee in the United States or at an overseas training site, it is
discovered that the trainee cannot qualify for training by reason of a
physical or mental condition which will require a significant amount of
treatment before entering or completing training, return such trainees
to their home country immediately or as soon thereafter as travel
permits.
(4) After entering training. When trainees require hospitalization
or are disabled after entering a course of training, return them to
their home country as soon as practicable when, in the opinion of the
commanding officer of the medical facility, hospitalization or
disability will prevent training for a period in excess of 30 days.
Forward a copy of the patient's clinical records with the patient. When
a trainee is accepted for treatment that is not expected to exceed 30
days, notify the commanding officer of the training acvitity. Further,
when a trainee is scheduled for consecutive training sessions convening
prior to the expected data of release from a naval MTF, make the next
scheduled training activity an information addressee. Upon
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release from the MTF, direct such trainees to resume training.
(b) Care authorized. Generally, all SATP and FMS personnel and their
ITO authorized dependents are entitled to care to the same extent.
However, certain agreements require that they be charged differently and
that certain exclusions apply.
(1) NATO members and their ITO authorized dependents--(i) Foreign
military sales (FMS). Subject to reimbursement per Sec. 728.46, FMS
personnel of NATO nations who are in the United States or at U.S. Armed
Forces installations outside the United States and their accompanying
ITO authorized dependents will be provided medical and dental care in
naval MTFs to the same extent and under the same conditions as
comparable United States military personnel and their dependents except
that:
(A) Dependent dental care is not authorized.
(B) Dependents are not authorized cooperative care under CHAMPUS.
(ii) International military education and training (IMET). Subject
to reimbursement for inpatient care at the appropriate IMET rate for
members or at the full reimbursement rate for dependents, IMET personnel
of NATO nations who are in the United States or at U.S. Armed Forces
installations outside the United States and accompanying dependents will
be provided medical and dental care in naval MTFs to the same extent and
under the same conditions as comparable United States military personnel
and their dependents except that:
(A) Dependent dental care is not authorized.
(B) Dependents are not authorized cooperative care under CHAMPUS.
(2) Other foreign members and ITO authorized dependents--(i) Foreign
military sales. Subject to reimbursement by the trainee or the trainee's
government for both inpatient and outpatient care at the full
reimbursement rate, FMS personnel of non-NATO nations and ITO authorized
accompanying dependents may be provided medical and dental care on a
space available basis when facilities and staffing permit except that:
(A) Prosthetic devices, hearing aids, orthopedic footwear, and
similar adjuncts are not authorized.
(B) Spectacles may be furnished when required to enable trainees to
perform their assigned duties, Provided the required spectacles are not
available through civilian sources.
(C) Dental care is limited to emergency situations for the military
member and is not authorized for dependents.
(D) Dependents are not authorized cooperative care under CHAMPUS.
(ii) International military education and training. Subject to
reimbursement for both inpatient and outpatient care at the appropriate
rates for members and dependents, IMET personnel of non-NATO nations may
be provided medical and dental care on a space available basis when
facilities and staffing permit except that:
(A) Prosthetic devices, hearing aids, orthopedic footwear, and
similar adjuncts are not authorized.
(B) spectacles may be furnished when required to enable trainees to
perform their assigned duties, Provided the required spectacles are not
available through civilian sources.
(C) Dental care is limited to emergency situations for military
members and is not authorized for dependents.
(D) Dependents are not authorized cooperative care under CHAMPUS.
(c) Application for care. Trainees and accompanying dependents will
present official U.S. identification or orders verifying their status
when applying for care. If any doubt exists as to the extent of care
authorized, ITOs should be screened (see paragraph (a)(1) of this
section).
(d) Notification. When trainees require hospitalization as a result
of illness or injury prior to or after entering training, the training
activity (the hospital if patient has been admitted) will make a message
report through the normal chain of command to the Chief of Naval
Operations (OP-63) with information copies to MAAG, COMNAV MEDCOM, Navy
International Logistics Control Office (NAVIL CO), Unified Commander,
the affected office, and the foreign naval attache concerned. Include
details of the incident, estimated period of hospitalization, physical
or
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mental condition of the patient, and diagnosis. For further
amplification, see OPNAVINST 4950.1H and NAVCOMPTMAN 032103.
Sec. 728.45 Civilian components (employees of foreign military services) and their dependents.
(a) Care authorized. Beneficiaries covered in this section are only
authorized care in naval MTFs in the United States and then only
civilian humanitarian emergency care on a reimbursable basis (subpart J)
rendered at installations which have been designated as remote by the
Secretary of the Navy. Make arrangements to transfer such beneficiaries
to a civilian facility as soon as their condition permits.
(b) Potential beneficiaries--(1) NATO. Civilian employee personnel
(and their dependents residing with them) accompanying military
personnel in Sec. 728.42(b)(1), Provided, the beneficiaries are not
stateless persons nor nationals of any state which is not a party to the
North Atlantic Treaty, nor nationals of, nor ordinarily residents in the
United States.
(2) Others. Civilian personnel not covered in Sec. 728.45(b)(1) (and
their dependents residing with them) accompanying personnel of foreign
nations on duty in the United States at the invitation of the Department
of Defense or one of the military departments.
(c) Application for care. Personnel covered by the provisions of
Sec. 728.45 will present orders or other official U.S. identification
verifying their status when applying for care.
Sec. 728.46 Charges and collection.
(a) Policy. Pub. L. 99-591, section 9029, contains provisions
prohibiting the expenditure of appropriated funds ``. . . to provide
medical care in the United States on an inpatient basis to foreign
military and diplomatic personnel or their dependents unless the
Department of Defense is reimbursed for the costs of providing such
care: Provided, That reimbursements . . . shall be credited to the
appropriations against which charges have been made for providing such
care, except that inpatient medical care may be provided in the United
States without cost to military personnel and their dependents from a
foreign country if comparable care is made available to a comparable
number of United States military personnel in that foreign country.''
(b) Canadian agreement. On 3 November 1986, the Department of
National Defence of Canada and DOD concluded a comparable care agreement
that covers certain military personnel. The agreement stipulates that:
(1) DOD will, upon request, provide Canadian Forces members the same
range of medical and dental services under the same conditions and to
the same extent as such services are provided comparable United States
military personnel. Inasmuch as the agreement covers only certain
military personnel, the reimbursement provisions of Pub. L. 99-591
remain in effect for inpatient care provided to Canadian diplomatic
personnel, Canadian dependents, and Canadian foreign military sales
trainees who receive care in the United States. Further:
(2) Permanently stationed Canadian units with established strengths
of more than 150 personnel are expected to have integral health care
capability. Any health care services which members of such units receive
from the host nation will be provided on a full reimbursement basis.
Groups of larger than 150 personnel, which conduct collective training
in the United States, are expected to deploy with an organic unit
medical capability. Naval MTFs may be requested to provide services,
beyond the capability of the organic unit, at full reimbursement rates.
(c) Procedures. (1) Until otherwise directed, naval MTFs in the 50
United States will collect the full reimbursement rate (FRR) for
inpatient care provided to all foreign military personnel (except
Canadians covered by the comparable care agreement in Sec. 728.46(b),
and military personnel connected with a Foreign Military Sales (FMS)
case number), foreign diplomatic personnel, and to the dependents of
both whether they are in the United States on official duty or for other
reasons.
(2) Subpart J contains procedures for the initiation of collection
action when inpatient care is rendered to beneficiaries from NATO
nations and when either inpatient or outpatient care is
[[Page 327]]
rendered to all others enumerated in this part. Chapter II, part 4 of
NAVMED P-5020 is applicable to the collection of and accounting for such
charges.
Subpart F--Beneficiaries of Other Federal Agencies
Sec. 728.51 General provisions--the ``Economy Act.''
The Economy Act, 31 U.S.C. 1535, generally permits agency heads, or
heads of major organizational units of agencies, to procure goods and
services from other agencies or within their own agency so long as funds
for procurement are available, the order is in the best interest of the
Government, the source from which the goods or services are ordered can
produce them or obtain them by contract, and the internal or inter-
agency procurement is more convenient, or less expensive, than
commercial procurement. Provisions of the Economy Act apply to requests
from other Federal agencies for medical and dental care for
beneficiaries for whom they are responsible. Consult specific provisions
of the Act respecting financial and acounting limitations and
requirements.
Sec. 728.52 Veterans Administration beneficiaries (VAB).
(a) Eligible beneficiaries--Those who have served in the Armed
Forces, have been separated under conditions other than dishonorable,
and have been determined by the Veterans Administration (VA) to be
eligible for care at VA expense. Prior to 7 September 1980, veterans
status could be obtained by virtue of 1 day's honorable service. The
following restrictions do not apply to individuals who are discharged
from active duty because of a disability or who were discharged for
reasons of ``early out'' or hardship program under 10 U.S.C. 1171 and
1173.
(1) For individuals with an original enlistment in the military
service after 7 September 1980, the law generally denies benefits,
including medical care.
(2) For individuals entering service after 16 October 1981, the law
generally denies medical benefits when such individuals do not complete
the shorter of:
(i) Twenty-four months of continuous active duty, or
(ii) The full period for which that person was called or ordered to
active duty.
(b) Inpatient control--Each VAB admitted will be required to conform
to regulations governing the internal administration of the naval
facility. Restrictive or punitive measures, including disciplinary
action or denial of privileges, will conform as nearly as possible to VA
instructions.
(c) Resolution of problems--All problems pertaining to VABs,
including admission, medical or other records, and all correspondence
will be matters of resolution between the commanding officer of the
naval facility and the VA office of jurisdiction authorizing admission.
Questions of policy and administration which cannot be so resolved will
be forwarded, through the normal chain of command, to the Administrator
of Veterans Affairs via COMNAVMEDCOM for resolution.
