R 261410Z OCT 22
MARADMIN 569/22
MSGID/GENADMIN/CMC WASHINGTON DC MRA RA//
SUBJ/INTERIM GUIDANCE FOR SELECTED MARINE CORPS RESERVE, INDIVIDUAL MOBILIZATION AUGMENTEE, INDIVIDUAL READY RESERVE MARINES, AND OFFICER CANDIDATES AUTHORIZED LINE OF DUTY MEDICAL HEALTH CARE BENEFITS// 
REF/A/MSGID: DOC/DODI/20160419//
REF/B/MSGID: DOC/SECNAV/20180823//
NARR/REFERENCE (A) IS DODI 1241.01, RESERVE COMPONENT (RC) LINE OF DUTY DETERMINATION FOR MEDICAL AND DENTAL TREATMENTS AND INCAPACITATION PAY ENTITLEMENTS. REFERENCE (B) IS SECNAVINST 1770.5, MANAGEMENT AND DISPOSITION OF LINE OF DUTY BENEFITS FOR MEMBERS OF THE NAVY AND MARINE CORPS RESERVE//
POC/PERRY, A/CTR/CARE MANAGEMENT MONITOR/WWR/TEL: 703-432-1868/DSN 278-1868/EMAIL: APRIL.PERRY.CTR@USMC.MIL// 
POC/BROKAW, M./CIV/RMED PROGRAM MANAGER/WWR/TEL: 703-432-1868/DSN 278-1868/EMAIL: MARK.T.BROKAW@USMC.MIL// 
POC/BRADEN, N./LTCOL/RESERVE INTEGRATION OFFICER/WWR/TEL: 703-432-1868/DSN 278-1868/EMAIL: NATHAN.BRADEN@USMC.MIL// 
GENTEXT/REMARKS/1.  Purpose.  To provide interim guidance regarding policies and administrative procedures for Selected Marine Corps Reserve, Individual Mobilization Augmentee, Individual Ready Reserve (SMCR/IMA/IRR) Marines and Officer Candidates who are authorized Line of Duty (LOD) medical health care benefits.  A LOD determination is an authorization of health care benefits provided by law to qualifying members (SMCR/IMA/IRR Marines and Officer Candidates) for any illness, injury or disease incurred or aggravated while the member was in a qualified duty status and requires continued medical care beyond the period of the active duty orders or Inactive Duty Training (IDT) period during which the medical condition was incurred or aggravated.  Qualifying duty includes active duty or IDT, funeral honors duty, while traveling directly to or from such duty or training, or while remaining overnight immediately before the commencement of or between successive periods of such duty (unless such injury, illness, or disease is the result of the gross negligence or misconduct of the SMCR/IMA/IRR Marine or Officer Candidate).
2.  Background.  Per reference (a), SMCR/IMA/IRR Marines and Officer Candidates are entitled to medical treatment for an injury, illness, or disease incurred or aggravated while in a qualified duty status by the direct care program in a Military Treatment Facility (MTF) or by a civilian provider via the Supplemental Health Care Program.  Per reference (b), members who reside outside MTF catchment areas must obtain preauthorization for non-emergency civilian care from the Defense Health Agency-Great Lakes (DHA-GL) prior to receiving medical treatment from a civilian provider.  A catchment area is defined as 50 miles or one hour drive time from the nearest MTF.
3.  Responsibilities.
3.a.  Deputy Commandant for Manpower and Reserve Affairs (DC MRA) has management and oversight authority for all Marine Corps SMCR/IMA/IRR Marines and Officer Candidates in the LOD determination program.
3.b.  Commanding Officer, Wounded Warrior Regiment manages the Reserve Medical Entitlements Determination (RMED) Program on behalf of DC MRA.  RMED is the designated Benefits Issuing Authority and is the sole authority for determining and authorizing LOD medical health care benefits for the Marine Corps.  The official program of record for submitting LOD determination requests to RMED is the Marine Corps Medical Entitlements Data System (MCMEDS).
3.c.  DHA-GL is the sole authority for preauthorizing civilian medical care for DoD members approved for LOD benefits and residing greater than 50 miles or one hour drive time from a MTF.
3.d.  The commanding officer of the respective command and the injured member are responsible for the proper execution of the LOD benefits process.
4.  Process Flow and Continuing Actions.
4.a.  Prior to training, it should be emphasized that any injuries that occur should be immediately reported to the Medical Department Representative (MDR) and the chain of command.  When a SMCR/IMA/IRR Marine or Officer Candidate reports an injury or illness was incurred or aggravated during a qualified duty status, or when in a covered travel status, the command will ensure proper medical documentation of the method and mode of injury is recorded.  This may include an SF600, emergency room/urgent care provider’s encounter note(s), or hospital admission documentation.  An emergency room discharge summary is not adequate documentation.
