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MEDICAL MANAGEMENT PROCESSING SYSTEM 101

MEDICAL MANAGEMENT PROCESSING SYSTEM 101. MAJ Paul Tumminello, PA-C ARNG -CSG. An Operational Force at Home and Abroad. Accreditation. Nurse Accreditation Statement

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MEDICAL MANAGEMENT PROCESSING SYSTEM 101

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  1. MEDICAL MANAGEMENT PROCESSING SYSTEM 101 MAJ Paul Tumminello, PA-C ARNG -CSG An Operational Force at Home and Abroad

  2. Accreditation Nurse Accreditation Statement PRIME Education, Inc. (PRIME®) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. PRIME® designates this activity for 6.0 contact hours. Case Manager Accreditation Statement The Commission for Case Manager Certification designates this educational activity for 6.0 contact hours for certified case managers. NASW AccreditationThis program is Approved by the National Association of Social Workers (Approval #886602863-2041) for 13 Social Work continuing education contact hours.

  3. Disclosure Policy PRIME Education, Inc. (PRIME®) endorses the standards of the ACCME, as well as those of the AANP, ANCC, and ACPE, which require everyone in a position of controlling the content of a CME/CE activity to disclose all financial relationships with commercial interests related to the activity content. CME/CE activities must be balanced, independent of commercial bias, and designed to improve quality in health care. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession. A conflict of interest is created when individuals in a position of controlling the content of CME/CE activities have a relevant financial relationship with a commercial interest which therefore may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks, or other financial benefits. PRIME® will identify, review, and resolve all conflicts of interest that speakers, authors, course directors, planners, peer reviewers, or relevant staff disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Disclosure information for speakers, authors, course directors, planners, peer reviewers, and/or relevant staff is provided with this activity. Presentations that provide information in whole or in part related to non-FDA-approved uses of drugs and/or devices will disclose the unlabeled indications or the investigational nature of their proposed uses to the audience. Participants should refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Participants should verify all information and data before treating patients or employing any therapies described in this educational activity. The opinions expressed in the educational activity are those of the presenting faculty and do not necessarily represent the views of PRIME®, ACCME, AANP, ACPE, ANCC, or other relevant accreditation bodies.

  4. Disclosure Information

  5. Learning Objectives • State the purpose of the Medical Management Processing System • Understand your role and responsibilities in the MMPS process • Describe the MMPS process • Describe active duty and M-Day options for medical care COL Brown / NGB-ARS / 703-607-7142 / rob.brown@us.army.mil

  6. MMPS Purpose • The Medical Management Processing System (MMPS) provides a baseline structure for case management of Soldiers with unresolved medical issues to assist in achieving medical recovery and increase unit readiness • Comprehensive medical case management structure • from identification of condition to finaldisposition • (i.e return to duty or processed through a board action). 2

  7. MMPS Roles/Responsibilities • Case management support (main body) • Medical Readiness NCOs (MRNCO), Care Coordinators (CC), and Case Managers (CM) • MRNCO(BN) • Provide a monthly list to BN command of Soldiers that are tracked through MMPS • Assist the Soldier with tasks to include/not limited to: obtaining an LOD, a temporary profile, and collecting pertinent medical records (in coordination with the HSS) 7

  8. MMPS Roles/Responsibilities • Care Coordinators (CC) • Report to CM • Assist the Soldier with appointments and obtaining medical documents etc • Case Managers (CM) • Report to DSS • Arrange case meetings, advise CCs as required, develop Medical Action Plan to ensure progression through the prescribed medical plan of care • HSS/Military Providers(State Surgeons/PAs/Dentists) 8

  9. MMPS Process Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) MRNCO -assist SM w records/profiles - BN monthly report - hand off to CM CC continues to: -assist SM with case/issue -coordinate w CM/MRNCO 0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO Case meeting Case meeting Case meeting SM issued temp profile MRDP Medical Retention Decision Point (SM RTD and/or gets permanent profile) Case meeting agenda: 1) Temporary profile reviewed 2)Evaluate for WTU/RCMCactive duty orders for care* 3) Evaluate for Medical Management Activity assignment * *Requires acknowledgement from: CMD/SS/G1 and CM* 9

  10. MMPS Process - IDES Reporting MRNCO -assist SM w records/profiles - BN monthly report - hand off to CM Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) CC continues to: assist SM coordinates with CM/MRNCO as needed 0 MO 2MO 4MO 6MO 8MO 12MO MRDP Case meeting #1 Case meeting #2 Case meeting #3 Case meeting #4 SM issued temp profile Profile issued or RTD CO CMD participation BN CMD participation BDE CMD participation SNR CMD participation (BN)MRNCO – performs monthly report for Commands Per IDES EXORD:T3/4 profile/status review to CMD 10

  11. Active Duty Options for Medical Care 1)Reserve Component Managed Care (RCMC) • RCMC-Mfor mobilized (OCONUS/T10 illness/injury) • RCMC-T for training (CONUS AT or IADT illness/injury) • 2)Warrior Transition Unit (WTU) • ADME (CONUS AT or IADT illness/injury) • MRP2 (OCONUS/T10 illness/injury)

  12. Active Duty Options for Medical Care • 1)Reserve Component Managed Care (RCMC) • State Managed Active Duty orders for local care of simple/low complexity medical conditions • Orders for up to 179 days of medical treatment with a goal of condition resolution • NOT for: complex cases • issues found NOT in the Line of Duty

  13. Active Duty Options for Medical Care • 2) Warrior Transition Unit (WTU) • Packets submitted for placement into a WTU for full time care/treatment as determined by provider diagnosis and treatment plan. For complex medical care and/or care that will take more than 6 months to complete 9

  14. M-Day Options for Medical Care • IN Line of Duty: • LODDetermination period - initial evaluation to obtain a diagnosis and/or stabilization of emergent condition. This is at no cost to the Solider UNTIL an LOD determination is made. • Treatment period - for any illness/injury that is found In Line of Duty a Solider can obtain medical care (coordinated through Health Service Support (HSS) section through the Military Medical Support Office (MMSO). • INCAP – to cover gaps between/while awaiting medical orders or for Soldiers receiving medical care (cannot perform civilian job). Applied for retroactively. • PDHRA funds cover pay and travel for the day of a medical appt for a post deployment medical issue. (Limited to seven visits). 10

  15. M-Day Options for Medical Care • NOT in Line of Duty: • TRICARE Reserve Select – SM purchased health insurance to obtain care for medical issues that ARE NOT ILD. Premium = $53.16/mo. • * MAXIMUM out of pocket cost in 1yr = $1000.00/family member for any injury or illness incurred.

  16. MMPS vs MMA MMPSMMA • Medical Management Activity - Soldiers with medical issues that will most likely be separated from service are candidates for the MMA • Two elements of the MMA: • 3 cadre (admin supervision/support) • Main body (Soldiers with ongoing medical treatment or board action followed within MMPS) • Soldiers selected for the MMA: • assigned to vacant positions within the MMA host command (e.g. JFHQ/Med Det/Troop Cmd) or to a dedicated paragraph number via the Temporary TDA process (to create unit vacancies for backfill). *Case management system* *Para/line assignment* • A decision making process which provides direction for case management of Soldiers with unresolved medical issues or conditions to assist in achieving medical recovery and increase unit readiness. • Focuses on assisting medically non-available Soldiers to reach a final disposition of their medical condition. • Case management team includes: • Medical Readiness NCOs (MRNCO), Care Coordinators (CC), and Case Managers (CM).

  17. QUESTIONS

  18. THE END

  19. This has been another Alex The Army Dog Production

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