(d) Care in the United States--(1) Inpatient care. An eligible VAB
may be admitted to a naval MTF on presentation of a written
authorization for admission signed by an official of the VA office of
jurisdiction. Neurological and certain neuropsychiatric patients without
obvious evidence of psychosis and not requiring restraints, and
instances of suspected tuberculosis, may be admitted for diagnosis. When
diagnosed, promptly report instances of psychosis, psychoneurosis, and
tuberculosis of present clinical significance to the VA office of
jurisdiction with a request for transfer to a VA facility.
(i) Extent of care. Provide eligible VABs medical and surgical care,
including prostheses such as eyes and limbs and appliances such as
hearing aids, spectacles, or orthopedic appliances when required for the
proper treatment of the condition upon which eligibility is based.
(ii) Disposition of emergency admission. Notify the appropriate VA
office of jurisdiction by message or other expeditious means within 72
hours after the date and hour of an emergency admission of a potential
VAB. Include a request for an authorization for admission and emergency
treatment. If VA
[[Page 328]]
denies VAB status to such a person admitted in an emergency, the
provisions of Sec. 728.81(a) are applicable. Once admitted in an
emergency situation, discharage a VAB promptly upon termination of the
emergency unless arrangements have been made with the VA office of
jurisdiction:
(A) For transfer to a VA treatment facility if further treatment is
required.
(B) To retain the patient as a VAB in the naval MTF.
(2) Outpatient care. Outpatient care, including post hospitalization
outpatient care, may be provided upon authorization by the VA office of
jurisdiction. When outpatient followup care is requested, commanding
officers are responsible for determining whether capabilities and
workload permit providing such care. In an emergency, provide necessary
care.
(3) Physical examinations. Upon a determination by a naval MTF
commanding officer that space, facilities, and capabilities exist, naval
MTFs may provide physical examinations when requested by the VA for the
purpose of adjudicating claims for VA physical disability compensation.
If authorized by the VA, patients may be admitted when the examination
requires more than 1 day.
(4) Dental care. Limit dental treatment to inpatients who require
services adjunctive to medical or surgical conditions for which
hospitalized.
(e) Care outside the United States--(1) Eligible beneficiaries.
Beneficiaries described in paragraph (a) of this section who are
citizens of the United States and residing or sojourning abroad may,
within the capabilities of the facility as determined by the commanding
officer, be provided inpatient and outpatient care upon presentation of
an authorization from the appropriate VA office of jurisdiction listed
in paragraph (e)(3) of this section.
(2) Emergency care. Overseas naval MTFs furnishing emergency care to
potential VABs will promptly notify the appropriate VA office of
jurisdiction and request authorization for treatment and instructions
for disposition of the patient.
(3) Offices of jurisdiction. The following activities are vested
with responsibility for issuing authorizations for care and furnishing
dispisition instructions for VABs in overseas naval MTFs:
(i) In the Trust Territory of the Pacific (Micronesia), VA Office,
Honolulu, Hawaii.
(ii) In the Philippines, VA Regional Office, Manila, Philippines.
(iii) In Canada, Canadian Department of Veterans Affairs, Ottawa,
Canada.
(iv) In all other foreign countries, consular offices of U.S.
embassies.
(f) Forms required. (1) Complete a VA 10-10 (Application for Medical
Benefits) when potential VABs are admitted for emergency care without
prior authorization.
(2) Prepare a VA 10-10m (Medical Certificate and History) when care
is rendered. All information required in the medical certificate thereon
will be furnished whether the admission is subsequently approved or
disapproved by the VA office of jurisdiction.
(3) Since the completion of VA 10-10m requires an examination of
patients, admissions which are disapproved will be reported as medical
examinations on DD 7A, Report of Treatment Furnished Pay Patients,
Outpatient Treatment Furnished (part B) (See subpart J).
(4) Prepare and submit a DD 7 (Report of Treatment Furnished Pay
Patients, Hospitalization Furnished (part A)) on all VABs and potential
VABs admitted (see subpart J).
(5) Complete an SF 502 (Narrative Summary) or SF 539 (Abbreviated
Clinical Record), as appropriate, when a VAB or potential VAB is
discharged or otherwise released. When an interim report of
hospitalization is requested by the VA office of jurisdiction, it may be
prepared on an SF 502.
Sec. 728.53 Department of Labor, Office of Workers' Compensation Programs (OWCP) beneficiaries.
(a) Potential beneficiaries. The following may be beneficiaries of
one of the programs sponsored by the Office of Workers' Compensation
Programs (OWC) under the conditions set forth. They are not
beneficiaries of OWCP until authorized as such by the appropriate
district officer of OWCP. However, they may be carried as potential
[[Page 329]]
beneficiaries pending OWCP determination of eligibility. DOD civilian
employees provided medical services under a Defense or service health
program are not included under this authority (see subpart G).
(1) Members and applicants for membership in the Reserve Officers'
Training Corps of the Navy, Army, and Air Force, provided the condition
necessitating treatment was incurred in line of duty during an off-
campus training regimen. Such care is authorized for injury (a disease
or illness which is the proximate result of performance of training is
considered an injury) incurred while engaged in:
(i) Training.
(ii) Flight instructions.
(iii) Travel to or from training or flight instructions.
(2) The following employees of the Government of the United States,
regardless of nationality or place of work, are entitled to receive care
as outlined in paragraph (e) of this section for work incurred traumatic
injuries at the expense of OWCP. (In addition to injury by accident, a
disease or illness which is the proximate result of performance of
employment duties is considered an injury.) This category includes but
is not limited to:
(i) Civilian student employees in training at Navy and Marine Corps
facilities.
(ii) Civilian seamen in the service of vessels operated by the
Department of the Army (see paragraph (a)(7) of this section and
Sec. 728.80(c)(2) for civilian Military Sealift Command (MSC)
personnel).
(iii) All civilian employees of the Government except
nonappropriated-fund-activity employees. Nonappropriate fund employees
may be covered under the Longshore and Harbor Workers' Compensation Act
(contact cognizant district office of OWCP).
(3) Civilian members of the Civil Air Patrol (except Civil Air
Patrol Cadets) for injury or disease which is the proximate result of
active service or travel to and from such service, rendered in
performance or support of operational missions of the Civil Air Patrol
under the direction and written authority of the Air Force.
(4) Former Peace Corps enrollees for injury or disease which is the
proximate result of their former employment with the Peace Corps or
which was sustained or contracted while located with the Peace Corps
outside the United States and its territories.
(5) Former Job Crops enrollees for injury or disease which is the
proximate result of employment with the Job Corps.
(6) Former VISTA (Volunteers in Service to America) enrollees for
injury or disease which is the proximate result of employment with
VISTA.
(7) Military Sealift Command (MSC) civilian marine personnel
(CIVMARPERS or CIVMARS) (including temporary employees, intermittent
employees, and employees with less than 1 year's service) are entitled
to occupationally related care at the expense of OWCP. CIVMARS are in a
crew status only after reporting to their assigned ship. They are in a
travel status from crewing point to ship and return. While in a travel
status, they are entitled to the same health care benefits as other
Federal civil service employees in a travel status (5 U.S.C. 8101).
CIVMARS presenting for treatment with a properly completed CA-16,
Request for Examination and/or Treatment, will:
(i) Enter the naval MTF's system through the occupational medicine
service.
(ii) Be treated for any injury or disease proximately caused by
their employment. Although the actual determination of whether an
illness or injury is occupationally related is a function of OWCP,
determinations are based on the required injury report along with the
treatment record from the attending physician. Therefore, when doubt
exists as to the relationship of the condition to the potential
patient's employment, the physician should report an unbiased medical
conclusion and the medical rationale therefor, indicating the conditions
which are responsible for the claimant's disability. As a general rule,
the following may be initially considered as occupationally related,
however, it should be emphasized that OWCP is the final approval
authority:
[[Page 330]]
(A) Any injury or illness occurring as a direct result of
employment. May occur on a ship, at a Government installation ashore, or
in an aircraft while performing a requirement of employment.
(B) Any injury or illness which becomes manifest while away from
work (on leave or liberty) while in a crew status or travel status as
long as the condition may be directly related to job activities or to
exposures incident to travel to ship assignment.
(C) Required immunizations.
(D) Required physical examinations.
(E) Periodic medical surveillance screening examinations for DOD
occupational and industrial health programs, i.e., asbestos medical
surveillance, hearing conservation, etc.
(iii) Be referred to a non-Federal source of care where back-to-work
care may be provided at the CIVMAR's expense after, if necessary, the
immediate emergency is alleviated when a reasonable determination can be
made that the injury or illness is not occupationally related.
(A) Per 5 U.S.C. 7901(c)(3), the health service program for Federal
civilian employees is limited to referral of employees, upon their
request, to private sources of care.
(B) Long term extended care of chronic illnesses such as
hypertension, diabetes, etc., is not authorized in naval MTFs at the
expense of OWCP nor at the CIVMAR's personal expense.
(C) Patients who cannot be referred, because of medical reasons or
because non-Federal sources are not available or available but
inadequate, may be retained in naval MTFs at the expense of the CIVMAR
or of his or her private insurance until transfer becomes possible.
Although the means of access to the naval MTF may have been through the
occupational medicine service, retention in the naval MTF is on a
civilian humanitarian basis. This is also applicable when OWCP disallows
a CIVMAR's claim (see paragraph (c) of this section).
(b) Authorization required. Personnel in paragraph (a) (1) through
(6) may be rendered inpatient and outpatient care as outlined in
paragraph (e) of this section, unless otherwise stipulated in this
section, upon presentation of a properly prepared and signed
authorization from CA-16 (Request for Examination and/or Treatment).
District offices of OWCP will honor these authorizations for 60 days
unless written notice of termination of authorization is given earlier.
