Reserve Medical Readiness Management Lisa Evers, RN, BSN, CWO4, USCGR PSC (rpm), July 2009 (CG-1311 until 30JUN09)
Topics being Addressed Readiness Overview PHA’s Injury and Illness (NOE’s) & Incap Pay Medical AD orders (ADHC vs Med Hold) PDES TRICARE- TRS and TDP Mobilization Summary & Resources
“Medically Ready” To be fully medically ready, also known as “green”, an individual must meet all six of the criteria. Medical data entered in MRRS… Periodic Health Assessment (annual)- PHA fully implemented CG-wide MAR09. (See ALCOAST 118/09). Were still green until then if PE approved on old Quinquennial/ Triennial schedule. Dental- Class 1 or 2 (DENCAS) Immunizations current for assignment Medical Equipment- 2 pr glasses & if expeditionary, 1 pr mask inserts Medical Readiness Labs- DNA, G6PD, Sickle cell, baseline PPD, HIV q2yrs No deployment limiting conditions per Chapter 3 of Med Manual. Medical Readiness does not mean deployability- Deployability also includes other factors determined by the Commanding Officer such as core competenciesin job skills, but all medically ready individuals are deployable from a medical standpoint and that is the goal with Medical Readiness.
Readiness Implications • New Guidance in ALCOAST draft: • PRIOR TO ISSUING AD ORDERS FOR 31 DAYS OR MORE, SPOS SHALL VERIFY MEMBER'S INDIVIDUAL MEDICAL READINESS (IMR) BY CHECKING CURRENT PHYSICAL AND DENTAL READINESS. SOON, CGBI 2.0 WILL CAPTURE THIS (IMR) SUMMARY IN A NEW MEASURE WHICH WILL BE FOUND AT HTTP://CGBI.OSC.USCG.MIL. TO ACCESS, EXPAND "ALL CUBES AND REPORTS", SCROLL DOWN TO SELECT THE "DEPLOYABILITY BY EMPLID" REPORT. FOLLOW THE DIRECTIONS LISTED. REGARDLESS OF THE MEASURE REFERENCED (PE/ DENTAL OR IMR) MEMBERS MUST BE GREEN TO BE ISSUED AD ORDERS FOR 31 DAYS OR MORE. • Recall: Ready or Partially Ready= GREEN; Indeterminate or Not Ready =RED.
Verifying “Deployability” • MRRS- (medical data entry source- feeds others) • IMR- Individual Medical Readiness • Fully Ready • Partially Ready • Indeterminate- (Class 4 dental &/ or Required PE expired) • Not Ready-Soon will prevent orders in DA (along w/ Indet) • Pregnant • Class 3 dental (NEEDS tx within 12 months) • TNPQ, TNDQ, LOD- Basically Ill/ injured- not fit to deploy • DA- Direct Access- PE date on Mbr Information • CGBI 2.0- Indeterminate and Not Ready- RED
Percentage of Reservists Not Ready: 2.2% Indeterminate: 25.1% TOTAL: 27.3% (Compare: AD overall IMR Red: 21.3%)
Percentage of Reservists Not Ready: 1.4% Indeterminate: 36.3% TOTAL: 37.7% (Compare: AD overall IMR Red: 35.2%)
Dental- Annual exam- Class 2 at least; Class 3 disqualifies member- MUST be corrected! Class I- No treatment, except prophy… Class 2- Minor treatment- fillings, routine non-surgical periodontal care… Class 3- Major treatment needed; if not done in 12 months could cause a dental emergency. Class 4- No exam on record… get ‘er done! Dental Issues
Schedule Dental Exam at CG Clinic/ local MTF (no charge); exam and DENCAS entries done on site. Use private dentist (have DD-2813 completed and faxed to local CG Clinic or MLC (k)/ HSWL for data entry, if remote) Civilian Dental Insurance TRICARE dental- New rates 2/1/09- www.ucci.com SELRES- $12.12/ mo sponsor; $30.29 1 family mbr; IRR - $30.29/ mo sponsor; $75.73/ mo > 1 family mbr Schedule Dental Exam through RHRP provider (ALCOAST 421/09) Reimbursement of exams no longer authorized by HSWL. REMEMBER! ONLY the exam is covered by the CG! If no dental insurance and unable to utilize the above choices, cleanings and treatment are the responsibility of the member. Once completed for the year, verify in CG Central until GREEN. Dental Options
