BY ORDER OF THE SECRETARY OF THE AIR FORCE AIR FORCE MANUAL 41-120 6 ...

122 Pages·2016·1.26 MB·English

AIR FORCE MANUAL 41-120
BY ORDER OF THE
SECRETARY OF THE AIR FORCE
28 AUGUST 2019
Health Services
MEDICAL RESOURCE
MANAGEMENT OPERATIONS
COMPLIANCE WITH THIS PUBLICATION IS MANDATORY
ACCESSIBILITY: Publications and forms are available on the e-Publishing website at
www.e-Publishing.af.mil for downloading or ordering.
RELEASABILITY: There are no releasability restrictions on this publication.
OPR: AF/SG1/8Y Certified by: AF/SG1/8
(Brigadier General Susan J. Pietrykowski)
Supersedes: AFMAN 41-120, 6 November 2014 Pages: 122
This publication implements Air Force Policy Directive (AFPD) 41-1, Health Care Programs and
Resources, 3 October 2018. It provides general guidance and procedures for Air Force planning,
programming, budgeting, and execution of the Defense Health Program (DHP) appropriation. This
Air Force Manual (AFMAN) applies to uniformed members and civilian employees of the Regular
Air Force and Air Force Reserve at all levels who manage, approve, expend, or distribute Defense
Health Program appropriations. It only applies to the Air National Guard (ANG) when operating
in a Title 10 status. This AFMAN may be supplemented at any level, but all supplements must be
routed to AF/SG1/8Y for coordination prior to certification and approval. Refer recommended
changes and questions about this publication to the Office of Primary Responsibility (OPR) using
the AF Form 847, Recommendation for Change of Publication; route AF Forms 847 from the field
through the appropriate functional chain of command. The authorities to waive wing/unit level
requirements in this publication are identified with a Tier (“T-0, T-1, T-2, T-3”) number following
the compliance statement. See Air Force Instruction (AFI) 33-360, Publications and Forms
Management, 1 December 2015, for a description of the authorities associated with the Tier
numbers. Submit requests for waivers through the chain of command to the appropriate Tier waiver
approval authority, or alternately, to the requestor’s commander for non-tiered compliance items.
This manual requires the collection and/or maintenance of information protected by Title 5 United
States Code Section 552a(b), Privacy Act of 1974, authorized by Title 10 U.S.C. 8013, Secretary
of the Air Force. The applicable SORN F044 AF SG F, Uniform Business Office Records (August
29, 2003, 68 FR 51998) is available at http://dpclo.defense.gov/Privacy/SORNs.aspx.
2 AFMAN41-120 28 AUGUST 2019
Ensure all records created as a result of processes prescribed in this publication are maintained in
accordance with AFMAN 33-363, Management of Records, and disposed of in accordance with
the Air Force Records Disposition Schedule located in the Air Force Records Information
Management System.
SUMMARY OF CHANGES
This document has been revised and must be reviewed in its entirety. Major changes include
updates to the Medical Accountants Receivable Programs and to Financial Improvement and Audit
Readiness.