Whereas the CA-16 is used primarily for traumatic injuries, it may also
be used to authorize examination and treatment for disease or illness
provided the affected agency has obtained prior permission from the
cognizant district office of OWCP. If the condition for which treatment
is requested appears related to employment, treatment of beneficiaries
in paragraph (a) (1) through (7) of this section may be initiated
without presentation of a CA-16. Patients provided treatment without a
CA-16 may be carried as OWCP beneficiaries from the time of initial
treatment, provided the appropriate district office of OWCP is notified
and requested to submit a CA-16 within 48 hours giving authorization as
of the date of actual treatment. OWCP will not be liable for payment of
bills for unauthorized treatment. Post hospitalization care following
authorized inpatient care does not require an additional authorization.
First aid treatment rendered civilian employees does not require an
authorization form
(c) Disallowance by OWCP. When OWCP determines that any claim should
be disallowed, OWCP will advise the naval facility rendering care that
no further treatment should be rendered at OWCP expense. The patient
ceases to be an OWCP beneficiary as of the date of receipt of the notice
of disallowance by the naval MTF and the patient will be so notified.
Any treatment subsequent to the date of receipt of the notice of
disallowance will be at the personal expense of the patient (see
Sec. 728.81(a)).
(d) Authorization for transfer. Prior approval of OWCP is required
before a transfer can be effected, except in an emergency or when
immediate treatment is deemed more appropriate in another Federal
facility. When transfer is effected without approval, the transferring
facility will immediately request such authorization from the
appropriate district office of OWCP. When authorized by OWCP, evacuation
to the United States can be effected per
[[Page 331]]
OPNAVINST 4630.25B. Medical records and a CA-16 will accompany such
patients.
(e) Care authorized--(1) Inpatient care. Medical and surgical care
necessary for the proper treatment of the condition upon which
eligibility is based. Specific OWCP authorization is required before
major surgical procedures can be performed unless the urgency of the
situation is such that time does not permit obtaining said
authorization. All necessary prostheses, hearing aids, spectacles, and
orthopedic appliances will be furnished when required for proper
treatment of the condition upon which eligibility is based. Upon
specific authorization, damaged or destroyed medical braces, artificial
limbs, and other orthopedic and prosthetic devices will be replaced or
repaired, except that eyeglasses and hearing aids will not be replaced
or repaired unless their damage or destruction is incidental to a
personal injury requiring medical services.
(2) Outpatient care. Complete medical and surgical care not
requiring hospitalization, and posthospitalization services following
authorized inpatient care in a naval MTF for the proper treatment of the
condition upon which eligibility is based.
(3) Dental care. Limit dental treatment to emergencies and that care
necessary as an adjunct to inpatient hospital care authorized in
advance. Such care will not include dental prostheses, unless
specifically authorized, nor orthodontic treatment.
(f) Reports and records. (1) Copies of medical records will
accompany OWCP patients being transferred from one medical treatment
facility to another. Records accompanying OWCP patients to a debarkation
hospital will be the same as for military personnel and will clearly
identify the patient as an OWCP beneficiary.
(2) Forward a CA-20 (Attending Physician's Report) to the
appropriate district office of OWCP on discharge of the patient unless
hospitalization exceeds 1 month. In such instances, a report will be
submitted every 30 days. When extensive hospitalization is required, use
an SF 502 or a narrative format in lieu of CA-20. When submitted to
OWCP, the physician's report will include:
(i) History.
(ii) Physical findings.
(iii) Laboratory findings.
(iv) Abstract of hospital records.
(v) Diagnosis for conditions due to injury and not due to injury.
(vi) Rationalized medical opinion for the physician's belief that
the illness or disease treated was causally related to a specific
condition or set of conditions to which the claimant was subjected.
(vii) Condition on discharge with opinion as to degree of impairment
due to injury, if any.
(3) Complete and submit, per subpart J, a DD 7 (Report of Treatment
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered to any OWCP
beneficiary.
Sec. 728.54 U.S. Public Health Service (USPHS), other than members of the uniformed services.
(a) Potential beneficiaries. The following may be beneficiaries of
the USPHS for care in naval MTFs upon submission of the necessary form
from appropriate officials as outlined in paragraph (b) of this section.
(1) Within and outside the United States. Any individuals the USPHS
may determine to be eligible for care on an interagency reimbursable
basis.
(2) Within the 48 Contiguous United States and the District of
Columbia. American Indians, Alaska Natives, Eskimos, and Aleuts.
(3) In Alaska. American Indians, Eskimos, and Aleuts.
(b) Authorization required--(1) Normal circumstances. An American
Indian or Alaska Native may be rendered inpatient care upon presentation
of form HRSA 43 (Contract Health Service Purchase Order for Hospital
Services Rendered) or HRSA form 64 (Purchase/Delivery Order for Contract
Health Services Other Than Hospital Inpatient or Dental). Either form
must be signed by an appropriate Indian Health Service or Alaska Native
Health Service area/program official.
[[Page 332]]
(2) Emergencies. In an emergency, care may be rendered upon written
request of patient's commanding officer or superior officer, or the
patient if neither of the above is available. When emergency care is
rendered without prior authorization, the facility rendering care must
notify the service unit director of the patient's home reservation
within 72 hours from the time such care is rendered unless extenuating
circumstances preclude prompt notification.
(c) Care authorized. Unless limited by the provisions stipulated in
paragraph (a) of this section and subject to the provisions of
Sec. 728.3, the following care may be rendered, when requested, to all
beneficiaries enumerated in paragraph (a) of this section.
(1) Inpatient care. Necessary medical and surgical care.
(2) Outpatient care. Necessary medical and surgical care.
(3) Dental care. (i) Limit dental care in the United States, its
territories, possessions, and the Commonwealth of Puerto Rico to
emergencies for the relief of pain or acute conditions and that
necessary as an adjunct to inpatient hospital care. Prosthetic dental
appliances and permanent restorations are not authorized.
(ii) In overseas areas, dental care is authorized to the extent
necessary pending the patient's return to the United States, its
territories, possessions, or the Commonwealth of Puerto Rico.
(d) Report. Complete and submit, per subpart J, a DD 7 (Report of
Treatment Furnished Pay Patients, Hospitalization Furnished, part A) or
a DD 7A (Report of Treatment Furnished Pay Patients, Outpatient
Treatment, part B) when outpatient or inpatient care is rendered.
Sec. 728.55 Department of Justice beneficiaries.
Upon presentation of a letter of authorization that includes
disposition of SF 88 (Report of Medical Examination), SF 93 (Report of
Medical History), and address for submission of claim, the following
personnel may be furnished requested care as beneficiaries of the
Department of Justice. See subpart J on completing and submitting forms
for central collection of the cost of care provided.
(a) Federal Bureau of Investigation. Investigative employees of the
Federal Bureau of Investigation (FBI) and applicants for employment as
special agents with the FBI may be provided:
(1) Immunizations.
(2) Physical examinations and hospitalization when required to
determine physical fitness. Use this period of hospitalization for
diagnostic purposes only. Do not correct disqualifying defects.
(b) U.S. Marshals. U.S. Marshals may receive physical examinations
and hospitalizations when required to determine physical fitness. Use
this period of hospitalization for diagnostic purposes only. Do not
correct disqualifying defects.
(c) Claimants against the United States. Claimants whose suits or
claims against the United States are being defended by the Department of
Justice may be furnished physical examinations to determine the extent
and nature of the injuries or disabilities being claimed.
Hospitalization is authorized for proper conduct of the examination.
Upon completion, forward the report of the examination promptly to the
U.S. Attorney involved.
Sec. 728.56 Treasury Department beneficiaries.
(a) Potential beneficiaries. The following may be beneficiaries of
the Treasury Department and may be rendered care as set forth below.
(1) Secret Service Special Agents and support personnel.
(2) Secret Service Agents providing protection to certain
individuals.
(3) Persons being provided protection by the Secret Service.
(4) Agents of the U.S. Customs Service.
(5) Prisoners (detainees) of the U.S. Customs Service.
(b) Care authorized. (1) Secret Service Special Agents may be
provided routine annual physical examinations upon request and
presentation of a letter of authorization. Conduct and record
examinations in the same manner as routine examinations rendered naval
officers except that they may be conducted only on an outpatient basis.
[[Page 333]]
If hospitalization is considered desirable in connection with an
examination, patient administration department personnel will contact
the United States Secret Service at (202) 535-5641 at the address in
paragraph (c) of this section. Enter a statement, attesting to the fact
that hospitalization is desirable, in item 73 or 75 of the SF 88, as
appropriate, before forwarding to the United States Secret Service as
directed by the letter of authorization.
(2) Secret Service Agents providing protection to certain
individuals and those persons being provided such protection may be
rendered all required medical services including hospitalization subject
to the provisions of Sec. 728.3.
(3) Agents of the U.S. Customs Service and their prisoners
(detainees) may be provided emergency medical treatment and evacuation
services to the nearest medical facility (military or civilian) in those
remote areas of the United States where no other such services are
available. Limit evacuation to the continental United States and do not
cross borders. The Navy's responsibility for medical care of such
prisoners terminates once the medical emergency has been resolved.
Guarding of prisoners, while they or their captors are receiving
treatment at naval MTFs, remains the responsibility of the U.S. Customs
Service or other appropriate Federal (nonmilitary) law enforcement
agencies.
(c) Reports and records. (1) When examinations are rendered to
Secret Service Special Agents and support personnel, forward one copy of
the SF 88, one copy of the SF 93, and one copy of any forms provided
with the letter of authorization to United States Secret Service,
Administrative Operations Division, Safety and Health Branch, 1800 G
Street, NW., Room 845, Washington, DC 20223 or as otherwise directed by
the letter of authorization. Provide an information copy to the Deputy
Comptroller of the Navy.
(2) Complete and submit, per subpart J, a DD 7 (Report of Treatment
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered.
Sec. 728.57 Department of State and associated agencies.
Eligibility for care under the provisions of this section will be
determined by the Department of State, Office of Medical Services.
(a) Beneficiaries. Officers and employees of the following agencies,
their dependents, and applicants for appointment to such agencies are
authorized inpatient and outpatient medical care as set forth below in
addition to that care that may be authorized elsewhere within this part
(i.e., Sec. 728.53, Sec. 728.55, Sec. 728.56, and Sec. 728.58). Limit
dental care to that delineated in paragraph (b)(6) of this section.