Recent Medical ALCOASTs • 421/09- 7/22/09: SELRES Dental Screening: • Exams for mbrs w/o ins, thru RHRP Dental • 1-888-697-4299 • Starts now for Names: A-F; G-Z start 01SEP09 • However, reimbursement no longer authorized • 414/09- 7/20/09: 2009-2010 Flu Program • Starts 01AUG09 when serum available • Mandatory for all AD and SELRES • To be completed by 01DEC09
SHOTS… it could be worse.. • Flu- Each year in autumn; based on availability…
Immunizations Tetanus- Every 10 years; Tdap next dose x1 Hepatitis A- 2 shots (6 months apart) Hepatitis B- 3 shots (initial, 1 month later, then 4-6 months after 1st dose) Polio- Once MMR- Measles, Mumps, Rubella- Once Flu- Captured here and Separately, too! Anthrax- 5 shots (initial, 1 mo, 6 mo, 12 mo,18 mo); annual booster thereafter; new chg 051947Z Jan 09, ALCOAST; IM vs SQ
Medical Tests • Medical Readiness Labs- (each one 16.7%) • DNA- once in career, • G6PD- once in career, • Sickle cell- once in career, • PPD- Baseline and upon separation, • HIV- Every 2yrs (still only at CG Clinics) • Blood Type- once in career. • These items, which affect IMR (“partially ready” if missing), will be updated during PHA.
Verify Data Entry • MEMBER is responsible to verify that the PE, dental, shots, tests, etc are inputted in databases and captured in CGBI. • EASILY done by via http://cgbi.osc.uscg.mil 1-2 weeks after any readiness field is updated. • Choose “Personal”- top right screen (vs “unit”). • “My Readiness” pops up showing: PE, PHA, Dental, Influenza, Weigh In, Immunizations, Med Tests, Req’d Clearance, Evals, ASQ, & Self Validation- (11 items). • To verify date performed, click “show details”.
Pha’S (Periodic Health Assessments)
Periodic Health Assessment (PHA) • What it IS- A PREVENTIVE HEALTH SCREENING AND MEDICAL READINESS REVIEW. • It’s a multi-component process that will ensure CG members are ready for deployment, ensure IMR data is electronically recorded, and deliver evidence-based clinical preventive services. • It will ALSO address prevention of disease and injury by focusing on prevention strategies each member can incorporate into his/her lifestyle. .. Providing guidance to create a more healthy lifestyle. • Being done ANNUALLY vs every 3-5 yrs as before. • What it is NOT- A FULL, COMPREHENSIVE PHYSICAL EXAMINATION. Though “different” and less invasive than our old exams, the PHA is based on sound research & is focused on prevention…
PHA’s- Short Answers • Who? Every Military member, AD & Reserve • What? Annual Physical Screening • Where? RHRP Contract facilities • When? During your birth month (or 2 months earlier, if unavailable)… easy to remember! • Why? Congressionally mandated • National Defense Authorization Act (NDAA) Fiscal Year 2005 • How? Starts with online screening and a simple phone call (1-888-MYPHA99/ 1-888-697-4299)
PHA details… • Pearls from ALCOAST 118/09 • Complete the Fleet HRA: http://126.96.36.199/pls/newhra/hra • Answer the questions and print out for PHA appt. • 21 categories; risks will be printed on report. • Call RHRP #1-888-MYPHA99 (new #): schedule exam • Appt desk open: M-F: 0700-2200 CST & Sat: 0700-1500 CST • Notify Supervisor of date and enter RMP in Direct Access. • Bring printed HRA and kit to appt, along with glasses & any pertinent civilian medical info. • Expectations: Routine tests will be done based on age/ sex AND any other items found on HRA will be discussed.