Chapter 1— PROGRAM OVERVIEW 9
1.1. Overview. ............................................................................................................... 9
1.2. DoD Medical Mission. ........................................................................................... 9
1.3. Defense Health Program History. .......................................................................... 9
1.4. Military Service Re-organizations. ........................................................................ 9
1.5. Funding Distinctions. ............................................................................................. 9
1.6. Defense Health Program (DHP) Appropriation Legislation. ................................. 10
1.7. Beneficiaries of the Defense Health Program Appropriation. ............................... 10
1.8. TRICARE Contracts. ............................................................................................. 10
1.9. Other Defense Health Program Purposes. .............................................................. 10
1.10. Defense Health Program Budget Authority. .......................................................... 10
1.11. Other Defense Health Program authorities: ........................................................... 11
1.12. Medicare Eligible Retiree Health Care Fund (MERHCF). .................................... 11
Chapter 2— ROLES AND RESPONSIBILITIES 13
2.1. Air Force Surgeon General (AF/SG). .................................................................... 13
2.2. AF/SG Medical Planning and Programming Directorate (AF/SG1/8S). ............... 13
2.3. AFMS Chief Financial Officer (CFO) (AF/SG1/8Y). ........................................... 13
2.4. Air Force Medical Operations Agency, Financial Management Division
(AFMOA/SGAR). .................................................................................................... 14
2.5. MTF Commander (CC). ......................................................................................... 14
2.6. Resource Management Office (RMO) Responsibilities. ........................................ 15
Chapter 3— FUNDAMENTALS OF FEDERAL FINANCIAL MANAGEMENT 17
AFMAN41-120 28 AUGUST 2019 3
3.1. Overview. ............................................................................................................... 17
3.2. Responsibility of Air Force Members and Employees. ........................................ 17
Table 3.1. Appropriation Lifecycles. ....................................................................................... 17
Table 3.2. Appropriation Classification Status. ....................................................................... 17
3.3. Defense Health Program Funds Transferred Among Air Force, Army, and Navy
Medical Services. .................................................................................................... 18
3.4. Direct Care Workload Shifts to the Private Sector. ............................................... 18
Chapter 4— FINANCIAL DATA ELEMENTS AND CODES 19
4.1. Overview. ............................................................................................................... 19
4.2. Relevant Financial Definitions. ............................................................................. 19
4.3. Fiscal Code Architecture......................................................................................... 19
4.4. AF Accounting Systems. ....................................................................................... 19
4.5. Fiscal Code Support. .............................................................................................. 19
Table 4.1. DHP BAGs and PEs. .............................................................................................. 20
Table 4.2. GAFS LOA. ............................................................................................................ 21
Table 4.3. DEAMS and SFIS Line of Accounting. ................................................................. 22
Table 4.4. AFMS Commonly Used Element of Expense Investment Codes (EEIC). ............. 23
4.6. Stages of Accounting. ............................................................................................. 28
Table 4.5. Disbursement Codes. .............................................................................................. 28
Table 4.6. Reimbursement BIDs. ............................................................................................. 29
Table 4.7. Post Codes............................................................................................................... 29
Chapter 5— MEDICAL PLANNING AND PROGRAMMING 31
5.1. Overview. ............................................................................................................... 31
5.2. The AFMS Program Objectives Memorandum (POM). ........................................ 31
5.3. The Medical Planning and Programming Guidance (MPPG). .............................. 31
5.4. General Roles and Responsibilities within the AFMS POM Construct. ................ 31
5.5. Program Objectives Memorandum (POM) Build Process. ..................................... 33
5.6. Financial Plans (Fin Plan). ...................................................................................... 33
Chapter 6— MEDICAL CIVILIAN EMPLOYEES AND PAY 34
4 AFMAN41-120 28 AUGUST 2019
6.1. Overview. ............................................................................................................... 34
6.2. Manpower Responsibilities. .................................................................................... 34
6.3. Civilian Pay Responsibilities. ................................................................................ 34