(1) Department of State-U.S.Arms Control and Disarmament Agency and
the Office of International Conferences.
(2) U.S. Agency for International Development.
(3) International Communications Agency.
(4) ACTION--Peace Corps Staff.
(5) Department of Agriculture--Foreign Agriculture Service.
(6) Department of Commerce--Bureau of Public Roads.
(7) Department of Interior--Bureau of Reclamation and the U.S.
Geological Survey.
(8) Department of Transportation--Federal Aviation Administration
and the Federal Highway Administration.
(9) Department of Justice--Drug Enforcement Agency.
(10) Department of Treasury--U.S. Customs, U.S. Secret Service,
Office of International Affairs (OIA), U.S.--Saudi Arabian Joint
Commission for Economic Cooperation (JECOR), and the Internal Revenue
Service.
(11) National Aeronautics and Space Administration.
(12) Library of Congress.
(13) Beneficiaries of such other agencies as may be included in the
Department of State Medical Program.
(b) Care authorized--(1) General. The Foreign Service Act of 1946,
as amended, authorizes care delineated in this section. Subject to the
restrictions and priorities of Sec. 728.3 and the restrictions of this
section, care may be rendered at the expense of the Department of State
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or one of the agencies listed in paragraph (a) of this section. The law
allows for payment when care is furnished for an illness or injury which
results in hospitalization or equal treatment. Outpatient care is only
authorized as an adjunct to hospitalization.
(2) Overseas. (i) When, in the opinion of the principal or
administrative officer of an overseas post of the Department of State,
an individual meets the conditions of eligibility, the post will furnish
authorization to the naval MTF for care at the expense of the Department
of State or one of the agencies listed in paragraph (a) of this section.
(ii) Should the Department of State official determine that the
illness or injury does not meet the conditions of eligibility for care
at the expense of one of the agencies, all care provided will be at the
expense of the patient or patient's sponsor and charged at the full
reimbursement rate.
(3) In the United States. (i) Care is not authorized for an injury
or illness incurred in the United States. Authorizations and other
arrangements for care in the United States for individuals incurring
injury or illness outside the United States will be provided by the
Deputy Assistant Secretary for Medical Services, Department of State,
using appropriate authorization form(s). When personnel are admitted in
an emergency without prior authorization, the commanding officer of the
admitting naval MTF will immediately request authorization from the
Deputy Assistant Secretary for Medical Services.
(ii) The extent of care furnished in the United States, to
individuals in paragraph (a) of this section who are evacuated to the
United States for medical reasons, will be comparable in all respects to
that which is authorized or prescribed for these individuals outside the
United States. When determined appropriate by the Deputy Assistant
Secretary for Medical Services, officers and employees and their
accompanying dependents who have returned to the United States for
nonmedical reasons may be furnished medical care at the expense of one
of the above agencies for treatment of an illness or injury incurred
while outside the United States.
(4) Physical examinations. The Secretary of State is authorized to
provide for comprehensive physical examinations, including dental
examinations and other specific testing, of applicants for employment
and for officers and employees of the Foreign Service who are U.S.
citizens and for their dependents, including examinations necessary to
establish disability or incapacity for retirement purposes. An
authorization will be executed by an appropriate Department of State
official and furnished in duplicate to the naval MTF, listing the type
of examination required and stating that the individual is entitled to
services at the expense of the Department of State. Furnish reports per
the letter of authorization.
(5) Immunizations. Inoculations and vaccinations are authorized for
officers, employees, and their dependents upon written authorization
from an appropriate Department of State official. This authorization, in
duplicate, will include the type of inoculation or vaccination required
and will state that the individual is entitled to services at the
expense of the Department of State. Furnish reports per the letter of
authorization.
(6) Dental care. Limit dental care to emergencies for the relief of
pain or acute conditions, or dental conditions as an adjunct to
inpatient care. Do not provide prosthetic dental appliances.
(c) Evacuation to the United States. Should a beneficiary in an
overseas naval MTF require prolonged hospitalization, the commanding
officer of the overseas facility will report the requirement to the
nearest Department of State principal or administrative officer and
request authority to return the patient to the United States. Release
dependents who decline evacuation to the custody of their sponsor.
Aeromedical evacuation may be used per OPNAVINST 4630.25B. Travel of an
attendant or attendants is authorized at Department of State expense
when the patient is too ill or too young to travel unattended.
(d) Report. Complete and submit, per subpart J, a DD 7 (Report of
Treatment
[[Page 335]]
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered.
Sec. 728.58 Federal Aviation Agency (FAA) beneficiaries.
(a) Beneficiaries. Air Traffic Control Specialists (ATCS) of the FAA
when appropriate authorization has been furnished by the FAA regional
representative.
(b) Authorization. Written authorization from an FAA Regional Flight
Surgeon is required and will include instructions for forwarding the
results of services rendered.
(c) Care authorized. Subject to the provisions of Sec. 728.3,
authorized personnel may be rendered chest x-rays, electrocardiograms,
basic blood chemistries, and audiograms, without interpretation in
support of the medical surveillance program for ATCS personnel
established by the FAA.
(d) Report. Complete and submit, per subpart J, a DD 7A (Report of
Treatment Furnished Pay Patients, Outpatient Treatment, part B)
outpatient care is rendered.
Sec. 728.59 Peace Corps beneficiaries.
(a) Potential beneficiaries. (1) Applicants for the Peace Corps.
(2) Peace Corps Volunteers.
(3) Minor children of a Peace Corps volunteer living with the
volunteer.
(b) Care authorized in the United States. Upon written request of a
Peace Corps official, stating care to be provided and disposition of
reports, the following may be provided subject to the provisions of
Sec. 728.3.
(1) Physical examinations. Physical examinations are authorized on
an outpatient basis only. Except for interpretation of x-rays, make no
assessment of the physical qualifications of examinees.
(i) Preselection physical examination may be provided applicants
(volunteers) for the Peace Corps.
(ii) Separation or other special physical examinations may be
provided volunteers and their dependents as listed in paragraph (a)(3)
of this section. Unless otherwise prescribed in written requests, report
such examinations of Peace Corps volunteers on SF-88 and SF-93. Include:
(A) Medical history and systemic review.
(B) Chest x-ray with interpretation.
(C) Complete urinalysis, serology, and blood type.
(D) Pelvic examination and Pap smear for all female volunteers.
(E) Hematocrit or hemoglobin for all females and for all males over
40 years of age.
(F) Electrocardiogram for all volunteers over 40 years of age.
(2) Immunizations. Immunizations, as requested, may be provided all
beneficiaries listed in paragraph (a) of this section.
(3) Medical care. Both inpatient and outpatient care may be provided
volunteers for illnesses or injuries occurring during their period of
service which includes all periods of training. Dependents of volunteers
specified in paragraph (a)(3) of this section are authorized care to the
same extent as their sponsor.
(4) Dental care. Limit dental care to emergencies. Render only that
care essential to relieve pain or prevent imminent loss of teeth. All
beneficiaries seeking dental care will be requested, whenever possible,
to furnish advanced authorization.
(c) Care authorized outside the United States--(1) Physical
examinations. Termination physical examinations may be provided
volunteers and eligible dependents of volunteers. In most instances,
Peace Corps staff physicians will provide these examinations; however,
help may be required of naval MTFs for ancillary services.
(2) Immunizations. When requested, immunizations may be provided all
beneficiaries listed in paragraph (a) of this section.
(3) Medical care. When requested in writing by a representative or
physician of a Peace Corps foreign service post, volunteers, eligible
dependents of volunteers, and trainees of the Peace Corps may be
provided necessary medical care at Peace Corps expense. When emergency
treatment is rendered without prior approval, forward a request to the
Peace Corps foreign service post as soon as possible.
[[Page 336]]
(4) Dental care. Limit dental care to emergencies. Render only that
care essential to relieve pain or prevent imminent loss of teeth. All
beneficiaries seeking dental care will be requested, whenever possible,
to furnish advanced authorization.
(5) Evacuation to the United States. When a beneficiary in an
overseas naval MTF requires prolonged hospitalization, the commanding
officer of the overseas facility will report the requirement to the
nearest Peace Corps foreign service post and request authorization to
return the patient to the United States. Releases custody of dependents
to their sponsor when evacuation is declined. Aeromedical evacuation may
be used per OPNAVINST 4630.25B. Travel of attendant(s) is authorized
when the patient is too ill or too young to travel unattended.
(d) Report. Complete and submit, per subpart J, a DD 7 (Report of
Treatment Furnished Pay Patients, Hospitalization Furnished, part A) or
DD 7A (Report of Treatment Furnished Pay Patients, Outpatient Treatment,
part B) when outpatient or inpatient care is rendered.
Sec. 728.60 Job Corps and Volunteers in Service to America (VISTA) beneficiaries.
(a) Beneficiaries. Job Corps and VISTA enrollees and Job Corps
applicants may be provided services as set forth. For former members,
see Sec. 728.53.
(b) Authorization required--(1) Job Corps enrollees. Presentation of
a Job Corps Identification Card after appointment has been made by the
corpsmember's Job Corps center.
(2) Job Corps applicants. Presentation of a letter from a screening
agency (e.g., State Employment Service) after an appointment has been
made by that agency.
(3) VISTA Volunteers and VISTA Trainees. A ``Blue-Cross and Blue
Shield Identification Card'' is issued to such personnel as
identification. Each card has a VISTA identification number which will
be used on all records and correspondence.
(c) Care authorized. Normally, medical services are provided only
when civilian of VA facilities are not available. or if available, are
incapable of providing needed services. However, upon presentation of an
appropriate authorization, the following services may be rendered
subject to the provisions of Sec. 728.3.
