1 / 37

Patient Administration

Patient Administration Department (Personnel Matters) Briefed by YNC(AW) Robert S. Brooks, Jr. robert.s.brooks@navy.mil (901) 874-3230. Patient Administration. Most information in this brief is based on MANMED, MILPERSMAN, SECNAVINST 1850.4E, and other related instructions and laws.

wilson
Download Presentation

Patient Administration

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Patient AdministrationDepartment(Personnel Matters)Briefed byYNC(AW) Robert S. Brooks, Jr.robert.s.brooks@navy.mil(901) 874-3230 PERS-821 901-874-3230 / 3229

  2. Patient Administration • Most information in this brief is based on MANMED, MILPERSMAN, SECNAVINST 1850.4E, and other related instructions and laws. • Some information is provided as recommendations with valid points and interests of the member in mind. • This brief was made for the PAD officer and staff to have an understanding of the overall “personnel” picture in relation to the member, family, non-medical case management, and communication and not the “medical” aspects of the patient. • Information will help you make correct decisions. PERS-821 901-874-3230 / 3229

  3. Duty Type Codes • Five types of duty designations identify commands: • May require TEMDU if member must be geo relocated for medical care or member is geo relocated > 90 days. Members in these type commands normally go through an MEB then YH avail for LIMDU movement vice TEMDU direction, MEB, and YH avail: • Type Duty Code “1”: Shore Duty (CONUS) – in the U.S., including Hawaii and Alaska • Type Duty Code “3”: Overseas Remote Land-based. Credited as sea duty for rotational purposes only due to the relative undesirability of the geographic area. • Type Duty Code “6”: Shore Duty (OCONUS) – overseas. • Must require TEMDU direction if treatment plan > 60 days • Type Duty Code “2”: Vessels and deployable squadrons home ported in the U.S. including Hawaii and Alaska. • Type Duty Code “4”: Vessels and deployable squadrons home ported overseas. PERS-821 901-874-3230 / 3229

  4. Types of Orders • BUPERS PCS • In transit (ACC 400)? • Hospitalized? If so, gain member (both enlisted or officer). • Walk in-not hospitalized? Most likely No Gain required. • LIMDU orders come from the member’s detailer. PERS-4013 provides input via YH avail. • GWOT Support Assignments (GSA) • Gained at ECRC of NMPS, receives funded TEMADD orders to go in theater. GSA is the new IA. GSA is given to those avail in between rotation PCS. • GSA orders come out of PERS-4G • TEMADD for outpatient care. • When should it be funded? 50 miles from the MTF is key • Who funds? Parent Command. See the P-1000. • Standard Transfer Orders or STO. Funding data - BUPERSINST 7040.6 • Enlisted disability separations, EPTS, and TDRL/PDRL orders are funded using same instruction. These orders are generated by the PSD. • Individual Augmentation (IA) orders. IA orders come out of PERS-4G. PERS-821 901-874-3230 / 3229

  5. Accounting Codes • Five authorized Accounting Codes (ACC) for Navy MTF inpatient UIC use: • ACC “370”: TEMDU – hospitalized in Navy MTF • ACC “371”: TEMDU – Medical Holding Company • ACC “372”: TEMDU – hospitalized in Non-MTF • ACC “373”: TEMDU – hospitalized in Other Service MTF • ACC “374”: TEMDU – Extended Outpatient Treatment (avail Sept 2008) • Direct the use of these ACCs for Active and Reserve component Navy personnel. PERS-821 901-874-3230 / 3229

  6. Accounting Codes • Other ACCs you may see: • ACC “103”: Temporary Active Duty • Reserve component on ADSW or MEDHOLD • ACC “105”: Limited Duty • Active Component • ACC “107”: Mobilization • Reserve component on mobilization or at the NMPS receiving light duty care up to 90 days before demobilization or transfer to ACC 103 to MEDHOLD. • ACC “320”: TEMDU – For Further Assignment – Not for Officers • Personnel at TPU awaiting for LIMDU orders PERS-821 901-874-3230 / 3229