SELRES guidance • PHA- CG wide implementation 01 March 09- • ALCOAST 118/09, dtd 25FEB09. • -PHA Process Clarification for SELRES • ALCOAST 217/09, dtd 15APR09 • SELRES members (DRILLING and NOT on orders 31 days or more) utilize RHRP ( RESERVE HEALTH READINESS PROGRAM) contract facilities, only. • ALCOAST 418/09, dtd 21JUL09- • allows waivers to have PHA done at CG clinics • Route through COC to HSWL SUPACT- LT Timothy J. Kulzer.
SELRES guidance (cont’d) • SELRES members (on AD orders >30 days) assigned to CG clinics shall utilize clinic for PHA • However, if NOT assigned to CG clinic, utilize RHRP contract (just like their AD counterparts). • Complete the Fleet HRA online: • http://188.8.131.52/pls/newhra/hra • To log in, place an “R” before own OPFAC, answer the Fleet HRA questions, print a copy for appt. • Prepare to make an appointment- Suggest 2 months before birth month.
What to know BEFORE calling for appt • Home unit OPFAC (not DEPTID) • Health Record Custodian (HRC) Contact information: • OPFAC • Name, Address and Phone Number • Best dates available for appointment…facility will be found within 50 miles of home address. • “PHA Checklist “ found on www.uscg.mil/reserve • Click: Member Resources (left side)… “Medical Resources”
What to Expect:ALCOAST 055/09 • AT A MINIMUM, A MEMBER SHOULD EXPECT THE FOLLOWING: • A. REVIEW OF THEIR FLEET HEALTH RISK ASSESSMENT (HRA) AND DISCUSSION OF THE MEMBER'S GENERAL HEALTH STATUS AND HEALTH RISK BEHAVIORS (E.G. SMOKING, LACK OF EXERCISE, ETC.). • B. BLOOD PRESSURE CHECK. • C. VISION SCREENING. • D. REVIEW OF ANY HEALTH CONCERNS. • E. ADDITIONAL SERVICES MAY INCLUDE UPDATING A MEMBER'S MEDICAL READINESS (E.G. HIV TEST, IMMUNIZATIONS, ETC.) AND ADDRESSING AGE AND GENDER SPECIFIC CLINICAL PREVENTIVE SERVICES REQUIREMENTS (E.G. CHOLESTEROL TEST, PAP SMEAR, ETC.). • NOTE: If required as part of the screening process- CG pays… IF further testing is needed to prove fitness, MEMBER is responsible.
Want to Learn MORE? • MEMBERS CAN FIND OUT ABOUT AGE AND GENDER SPECIFIC CLINICAL PREVENTIVE SERVICES REQUIREMENTS AT THE COAST GUARD OPERATIONAL MEDICINE WEBSITE AT : • http://www.uscg.mil/hq/cg1/cg112/cg1121/default.asp • CLICK ON "PERIODIC HEALTH ASSESSMENT (PHA)" THEN CLICK "CIM 6150 3C" ON THE RIGHT SIDE OF THE WEBSITE AND REVIEW ENCLOSURE (3) AND RHRP FLOWCHART ENCLOSURE (4). • MEMBERS WHO HAVE COMPLETED THE PHA PROCESS CAN COMPLETE AN ANONYMOUS PHA SATISFACTION SURVEY VIA: • HTTP://APPS.MLCA.USCG.MIL/DYNAMICSURVEY/_ViewSurvey.cfm?SID=6223 • Don’t be afraid to ask questions along the way; yet PLEASE do your research, read the regs. & be patient as this is a NEW program for the CG, and especially for the CGR (with the RHRP contract).
