CCW2

1. Reserve Component Managed Care-Mobilization/Training (RCMC-M/T) Developed by G1/personnel in collaboration with ARNG Office of the Chief Surgeon CCW2

2. Medical Management Processing System Workflow Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) MRNCO - assists SM w records profiles, and appointments CC continues - assist SM CC continues - assist SM - coordinate w CM/MRNCO as needed - coordinate w CM/MRNCO as needed 0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO SM identified w issue by self report, PHA, PDHA, or PDHRA Case meeting #1 Commander,SS,G1 and CM Case meeting #2 Commander,SS,G1 and CM Case meeting #3 Commander,SS,G1 and CM Not reached MRDP ? May get ONE TIME temp prof extension up to 6 MO Assure:1) temp profile updated 2) eval for AD orders for medical care 3)eval for MMA assignment Assure:1) temp profile updated 2) eval for AD orders for medical care 3)eval for MMA assignment Assure:1) temp profile updated 2) eval for AD orders for medical care 3)eval for MMA assignment 2

3. Medical Management Processing SystemOrders Workflow MEDICAL (MMPS) SM found to qualify for RCMC (T/M) Orders (NGB cuts orders) SM found to qualify for WTU (ADME or MRP2) SM identified with medical issue Assisted by MRNCO (by 90 d case given to Case Manager - CM) SM could be assigned to MMA if high prob of medical separation 90 DAYS CASE MEETING #1 SM assisted w med issue by CM and Care Coordinator (CC) 180 DAYS CASE MEETING #2 SM assisted w med issue by CM and CC 270 DAYS CASE MEETING #3 SM assisted w med issue by CM and CC Max 180 day orders SM may be in MMA while awaiting MEB/PEB/SEP 360 DAYS CASE MEETING #4

4. RCMC-M Soldiers with an approved In Line Of Duty (ILOD) determination for an injury, disease, or illness incurred while mobilized in support of a contingency operation, may voluntarily return to Active Duty for care utilizing RCMC–M orders for Managed Care, under the authority of Title 10 USC, Section 12301(h) for medical treatment or evaluations ngrcmc-mob/tng@ng.army.mil 3

5. RCMC-T Soldiers with an approved In Line Of Duty (ILOD) determination for an injury, disease, or illness incurred while participating in training (IET, IADT, IDT, AT, RC–ADOS), may voluntarily return to Active Duty for care utilizing RCMC–T Active orders for Managed Care, Under the authority of Title 10 USC, Section 12301(h) for medical treatment or evaluations ngrcmc-mob/tng@ng.army.mil 4

6. RCMC Eligibility Eligible: • Low risk, low acuity continuing medical conditions resulting from an approved Line of Duty illness, injury or disease • Soldiers who require medical care for 180 days or less Not Eligible: • Behavioral Health, PTSD, and MTBI • these are considered high risk conditions and do not qualify • When a Soldier declines medical care at the de-mobilization site and a declination form is signed, the Soldier is not eligible for RCMC-M orders 2

7. Managed Care • States provide a memorandum that verifies implementation of the RCMC pilot program (signed by the TAG) • Soldiers remain under the supervision of a Duty Site Supervisor and Case Manager • Commanders, Duty Site Supervisor and Soldiers will adhere to Soldiers profile limitation when assigning duties • Uniform Code of Military Justice (UCMJ) authority resides with the supporting Community Base Warrior Transition Unit (CBWTU) Commander ngrcmc-mob/tng@ng.army.mil 5

8. Managed Care (Cont) • Soldiers enrolled in the RCMC will be entered and tracked through the MMPS by the State Case Management Team • Soldiers will not perform T-32 duties or missions (i.e. RMP, IADT, IDT, ADT, AT or ADSW) while on RCMC orders • Civilian employment is not authorized while on RCMC orders • Soldier is not authorized to be enrolled in civilian education during normal duty hours while on RCMC orders ngrcmc-mob/tng@ng.army.mil 6