(1) Job Corps enrollees are authorized emergency medical care upon
presentation of their Job Corps Identification Card; however, the
corpsmember's Job Corps center should be notified immediately.
(2) Job Corps applicants may be provided preenrollment physical
examinations and immunizations on an outpatient basis only.
(3) Job Corps enrollees, VISTA trainees, and VISTA volunteers are
authorized:
(i) Outpatient medical examinations, outpatient treatment, and
immunizations.
(ii) Inpatient care for medical and surgical conditions which, in
the opinion of the attending physician, will benefit from definitive
care within a reasonable period of time. When found probable that a
patient will require hospitalization in excess of 45 days, notify the
Commander, Naval Medical Command (MEDCOM-33) by the most expeditious
means.
(iii) Limit dental care to emergencies. Render only that care
essential to relieve pain or prevent imminent loss of teeth.
Beneficiaries seeking dental care will be requested to furnish, whenever
possible, advanced authorization.
(d) Report. Complete and submit, per subpart J, a DD 7 (Report of
Treatment Furnished Pay Patients, Hospitalization Furnished, part A) or
DD 7A (Report of Treatment Furnished Pay Patients, Outpatient Treatment,
part B) when outpatient or inpatient care is rendered.
Sec. 728.61 Medicare beneficiaries.
(a) Care authorized. Emergency hospitalization and other emergency
services are authorized for beneficiaries of the Social Security Health
Insurance Program for the Aged and Disabled (Medicare) who reside in the
50 United States and the District of Columbia, Guam, Puerto Rico, the
Virgin Islands, American Samoa, and the Northern Mariana Islands. Such
care in naval
[[Page 337]]
MTFs may be rendered when emergency services, as defined in
Sec. 728.61(b), are necessary.
(b) Emergency services. Services provided in a hospital emergency
room after the sudden onset of a medical condition manifesting itself by
acute symptoms of sufficient severity (including severe pain) such that
the absence of immediate medical attention could reasonably be expected
to result in:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions of serious dysfunction of
any bodily organ or part.
(c) General provisions--(1) Limitations. Benefit payments for
emergency services under Medicare can be made for only that period of
time during which the emergency exists. Therefore, when the emergency is
terminated and it is permissible from a medical standpoint, discharge or
transfer the patient to a facility that participates in Medicare.
(2) Notification. Notify the nearest office of the Social Security
Administration as soon as possible when a Medicare beneficiary is
rendered treatment.
(d) Report. Complete and submit, per subpart J, a DD 7 (Report of
Treatment Furnished Pay Patients, Hospitalization Furnished, part A) or
DD 7A (Report of Treatment Furnished Pay Patients, Outpatient Treatment,
part B) when outpatient or inpatient care is rendered.
Subpart G--Other Persons
Sec. 728.71 Ex-service maternity care.
(a) Eligible beneficiaries. After separation from the service under
honorable conditions because of pregnancy, or separated from the service
under honorable conditions and found to have been pregnant at the time
of separation, the following former members and their newborn infant(s)
may be provided care as set forth below. The rendering of this care is
subject to the provisions of Sec. 728.3. When certified by medical
authorities that the pregnancy existed prior to entry into service
(EPTE), maternity benefits are not authorized.
(1) Former women members of the Army, Air Force, Navy, and Marine
Corps.
(2) On or after 12 August 1985, former women members of the
Commissioned Corps of the United States Public Health Service (USPHS)
and the National Oceanic and Atmospheric Administration (NOAA).
(b) Care authorized. (1) Former women members may be rendered
medical and surgical care in naval MTFs incident to that pregnancy,
prenatal care, hospitalization, postnatal care, and, when requirements
of SECNAVINST 6300.2A are met, abortions. Limit postnatal care to 6
weeks following delivery. Do not promise civilian sources under any
circumstances for either the mother or the infant as such care is not
authorized.
(2) Treatment of the newborn infant in USMTFs includes care, both
inpatient and outpatient, only during the first 6 weeks (42 days)
following delivery. If the newborn infant requires care beyond the 6-
weeks postnatal period, the mother or other responsible family member
must make arrangements for disposition to private, State, welfare, or
another Federal facility.
(c) Application for care. In making application for care authorized
by this section, former women members should apply either in person or
in writing to the Armed Forces inpatient MTF nearest their home and
present either their DD 214 (Armed Forces of the United States Report of
Transfer or Discharge) or DD 256A (Honorable Discharge Certificate) as
proof of eligibility for requested care. In areas with more than one
Armed Forces MTF available and capable of providing required care,
application should be made to the MTF of the service from which
separated, as applicable. Disengagement in such areas to MTFs of other
services may be made only when space is not available or capability does
not exist in the MTF of the services from which the individual was
separated.
(d) Charges and collection. Charges and reimbursement procedures for
care rendered to beneficiaries in paragraph (a)(2) of this section are
the same as prescribed by current regulations for active Coast Guard,
USPHS, and NOAA members.
[[Page 338]]
Sec. 728.72 Applicants for enrollment in the Senior Reserve Officers' Training Program.
When properly authorized, designated applicants (including
applicants for enrollment in the 2-year program and Military Science II
enrollees applying for Military Science III) may be furnished medical
examinations at naval MTFs including hospitalization necessary for the
proper conduct thereof. Medical care, including hospitalization, is
authorized for diseases contracted or injuries incurred in line of duty
while at or traveling to or from a military installation for the purpose
of undergoing medical or other examinations or for visits of
observation.
Sec. 728.73 Applicants for enlistment or reenlistment in the Armed Forces, and applicants for enlistment in the reserve components.
(a) Upon referral by a commander of a Military Enlistment Processing
Station (MEPS), applicants will be furnished necessary medical
examinations, including hospitalization when qualifications for service
cannot otherwise be determined. Use the hospitalization period only for
diagnostic purposes. Do not correct disqualifying defects.
(b) Applicants who suffer injury or acute illness while awaiting or
undergoing processing at Navy and Marine Corps facilities or MEPS may be
furnished emergency medical and dental care, including emergency
hospitalization, for that injury or illness.
Sec. 728.74 Applicants for appointment in the regular Navy or Marine Corps and reserve components, including members of the reserve components who apply for
active duty.
(a) Necessary medical examinations may be furnished, including
hospitalization when qualifications for service cannot otherwise be
determined. Use such a period of hospitalization only for diagnostic
purposes. Do not correct disqualifying defects.
(b) Applicants who suffer injury or acute illness while awaiting or
undergoing processing at Navy and Marine Corps facilities or MEPS may be
furnished emergency medical and dental care, including emergency
hospitalization, for that injury or illness.
Sec. 728.75 Applicants for cadetship at service academies and applicants for the Uniformed Services University of Health Sciences (USUHS).
(a) Upon presentation of a letter of authorization from the
Department of Defense Medical Examination Review Board (DODMERB),
applicants for cadetship at Service Academies (Navy, Army, Air Force,
Coast Guard, and Merchant Marine) and applicants for the Uniformed
Services University of Health Sciences (USUHS) will be furnished medical
examinations at facilities designated by the DODMERB. Hospitalization is
authorized when qualifications for service cannot otherwise be
determined. Use the hospitalization period for diagnostic purposes only,
and not to correct disqualifying or other defects. Perform examinations
and make disposition of completed forms per BUMEDINST 6120.3M.
(b) Applicants who suffer injury or acute illness while awaiting or
undergoing processing at Navy and Marine Corps facilities or at MEPS may
be furnished emergency medical and dental care, including emergency
hospitalization, for that injury or illness.
Sec. 728.76 Naval Home residents.
Provide necessary medical and dental care, both inpatient and
outpatient, to residents of the Naval Home when requested by the
Governor of the Home. In an emergency, care may be rendered without
prior approval of the Governor; however, the Governor of the Home should
be contacted immediately and requested to furnish authorization.
Sec. 728.77 Secretarial designees.
Subject to the capabilities of the professional staff and the
availability of space and facilities, naval MTFs and DTFs will provide
treatment to individuals that have been granted Secretarial designee
status by any of the three service Secretaries (Navy, Army, or Air
Force), the Secretary of Commerce for NOAA personnel, the Secretary of
Health and Human Services for USPHS personnel, or the Secretary of
Transportation for Coast Guard personnel.
(a) Potential designees. Upon a showing of sufficient cause, the
Secretary of the Navy may authorize individuals,
[[Page 339]]
not otherwise authorized by law, to receive such care as is available in
naval MTFs in the United States. Designation may be extended on a
worldwide basis for preadoptive children and wards of active duty
members, and for abused dependents delineated in paragraph (a)(6) of
this section. Temporary in loco parents or foster parent status of the
member with regard to a minor is insufficient for approval. Also,
civilian health care under the CHAMPUS program cannot be authorized for
other than abused dependents. The Secretary's discretionary authority is
exercised most conservatively, however, favorable action is usually
taken on requests involving the following situations:
(1) Preadoption proceedings wherein an active duty member or a
retired member has taken affirmative legal action to adopt a child.
(2) Custodianships and guardianships authorized by a court order
wherein the member is designated by the court as the custodian or
guardian and the child is fully dependent upon the active duty or
retired member sponsor.
(3) Evaluation and selection of nonbeneficiaries who are donor
candidates for an organ or tissue transplant procedure in behalf of a
military service beneficiary.
(4) Nonbeneficiary participants in officially approved clinical
research studies.
(5) Unremarried former spouses who: Require care for a condition
incurred during or caused/aggravated by conditions associated with the
member's or former member's creditable service; do not qualify under the
former spouses act; and do not have medical coverage under an employer-
sponsored health plan which will provide for the care required.
(6) Abused dependents of discharged or dismissed former uniformed
services members in need of medical or dental care resulting from
knowledge of the abuse or for an injury or illness resulting from abuse
by the former member. Eligibility will terminate the earliest of 1 year
after the date on which the member is discharged or dismissed from a
uniformed service, or when care is no longer needed.