What if more tests are needed? • SELRES members will be referred back to their civilian Primary Care Manager (PCM). • Follow-up documentation and results will be returned to member’s Health Record Custodian (HRC) NOT the RHRP facility, • within 30-60 days of PHA. • Remember: It is the member’s responsibility to maintain readiness 24/7; therefore proof & maintenance of fitness, is up to the member.
PHA for RELAD?... NO! • Release from AD exam (“retention” standards)… • “RELAD” (no longer choice on DD-2808: PE form) often confuses the AD since they usually hold those RELAD AD mbrs to SEPARATION standards • For any member (AD or reserve) leaving AD to affiliate with the SELRES or IRR (“ready reserve”) they must meet RETENTION standards (basically, old Quin requirements); obtain approved exam 1st! • If disqualifying condition is noted (regardless of the type of PE)- MO convenes MEB (PDES is only process to determine fitness for continue service)
Readiness Measures • PHA: • Green- “Current” (done by end 2009 birth month). • Yellow- Due in next 3 months. • Red- OVERDUE(missed birth month 2009 after full implementation 3/09). • PHYSICAL: (current measures, CGBI 2.0) • Aviators: < 48 y/o: Every 2 years; age 50+: Annually • Still Required to be maintained; PHA - in between yrs. • Age 20-50: Good for 5 years; Over 50 y/o: Good for 3 years. • Accession: Good for 2 years
Questions? • My Contact Information- • CWO4 Lisa M. Evers, PSC (rpm), (202) 493-1789. • PHA/ Medical Policy specifics- • CDR Erica G. Schwartz, CG-1121, (202) 475-5172. • Reserve Medical Policy- • LTjg Patrick O’Donnell, CG-1311, (202) 475-5432.
Scenario… • Active duty LTjg, involuntarily leaving AD, wishes to affiliate with the SELRES, The RELAD exam notes a disqualifying condition. AD command knows that member is eligible for TAMP for 6 months and allows member to be released since the medical issue will be taken care of during TAMP period. • Can this member affiliate with the SELRES at this time? _______________________________________________________________ • Why or why not? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What happens if reservist is sick / hurt on orders? Member is to Notify supervisor/ command immediately, even if he/she does not consider it to be severe enough to warrant medical attention. Commands must document all injuries (at a minimum, in the H/R on an SF-600). May use Injury Report (CG-3822) or Report of Illness of a Reservist (CG-4614) to collect basic information (LOD statement, too). Commands must insure member receive required treatment while on duty, being certain to obtain a clear DUTY STATUS (AFFD or AFLD) at this time.
Duty Status Clarification • Medical Officers: • AFFD: Available for Full Duty • AFLD: Available for Limited Duty (specific limitations shall be listed) • If disqualifying condition is noted or mbr AFLD for 6 months: MEB needed for further determination • PDES Board Determinations: • FFD: Fit for Duty • NFFD: Not fit for Duty
OUCH! • In an effort to stay healthy, 40 year old BM2 is playing volleyball on Saturday, while performing 2 weeks ADT, and comes down hard on left knee. He toughs it out over the weekend, the pain continues and he finally sees medical on Tuesday, 3 days before his orders are finished. What MUST be done prior to his departure? • __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.
INJURY/ ILLNESS IDT (or AT <31 days) IF AFLD … Notify ISC (fot)/ soon District (dxr) to authorize Notice of Eligibility (NOE) as needed, or retain on ADHC with member’s consent. (Reserve Policy Manual (RPM)- Chap 6, Section B) What about reporting Civilian Health Care? If seen at a local ER while under IDT orders or performing AD for 30 days or less, MLC (kma) must be notified within 3 working days- Be sure to copy the servicing ISC (fot) [soon District (dxr)] and PSC-rpm, also. This is critical for proper authorization & PAYMENT of bills that are generated!
