Patient Administration - Army Publishing Directorate - U.S. Army
Patient Administration - Army Publishing Directorate - U.S. Army Patient Administration - Army Publishing Directorate - U.S. Army
Bed day a. Bassinet day. A day in which a live birth at the reporting facility occupied a bassinet in the newborn nursery at the census taking hour (normally midnight). The stay must be continuous since birth. The stay is also not dependent on the status of the mother. This excludes days spent by infants in a bassinet on a pediatric nursing unit, pediatric or neonatal intensive care unit, or other nursing unit. b. Bed day. (1) A day in which a patient occupied an operating bed at the census taking hour (normally midnight). The following are also counted as bed days: (a) A patient admitted and discharged on the same day. This excludes ambulatory surgery procedures performed in a clinic. (b) Same day transfer out if a patient is transferred to a nonmilitary treatment facility. (2) When the patient occupies a bed day in more than one inpatient care area in 1 day, the bed day shall be counted only in the inpatient care area where the patient is located at the census-taking hour. (3) This definition excludes days during which the inpatient is subsisting out, on convalescent leave, on authorized or unauthorized leave, or in a transient status. AD military patients not requiring inpatient care, and assigned for administrative or other non-medical reasons, shall not be counted as a bed day. Beneficiary Defined for purposes of 10 USC 1095, the Third Party Collection Program, any person determined to be eligible for benefits and authorized treatment in an MTF, covered by 10 USC 1074(b), 1076(a) or 1076(b). These are retirees, Family members of retirees, and Family members of AD; for purposes of automobile insurance, authority extends to AD members of the Uniformed Services. Carded for record only Special cases not admitted to an inpatient status but require the preparation of a DA Form 3647 or a DD Form 1380 (US Field Medical Card) and the assignment of a register number. CHAMPUS maximum allowable charge The maximum payment reimbursable by CHAMPUS for a specific medical/clinical treatment or procedure. Civilian agency Physicians, hospitals, clinics, special nurses, dentists, pharmacists, veterinarians, practitioners in allied sciences, blood donors, ambulance companies, and makers of prosthetic devices. Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) The “insurance plan” instituted by Congress for cost sharing with eligible beneficiaries in obtaining covered health care benefits from the civilian community when those health care needs cannot be met by a uniformed MTF. Continental United States The 48 contiguous States and the District of Columbia. Convalescent leave In this regulation, an authorized leave status considered a sick day when the convalescent leave occurs before the disposition of the patient. It is granted to AD members while under medical or dental care and prescribed for their recuperation or convalescence. Convalescent leave under this regulation is not the same as convalescent leave occurring after disposition of the patient or while the patient is en route to a new command. It is also not the same as convalescent leave granted by a line commander after patient discharge from the hospital. Custodial care Care rendered to mentally or physically disabled patients who require a protected, monitored, or controlled environment as opposed to active and specific medical, surgical, or psychiatric treatment. Deductible An annual amount that a patient must pay out-of-pocket for care before CHAMPUS begins to share costs. Direct admission Admission to the reporting MTF for the current, uninterrupted period of hospitalization. 128 AR 40–400 27 January 2010
Disability separation Temporary or permanent retirement and discharge for physical disability, with or without entitlement to receive severance pay. Disposition The discharge of a patient from a MEDCEN or hospital, that is, a discharge to duty or home, transfer to another MTF, death, or other termination of inpatient care. Domiciliary care Inpatient institutional care provided the beneficiary not because it is medically necessary, but because the care in the home setting is not available, is unsuitable, or members of the patient’s Family are unwilling to provide the care. Institutionalization because of abandonment constitutes domiciliary care. Note. Domiciliary care and custodial care represent separate concepts and are not interchangeable. Elective care Nonemergency care that, in the opinion of the cognizant medical authority, is not medically required but is requested or p r e f e r r e d b y t h e p a t i e n t . E x a m p l e s a r e : f a c e l i f t , v a s e c t o m y , a u g m e n t a t i o n m a m m o p l a s t y , a b d o m i n o p l a s t y , a n d liposuction. Emergency care a. Medical treatment of patients with severe life-threatening or potentially disabling conditions resulting from accident or illness of sudden onset. These conditions necessitate immediate care to prevent undue suffering or loss of life. b. Dental treatment for relief of painful or acute conditions. Existed prior to service A term added to a medical diagnosis to signify there is clear and unmistakable evidence that the disease or injury or the underlying condition producing the disease or injury existed prior to the individual’s entry into military Service. Family members a. Family members of members of the Uniformed Services. Family members include persons who are related ((1) through (5) below) to an AD Soldier who is serving under a call or order that does not specify a duty period of 30 days or less. Persons are also Family members if the Soldier died while serving on such AD, is retired, or died while in a retired status. This includes Family members of retired members of RC if the member died while under 60 years of age and chose to take part in the Survivor Benefit Plan. In such a case, the Family member’s entitlement becomes effective on the date the deceased retiree would have been 60 years of age. Categories of Family members and their specific entitlements are as follows: (1) Spouse, even if not