4.b.  Witness statements may augment medical documentation to further validate date, method, and mode of injury, but are not adequate on their own.  Witness statements should also be provided by unit leadership to whom the member reported the injury or aggravation.  Documentation must clearly indicate the claimed injury or illness was incurred or aggravated while the member was in a qualified duty status.
4.c.  Within 10 days of notification of the injury, the member’s unit must endorse and forward, via MCMEDS, the request for LOD medical health care benefits with all required documentation to RMED for an official determination.
4.d.  Upon RMED issuing a LOD benefits authorization letter via MCMEDS, the member’s unit must verify if the member resides inside or outside of a MTF catchment area.  If the member resides inside a MTF catchment area, provide the RMED-issued LOD benefits authorization letter to the member and direct the member to the MTF to seek medical treatment.  The LOD benefits authorization letter should be presented to the patient administration office at the MTF for further action.  If the member resides outside a MTF catchment area, the member’s unit must request preauthorization for civilian medical care from DHA-GL.  The individual responsible for this action is determined by the component code of the injured or ill member, as follows: 
4.d.1.  For SMCR Marines, it is normally the unit Limited Duty Coordinator or MDR.
4.d.2.  For IMA Marines, it is normally the detachment Operational Sponsor.
4.d.3.  For IRR Marines, it is normally designated personnel assigned to Marine Corps Individual Reserve Support Activity.
4.d.4.  For Officer Candidates, it is normally the Officer Selection Officer or Human Resource Assistant.
4.e.  Requests to DHA-GL for preauthorization for civilian medical care must be submitted by command leadership or unit representative via one of the following methods:
4.e.1.  DOD-Safe, use the email address: DHA NS Great Lakes J-10 Mailbox MMSO Initial LOD MMA <dha.great-lakes.j-10.mbx.mmso-initial-lod-mma@health.mil> in the “To” line and ensure to encrypt the files; or
4.e.2.  Fax at 847-688-7394 or 6369; or
4.e.3.  Mail to Defense Health Agency Great Lakes (DHA-GL), Attn:  Reserve Eligibility, 2834 Green Bay Road Ste 304, Great Lakes, IL 60088.
4.f.  All requests to DHA-GL for preauthorization for medical care must include the following:
4.f.1.  DHA-GL Worksheet-02 “Pre-Authorization Request For Medical Care:  Reserve Component.”
4.f.2.  RMED-issued LOD benefits authorization letter.
4.f.3.  Supporting clinical documentation.
4.g.  Upon approval by DHA-GL Authorizers, DHA approved authorizations are submitted to regional TRICARE contractors for processing.  TRICARE approved medical treatment authorization letters can be accessed by the member once they have registered for a self-service account on the contractor website.  The following are the current TRICARE contractor websites:
4.g.1.  Humana Military (TRICARE East Region), https:(slash)(slash)www.humanamilitary.com.
4.g.2.  Health Net Federal Services(TRICARE West Region), https:(slash)(slash)www.hnfs.com.
4.h.  Following receipt of LOD benefits, ensure the SMCR/IMA/IRR Marine or Officer Candidate complies with LOD benefits procedures, to include the submission of monthly medical status reports to RMED via MCMEDS.  Members are required to provide updates within five days of completing a medical appointment and must provide an update of the next scheduled appointment.  If there are no updates, submit a Memorandum for the Record explaining why no updates were submitted, along with any supporting documentation.  A Memorandum for the Record template is available in the Forms tab in MCMEDS.
4.i.  For approved LOD cases in which the member has been returned to full duty, the command shall ensure a return to duty note signed by the treating physician, physician assistant, or nurse practitioner is uploaded into MCMEDS, and a Return to Duty request is submitted.  This will properly close the case in MCMEDS.
4.j.  If the service member is not returned to full duty within 12 months of their injury, they may be directed by Headquarters Marine Corps (RMED) for a medical fitness for duty evaluation at the nearest Navy MTF (if this process has not already been initiated by the unit LDC).
4.k.  If the service member fails to provide the appropriate medical information/documentation, the unit must counsel the service member in writing via a Noncompliance Letter, which is to be uploaded into MCMEDS.  A Noncompliance Letter template is available in the Forms tab in MCMEDS.  This will serve as legal grounds for closure of the MCMEDS case and termination of LOD benefits if the service member fails to comply with actions identified in the counseling.
5.  Member Action.
5.a.  Report any injury, illness, or disease incurred or aggravated during a period of duty as soon as possible via the chain of command after occurrence and prior to termination of such duty.
5.b.  If you reside within the catchment area of a MTF, all care must be managed through the MTF.