(7) In other instances wherein the circumstances clearly merit the
providing of treatment in naval MTFs, and in which the best interest of
the patient, the Navy, and the Government will be served, favorable
Secretarial action may result. The mere need of medical care by a former
beneficiary or other person, alone, will not support approval of such a
request.
(b) Requests for consideration. Requests for consideration will be
submitted to the Commander, Naval Medical Command (MEDCOM-33) by
applicants via their command, when applicable, or by the Medical
Department command concerned. Requests should include any pertinent
information which will support resolution and a return address. Requests
involving:
(1) Preadoption must include a legible reproducible copy of an
interim court order or adoption agency placement agreement which names
the sponsor and identifies the other participating parties. A petition
for a court order is insufficient to support a recommendation for
approval.
(2) Custodianships and guardianships must include a legible
reproducible copy of the court order, identification of the parties, and
also identify any amounts of income to which the ward is entitled.
(3) Participants in clinical research studies must include:
(i) Sufficient clinical information concerning the nature of the
study.
(ii) Benefits which may accrue to the individual.
(iii) The extent, if any, to which access by other authorized
beneficiaries will be impaired.
(iv) Benefits which will accrue to the command, e.g., enhancement of
training, maximum use of specialized facilities, etc.
(v) Recommended duration of designation.
(vi) Whether the consenting individual has been informed concerning
the nature of the study, its personal implications, and freely consents.
(4) Unremarried former spouses must include:
(i) A notarized copy of the marriage license.
(ii) A statement attesting to the fact that the sponsoring former
spouse
[[Page 340]]
achieved 20 or more years of creditable military service.
(iii) Copy of divorce decree with official date.
(5) Abused depdendents must include:
(i) Full name, social security number, grade or rate, branch or
service, and date and type of discharge or dismissal of the former
member. Such a member must have received a dishonorable or bad-conduct
discharge or dismissal from a uniformed service as a result of court-
martial conviction for an offense involving abuse of a dependent of the
member.
(ii) Full names, social security numbers (if assigned), and
relationship to the former member of any dependent in need of medical or
dental care to treat adverse health conditions resulting from such
dependent's knowledge of the abuse or any injury or illness suffered by
the abused person as a result of such abuse.
(c) Blanket designation. (1) The Secretary of Defense has granted
Secretarial designee status to full-time Schedule ``A'' faculty members
of the Uniformed Services University of Health Sciences (USUHS). They
have been provided documentation substantiating their eligibility and,
where necessary, an eligibility termination date. These personnel are
authorized routine care at the Naval Hospital, Bethesda, MD. At other
naval MTFs, only emergency treatment is authorized while they are
traveling on official university business. The letter of authorization
excludes routine dental care, prosthetic appliances, and spectacles.
(2) The following officials within the Government, the Department of
Defense, and military departments have been granted blanket Secretarial
designation for medical and emergency dental care in naval MTFs in the
United States:
(i) The President.
(ii) The Vice President.
(iii) Members of the Cabinet.
(iv) Article III Federal Judges.
(v) U.S. Court of Military Appeals Judges.
(vi) Members of Congress.
(vii) The Secretary, Deputy Secretary, and the Assistant Secretaries
of Defense.
(viii) The Under Secretary of Defense for Policy.
(ix) The Under Secretary of Defense for Research and Engineering.
(x) The Secretaries, Under Secretaries, and the Assistant
Secretaries of the Military Departments.
(d) Authorization. Designees will present a signed letter bearing
the letterhead of the designating service. Secretarial designees are not
included in the DEERS data base and may not possess Government
identification cards. Therefore, the only proof of their eligibility for
treatment may be the letter of authorization. When a Secretarial
designee presents for treatment:
(1) Ask for identification of the individual presenting the letter
of authorization to assure that the person seeking care is the
individual to whom the letter was issued.
(2) Check the expiration date on the letter of authorization. Many
authorizations are issued for only a specified period of time, e.g.,
abused dependents--no longer than 1 year.
(3) Check to assure that the individual is applying for care
authorized by the letter of authorization. Designation is often granted
for a specific diagnosis or specific mode of treatment.
(4) Check to assure that the individual has not been designated for
care only as specific facility. Many authorizations are granted for
conditions or for care that can be rendered only by a specified
physician or under a specific program.
(5) Place a copy of the letter of authorization in the individual's
Health Record or outpatient treatment record on the left side at the
first visit or admission.
(e) Charges and collection. (1) Interagency rates are applicable for
inpatient and outpatient care provided outside the National Capital
Region to all individuals listed in paragraph (c)(2) of this section
with the exception of Members of Congress. Charges are at full
reimbursement rates for Members of Congress provided inpatient or
outpatient care outside the National Capital Region.
(2) In the National Capital Region:
(i) Charges are waived for outpatient care provided to all
categories listed in paragraph (c)(2) of this section.
[[Page 341]]
(ii) Charge interagency rates for inpatient care of all individual
in paragraph (c)(2) of this section except Members of Congress. Charge
Members of Congress at full reimbursement rates.
(3) Complete and submit, per subpart J, a DD 7 (Report of Treatment
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered to Secretarial
designees whose charges for care have not been waived.
Sec. 728.78 American Red Cross representatives and their dependents.
(a) Potential beneficiaries.
(1) Volunteer workers.
(2) Full-time, paid employees.
(3) Dependents of personnel enumerated in paragraph (a) (1) and (2)
of this section when accompanying their sponsor outside the continental
United States, including Alaska, Hawaii, and Puerto Rico.
(b) Care authorized. (1) When services of the American Red Cross
(ARC) have been accepted in behalf of the Federal Government under
applicable DOD regulations, beneficiaries in paragraph (a)(1) of this
section are considered ``employees'' of the Government for the purpose
of this part and are authorized health care in USMTFs, both in and
outside the United States for work-related conditions. See
Sec. 728.53(a)(2) regarding the specific application of this
authorization.
(2) Beneficiaries enumerated in paragraph (a) (1) and (2) of this
section are authorized health care in USMTFs located outside the United
States for both work and nonwork-related conditions. See
Sec. 728.53(a)(2) for treatment of work-related conditions of those in
paragraph (a)(1) of this section.
(3) Beneficiaries identified in paragraph (a) (1), (2), and (3) of
this section are authorized emergency care in USMTFs outside the
continental United States, including Alaska, Hawaii, and Puerto Rico
where facilities are not otherwise available in reasonably accessible
and appropriate non-Federal hospitals. Provide hospitalization only for
acute medical and surgical conditions, exclusive of nervous, mental, or
contagious diseases or those requiring domiciliary care. Routine dental
care, other than dental prosthesis and orthodontia, is authorized on a
space available basis provided facilities are not otherwise available in
reasonably accessible non-Federal facilities.
(c) Records disposal. Upon completion of treatment of accredited
representatives of the American Red Cross or their dependents, forward
medical records, including all clinical records and x-ray films, to the
Medical Director, National Headquarters, American Red Cross, 20th and D
Street NW., Washington, DC 20006.
(d) Charges and collection. Charge beneficiaries in paragraph (a)
(1) and (2) of this section the rate applicable to officer personnel and
dependents in paragraph (a)(3) of this section the dependent rate.
Complete and submit, per subpart J, a DD 7 (Report of Treatment
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered to ARC personnel or to
their dependents.
Sec. 728.79 Employees of Federal contractors and subcontractors.
(a) Beneficiaries. (1) U.S. citizen contractor, engineering, and
technical service personnel designated as U.S. Navy Technicians.
(2) Civilian employees of contractors and subcontractors operating
under U.S. Government contracts.
(3) Dependents of personnel enumerated in paragraph (a) (1) and (2)
of this section when accompanying their sponsor outside the continental
United States or in Alaska.
(b) Care authorized. (1) Beneficiaries identified in paragraph (a)
(1) and (2) of this section may be provided emergency care in naval MTFs
for illnesses and injuries occurring at work in or outside the United
States.
(2) While serving outside the continental United States or in
Alaska, where facilities are not otherwise available in reasonably
accessible and appropriate non-Federal facilities, beneficiaries
identified in paragraph (a) (1), (2), and (3) of this section may
receive hospitalization and necessary
[[Page 342]]
outpatient services in naval MTFs on a reimbursable basis. Except for
beneficiaries in paragraph (a)(1) of this section who are serving aboard
naval vessels, all others enumerated may only be hospitalized for acute
medical and surgical conditions, exclusive of nervous, mental, or
contagious diseases or those requiring domiciliary care. Routine dental
care, other than dental prosthesis and orthodontia, is authorized on a
space available basis provided facilities are not otherwise available in
reasonably accessible and appropriate non-Federal facilities.
(c) Charges and collection. Care is authorized on a reimbursable
basis. Complete and submit, per subpart J, a DD 7 (Report of Treatment
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered.
Sec. 728.80 U.S. Government employees.
(a) Civil service employees of all Federal agencies, including
teachers employed by Department of Defense Dependent's Schools (DODDS)
and their dependents, may be provided hospitalization and necessary
outpatient services, (other than occupational health services), on a
reimbursable basis, outside the continental limits of the United States
and in Alaska, where facilities are not otherwise available in
reasonably accessible and appropriate non-Federal hospitals. Except for
employees who are serving aboard naval vessels, hospitalization may be
furnished only for acute medical and surgical conditions, exclusive of
nervous, mental, or contagious diseases or those requiring domiciliary
care. Routine dental care, other than dental prosthesis and orthodontia,
is authorized on a space available basis provided facilities are not
otherwise available in reasonably accessible and appropriate non-Federal
facilities.
(b) Such civilian employees and their dependents may be provided
medical, surgical, dental treatment, hospitalization, and optometric
care at installations in the United States which have been designated
remote by the Secretary of the Navy for the purpose of providing medical
care.
(c) The major objective of the following programs for civil service
employees, regardless of location, is emergency treatment for relief of
minor ailments or injuries to keep the employee on the job:
(1) The Department of Labor, Office of Workers' Compensation
Programs (OWCP), governs the overall medical care program for employees
of the Government who sustain injuries while in the performance of duty,
including diseases proximately caused by conditions of employment (see
Sec. 728.53).