6.4. Civilian Pay Monitoring Tools. ............................................................................. 35
6.5. Civilian Personnel Leave Policy. ........................................................................... 35
6.6. Civilian Vacancies. ................................................................................................ 36
6.7. Civilian Overhires. ................................................................................................. 36
6.8. New Hires. ............................................................................................................. 36
6.9. Non- Defense Health Program (DHP) Civilians. ................................................... 36
6.10. Incentives & Bonuses. ........................................................................................... 36
Chapter 7— FUNDING FOR MEDICAL READINESS PROGRAMS 37
7.1. Overview. ............................................................................................................... 37
7.2. Identifying Contingency-related Costs. ................................................................ 37
7.3. Approval to Use Defense Health Program Funds for Medical Readiness Training
and Exercises. ......................................................................................................... 37
7.4. Funding for LAF or Combatant Command (CCMD) Directed Exercises. ............ 37
7.5. Special Categories. ................................................................................................. 37
7.6. Medical Readiness Defense Health Program (DHP) Unfunded Requirements
(UFRs). ................................................................................................................... 40
Table 7.1. International Health Specialist (IHS)/Defense Institute for Medical Operations
(DIMO) Frequently Asked Questions. ..................................................................... 41
Chapter 8— MEDICAL RELATED TRAVEL 45
8.1. Patients. .................................................................................................................. 45
Table 8.1. Patient Travel Responsibility Center and Cost Centers (RC/CC). .......................... 45
8.2. Medical Referrals within the Local Permanent Duty Station (PDS) Area. ............ 46
8.3. Medical Referral Travel at the Member’s Expense. .............................................. 47
8.4. Medical Referral Travel outside the Permanent Duty Station. .............................. 47
8.5. Medical Referral Travel for Government Employees Overseas and Their Family
Members. ................................................................................................................ 47
8.6. Travel to Specialty Care Over 100 Miles. ............................................................. 47
AFMAN41-120 28 AUGUST 2019 5
8.7. Non-Medical Attendant (NMA) Travel. ................................................................ 47
8.8. NMAs for Medical Referrals within the Local Permanent Duty Station Area. ..... 47
8.9. NMAs for Medical Referrals outside the Local Permanent Duty Station Area. .... 47
8.10. Non-Concurrent NMA Travel. ............................................................................... 48
8.11. Civilian Family Member of a Seriously Ill or Injured Uniformed Service
Member. .................................................................................................................. 48
8.12. Retirees with a Combat-related Disability who are not Enrolled in TRICARE
Prime. ...................................................................................................................... 48
8.13. Convalescent Leave Transportation for Illness or Injury. ...................................... 49
8.14. Emergency Family Member Travel (EFMT) Program. ......................................... 50
Figure 8.1. Request for Initial EFMT Format. .......................................................................... 52
Chapter 9— CONTINUING MEDICAL EDUCATION, FORMAL TRAINING,
PROFESSIONAL CERTIFICATIONS AND LICENSURES 53
9.1. General. .................................................................................................................. 53
9.2. Continuing Medical Education (CME) Programs. ................................................. 53
9.3. Element of Expense Investment Code (EEIC) to Charge. EEIC558XX –
Education & Training Costs. .................................................................................. 55
Table 9.1. Education & Training EEICs. ................................................................................. 55
9.4. Civilian Employees. ............................................................................................... 56
9.5. Air Reserve Component (ARC). ............................................................................ 57
9.6. Active Duty Military Personnel. ............................................................................ 57
9.7. Accounting for Student Travel - RCCC. ................................................................ 57
9.8. Reimbursement for Professional Board and National Certification Examinations.
................................................................................................................................. 57
9.9. Reimbursement Prior to Course Completion. ........................................................ 57
9.10. Professional Licenses (Military and Civilian). ...................................................... 57
Chapter 10— MEDICAL FACILITIES AND MEDICAL EQUIPMENT 59
10.1. Overview. ............................................................................................................... 59
10.2. Sustainment, Restoration & Modernization (SRM). .............................................. 59