  7. Accounting Codes • Other ACCs you may see: • ACC “355”: TEMDU – Awaiting PEB decision – Not for Officers • Personnel are always moved to TPU from type duty 2 or 4. • Personnel at type duty 1, 3, or 6 will stay or change to ACC 105 and stay in the parent command if not moved to the TPU. • Use this code if member is at TPU/Others activity and an MEB is not completed yet. • ACC “400”: In Transit • Member was a loss to a command, but not gained yet by prospective command. PERS-821 901-874-3230 / 3229

  8. TEMADD FUNDING • Member should always have funded TEMADD orders from parent command if member is 50 miles away from treatment location. • Navy Financial Manual P-1000 directs parent commands to provide funded orders to members receiving outpatient care. • BUMED M8 provides annual message as well. • DoD matrix showing who is responsible for all Services. • Rule is member must be funded “one round trip.” Not “one way” trip. • Direct that the funded TEMADD orders have POC information, so you may contact the command. PERS-821 901-874-3230 / 3229

  9. TEMADD to TEMDU • Navy MTF shall direct change of status from TEMADD to TEMDU by message no later than the next work day to parent command and servicing PSD if one of the following occurs: • A determination is made that member is no longer fit for full duty and member will not return to a type 2 or 4 duty within 60 days. • Member will be processed by an outpatient MEB and member is of a type 2 or 4 command. • The period of hospitalization or treatment will exceed 90 days and type 1, 3, or 6 duty location is not in the area of treatment site. Only do this if you must. Preferred process is member’s MTF initiates and approves an MEB for YH availability report submission. • In most cases, do not direct TEMDU from your MTF if member is from a 1, 3, or 6 duty from another geo location requiring LIMDU. Member’s MTF should complete the AMEBR/MEBR and direct member’s servicing PSD to submit a YH Availability Report if member must be moved to your MTF area. Member will receive LIMDU PCS orders. PERS-821 901-874-3230 / 3229

  10. TEMDU • What happens if member is TEMDU transferred? • Member is a loss to PDS, and a gain to new TEMDU station. • BAH changes • Member’s family does not have to move. It is optional; a family decision. • Family is recommended to wait until LIMDU orders are provided or upon knowing member will be treated in the area of TEMDU. • BAH waivers are authorized via PERS-451. Send Secretarial BAH Waiver requests for members to continue to receive BAH at the dependent location if member is hospitalized or in extended outpatient, and dependents didn’t move, and the dependents location BAH is greater than the member’s current BAH entitlement. Send to PERS451@navy.mil. PERS-821 901-874-3230 / 3229

  11. TEMDU continued • What happens if member is TEMDU transferred? • A Standard Transfer Order (STO) allows all benefits of a normal PCS order if the medical treatment at the location shown on the STO is prolonged. • A combination of medical input on treatment length and STO will allow HHG shipment per the JFTR. • Specifically, U5372.3.C.1.B of the JFTR allows HHG movement to a place INCONUS for an injured/ill member receiving prolonged treatment. • See U5372 paragraph 4 of the JFTR for storage authorization anywhere INCONUS. • U5372 of JFTR pertain to HHG movement. PERS-821 901-874-3230 / 3229

  12. INPATIENT (not theater) • Inpatient • NOT FROM THEATER OPERATIONS • Hospitalization Message • Is hospitalization based on the medical condition member incurred in theater? If so, ensure Pay and Personnel Review/Action with PSD/CSD. There are entitlements. • Type of Orders? PCS? GSA? TEMADD funded? IA? Nothing? • Type 2 or 4 Duty? GSA tour is type 2. • Treatment plan > 60 days and member from type 2 or 4? • PAD Direct TEMDU to your inpatient UIC if treatment plan (not hospitalization) is greater than 60 days. • Treatment plan > 90 days and member from type 1, 3, or 6? • PAD Direct TEMDU to your inpatient UIC if member is geo dislocated greater than 90 days.. • Inpatient UIC (do you know yours?) PERS-821 901-874-3230 / 3229