(2) Federal civil service employees and applicants for such
employment are authorized services as outlined in chapter 22, section
XIII, of the Manual of the Medical Department (MANMED). When
appropriated fund and nonappropriated fund employees, including unpaid
volunteer employees, require emergency and nonemergency occupational
health services due to an illness or an injury on the job, provide this
limited care through your occupational health service, emergency room,
or evening primary care clinic, as appropriate. This care is rendered
free of charge to the employee, the employee's command, or insurance
carrier. Included with this group are Military Sealift Command (MSC)
civilian marine personnel (authorized additional care and services as
outlined in BUMINST 6320.52 and care under Sec. 728.53(a)(7)) and
members of the National Oceanic and Atmospheric Administration (NOAA)
serving with the Navy.
(3) Under the technical control of the Surgeon General of the Army,
the DOD Civilian Employees' Health Service is responsible for
administering the health program for all Federal civil service employees
in the District of Columbia area.
(d) Care, other than occupational health services, is provided on a
reimbursable basis. Complete and submit, per subpart J, a DD 7 (Report
of Treatment Furnished Pay Patients, Hospitalization Furnished, part A)
or DD 7A (Report of Treatment Furnished Pay Patients, Outpatient
Treatment, part B) when outpatient or inpatient care is rendered.
[[Page 343]]
Sec. 728.81 Other civilians.
(a) General. In an emergency, any person may be rendered care in
naval MTFs to prevent undue suffering or loss of life or limb. Limit
care to that necessary only during the period of the emergency, and if
further treatment is indicated, initiate action to transfer the patient
to a private physician or civilian facility as soon as possible.
Further, subject to the provisions of Sec. 728.3, the following
personnel are authorized care as set forth.
(b) Beneficiaries and extent of care. (1) Provide all occupational
health services to civilian employees paid from nonappropriated funds,
including Navy exchange employees and service club employees, free of
charge (see Sec. 728.80(c)(2)). Provide treatment of occupational
illnesses and injuries other than in emergencies per rules and
regulations of the Office of Workers' Compensation Programs (see
Sec. 728.53).
(2) Civilians attending the Federal Bureau of Investigation (FBI)
Academy, Marine Corps Development and Education Command, Quantico, VA,
may be rendered care at the Naval Medical Clinic, Quantico, VA, for
emergencies. Such persons who are in need of hospitalization for
injuries or disease may be hospitalized and classed as civilian
humanitarian nonindigents with the approval of the cognizant hospital's
commanding officer. Exception: Certain individuals, such as employees of
the Federal Bureau of Investigation who are injured in the line of duty,
may be entitled to care at the expense of the Office of Workers'
Compensation Programs (OWCP) (see Sec. 728.53).
(3) The following civilians who are injured or become ill while
participating in Navy or Marine Corps sponsored sports, recreational or
training activities may be rendered care on a temporary (emergency)
basis until such time as disposition can be effected to another source
of care.
(i) Members of the Naval Sea Cadet Corps.
(ii) Junior ROTC/NDCC (National Defense Cadet Corps) cadets.
(iii) Civilian athletes training or competing as part of the U.S.
Olympic effort.
(iv) Civilians competing in Navy or Marine Corps sponsored
competitive meets.
(v) Members of Little League teams and Youth Conservation groups.
(vi) Boy Scouts and Girl Scouts of America.
(4) Other civilian personnel included below are not normally
eligible for care in naval MTFs; however, under the conditions set
forth, care may be rendered.
(i) Potential beneficiaries.
(A) Civilian representatives of religious groups.
(B) Educational institutions representatives.
(C) Athletic clinic instructors.
(D) USO representatives.
(E) Celebrities and entertainers.
(F) Social agencies representatives.
(G) Others in a similar status to those in Sec. 728.81(b)(4)(i) (A)
through (F).
(H) News correspondents.
(I) Commercial airline pilots and employees.
(J) Volunteer workers. This category includes officially recognized
welfare workers, other than Red Cross.
(ii) Care authorized. (A) Persons enumerated in paragraph (b)(4)(i)
(A) through (G) of this section, who are contracted to provide direct
services to the Armed Forces and who are acting under orders issued by
the Department of Defense or one of the military departments to visit
military commands overseas, and their accompanying dependents, may be
provided medical care in naval MTFs outside the 48 contiguous United
States and the District of Columbia provided local civilian facilities
are not reasonably available or are inadequate. Limit inpatient care to
acute medical and surgical conditions exclusive of nervous, mental, or
contagious diseases, or those requiring domiciliary care. Routine dental
care, other than dental prostheses and orthodontia, is authorized on a
space available basis outside the United States, provided such care is
not otherwise available in reasonably accessible and appropriate non-
Federal facilities.
(B) Persons enumerated in paragraph (b)(4)(i) (H) and (I) of this
section are authorized emergency medical and dental care in naval MTFs
outside the 48
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contiguous United States and the District of Columbia provided local
civilian facilities are not reasonably available or are inadequate.
(C) Persons enumerated in paragraph (b)(4)(i)(J) of this section,
both within and outside the 48 contiguous United States and the District
of Columbia, may receive care in naval MTFs for injuries or diseases
incurred in the performance of duty as beneficiaries of OWCP (see
Sec. 728.53). Additionally, if such volunteers are sponsored by an
international organization (e.g., the United Nations) or by a voluntary
nonprofit-relief agency registered with and approved by the Advisory
Committee on Voluntary Aid (e.g., CARE), they may receive other
necessary nonemergency medical care and occupational health services
while serving outside the 48 contiguous United States and the District
of Columbia.
(c) Charges and collection. Care is provided on a reimbursable
basis. Complete and submit, per subpart J, a DD 7 (Report of Treatment
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered.
Sec. 728.82 Individuals whose military records are being considered for correction.
Individuals who require medical evaluation in connection with
consideration of their individual circumstances by the Navy, Army, and
Air Force Board for Correction of Military Records are authorized
evaluation, including hospitalization when necessary for the proper
conduct thereof.
Sec. 728.83 Persons in military custody and nonmilitary Federal prisoners.
(a) Potential beneficiaries.
(1) Military prisoners.
(2) Nonmilitary Federal prisoners.
(3) Enemy prisoners of war and other detained personnel.
(b) Care authorized--(1) Military prisoners. (i) Whose punitive
discharges have been executed but whose sentences have not expired are
authorized all necessary medical and dental care.
(ii) Whose punitive discharges have been executed and who require
hospitalization beyond expiration of sentences are not eligible for care
but may be hospitalized as civilian humanitarian nonindigents until
final disposition can be made to some other appropriate facility.
(iii) On parole pending completion of appellate review or whose
parole changes to an excess leave status following completion of
sentence to confinement while on parole are members of the military
service and as such are authorized care as outlined in subpart B.
(iv) On parole whose punitive discharge has been executed are not
members of the military service and are therefore not entitled to care
at Government expense. If the circumstances are exceptional, individuals
herein who are not authorized care may request Secretarial designee
status under the provisions of Sec. 728.77.
(2) Nonmilitary Federal prisoners. Under the provisions of this
section, nonmilitary Federal prisoners are authorized only emergency
medical care. When such care is being rendered, the institution to which
prisoners are sentenced must furnish necessary guards to effectively
maintain custody of prisoners and assure the safety of other patients,
staff members, and residents of the local area. Under no circumstances
will military personnel be voluntarily used to guard or control such
prisoners. Upon completion of emergency care, make arrangements for
immediate transfer of the prisoners to a nonmilitary MTF or for return
to the facility to which sentenced.
(3) Enemy prisoners of war and other detained personnel. Subject to
the provisions of Sec. 728.3, enemy prisoners of war and other detained
personnel are entitled to and may be rendered all necessary medical and
dental care.
(c) Charges and collection. Care provided individuals enumerated in
Sec. 728.83(b)(1) (ii), (iv), and (2) is on a reimbursable basis.
Complete and submit, per subpart J, a DD 7 (Report of Treatment
Furnished Pay Patients, Hospitalization Furnished, part A) or DD 7A
(Report of Treatment Furnished Pay Patients, Outpatient Treatment, part
B) when outpatient or inpatient care is rendered.
[[Page 345]]
Subpart H--Adjuncts to Medical Care
Sec. 728.91 General.
Adjuncts to medical care include but are not limited to prosthetic
devices such as artificial limbs, artificial eyes, hearing aids,
orthopedic footwear, spectacles, wheel chairs, hospital beds, and
similar medical support items or aids which are required for the proper
care and management of the condition being treated. Generally, expenses
incurred for procurement of such items, either from civilian sources as
supplemental care or from stocks maintained by the facility, are payable
from operation and maintenance funds available for support of naval
MTFs. However, certain adjuncts may be cost-shared under CHAMPUS for
CHAMPUS-eligible individuals under circumstances enumerated in the
cooperative care or services criteria of Sec. 728.4(z).
Sec. 728.92 Policy.
(a) Provide adjuncts to medical care to eligible beneficiaries
receiving inpatient or outpatient care when, in the opinion of the
attending physician, such adjuncts will offer substantial assistance in
overcoming the handicap or condition and thereby contribute to the well-
being of the beneficiary.
(b) Unless necessary for humanitarian reasons, do not furnish
orthopedic and prosthetic appliances on an elective basis to members of
the naval service with short periods of service remaining when the
defect requiring the appliance existed prior to entry into service and
when such members will be separated from the service because of these
defects.
(c) For active duty members, make the initial allowance of
orthopedic footwear and orthopedic alterations to standard footwear the
same quantity as provided in the initial clothing allowance.
(d) Base the number of orthopedic and prosthetic appliances issued
or replaced for other authorized recipients upon the individual's
requirements as determined by the attending physician to be consistent
with the highest standards of modern medicine.