10.3. Accounting for SRM Expenditures. ....................................................................... 59
6 AFMAN41-120 28 AUGUST 2019
10.4. Medical Equipment. ............................................................................................... 59
10.5. Defense Medical Logistics Standard Support (DMLSS) System. ......................... 60
10.6. Deobligations. ....................................................................................................... 61
10.7. Delivery of Materials beyond the Fiscal Year. ..................................................... 61
Chapter 11— Defense Health Program (DHP) CONTRACTS 62
11.1. Overview. ............................................................................................................... 62
11.2. Military Treatment Facility (MTF) Responsibilities. ............................................ 62
11.3. Contract Funding. ................................................................................................... 62
11.4. Acquisition of Services. ........................................................................................ 63
11.5. Deobligating Contract Funding. ............................................................................. 63
11.6. Authorization for Personal Services Contracts. ..................................................... 63
11.7. Economy Act Orders. ............................................................................................ 64
11.8. Non-Economy Act Orders. .................................................................................... 64
11.9. Support Agreements. .............................................................................................. 64
11.10. Recording Obligations Pertaining to Contracts. .................................................... 64
11.11. Timely Invoicing and Vendor Payments. .............................................................. 64
11.12. Supporting Documents Required to Process Payments. ........................................ 65
11.13. Intragovernmental Payments. ................................................................................ 65
11.14. Proactive Contract Modifications. .......................................................................... 65
11.15. Unauthorized Contractual Commitments. .............................................................. 65
Chapter 12— BUDGETING AND FUNDING GUIDANCE FOR VARIOUS PROGRAMS 66
12.1. Information Management/Information Technology. ............................................. 66
12.2. Professional Membership Fees (Military and Civilian). ........................................ 66
12.3. Funding for Community Action Information Board and Integrated Delivery
System (CAIB/IDS) Activities. .............................................................................. 66
12.4. Funding for Hypobaric and Hyperbaric Chambers. ................................................ 66
12.5. Use of Defense Health Program (DHP) Supplemental Health Care Program
Funds for Foreign Cadets Attending the Air Force Academy. ............................... 67
12.6. Funding for Clothing Destroyed During Medical Care. ........................................ 67
AFMAN41-120 28 AUGUST 2019 7
12.7. Leased Housing for Military Graduate Medical Education (GME) Residents. ..... 67
12.8. Publication of GME Research Articles in Professional Journals. .......................... 67
12.9. Health Promotion Incentive Items. ........................................................................ 67
12.10. Non-prescription items. ......................................................................................... 67
12.11. Transportation of Human Remains to the Defense Health Program (DHP). ......... 67
12.12. Serving Materials for Military Treatment Facilities (plates, utensils, cups, etc.). . 67
12.13. Funding for Reserve Officer Training Corps (ROTC) Injuries/Illness Incurred in
Line of Duty (LOD). ............................................................................................... 68
12.14. Checks Received from Pharmaceutical Companies. .............................................. 68
12.15. AFMS Procurement (OP) Process. ......................................................................... 68
12.16. Air Force Medical Research, Development and Evaluation (RDT&E)
Requirements Process. ............................................................................................ 69
12.17. Payment for Occupational Medical Exams of Civilian Employees. ...................... 69
12.18. Retired Pay, Physical or Mental Incapacitation while Inpatient. ........................... 70
Figure 12.1. Memorandum, Request for Commander’s Authorization of Payment for Civilian
Medical Exam. ......................................................................................................... 71
Figure 12.2. Memorandum, Commander's Authorization of Payment for Civilian Medical
Exam ........................................................................................................................ 72
Figure 12.3. Instructions to the Unit Resource Advisor .............................................................. 73
12.19. Government Purchase Card (GPC) Program. ........................................................ 73
Chapter 13— COMMODITIES NOT FUNDED WITH THE DEFENSE HEALTH
PROGRAM (DHP) APPROPRIATION 74
13.1. Commodities Not Funded with the AF DHP Appropriation Allocation. ............... 74
Chapter 14— MEDICAL COLLECTIONS AND ACCOUNTS RECEIVABLE
PROGRAMS 77
14.1. Medical Reimbursements Overview. ..................................................................... 77