  13. INPATIENT (coming from theater) • Inpatient • FROM “IN THEATER” OPERATIONS • Hospitalization Message • Ensure Pay and Personnel Review/Action at PSD/CSD • Type of Orders? GSA? TEMADD funded? IA? Nothing? • Is member from a shore or sea (operational) command? • Did you know…GSA are fm ECRC within NMPS Norfolk/SD • Type 2 or 4 Duty? GSA tour is type 2, too. • Treatment plan > 60 days and member from type 2 or 4? • PAD Direct TEMDU • Treatment plan > 90 days and member from type 1, 3, or 6? • PAD Direct TEMDU if member must be geo relocated • Inpatient UIC (do you know yours?) PERS-821 901-874-3230 / 3229

  14. INPATIENT TRANSFERS • Inpatient Transfers • Physician determines treatment plan/location • Medical Case Manager Involvement • Follow-up and discuss status of member with PAD • Changing MTF responsibility? • Communication of Clinical • Communication of non-clinical to PAD to inform/direct/request from parent command/PSD • PSD to PSD communication and transfer of pay UIC account based on PAD to PSD communication. • Transfer of TEMDU to new MTF inpatient UIC if already assigned to current MTF inpatient UIC • Physician needs to determine if treatment plan is greater than 60 (sea) or 90 (shore & geo dislocated) if not done so at this point at the same time clinical transfer is determined. • PAD Directs parent command to TEMDU member to the MTF inpatient UIC responsible. PERS-821 901-874-3230 / 3229

  15. How did member get to you?(TAD in area – Example 1) • Member is TEMADD for duty/training etc. away from parent command in your MTF’s area and member gets injured. • contact command for more TEMADD funding for treatment and provide status of member appropriately • If an officer, remember to submit BUPERS 1301-13 per PERS451@navy.mil and the PERS-821 officer LIMDU POC…currently robin.ferdinand@navy.mil. • If outpatient basis, and after the level of treatment is completed, can the major MTF that services member’s parent command treat member? If so, communicate with that MTF, setup appointment for member, and refer member appropriately. Member’s local MTF will provide continued treatment, complete the MEB, and direct case as applicable. • If the member’s MTF cannot service member at member’s command location, then complete the MEB appropriately, allow member to return to command for preparation of move (if possible), direct member’s servicing PSD upon completion of the MEB to move member via YH availability report to location determined by physician. Member will be moved via LIMDU orders. • Exception of above…if member is of a type 2 or 4 duty…then to TPU as the MTF treating directs, but if at all possible, to the TPU/TPD/Others activity closest to the member’s PDS. • If an officer, PERS-821 will determine LIMDU once MEB is submitted to allow detailer to provide LIMDU orders vice PSD submitting YH avail. • If member is hospitalized based on injury, follow TEMDU/TEMADD requirements. PERS-821 901-874-3230 / 3229

  16. How did member get to you?(TAD referral – Example 2) • Member is TEMADD for treatment to your MTF as a referral from another MTF. • Example…NH Lemoore to NMC San Diego. • Ensure member has funded TEMADD orders. If not, direct appropriately to document required entitlements. • If outpatient basis, can the major MTF that services member’s parent command treat member appropriately after review/initial treatment? If so, communicate with that MTF, setup appointment for member, and refer member back to the MTF appropriately. Member’s local MTF will provide continued treatment, complete the MEB, and direct TEMDU as applicable. • If the MTF cannot service member at command location, then: • Provide referral information back to the member’s MTF for initiation of an MEB, or • Complete the MEB, allow member to return to command for preparation of move, direct member’s servicing PSD upon completion of the MEB to move member via YH availability report to location determined by physician. Member will be moved via LIMDU orders at the recommended treatment area, or • If member is from a type 2 or 4 duty…TEMDU required to the TPU/TPD/Others activity the MTF approving the MEB directs, but preferably to the TPU/TPD/Others activity closest to the member’s PDS, if able. • If an officer, PERS-821 will determine LIMDU once the MEB is submitted to allow detailer to provide LIMDU orders vice PSD submitting YH avail. • If member is hospitalized based on injury, follow TEMDU/TEMADD requirements. PERS-821 901-874-3230 / 3229