INJURY/ ILLNESS IDT (or AT <31 days) Refer to RPM- Section 6.B.2 for specifics of the notification: Name, rank/ rate, EMPLID Duty Status (IDT/ ADT; traveling to/from and copy of orders)… Time/ place of occurrence Name & location of provider with ICD-9 and CPT codes Estimated period of impairment; fitness for duty after treatment; NOE request sent or needed? Line of Duty Statement and unit POC/ phone number.
Line of Duty Investigation Required if injury to CG member is likely to result in disability benefits, or likely to result in lost time in excess of 24 hrs (Chap 2.B.4.c, COMDTINST 5830.1). Done after emergency treatment/ stabilization has been achieved, especially if there has been a delay in reporting of the illness/ injury until after the initial occurrence (NLT 21 days after incapacitation) Refer to Administrative Investigations Manual, COMDTINST 5830.1 (series) for specifics. Basically, the CO of injured member’s unit is responsible for “getting the ball rolling”- (Chap 7.G); for ease of reporting, may use Injury Report (CG-3822) or Report of Illness of a Reservist (CG-4614) to collect basic information. Both include “incurred in the line of duty and not as the result of misconduct”
INJURY/ ILLNESS(ADOS- 31 days or more) • Treated like a REGULAR, since covered by TRICARE Prime; no special notification needed. • If referred to MTF or civilian provider, be sure to return to CG Medical Officer (Primary Care Manager- PCM) for clear duty status update after each visit. • If Surgery recommended, be certain to discuss w/ CG MO (PCM) prior to scheduling appt- Typically only IF DQ condition or AFLD & not improving. • EVERYONE- Must schedule RELAD exam (RETENTION) 60 days before expiration of orders.
What happens if SELRES member is sick or hurt while NOT on orders? Member should still notify command IF duty status is restricted- (Limited Duty or hospitalized), and should bring documentation to next scheduled drill for inclusion into Medical Record & review by CG Medical Officer. Member is NOT authorized to perform ADT/ ADOT, or be recalled until AFFD; however member may perform IDT drills, if rate permits (RPM 6.B.3.a). IF IDT drills are deferred, members will be permitted to make up any missed/ excused drills once found AFFD. Since NOT incurred on duty, no NOE- (yet TNPQ in MRRS) All reservists not found AFFD within 6 months shall be referred to a Medical Evaluation Board (Med Manual, 3.F.1.c); yet disability benefits are tied to Line of Duty/ orders.
Stuff Happens… • A reserve CDR, not on orders, vacationing with her family, suffers an acute MI (heart attack) which leaves her hospitalized for several days. 1. Does this need to be reported and to whom? ____________________________________________________________2. What is the unit’s responsibility? ________________________________________________________________________________________________________________________This particular CDR has 17 “good” years toward retirement and does not want to go before a medical board and loose her retirement? • 3. Does she have anything to be concerned about from the CGR perspective?_________________________________________________________________________________________________________________________________________________________________________
Incap Pay $$$ • Incap Pay may be requested by members who are issued NOE’s (injured on orders) & who demonstrate a loss of civilian income- RPM Chapter 6.B.4. • Counseling is being added to the documentation with NOE receipt, per Chapter 6 of RPM • Command forwards package thru Chain of Command (currently ISC/ fot’s) to PPC(ses) for payment, with accounting data coming from CG-1312 after amount calculated by PPC(ses).
Basic Incap Pay Package • Statement from Member declaring any lost income (see Figure 6-4 in RPM), • Copy of the NOE (assumed LOD done) • Medical officer’s certification (see Figure 6-5 in RPM), and • Letter from his or her civilian employer containing the following information: • RPM, Chapter 6.B.4.c • Note: Verbiage in Sample Letters above being updated
Incap Package (cont’d) • If submitting a claim for lost civilian income as a result of a AFLD status, the 4th document required, letter from his or her civilian employer contains the following: • The employer’s mailing address, • Supervisor’s name and phone number, • Reason that income or other compensation that has been reduced due to the injury or illness, and • Documentation of the amount of income or other compensation that has been reduced due to the injury or illness.
Medical AD orders (ADHC vs Med Hold)