Table 14.1. Percentage Surcharge Calculations. ........................................................................ 77
14.2. Third Party Collections (TPC) Program. ............................................................... 80
14.3. Medical Affirmative Claims (MAC) Program. ...................................................... 81
14.4. Over-the-Counter Network (OTCnet) Deposit Requirement. ................................ 82
14.5. Mandatory Actions when Depositing Collections. (T-1). ....................................... 83
8 AFMAN41-120 28 AUGUST 2019
14.6. Deposits Stemming from FedDebt Debts and Claims Management Office
(DCMO) Out-of-Service Debt Collections. ............................................................ 85
14.7. Overseas Pay Patients. ........................................................................................... 85
14.8. Sales Codes. ........................................................................................................... 86
Table 14.2. Monthly Audit of Deposits & Refunds ................................................................... 86
Table 14.3. Chart of Authorized Sales Codes for MTFs. .......................................................... 87
Chapter 15— DEFENSE HEALTH PROGRAM (DHP) TRIANNUAL/OPEN
DOCUMENT REVIEW 92
15.1. Triannual Reviews (TAR) of Commitments, Obligations, Accounts Payable and
Accounts Receivable. .............................................................................................. 92
15.2. TAR/Open Document (OD) Periods Covered. ...................................................... 92
Table 15.1. Funds Holder TAR Confirmation Statement. ......................................................... 93
Table 15.2. Budget Submitting Officer (MAJCOM) TAR Confirmation Statement................. 96
15.3. FMSuite Acceptable and Unacceptable TAR Remarks on Line Items. .................. 98
15.4. Deobligations. ........................................................................................................ 99
15.5. Dormant Obligations Resulting from DMLSS Transactions. ................................ 99
Chapter 16— DATA QUALITY MANAGEMENT CONTROL PROGRAM (DQMCP)
AND MEDICAL EXPENSE AND PERFORMANCE REPORTING
SYSTEM (MEPRS) 100
16.1. Data Quality (DQ). ................................................................................................ 100
16.2. Medical Expense and Performance Reporting System (MEPRS). ........................ 103
16.3. Executive Management and Functional Manager Information. ............................. 103
16.4. AFMS Medical Coding Program. ......................................................................... 104
Chapter 17— FINANCIAL IMPROVEMENT AND AUDIT READINESS 106
17.1. Financial Improvement and Audit Readiness (FIAR). .......................................... 106
17.2. Financial Improvement and Audit Readiness Framework. .................................... 106
17.3. Audit Documentation to Support AFMS Financial Statements. ............................ 106
17.4. MICP Overview. .................................................................................................... 106
17.5. Assessable Units. ................................................................................................... 107
Attachment 1— GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION 109
AFMAN41-120 28 AUGUST 2019 9
Chapter 1
PROGRAM OVERVIEW
1.1. Overview. This manual establishes general guidance and procedures for Air Force planning,
programming, budgeting, and execution of the Defense Health Program (DHP) appropriation.
Resource management includes the process of determining requirements, obtaining resources, and
effectively and efficiently applying those resources to meet the Air Force's direct mission and
support responsibilities. Resource management also includes evaluation of internal controls,
procedures, and protection of government assets.
1.2. DoD Medical Mission. The medical mission of the Department of Defense (DoD) is to
enhance DoD and our Nation’s security by providing health support for the full range of military
operations and sustaining the health of the DoD health care beneficiary population.
1.3. Defense Health Program History. Prior to fiscal year (FY) 1993, each of the Military
Departments funded their respective healthcare operations from within their own appropriations.
Across the nation, and within DoD, healthcare costs were escalating rapidly. In an effort to control
increasing healthcare costs of the DoD and to lend greater visibility into healthcare expenditures,
Congress directed the establishment of a unified DoD medical appropriation.
1.3.1. On December 14, 1991, the Deputy Secretary of Defense signed Program Budget
Decision (PBD) 742 to consolidate all medical resources under the control of the Assistant
Secretary of Defense for Health Affairs, (ASD(HA)), and to make other required adjustments
to the medical program. The three military departments were directed to (1) parse out what
they historically spent on medical care and resources, and (2) transfer those amounts from their
respective Operations and Maintenance (O&M), Research, Development, Test, and Evaluation
(RDT&E), and Procurement appropriations into the new DHP appropriation.
1.3.2. The only exceptions to the merger were Military Personnel Appropriations (MPA)
resources in support of combat operations, field and numbered medical units, hospital ships,
and ship-board medical operations; and Military Construction (MILCON) funding for medical
facilities. MILCON continues to be reflected in the Service MILCON account, but is
administered by ASD (HA). Combat medical support continues to be funded via Line funds or
funds appropriated for that purpose (i.e., Other Contingency Operations (OCO) appropriation).