  17. How did member get to you?(GSA – Example 3) • Member received and member’s parent command is ECRC within the NMPS on GSA orders (regardless if in-theater operations or not) • This is a type 2 command. Treat the case as such. • Ensure member has funded TEMADD orders. If not, direct appropriately to document required entitlements. Member should be funded under the orders provided for GSA assignment. There may be no action on this…but verify. • If member cannot return to full duty within 60 days regardless of combination of inpatient/outpatient, follow TEMDU direction. If an officer, follow TEMADD direction. • ECRC is the parent command for all personnel on GSA tour. There is only two ECRC commands. One in NMPS San Diego, and the other at NMPS Norfolk. • When you direct ECRC to TEMDU member…ECRC and PERS-4G/detailer will follow member for new assignment, or if an MEB is pending, a YH availability report will be submitted by TPU/PSD once MEB is completed for LIMDU orders or stay at TPU for PEB processing. If an officer, the MEB will be submitted to PERS-821 for disposition. PERS-821 901-874-3230 / 3229

  18. How did member get to you?(IA – Example 4) • Member received and member is on Individual Augmentation (IA) orders. • Member’s parent command is the command member went on IA from. • Parent command could be any type duty. Verify UIC for type of duty. • Ensure member has funded TEMADD orders. If not, direct appropriately to document required entitlements. Member should be funded under the orders provided for on IA. There may be no action on this…but verify availability of funds. • If member cannot return to full duty within 60 days regardless of combination of inpatient/outpatient, and member is type 2 or 4 duty, follow TEMDU direction. If an officer, follow TEMADD direction. • If member is from a type 1 command, follow example 2. • If member is from a type 3 or 6 command, follow example 2 and determine further if the overseas MTF may be able to treat member. • Report status of member via message to parent command and PERS-4G. Parent command to know status of member, and PERS-4G to indicate member will or will not return to IA assignment. PERS-821 901-874-3230 / 3229

  19. How did member get to you?(No Notice – Example 5) • Member received at Other Services MTF (i.e. BAMC), VA hospital, or other civilian hospital as an inpatient (not transferred from an MTF). • Ensure your level 4 and 5 hospitals in your area know how to contact you. • Member could be any type duty command including an in transit. Verify UIC for type of duty and ACC code. • Was member on regular leave? If so, ensure you notify parent command of member’s hospitalization. • Was member on separation or retirement leave? If so, notify losing command. Additionally, determine if member needs an extension of retirement/separation for hospitalization or PEB referral to separating or retirement authority. • If member cannot return to full duty within 60 days regardless of combination of inpatient/outpatient, and member is type 2 or 4 duty, follow TEMDU direction. If an officer, follow officer TEMADD direction. • If member is from a type 1 command, follow example 2. • If member is from a type 3 or 6 command, follow example 2 and determine further if the overseas MTF may be able to treat member. PERS-821 901-874-3230 / 3229

  20. How did member get to you?(Inpatient – Example 6) • Member received at Other Services MTF (i.e. BAMC), VA hospital, or other civilian hospital as an inpatient from another MTF. • The Navy MTF’s medical case manager and PAD should have already communicated the clinical/non-clinical transfer information to the new MTF. • The losing MTF should have directed TEMDU if member was a type 2 or 4 duty and gained in that MTF’s inpatient UIC prior to transfer, if applicable. • If TEMDU did not occur, ensure the losing MTF directs the TEMDU to be gained to your MTF inpatient UIC now; your MTF shouldn’t be directing TEMDU if member’s case was already determined to be prolonged by the other MTF, but may be necessary if not already completed. • Waiting to direct TEMDU may be appropriate if the MTF knows member will be farmed out for other Navy MTF responsibility. Knowledge of this should come from attending physician, but never wait longer than 60 days to direct TEMDU by any combination. • Do not go over 60 days without directing TEMDU. Key is “as soon as it is known” member will not return to operational unit within 60 days full up. • Be proactive. Communication is key to medical, personnel, and pay. PERS-821 901-874-3230 / 3229

