The National Quality Monitoring Contractor

1
The National Quality Monitoring Contractor

• MAXIMUS is a subcontractor for TRICARE
  Management Activity (TMA). TMA has designated
  MAXIMUS as the National Quality Monitoring
  Contractor and the designee responsible for
  determining whether Partial Hospitalizations
  Programs (PHP), Residential Treatment Centers
  (RTC), and Substance Use Disorder Rehabilitation
  Facility (SUDRF) meet TRICARE requirements to be
  an authorized provider in accordance with the
  provisions of Standards and Regulations.

2
Mental Health /Substance AbuseFacilities TMA
Certifies

• Partial Hospitalizations Programs (PHP)
• children and adult psychiatric treatment
  program
• 3 hours of direct service 5 days per week is a
  half day program
• 6 hours of direct service 5 days per week is a
  full day program
• Residential Treatment Centers (RTC)
• 21 years old and under psychiatric
  treatment
• Substance Use Disorder Rehabilitation Facilities
  (SUDRF)
• Substance Use treatment for adults and
  adolescents
• Detoxification
• Inpatient Rehabilitation
• Partial Hospitalization Programs-15 hours of
  direct service/week

3
A PHP or RTC needs to be JCAHO accredited to be
a TRICARE provider.

• Partial Hospital Programs (PHP) and Residential
  Treatment Centers (RTC) must be accredited by
• The Joint Commission on Accreditation of
  Healthcare Organizations (JCAHO)
• Under the current edition of the Comprehensive
  Accreditation Manual for Behavioral Health Care.

4
A SUDRF Has Options to Being JCAHO Accredited

• Substance Use Disorder Rehabilitation Facilities
  (SUDRF) must be
• Currently accredited by the Joint Commission on
  Accreditation of Healthcare Organizations under
  the Comprehensive Accreditation Manual for
  Behavioral Health Care or,
• The Commission on Accreditation of Rehabilitation
  Facilities (CARF) http//www.carf.org/
• as an alcoholism and other drug dependency
  rehabilitation program
• under the Standards Manual for Organizations
  Serving People with Disabilities or,
• If a SUDRF is Medicare or TRICARE certified as a
  hospital your local managed care contractor is
  responsible for certification and contracting,
  NOT the NQMC. If the SUDRF bills under the
  hospital tax ID number and is paid through claims
  that way, then the SUDRF does not go through the
  NQMC to become certified.

5
OTHER CERTIFICATION INFORMATION

• An on site survey is not required along with the
  application review process.
• There is no cost to the facility for the
  certification process.
• The Provider Agreement may be up to five years
  from date of execution.
• However, recertification review occurs at least
  once every three years to evaluate whether the
  facility remains in compliance with TRICARE
  requirements.
• An annual, one-page, self-assessment form
  certifying compliance, or stating what is
  non-compliant, is required.

6
TRICARE Regions

7
Contact Information for MAXIMUS/ NQMC Mental
Health Facility Certification

• Beth FriedmanManager of Mental Health Facility
  ReviewEmail bethfriedman_at_maximus.com
• Phone [phone]Facsimile 602-308-7166
• 1600 E. Northern Avenue, Suite 100 Phoenix, AZ
  85020
• http//maximus.com/nqmc/pages/mentalhealthinfo.asp