actually dependent on the AD or retired member. (2) The unremarried former spouse of an active or retired member whose marriage to the member was dissolved on or after 1 February 1983 who— (a) On the date of marriage dissolution had been married to the member for at least 20 years during which time the member performed at least 20 years of service that is creditable in determining eligibility for retired or retainer pay. (b) Does not have medical coverage under an employer-sponsored health plan. (3) Unremarried widow or widower even if not actually dependent on the AD or retired member at the time of the member’s death. (4) A legitimate child, an illegitimate child who has been legitimized or whose paternity has been judicially determined, an adopted child who is adopted before age 21, or stepchild, who is unmarried and is— (a) Under 21 years of age even if not dependent on the AD or retired member. (b) Twenty-one years of age or older but incapable of self-support due to a mental or physical disorder that existed prior to his or her 21st birthday (23rd birthday if in student status) and is, or was at the time of death of the AD or retired member, dependent on the member for over one-half of his or her support. (Sponsor must submit a request for dependency determination to DFAS. A medical sufficiency statement must accompany request. See AR 600-8-14 for sample medical sufficiency statement.) (c) Twenty-one or twenty-two years of age and pursuing a full-time course of education. The course must be approved by the Secretary of Defense or the Secretary of Education, as applicable, or by a State agency under 38 USC 1775. Further, the person must be, or must have been at the time of death of the AD or retired member, dependent for over one-half of his or her support. A child in this category, who during the school year or between semesters suffers a disabling illness or injury that interrupts attendance at the institution, remains eligible for care until 6 months after the disability is removed or until his or her 23rd birthday, whichever occurs earlier. Note. A child includes an unmarried child of a male member who was illegitimate at the time of birth and who is, or was at the time AR 40–400 27 January 2010 129
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Bed day<br />
a. Bassinet day. A day in which a live birth at the reporting facility occupied a bassinet in the newborn nursery at<br />
the census taking hour (normally midnight). The stay must be continuous since birth. The stay is also not dependent on<br />
the status of the mother. This excludes days spent by infants in a bassinet on a pediatric nursing unit, pediatric or<br />
neonatal intensive care unit, or other nursing unit.<br />
b. Bed day.<br />
(1) A day in which a patient occupied an operating bed at the census taking hour (normally midnight). The<br />
following are also counted as bed days:<br />
(a) A patient admitted and discharged on the same day. This excludes ambulatory surgery procedures performed in a<br />
clinic.<br />
(b) Same day transfer out if a patient is transferred to a nonmilitary treatment facility.<br />
(2) When the patient occupies a bed day in more than one inpatient care area in 1 day, the bed day shall be counted<br />
only in the inpatient care area where the patient is located at the census-taking hour.<br />
(3) This definition excludes days during which the inpatient is subsisting out, on convalescent leave, on authorized<br />
or unauthorized leave, or in a transient status. AD military patients not requiring inpatient care, and assigned for<br />
administrative or other non-medical reasons, shall not be counted as a bed day.<br />
Beneficiary<br />
Defined for purposes of 10 USC 1095, the Third Party Collection Program, any person determined to be eligible for<br />
benefits and authorized treatment in an MTF, covered by 10 USC 1074(b), 1076(a) or 1076(b). These are retirees,<br />
Family members of retirees, and Family members of AD; for purposes of automobile insurance, authority extends to<br />
AD members of the Uniformed Services.<br />
Carded for record only<br />
Special cases not admitted to an inpatient status but require the preparation of a DA Form 3647 or a DD Form 1380<br />
(US Field Medical Card) and the assignment of a register number.<br />
CHAMPUS maximum allowable charge<br />
The maximum payment reimbursable by CHAMPUS for a specific medical/clinical treatment or procedure.<br />
Civilian agency<br />
Physicians, hospitals, clinics, special nurses, dentists, pharmacists, veterinarians, practitioners in allied sciences, blood<br />
donors, ambulance companies, and makers of prosthetic devices.<br />
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)<br />
The “insurance plan” instituted by Congress for cost sharing with eligible beneficiaries in obtaining covered health care<br />
benefits from the civilian community when those health care needs cannot be met by a uniformed MTF.<br />
Continental United States<br />
The 48 contiguous States and the District of Columbia.<br />
Convalescent leave<br />
In this regulation, an authorized leave status considered a sick day when the convalescent leave occurs before the<br />
disposition of the patient. It is granted to AD members while under medical or dental care and prescribed for their<br />
recuperation or convalescence. Convalescent leave under this regulation is not the same as convalescent leave occurring<br />
after disposition of the patient or while the patient is en route to a new command. It is also not the same as<br />
convalescent leave granted by a line commander after patient discharge from the hospital.<br />
Custodial care<br />
Care rendered to mentally or physically disabled patients who require a protected, monitored, or controlled environment<br />
as opposed to active and specific medical, surgical, or psychiatric treatment.<br />
Deductible<br />
An annual amount that a patient must pay out-of-pocket for care before CHAMPUS begins to share costs.<br />
Direct admission<br />
Admission to the reporting MTF for the current, uninterrupted period of hospitalization.<br />
128 AR 40–400 27 January 2010
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