  21. How did member get to you?(MEB referral – Example 7) • Member received at your MTF for your MTF to do MEB action. • Does the other MTF have convening authority? If so, then the other MTF should have completed the MEB, and: • If member is shore duty (1, 3 or 6), directed servicing PSD to submit YH availability report for member to be transferred to new MTF area for treatment. If an officer, submit MEBR to PERS-821 for disposition. • If member is sea duty (2 or 4), directed parent command to TEMDU member to TPU/Others activity for LIMDU/PEB processing to their own servicing TPU/TPD/Others activity. • If gaining MTF determines to do the MEB, then note the following. • A member’s transfer to other MTF location for outpatient treatment may be delayed until the new MTF can direct appropriately. • Member may still have to return to parent command for personal property movement, etc. which will cause stress to member and family. • The other MTF directs member’s TEMDU, etc. • Simply put…if diagnosis cannot be treated by major MTF in member’s area…then the MTF does an MEB writing in treatment plan area that member must be moved to the new MTF area for treatment. Don’t make the other MTF do your MTF’s MEB and coordination. • Any DoD physician should know approx how long member may be medically restricted without the specialty clinic and without the proper equipment. PERS-821 901-874-3230 / 3229

  22. INPATIENT to OUTPATIENT (For LIMDU) • Will member ever be returned to duty? • No? Why LIMDU then. • Yes? Continue with LIMDU plan. • Surgery? Qualifies for LIMDU for healing time. • Career ending? Retirement, separation, or HYT within 1 year? Within 6 months? Within 3 months? Now? • Punitive separation pending? • Type duty 2 or 4?  Direct TEMDU to TPU/Others • Medical Holding Company available? • Transfer to TPU/Others if assigned inpatient UIC already • Type duty 1, 3 or 6? The MTF at duty location sufficient to treat member? • Yes, stay at current command. Communicate clinical. • No, direct member’s servicing PSD to submit YH availability report, after MEB is completed; provide: • Geo location member should be transferred for medical care based on physician direction if not on the MEBR • All other data needed is on the MEBR already provided to PSD PERS-821 901-874-3230 / 3229

  23. INPATIENT to OUTPATIENT(For PEB) • Physician dictates MEBR • Is there final punitive separation authority? Cancel PEB. • Pending? Suspend it. • Is there approved retirement or member is HYT? • Presumption of Fitness? • Need more time? Send message to PERS-823 (enlisted retirements & HYT) or 822 (officer retirements) • Current email and numbers for more time: • PERS-823: Mr. Mike Lynn, michael.j.lynn@navy.mil, 901-874-3246 • PERS-822: Ms. Kim Riddle, kimberly.riddle@navy.mil, 901-874-3180 • Submit message requesting 60 days extension to submit to PEB. Add message to the email. • Type duty 2 or 4?  Direct TEMDU to TPU/Others • Transfer to TPU/Others if assigned inpatient UIC already • Type duty 1, 3 or 6?  Stay on type 1, 3, or 6 station if possible…but may need to be moved if applicable. PERS-821 901-874-3230 / 3229

  24. INPATIENT to OUTPATIENT(Extended Outpatient) • MEB not required or desired • These patients are SVI or SI or equivalent if not reported. • Physician determines treatment plan/location. • If not assigned to your inpatient UIC in error, then do it now. • Change of MTF responsibility? • Communicate clinical transfer to new MTF responsible for the case. • Have your servicing PSD do the loss endorsement and send records and new STO etc. to gaining MTF’s servicing PSD. • Member should already be assigned to your inpatient UIC…change ACC to 374. • ACC-374 will be available in September 2008. • Use ACC-374 for patients who are not in a hospital in a bed, and patients are not able to work in LIMDU status in a workspace. • ACC-374 is for patients in nursing facilities, VA rehabilitation facilities, home in a bed with nursing care, etc., 90 day convalescent plans (cannot legally allow 90 days conv)…but, accounting member as ACC-374 may be authorized. • Specific reasons to use ACC-374 will be determined by PERS-821 and M3. • ACC-374 is equivalent to being hospitalized. Member is unable to work, but the treatment is extended or extensive to the fact member still cannot work. It’s the grey area between hospitalization and LIMDU. PERS-821 901-874-3230 / 3229