9. Orders/Pay • A request for RCMC-M/T Orders can be submitted at any time during the treatment period as recommended by the state assessment team • Submitting a packet for RCMC does not prevent a Soldier from requesting INCAP Pay. A request for INCAP Pay may be submitted while the RCMC packet is being prepared • INCAP and T10 active duty orders will not overlap ngrcmc-mob/tng@ng.army.mil 7

10. Validation • State MILPO will validate 01- 03, W3, E7 and below • Senior Leadership validation memorandum is required and will be validated as follow: 1. Chief, Personnel Division will validate O4, W4, and E8 and above 2. Director, Army National Guard (DARNG) will validate GO level submissions ngrcmc-mob/tng@ng.army.mil 17

11. RCMC Administrative Packet • Application Checklist • UnitCover Letter • DA 4187 – Request for Personnel Action • Duty Status Documentation (1379/Orders/Amendments/DD 214/etc) • DA 4856 – Counseling Statement • NGB Form 23B – RPAM Statement • Commander’s Referral Letter • MOU - Duty Site Supervisor and TAG • Validation Memo For Sr Leadership (if necessary)

12. RCMC Medical Packet • All required medical documents will be electronically filed as appropriate (i.e. HRR, LOD Module, e-Profile, AHLTA, and e-Case) • Their correct location needs to be identified as requested on the Commanders Letter • NO medical documents will be placed in TOD ngrcmc-mob/tng@ng.army.mil 18

13. RCMC Medical Packet(cont) • Forms that cannot be used to establish a definitive diagnosis: 1. DD Forms 689 (Sick Call Slip) 2. Forms listing pain, ache, or injury as a diagnosis 3. Forms completed by the Soldier 4. Forms not signed by a qualified medical professional ngrcmc-mob/tng@ng.army.mil 20

14. (XX) ARNG RCMC-M MONTHLY REPORT (Insert Month) for ARNG-HRP Metric Data must be provided NLT 5th of each month with data from previous month. 22

15. Way Ahead • ngrcmc-mob/tng@ng.army.mil has been established to receive administrative questions regarding packets for Soldiers being considered for the RCMC program. • Documents are not to be sent to the above mailbox. 27

16. POCs Action Officer: CW2 Ricci Moore, ARNG-HRP-P (Medical Actions) (703) 607-9219 ngrcmc-mob/tng@ng.army.mil Ms. Liz Driscoll, ARNG-HRP-P (Medical Actions) (703) 607-2984 ngrcmc-mob/tng@ng.army.mil CPT Laurie Fontaine, ARNG-CSG (703) 607-9534 Manuel Villalba, ARNG-HRP-P (Medical Actions) (703) 607-9981 28

17. BACK-UP SLIDES

18. Background General (Retired) Fred Franks conducted a strategic review of the Reserve Component’s (RC) medically not ready Soldiers and the RC Soldier’s ability to access the Disability Evaluation System. The study found that RC Soldiers, unless placed in WTUs, have inadequate access to managed medical care and treatment ngrcmc-mob/rng@ng.army.mil

19. Justification The RCMC-T and RCMC-M provides the Soldier an opportunity for expeditious medical treatment and follow-up care in order to return to a ‘fit for duty’ status, or to reach a Medical Retention Decision Point (MRDP) with subsequent possible referral to the Physical Disability Evaluation System (PDES), if required. ngrcmc-mob/tng@ng.army.mil

20. MEDICAL MANAGEMENT PROCESSING SYSTEM (MMPS) MEDICAL MANAGEMENT PROCESSING SYSTEM (MMPS) (Developed with G1/personnel) CPT Laurie Fontaine Medical Standards Officer ARNG Office of the Chief Surgeon laurie.fontaine@ng.army.mil 703-607-9534

21. AGENDA • Medical Management Processing System (MMPS) • Duties and Responsibilities • Understanding the MMPS process • MMPS Order Options • Understanding MMPS vs MMA • Questions

22. MEDICAL MANAGEMENT PROCESSING SYSTEM (MMPS) • The Medical Management Processing System (MMPS) is 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. • Monitors, manages, and facilitates medical care for medically non-available Soldiers. • Comprehensive medical case management tool • From identification of condition to final disposition . • System of case management support • Medical Readiness NCOs (MRNCO), Care Coordinators (CC), and Case Managers (CM).