1.4. Military Service Re-organizations. Each Service was given some leeway in determining
how much to transfer to the DHP and how it would restructure itself organizationally to manage
their respective DHP allocations. The Army and Navy established Medical Commands
(MEDCOM and BUMED, respectively). However, the newly established DHP appropriation did
not drive structural organizational changes for the AF. AF Military Treatment Facilities (MTFs)
continued to be a unit on the base, not unlike other units (OSG, MSG, etc.); but funded with the
DHP appropriation.
1.5. Funding Distinctions. In establishing MEDCOM and BUMED, the Army and Navy parsed
out and transferred substantial amounts of funding to the Defense Health Program for Base
10 AFMAN41-120 28 AUGUST 2019
Support. The transfer of Base Support enabled MEDCOM and BUMED to be self-supporting (not
unlike other Major Commands). The transfer of Army and Navy Base Support to the DHP included
resources for Base Support functions, such as Contracting and Legal Services. Alternatively, the
Air Force did not transfer Base Support to the DHP at all. The Air Force maintained that Base
Support would continue to be provided to its MTFs on a non-reimbursable basis as it had been
prior to the establishment of the DHP. The Air Force decided it would only transfer to the DHP
the funds needed to operate the MTFs proper (e.g., within the walls of the MTF).
1.5.1. The AFMS receives funds to pay for commodities consumed within the walls of Air
Force MTFs, such as medical supplies, office supplies, medical equipment, basic utilities (gas,
water, electricity, and long-distance telephone), and minor construction or repair the MTF, etc.
The Line of the Air Force (LAF) renders non-reimbursable common base support functions to
the AFMS (e.g., Security, Fire, MPF, legal support, Vehicles, etc.). This has not changed since
the inception of the DHP. In short, the Air Force transferred funds, not functions.
1.5.2. The AFMS executes the Defense Health Program through direct allotment to
performing installations and activities for all DHP costs, except those retained by LAF when
the DHP appropriation was initially established in FY93. AF military medical personnel costs
are paid centrally from the AF Military Personnel Appropriation, not the DHP.
1.6. Defense Health Program (DHP) Appropriation Legislation. The DHP appropriation
account was established via Title 10 United States Code Section 1100 (10 USC §1100) for the
purpose of carrying out the functions of the Secretary of Defense with respect to medical and health
care programs of the DoD. The Secretary of Defense may obligate or expend funds from the
account for purposes of conducting programs and activities under 10 USC Chapter 55, Medical
and Dental Care, including contracts entered into under section 10 USC sections 1071 to 1110b,
to the extent amounts are available in the account.
1.7. Beneficiaries of the Defense Health Program Appropriation. The purpose of 10 USC
Chapter 55, Medical and Dental Care, is established in 10 USC sections 1071 to 1110b, which
states:
“The purpose of this chapter is to create and maintain high morale in the uniformed services by
providing an improved and uniform program of medical and dental care for members and certain
former members of those services, and for their dependents.”
1.8. TRICARE Contracts. TRICARE contracts for medical care for spouses and children are
authorized under 10 USC §1079; contracts for health benefits for certain members, former
members, and their dependents are authorized under 10 USC §1086; contracts for medical care for
retirees, dependents, and survivors (alternative delivery of health care) are authorized under 10
USC §1097. Studies and demonstration projects relating to delivery of health and medical care are
authorized under 10 USC §1092. TRICARE contracts are executed and administered by ASD
(HA).
1.9. Other Defense Health Program Purposes. The DHP appropriation is available to fund
medical command headquarters (except for HQ AF authorizations), specialized medical training
of medical personnel, and occupational and public health services.
1.10. Defense Health Program Budget Authority. Appropriations represent legal authority
granted by Congress to incur obligations and to make disbursements (payments and outlays) for
the purposes, during the time periods, and up to the amounts specified in the appropriation act.