  25. INPATIENT to OUTPATIENT(Extended Outpatient) • Actual case #1 • Member was an inpatient from theater routed to an MTF CONUS, further sent to PALO ALTO for treatment. • Clinical transfer discussed, but not the non-clinical (the STO). • Member transitioned to extended outpatient treatment to continue PALO ALTO treatment; member started having pay complications. • STO direction completed very late after PERS-821 intervention, and a different MTF had to coordinate the non-clinical transfer. • Member was gained at an MTF inpatient UIC. • Impact of not directing the STO. • Member’s military wife separated for the basis of HM3 injury…but could not ship HHG to desired location. • Member was receiving incorrect BAH entitlements. Living in Palo Alto is very expensive. • Accounting code for hospitalization was not captured for historical purposes. • Member was not getting additional entitlements since he was not accounted correctly. • Parent command was an operational command…without a replacement. • Spouse could elect to travel to HM3 and store HHG anywhere in CONUS. • Above actions could have been resolved by simply directing TEMDU. PERS-821 901-874-3230 / 3229

  26. INPATIENT to OUTPATIENT(Extended Outpatient) • Actual case #2 • Member was an inpatient at a Navy MTF, further sent to VA MEDICAL in TAMPA FL for treatment. • Clinical transfer discussed, and non-clinical directed as well (the STO). Member was onboard the LABOON. However, the PSD Afloat was not informed. • Member was in extended outpatient treatment to continue TAMPA treatment; member started having pay complications. • STO direction completed on time, but the command didn’t forward the message to the servicing PSD Afloat. • Member was gained after PERS-821 provided TDRL authority. Impact of not following STO direction. • Member is single and continued to pay comrats on a ship. • Member not receiving BAH (since he is occupying gov’t housing…the ship) + being single. • Could not move personal property or store it. • Member was paying out of pocket expenses. • Accounting code for hospitalization was not captured for historical purposes. • Parent command was an operational command…without a replacement. –Their fault. • Above actions could have been resolved if LABOON simply did what the MTF directed. On top of that…member would have received BAH because he was not occupying gov’t quarters. PERS-821 901-874-3230 / 3229

  27. INPATIENT to OUTPATIENT(Extended Outpatient) • Actual case #3 • Members were sent to BAMC from GUAM. • Clinical transfer discussed, and non-clinical not directed (the STO). • Navy MTF finally directed STO after many conversations. • BAMC at the time was receiving Navy liaison support. • FRANK CABLE wouldn’t complete the STOs. FRANK CABLE was spending 30K + a month for per diem. Command felt member’s OHA was the problem. • FRANK CABLE thought if member’s were transferred that family could not continue OHA. Not true. • Members injured were a combination of hospitalization, extended outpatient treatment, and LIMDU. • Members were finally gained at BAMC. BAH waivers for dependent location submitted and approved, TSGLI packages submitted, etc. • Impact of not following STO direction. • Family not receiving bedside orders had to pay out of pocket expenses. • Family had no option to move HHG or even have funding to move. • Accounting code for hospitalization was not captured for historical purposes. • Parent command was an operational command…without a replacement. –Their fault. • Above actions could have been resolved if FRANK CABLE simply did what the MTF directed. PERS-821 901-874-3230 / 3229

  28. INPATIENT to OUTPATIENT(Extended Outpatient) • Actual case #4 • This is a Grey area…not LIMDU capable, and also not hospitalized. • Member was at a Navy MTF area on 2 LIMDU periods. • PERS-821 received 3rd LIMDU request for treatment plan not entirely matching member’s actual treatment plan (later discovered). • YH availability submitted to move member to KY/TN area near family for LIMDU and treatment at KY clinic. • Clinical transfer discussed, and non-clinical transfer approved via LIMDU PCS orders to CNRC. • CNRC refused to accept member since member was not reporting to command for LIMDU. • Further review determined that the MTF directed a combination of inpatient/outpatient. • Member would not be able to work in a work space per the MTF. • A YH availability report to move member on LIMDU PCS orders should have never been submitted. • Member should have been non-clinically coordinated to NH Pensacola to be gained in its inpatient UIC for tracking by its medical case manager or kept in the current MTF’s patient UIC and tracked. • This member would be perfect for ACC 374 since member is not an inpatient and not able for LIMDU. • Current MANMED directs the MTF to do an MEB to properly restrict a member once becoming an outpatient. ACC-374 will alleviate this action since ACC-374 is a medical restriction by default. PERS-821 901-874-3230 / 3229