23. CASE MANAGEMENT DUTIES AND RESPONSIBILITIES • Battalion Medical Readiness Non-Commissioned Officer (BN MRNCO) report to Battalion Commander • Provide a monthly list to command of all Soldiers in the BN that are tracked through the MMPS system. • Assist the Soldier with tasks to include, but not limited to, obtaining; an LOD, a temporary profile, establishing initial provider appointment and collecting any pertinent medical records (for the HSS). • Should the Soldier require more in-depth/continual health care beyond 90 days (from identification of the issue), the BN MRNCO will do a battle hand off to the Case Manager (CM).

24. CASE MANAGEMENT DUTIES AND RESPONSIBILITIES • Case Managers (CM)report to the Deputy State Surgeon (DSS) and are tasked with evaluating and assigning cases to Care Coordinators(CCs) • Clinical professionals (PAs, RN, social workers etc) • Arrange case meetings, work in an advisory capacity with the CC, reviewing and re-establish the comprehensive plan of care, to progress toward a final outcome.

25. CASE MANAGEMENT DUTIES AND RESPONSIBILITIES • Care Coordinators* (CC) report to the DSS and are the civilian equivalent of a BN MRNCO • Possess basic health care training. • Assist Soldiers with tracking medical and dental appointments, assuring attendance, maintaining communication as required with the Soldiers, and continue to update/collect current medical records (through collaboration w the HSS). *previously called Administrative Assistants

26. DUTIES AND RESPONSIBILITIES • Health Systems Specialists (HSSs) report to the State G1 (most states) and provide technical expertise and guidance for personnel health related programs. • Assist the Soldier with obtaining a DA Form 2173 (LOD)and communicates directly with the MRNCO, CCs (and CM) to assure that medical documents are loaded and indexed into the Health Readiness Record. • Military Health Care Providers are Medical Doctors (MDs), Physician Assistants (PAs), or Nurse Practitioners (NPs) who report to the State Surgeon, issue profiles and serve as the military medical point of contact (POC) for the CM and the CC.

27. Medical Management Processing System Workflow Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) MRNCO - assists SM w records profiles, and appointments CC continues - assist SM CC continues - assist SM - coordinate w CM/MRNCO as needed - coordinate w CM/MRNCO as needed 0 MO 3 MO 6 MO 9 MO 12 MO SM identified w issue by self report, PHA, PDHA, or PDHRA * MRNCO – performs monthly scrub for BN command *HSS works with case management team/receives any documents for indexing 27

28. MEDICAL MANAGEMENT PROCESSING SYSTEM (MMPS) • Case Meetings conducted no later than every 90 days • Coincide with temporary profile renewals • Minimally includes G-1 rep (MILPO), State Surgeon (or rep), Brigade-level commander (or rep) along with Case Manager (or rep from case management team)

29. Medical Management Processing System Workflow Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) MRNCO - assists SM w records profiles, and appointments CC continues - assist SM CC continues - assist SM - coordinate w CM/MRNCO as needed - coordinate w CM/MRNCO as needed 0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO SM identified w issue by self report, PHA, PDHA, or PDHRA Case meeting #1 Commander,SS,G1 and CM Assure:1) temp profile updated Case meeting #2 Commander,SS,G1 and CM Assure:1) temp profile updated Case meeting #3 Commander,SS,G1 and CM Assure:1) temp profile updated Not reached MRDP ? May get ONE TIME temp prof extension up to 6 MO 29

30. Medical Management Processing System Workflow Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) MRNCO - assists SM w records profiles, and appointments CC continues - assist SM CC continues - assist SM - coordinate w CM/MRNCO as needed - coordinate w CM/MRNCO as needed 0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO SM identified w issue by self report, PHA, PDHA, or PDHRA Case meeting #1 Commander,SS,G1 and CM Case meeting #2 Commander,SS,G1 and CM Assure:1) temp profile updated 2) eval for AD orders for medical care Case meeting #3 Commander,SS,G1 and CM Assure:1) temp profile updated 2) eval for AD orders for medical care Not reached MRDP ? May get ONE TIME temp prof extension up to 6 MO Assure:1) temp profile updated 2) eval for AD orders for medical care 30

