[Federal Register Volume 62, Number 128 (Thursday, July 3, 1997)]
[Notices]
[Pages 36052-36053]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-17457]


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DEPARTMENT OF DEFENSE


Mental Health Wrap-Around Demonstration Project

AGENCY: Office of the Secretary, DoD.

ACTION: Notice of demonstration project.

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SUMMARY: This notice is to advise interested parties of a demonstration 
project (an amendment to the managed care support contract in regions 7 
and 8), in which DoD will enroll a certain number of significantly 
emotionally disturbed children in TRICARE Regions 7 and 8 into a Mental 
Health Wraparound demonstration project. In order to be eligible for 
this project, children must be between the ages of 4 and 16 at the time 
of enrollment, have a serious emotional disturbance that is generally 
regarded as amenable to treatment, and, at the time of referral, 
require at least residential level of care, utilizing Health Management 
Strategies International, Inc. (HMSI) criteria, or are preparing for 
discharge from a residential or inpatient facility and are at high risk 
for recidivism. Additionally, a current DSM IV diagnosis is required. 
Children and adolescents who have a DSM IV diagnosis which is not 
generally regarded as either serious and/or amendable to treatment are 
not eligible for this demonstration. Parental consent is a necessary 
prerequisite to being enrolled in the demonstration.
    The purpose of this demonstration is to determine if: wraparound 
services provided through comprehensive and continued management of 
care for child and adolescent mental health patients: (1) Enables 
shorter inpatient stays and reduces recidivism for inpatient treatment 
and, (2) reduce costs of inpatient psychiatric and residential care. 
The contractor shall share financial risk by accepting as a maximum 
annual payment for such services a case rate reimbursement not in 
excess of the amount of the annual standard CHAMPUS residential 
treatment benefit payable (as determined in accordance with section 8.1 
of chapter 3 of volume II of the CHAMPUS policy manual). All 
participants enrolled in this project will be considered as TRICARE 
Prime enrollees for the purpose of applicable co-pays.
    Traditionally, mental health services to children and adolescents 
have constituted a large portion of CHAMPUS reimbursement costs for 
DoD. The most expensive form of these services has been the long term 
residential treatment of children. The efficacy of this treatment 
modality compared to other emerging less traditional programs has not 
been assessed sufficiently to determine if it is the most appropriate 
in terms of patient outcomes and costs. These services have been 
generally supported through a fee for service or per diem basis. With 
the transition to managed care principles and practices in DoD, 
attempts to control costs while maintaining or improving the quality of 
medical care provided to our beneficiaries has driven DoD to question 
the traditional mental health delivery systems.
    Although the standard CHAMPUS mental health benefit is generous as 
compared to industry standards, non-institutional benefits currently 
offered are conservative. They may not lend themselves to well to 
innovative, managed care efforts which try to effectively treat 
patients in the least restrictive and most cost effective health care 
settings. Local, supportive, and individualized services based on the 
specific needs of the emotionally disturbed child or adolescent are 
thought to lead to greater improvement in outcomes and relationships 
with other family members, and in less need for institutional care. The 
demonstration will provide residential and wraparound services, 
including nontraditional mental health services that will assist the 
child to be maintained in the least-restrictive and least-costly 
setting. The demonstration will offer benefits not currently available 
under CHAMPUS reimbursement; specifically, alternative living 
arrangements (therapeutic foster care; therapeutic group living; brief, 
time-limited respite services in a residential setting; and crisis 
stabilization in a residential setting), and psychiatric home health 
care.
    The contractor shall ensure a network of facilities is available to 
service the participants in the demonstration. This shall be a 
community-based program, utilizing established network and local 
resources. No mental health services shall be provided which are 
directly related to custodial care or determined to be primarily 
educational. All mental health providers used in this demonstration 
will be CHAMPUS authorized. Providers of unique, CHAMPUS excluded 
benefits must meet national/local licensing standards and/or 
credentialling mandates, (i.e. foster care/day care providers).
    Upon initial evaluation at the comprehensive treatment facility, 
each beneficiary in the demonstration project, will be afforded the 
services of a case manager, who will coordinate and monitor all 
services provided by each and every member of the client's treatment 
team. Case managers will, beyond case coordination, have the latitude 
to make implementation decisions about the provisions of all unique 
mental health services.
    A Clinical Management Committee will be established for the purpose 
of overseeing the quality of the clinical programs included in this 
demonstration project. The Clinical Management Committee will include 
multidisciplinary members.
    Portability of like services within regional boundaries may also 
threaten the efficacy of mental health treatment for DoD beneficiaries 
in this age group. The continuation of support for these children 
regardless of their location within the regional boundaries will be an 
important part of this demonstration. This seamless continuum of care 
offered to these children will contribute to their recovery with the 
most effective use of available resources. The demonstration will 
ensure that wraparound services will continue to be provided to an 
enrolled child who moves to another location within TRICARE Regions 7/8 
during the period of the demonstration.
    The demonstration project will be evaluated using predetermined 
outcome oriented treatment objectives. The evaluation will assess the 
feasibility of implementing the program throughout the military health 
service system. DoD will conduct this demonstration for a period of at 
least two years from November 1, 1997, through September 30, 1999. This 
demonstration project is being conducted under the authority of

[[Page 36053]]

10 U.S.C. 1092 and section 716 of the National Defense Authorization 
Act for Fiscal Year 1996 (Public L. 104-106).

EFFECTIVE DATE: November 1, 1997.

FOR FURTHER INFORMATION CONTACT: Ms. Marion Gosnell or Dr. John 
Sentell, Office of the Assistant Secretary of Defense (Health Affairs), 
telephone (703) 697-8975.

    Dated: June 27, 1997.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-17457 Filed 7-2-97; 8:45 am]
BILLING CODE 5000-04-M