  29. Enlisted in-transit between stations ENLISTED: • Get PCS orders from member/family any possible way (fax, etc.). Member may be hospitalized hundreds of miles from your MTF. • MILPERSMAN 1306-1600 directs that closest Navy MTF to gain member in transit. • Direct your servicing PSD to gain member in your inpatient UIC in appropriate 37x code. • Reason for gain: • Member doesn’t use leave • Provide status of member to losing/gaining/detailer via message using all PLADs listed on the PCS orders • Physician determines if member can continue on orders or NAVPERS should cancel orders based on medical restriction. • If orders must be cancelled due to medical restriction or unsuitability ensure member liquidates used portion of the PCS. • Have member or guardian discuss with qualified person on how to stop HHG movement, etc. if orders are cancelled. • Physician initiates MEB for LIMDU/PEB and orders cancelled. Send member to TPU/Others once outpatient. • LODI if needed: Always go to losing command or local installation. • Does your MTF have a relationship with those level 4 and 5 hospitals in your area of responsibility? • Do they know how to contact you? PERS-821 901-874-3230 / 3229

  30. Officer in-transit between stations OFFICERS: • Get PCS orders from member/family any possible way (fax, etc.). Member may be hospitalized hundreds of miles from your MTF. • MILPERSMAN 1301-010 directs that the closest Navy MTF to gain member in transit. • Direct PSD to gain member in your inpatient UIC in appropriate 37x code. • Reason for gain: • Member doesn’t use leave • Officer orders are not cancelled…just modified. • Provide Report Control Symbol BUPERS 1301-13 report (format in MILPERSMAN) to losing/gaining/detailer via message using all PLADs listed on the PCS orders. • Email or FAX above message to PERS-821 officer LIMDU coordinator and PERS-451 for faster service and coordination. PERS-821 POC is robin.ferdinand@navy.mil and PERS451@navy.mil. • Physician determines if member can continue on orders or NAVPERS should modify orders based on medical restriction. • Have member or guardian discuss with qualified persons on HHG movement change, etc. if orders are modified. • Physician initiates MEB for LIMDU/PEB or allows convalescent leave before continuing on orders, etc. • If orders are to be modified since member is outpatient, TAD (unfunded) officer appropriately in local area to await for new orders. Member uses current orders combined with gaining endorsement to your inpatient UIC as the I-stop. • LODI if needed: Always go to losing command or local installation. • Does your MTF have a relationship with those level 4 and 5 hospitals in your area of responsibility? Do they know how to contact you? PERS-821 901-874-3230 / 3229

  31. MEB action for LIMDU • Physician determines diagnosis • Physician further determines restriction by indicating limitations and treatment plan. • Who initiates an MEB? • Any certified DoD physician. • Who can approve an MEB? • The Navy MTF Convening Authority • Who initiates the MEB if a specialty physician/clinic is not available at the current MTF? • The current MTF if at all possible. • Directs the treatment plan via referrals. • Allows YH availability report submission to move member rather than allowing the other MTF to direct TEMDU in its TPU/Others activity. • Doing your own MEBs, directing your own TEMDU, and allowing your own PSDs to submit availability reports is needed for the member, the family, and allows less manpower, money, and confusion. PERS-821 901-874-3230 / 3229

  32. MEB action for LIMDU • If your MTF’s physician provides a referral to another MTF for review…why allow the other MTF initiate the MEB…who will also direct the TEMDU. • Recommend that the receiving MTF provide clinical report back to the referring physician. • Recommend the referring physician initiate the MEB and not the referred physician. • This will allow your MTF to hold the ace cards and not the other MTF staff. • If you allow the other MTF to do the MEB, then don’t gripe and fuss that they are directing your patients to a different geo located TPU/Other activity from member’s current PDS. That MTF is doing nothing wrong by instruction. • It is best to request action in the member in mind. I.e., where is your PDS. In severe medical cases, where is your spouse? • Your MTF should do the MEB and direct appropriately…don’t allow others to do your cleaning. Member will suffer, the PSD will get upset, the command will be in the middle figuring why it is happening, immediate family is impacted on daily living, and so forth… PERS-821 901-874-3230 / 3229