(e) Former members of the uniformed service should be advised that
they may obtain durable medical equipment, medical care, and adjuncts
from Veterans Administration facilities.
(f) Dependents are authorized certain adjuncts per Secs. 728.31 (c)
and (d) and in instances where items are not normally authorized at the
expense of the Government, they may be provided at cost to the United
States if available from Government stocks under the following
conditions:
(1) Outside the United States.
(2) At specific stations within the United States which have been
authorized by the Secretary of the Navy to sell these items.
Sec. 728.93 Chart of adjuncts.
The following chart and footnotes provide information relative to
adjuncts which may be furnished the several categories of beneficiaries
eligible for medical care at naval MTFs.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Others authorized the same
Adjuncts Active duty and retired benefits as active duty or Dependents authorized the Other beneficiaries(\8\)
members retired members(\8\) same benefits
--------------------------------------------------------------------------------------------------------------------------------------------------------
Ambulance service.................. Yes........................ Yes........................... Yes(\1\)................... No
Artificial eyes.................... Yes........................ Yes........................... Yes........................ Maybe(\3\)
Artificial limbs................... Yes........................ Yes........................... Yes........................ Maybe(\3\)
Contact or special lenses(\1\\1\).. Yes(\4\)................... Yes(\4\)...................... Maybe(\2\) (\4\) (\6\)..... No
Crutches(\7\)...................... Yes........................ Yes........................... Yes........................ Yes
Dental prostheses.................. Yes........................ Yes........................... Maybe(\9\)................. Maybe(\9\)
Elastic stockings.................. Yes........................ Yes........................... Yes........................ Yes
Hearing aids(\1\\0\)............... Yes(\5\)................... Yes(\5\)...................... Maybe(\2\)................. Maybe(\3\)
Hearing aid parts and batteries.... Yes(\1\\0\)................ Yes(\1\\0\)................... Maybe(\2\) (\1\\0\)........ No
Hospital beds (\7\)................ Yes........................ Yes........................... Yes........................ Yes
Joint braces....................... Yes........................ Yes........................... Yes........................ Yes
Orthopedic footware................ Yes........................ Yes........................... Maybe(\2\)................. Maybe(\3\)
Prosthetic devices, other(\7\)..... Yes........................ Yes........................... Maybe(\2\)................. No
Respirators and inhalators(\7\).... Yes........................ Yes........................... Yes........................ Yes(\1\)
Resuscitators (\7\)................ Yes........................ Yes........................... Yes........................ Yes(\1\)
Spectacles......................... Yes........................ Yes........................... Maybe(\2\) (\6\)........... No
Walking irons(\7\)................. Yes........................ Yes........................... Yes........................ Yes
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Wheel chairs(\7\).................. Yes........................ Yes........................... Yes........................ Yes
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\1\ When considered medically appropriate by the attending physician.
\2\ See Sec. 728.92(f).
\3\ Outside the United States and at designated remote stations when considered medically appropriate by the attending physician.
\4\ Contact or special lenses are not to be issued solely for cosmetic reasons. Further guidelines are contained in NAVMEDCOMINST 6810.1.
\5\ In addition to the hearing aid, include in initial issue one spare receiver cord, approximately 1 month's supply of batteries, and a statement
indicating make, model, type of receiver, serial number, code, part numbers, ``B'' battery voltage, and type of ``A'' and ``B'' batteries, as
appropriate. Provide replacement of hearing aids upon the same basis as initial issue and, except in unusual circumstances, will not be replaced
within 2 years of the initial furnishing or the last replacement of the appliance.
\6\ Spectacles, contact lenses, or intraocular lenses may be provided dependents with eye conditions which require these items for complete medical or
surgical management of a condition other than ordinary refractive error. For further information, consult NAVMEDCOMINST 6810.1.
\7\ May be loaned on a custody basis at the discretion of the attending physician.
\8\ See subpart of this part relating to specific beneficiary.
\9\ When considered by the attending physician and dentist to be an adjunct to a medical or surgical condition other than dental and when in consonance
with existing legislation and directives.
\10\ For further guidelines, consult BUMEDINST 6320.41B.
\11\ Includes intraocular lenses required for implantation upon removal of cataracts.
Subpart I--Reservists--Continued Treatment, Return to Limited Duty,
Separation, or Retirement for Physical Disability
Sec. 728.101 General.
(a) Notice of eligibility (NOE). While the NOE is basically a
document that substantiates entitlement to a disability benefit equal to
pay and allowances, it may be accepted when required to substantiate
eligibility for benefits other than pay and allowances, i.e., treatment
in USMTFs under the provisions of title 10, United States Code.
(b) Physical disability benefits. The following, excerpted and
paraphrased from SECNAVINST 1770.3, paragraph 10, is applicable when a
reservist may be entitled to physical disability benefits.
(1) When a notice of eligibility (NOE) has been issued to a member
hospitalized in a naval MTF and the attending physician is of the
opinion that recovery is not anticipated or that the reservist is not
expected to be fit for return to full duty within a reasonable period, a
medical board will be convened and the case managed the same as that of
a Regular member. Assure that a copy of the NOE accompanies the medical
board report forwarded to the Central Physical Evaluation Board.
Disability benefits, equal to pay and allowances, will continue in such
instances until final disposition.
(2) There is no limited duty status, per se, for inactive
reservists. However, if the attending physician determines that a
reservist is temporarily unfit for full duty, but will be fit for full
duty following a period of convalescence or following duty with physical
limitations, not to exceed 6 months, the physician may return the
reservist to duty with a summary of the hospitalization or treatment.
The summary will set forth the limitations posed by the member's
disability and the period of such limitations. Followup hospitalization,
treatment, and evaluation for the same condition may be provided at
USMTFs during the period of restricted duty, if required. If, during the
period of the restricted duty, it appears that the reservist will be
permanently unfit for full duty, promptly authorize the reservist to
report for evaluation, treatment if required, and appearance before a
medical board at the nearest naval MTF capable of accomplishing same.
Admission to the sicklist is authorized, when required. Should the
medical board recommend appearance before a physical evaluation board,
disability benefits equal to pay and allowances should continue until
final disposition is effected.
Sec. 728.102 Care from other than Federal sources.
The provisions of this subpart do not authorize care for reservists
at other than Federal facilities nor out of funds available for
operation of USMTFs
[[Page 347]]
(supplemental care) after a period of active duty or a period of
training duty ends, including travel to and from such training. Such
care may be rendered under the provisions of part 732 of this chapter.
Subpart J--Initiating Collection Action on Pay Patients
Sec. 728.111 General.
The Comptroller of the Navy has approved a system of transactions
that generates reports to COMNAV MEDCOM on unfunded reimbursable
transactions. The purpose of the final report is to provide data on
services furnished by naval health care facilities for which central
collection from other Government agencies and private parties is
required.
Sec. 728.112 Responsibilities.
(a) Patient administration departments. The initiation of the
collection process begins with patient administration departments.
Collection action cannot be accomplished unless patient administration
departments take the initial step to complete:
(1) DD 7, Report of Treatment Furnished Pay Patients,
Hospitalization Furnished (part A). Prepare a separate substantiating DD
7, in triplicate, for each category of pay patient receiving inpatient
care. At the end of each day that any pay patient is admitted, submit DD
7's to the collection agent.
(2) DD 7A, Report of Treatment Furnished Pay Patients, Outpatient
Treatment Furnished (part B). Prepare a separate substantiating DD 7A,
in triplicate, for each category of pay patient receiving outpatient
care. At the end of each day that any pay patient is treated on an
outpatient basis, submit DD 7A's to the collection agent.
(b) Collection agents. Upon receipt of a completed DD 7 or DD 7A,
collection agents will take the action indicated in paragraph 24304 of
the Resource Management Handbook, NAVMED P-5020, to effect central
collection action.
Sec. 728.113 Categories of pay patients.
The categories of patients for whom collection action must be
initiated are:
(a) Coast Guard. (1) Active Officers; (2) Retired Officers; (3)
Active Enlisted; (4) Retired Enlisted; (5) Dependents; (6) Cadets.
(b) Public Health Service. (1) Active Officers; (2) Retired
Officers; (3) Dependents of Officers.
(c) National Oceanic and Atmospheric Administration (NOAA). (1)
Active Officers; (2) Retired Officers; (3) Dependents of Officers.
(d) Foreign. (1) NATO Officers (Except Canadians provided care under
the comparable care agreement.); (2) NATO Enlisted (Except Canadians
provided care under the comparable care agreement.); (3) NATO
Dependents; (4) Civilians Accompanying NATO Members; (5) Foreign
Military Sales (FMS) Officers; (6) FMS Enlisted; (7) FMS Dependents; (8)
FMS Civilians; (9) Military Grant Aid Officers; (10) Military Grant Aid
Enlisted; (11) Military Grant Aid Dependents; (12) Military Grant Aid
Civilians; (13) Military Officers From Other Than NATO Nations; (14)
Military Enlisted From Other Than NATO Nations; (15) Dependents of
Officers and Enlisted From Other Than NATO Nations; (16) Civilians
Accompanying Military Members of Other Than NATO Nations; (17) Nationals
and Their Dependents.
(e) Secretarial designees not exempted from paying.
(f) Others. (1) Merchant Marines; (2) Military Sealift Command (MSC)
Personnel; (3) Public Health Service beneficiaries (Other than
Commissioned Corps); (4) Veterans Administration beneficiaries; (5)
Peace Corps beneficiaries; (6) Job Corps beneficiaries; (7) Volunteers
In Service to America (VISTA) beneficiaries; (8) Office of Workers
Compensation Program (OWCP) beneficiaries; (9) Bureau of Employees
Compensation (BEC) beneficiaries; (10) Department of State and Other
Federal Agencies beneficiaries (prepare a separate form for each Federal
agency); (11) Civilian Humanitarian Nonindigents (CHNI); (12) Trust
Territory beneficiaries; (13) Others not specified above who are not
entitled to health benefits at the expense of the Government.
[[Page 348]]