31. OPTIONS FOR ACTIVE DUTY CARE 1)Reserve Component Managed Care (RCMC) • RCMC-T for training (CONUS AT or IADT illness/injury) • RCMC-M for mobilized (OCONUS/T10 illness/injury) • State Managed orders (still being finalized) • Order set granted by the state for up to 180 days of eval/treatment to help reach MRDP or complete resolution. • Not for: complex cases that require a WTU admission behavioral health treatment issues found NOT in the Line of Duty (NLD). 2)WTU- ADME (for AT or IADT) or MRP2 (OCONUS injury or illness) packets can be submitted for placement into a WTU for full time care/treatment as determined by provider diagnosis and the corresponding treatment plan 31

32. Medical Management Processing System Workflow Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) MRNCO - assists SM w records profiles, and appointments CC continues - assist SM CC continues - assist SM - coordinate w CM/MRNCO as needed - coordinate w CM/MRNCO as needed 0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO SM identified w issue by self report, PHA, PDHA, or PDHRA Case meeting #1 Commander,SS,G1 and CM Case meeting #2 Commander,SS,G1 and CM Case meeting #3 Commander,SS,G1 and CM Not reached MRDP ? May get ONE TIME temp prof extension up to 6 MO Assure:1) temp profile updated 2) eval for AD orders for medical care 3) eval for MMA assignment Assure:1) temp profile updated 2) eval for AD orders for medical care 3) eval for MMA assignment Assure:1) temp profile updated 2) eval for AD orders for medical care 3) eval for MMA assignment 32

33. MMPS vs. MMA • 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. • Monitors, manages, and facilitates medical care for medically non-available Soldiers. • Focuses on assisting medically non-available Soldiers with a final disposition of their medical condition. • Case management team includes: • Medical Readiness NCOs (MRNCO), Care Coordinators (CC), and Case Managers (CM). • Assignment for Soldiers. • Soldiers with a Medical Readiness Class of 3B (MR3B) for nine months or greater are prime candidates for the MMA . • The MMA has two elements • 3 cadre (provides administrative supervision, assistance, and support) • Main body (Soldiers with ongoing medical treatment or evaluation being monitored or within the MMPS). • Soldiers selected for the MMA are assigned to vacant positions within the MMA host command (e.g., JFHQ, Medical Detachment, or Troop Command) or to a dedicated TDA paragraph number via the Temporary TDA process (to create unit vacancies for backfill). MMPSMMA *Case management system* *Para/line assignment*

34. Medical Management Processing SystemOrders Workflow MEDICAL (MMPS) SM found to qualify for WTU (ADME or MRP2) SM found to qualify for RCMC (T/M) orders (State cuts order set) SM identified with medical issue Assisted by MRNCO (by 90 d case given to Case Manager - CM) SM could be assigned to MMA if high prob of medical separation 90 DAYS CASE MEETING #1 SM assisted w med issue by CM and Care Coordinator (CC) 180 DAYS CASE MEETING #2 Max 180 day orders SM assisted w med issue by CM and CC 270 DAYS CASE MEETING #3 SM assisted w med issue by CM and CC SM may be in MMA while awaiting MEB/PEB/SEP 360 DAYS CASE MEETING #4

35. OTHER OPTIONS FOR CARE In Line of Duty: • LOD– initial evaluation to obtain a diagnosis (coordinated through Health Service Support sections under Military Medical Support Office (MMSO). • INCAP – to cover gaps between orders or for Soldiers receiving medical care (cannot perform civilian job). • PDHRA funds for seven medical appointments for issues identified post deployment NOT in Line of Duty: • TRICARE Reserve Select – SM purchased health insurance to obtain care for medical issue that ARE NOT ILD. (Prem = $53.16/mo. MAX out of pocket in 1yr = $1000.00 for any injury or illness incurred).

36. Questions ?????????