  33. WHO CAN INITIATE AN MEB • Per MANMED 18-6(2), MEBs will be composed of physicians who are properly credentialed and actively engaged in clinical practice on the staff of a DoD MTF. • There are a minimum of 2 members required on an MEB. • A junior member and a senior member. • A CA may name a 3rd member to an MEB. • A 3rd member is mandatory. Specifically, if MEB is convened for adjudicating mental incapacitation, and must be a psychiatrist as defined by MANMED article 18-6(8). • The CA cannot be both be a member of the MEB and the final reviewer…which is the CA signatory responsibility. • The CA must be a Navy MTF CA for a Navy member, but the MEB members may be any Service. • If an MEB is convened for a member needing specialty care not provided at the current MTF, then per MANMED 18-6(7), the MEBR must expressly indicate that key clinical information in the MEBR is predicated on specialty consultation by providers other than those comprising the MEB. • Note: just because your MTF doesn’t have a specialty clinic for the injured or ill member doesn’t mean the MTF cannot approve an MEB for referral of treatment…get member moved through personnel systems on the approved MEBR, and physician refers member appropriately for treatment. PERS-821 901-874-3230 / 3229

  34. LODD/I • Line of Duty Determination/Investigations (LODD/I) • See Article 18-16 for more info on LODD/I. • LODD/I maybe required if a member is placed on Light Duty if light duty was related to an injury. • Do not decline PEB processing if the LODD/LODI indicates a member’s condition was incurred outside the line of duty and/or due to the member’s misconduct. The final decision is the PEB. • JAGINST 5800.7C (JAGMAN), Chapter II, outlines policies and procedures for making LOD/M determinations. • If a member incurs a disease/injury that may result in a disability or results in the member’s physical inability to perform duty > 24 hours, as determined by medical, then LOD/M determination is required. • At a minimum, per JAGMAN 0220d, a PDS must convene an investigation and make findings concerning misconduct and LOD if: PERS-821 901-874-3230 / 3229

  35. More on LODD/I • At a minimum, per JAGMAN 0220d, a PDS must convene an investigation and make findings concerning misconduct and LOD if: • The injury was incurred that suggest a finding of misconduct (i.e., injury related to DUI incident), or • An injury was incurred that suggest “not in LOD,” or • Reasonable chance of disability decision, or • CO considers an investigation to make official record of the circumstance. • Except for medical defects and physical disabilities noted and recorded at the time of entrance, any injury or disease discovered after a service member enters active duty, with the exception of congenital and hereditary conditions, is presumed to have been incurred in the line of duty. PERS-821 901-874-3230 / 3229

  36. More on LODD/I • Process cases that fail to contain a required LOD/M as follows: • If the date of injury was > 2 years prior to date of MEB. • Consistent with JAGMAN, the MEB will presume a finding of “in the LOD and not due to the member’s own misconduct.” • If the date of injury was < 2 years prior to date of MEB. • Provide statement from GCMCA indicating that an LOD/M determination was not required per JAGMAN article 0221 or was not able to be obtained (i.e., diligent efforts, witness unavailability). • Always request LOD/M if you have to think about asking for one. This will allow you time to complete the MEBR per timeline allowed. • LOD/M is one of the most time-consuming steps. • LOD/M is required though to determine if member is eligible for disability compensation while on active duty. PERS-821 901-874-3230 / 3229

  37. Early Return • A member injured/ill from an overseas duty location IS NOT an “early return” request by the parent command (in regards to treatment), if: • The member was screened suitable and member was injured/ill after reporting to the command. • The member needs treatment at a CONUS MTF because local MTF is not capable of treating the member for a new or aggravated condition. • The command doesn’t want the member at the TYPE 3 or 6 command on LIMDU. • Member is inpatient to inpatient transfer, and TYPE 3 or 6 command requests movement. • ALL of the above must be an MTF input via MEB action or TEMDU request. PERS-821 901-874-3230 / 3229

More Related