b. Guidelines. The following guidelines are used by MTF commanders for
issuing non-availability statements for non-emergency inpatient care, non-emergency
outpatient adjunctive dental care, or maternity care to all eligible TRICARE
beneficiaries. In overlapping catchment areas, it is the responsibility of the MTF first
contacted by the patient to inquire as to the availability of required care at all uniformed
services MTF in the area of overlap.
(1) If required inpatient care is available at a uniformed service MTF or is
available at another uniformed services MTF located in a designated area of
overlap, a non-availability statement will not be issued unless the MTF commander
determines that non-issuance would be medically inappropriate. "Medically
inappropriate" means that requiring the patient to use the uniformed services MTF
would result in significant risk to the health of the patient. Each request is considered
on a case-by-case basis. The hospital commander must approve issuance of all such
non-availability statements.
(2) If the required care, either facilities or professional staff, is NOT available
at a uniformed services MTF or at another uniformed services MTF located in an area of
overlap, then a non-availability statement CAN be issued. Again, it is the responsibility
of the first MTF contacted by the patient to inquire about the availability of required care
at all uniformed services MTF comprising the area of overlap.
(3) If the patient requests delivery by natural childbirth, but the technique is
not offered at a uniformed services MTF nor at another in the area of overlap, then a
non-availability statement CAN be issued.
(4) If the patient requests maternity care, but the sponsor's discharge date is
prior to expected date of delivery, then a non-availability statement CAN be issued,
provided all other criteria for issuance are met. (NOTE: TRICARE benefits cease as of
midnight on the date the sponsor is discharged from active duty.)
(5) If the patient requires adjunctive dental care which is not available at a
uniformed services MTF in an area of overlap, then a non-availability statement CAN be
issued. (NOTE: Care must be medically indicated. This is determined through
consultation between the physician and dentist (military and civilian) and must be
authorized by the hospital commander.
(6) If the patient refuses, for personal reasons, to accept the care available at
a uniformed services MTF or at another in an area of overlap, then a non-availability
statement CANNOT be issued. However, the patient does have appeal rights. This is
not covered in this subcourse.
(7) The be neficiary must determine whether or not he resides in a
geographic area requiring a non-availability statement. Unless there is an emergency,
the beneficiary should obtain a non-availability statement before securing medical care
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