5.c.  If you do not reside in the catchment area of a MTF, ensure coordination with unit leadership to complete and submit all required DHA-GL forms to obtain pre-authorization for civilian medical treatment upon approval of the initial requests for LOD health care benefits and any subsequent extensions of the authorized LOD expiration date.  Failure to obtain DHA-GL preauthorization for health care may result in denial of payment for treatment with the member assuming liability for payment.  Do not seek non-emergent care for your condition prior to verifying a valid TRICARE authorization letter on the appropriate TRICARE contractor website listed in either paragraph 4.g.1 or 4.g.2.
5.d.  Provide Monthly Medical Status Updates; fully comply with MCMEDS case managers/management regarding arrangement and attendance of all medical appointments; and follow all medical provider instructions in order to facilitate a timely recovery and return to full duty.  Inform your unit MCMEDS case managers, in writing, of any appointment cancellations, to include a detailed justification for the cancellation.  Provide your unit MCMEDS case managers copies of all medical documentation within five days of completion of all medical examinations.
6.  Urgent Medical Care.
6.a.  If a member receives urgent or emergent medical care from a civilian emergency room or urgent care while in a qualified duty status, the medical bills from that visit should be paid by TRICARE upon approval from DHA-GL.
6.b.  An appropriate unit representative should accompany the injured member to the civilian emergency room or urgent care clinic with a letter stating that the named service member is eligible for health care and treatment under the Department of Defense Supplemental Health Care Program (SCHP).
6.b.1.  The letter should be printed on unit letterhead; state the injured member’s name, unit, and date; and provide a unit point of contact with accurate contact information.  A copy of this letter must be provided to personnel at the treatment facility.
6.b.2.  The letter should state that all claims for care provided should be sent to the applicable TRICARE Claims processor listed below:
6.b.2.a.  TRICARE East Region Claims, Attn: New Claims, PO Box 7981, Madison, WI 53707-7981.
6.b.2.b.  TRICARE West Claims Submission, Health Net Federal Services, LLC, c/o PGBA, LLC/TRICARE, PO Box 202112, Florence, SC, 29502-2112.
6.b.3.  Regardless of medical treatment facility location, the member’s primary residence determines TRICARE Region for claims processing.
6.b.4.  A letter template is available in the Forms tab in MCMEDS.
6.c.  Requests to DHA-GL to approve urgent civilian medical care payment must be submitted by command leadership or a unit representative via one of the following methods:
6.c.1.  DOD-Safe, use the email address: DHA NS Great Lakes J-10 Mailbox MMSO LOD MISC <dha.great-lakes.j-10.mbx.mmso-lod-misc@health.mil> in the “To” line and ensure to encrypt the files; or 
6.c.2.  Fax at 847-688-6460 or 7394; or 
6.c.3.  Mail to Defense Health Agency Great Lakes (DHA-GL), Attn:  Reserve Eligibility, 2834 Green Bay Road Ste 304, Great Lakes, IL 60088.
6.d.  All requests to DHA-GL to approve TRICARE payment for urgent civilian medical care while in a qualified duty status must include the following:
6.d.1.  DHA-GL Worksheet-01 “Medical Eligibility Verification:  Reserve Component.”
6.d.2.  Documentation to validate qualified duty status.
7.  Additional Information.
7.a.  Additional information, forms, and resources are available at https:(slash)(slash)www.tricare.mil and https(slash)(slash)www.health.mil/greatlakes.
7.b.  LOD benefits are not a resource for funding civilian dental care for pre-existing conditions or routine care.  Units should fully complete the LOD process prior to directing a service member to seek civilian dental care, as a denied LOD or care not authorized for payment will result in the service member being responsible for all costs associated with that episode of care.
7.b.1.  Civilian dental emergency treatment required prior to submission of an LOD benefits request is limited to emergent care for immediate treatment of bleeding, pain, or infection.
7.b.2.  Additional guidance concerning LOD dental care is available at https:(slash)(slash)www.tricare.mil/CoveredServices/Dental/NGRDental/LODDental.
7.c.  Amplifying guidance on policies and administrative procedures for SMCR/IMA/IRR Marines and Officer Candidates who incur or aggravate an injury, illness, or disease while in a qualified duty status will be detailed in a forthcoming Marine Corps Order.  Publication is anticipated within calendar year 2022.  Further in-depth guidance on this process is available via the DHA Process Guide and the MCMEDS Submission Guide, which can be found in the Forms tab in MCMEDS.
8.  This MARADMIN is applicable to the SMCR/IMA/IRR categories of the Reserve Component (RC) and Officer Candidates attending Officer Candidate School.  This MARADMIN is not applicable to RC Marines serving in the Active Reserve Program.
9.  Release authorized by LtGen J. F. Glynn, Deputy Commandant, Manpower and Reserve Affairs.//