Department of Defense

INSTRUCTION

NUMBER 6000.14

September 26, 2011

Incorporating Change 2, Effective April 3, 2020

References: See Enclosure 1

1. PURPOSE. In accordance with the authority in DoD Directive 5124.02 (Reference (a)), this

Instruction:

a. Reissues DoD Instruction (DoDI) 6000.14 (Reference (b)) to establish policy, assign

responsibilities, and provide procedures for implementation of the Consumer Bill of Rights and

Responsibilities (commonly referred to as the “Patient’s Bill of Rights”) (Reference (c)).

b. Incorporates and cancels Office of the Assistant Secretary of Defense for Health Affairs

Activities, and all other organizational entities within the DoD (hereinafter referred to

collectively as the “DoD Components”).

3. DEFINITIONS. See Glossary.

4. POLICY. It is DoD policy that:

a. MHS patients have explicit rights about information disclosure; choice of providers;

Change 2, 04/03/2020

b. This Instruction does NOT expand the scope of benefits or create any entitlement

inconsistent with chapter 55 of title 10, United States Code (U.S.C.) (Reference (e)); part 199 of

title 32, Code of Federal Regulations (CFR) (Reference (f)); or other applicable law or

regulation. Additionally, deviation from the guidelines in this Instruction does not result in a

legal cause of action. Failure of a patient to adhere to the responsibilities listed in Enclosure 2

will not by itself result in a loss of benefits or other adverse action.

(see Enclosure 2) and compliance with this Instruction.

b. Director, Defense Health Agency (DHA). The Director, DHA, under the authority,

direction, and control of the USD(P&R), through the ASD(HA), shall serve as the program

manager for TRICARE health and medical resources, supervising and administering TRICARE

programs and other resources within the DoD.

c. Secretaries of the Military Departments. The Secretaries of the Military Departments

shall oversee Service compliance with this Instruction through the Surgeons General of the

Military Departments and military treatment facility and dental treatment facility (MTF/DTF)

commanders.

8. SUMMARY OF CHANGE 2. The change to this issuance updates references and removes

expiration language in accordance with current Chief Management Officer of the Department of

Defense direction.

Change 2, 04/03/2020

Clifford L. Stanley

9. EFFECTIVE DATE. This Instruction is effective September 26, 2011.

3. Procedures and Compliance Guidelines

Glossary

Change 2, 04/03/2020 4 ENCLOSURE 1

(a) DoD Directive 5124.02, “Under Secretary of Defense for Personnel and Readiness

USD(P&R))”, June 23, 2008

(e) Chapters 47

and 55 of title 10, United States Code

(f) Part 199 of title 32, Code of Federal Regulations

(g) DoD 5400.11-R, “Department of Defense Privacy Program,” May 14, 2007

(h) Public Law 104-191, “Health Insurance Portability and Accountability Act of 1996,”

August 21, 1996

(i) Section 552a of title 5, United States Code

(j) Executive Order 13410, “Promoting Quality and Efficient Health Care in Federal

Government Administered or Sponsored Health Care Programs,” August 22, 2006

(k) Joint Commission Accreditation Manual for Hospitals, current edition

(l) Parts 160 and 164 of title 45, Code of Federal Regulations (also known as the “HIPAA

Privacy, Security and Breach Rules”)

(m) DoD Manual 6025.18, “Implementation of the Health Insurance Portability and

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DOD PATIENT BILL OF RIGHTS AND RESPONSIBILITIES

1. PATIENT RIGHTS

c. Privacy and Security. Patients have rights, defined by Federal law, DOD 5400.11-R

(Reference (g)), Public Law 104-191 (Reference (h)), and section 552a of title 5 U.S.C. (also known

as “The Privacy Act of 1974, as amended”) (Reference (i)), to reasonable safeguards for the

confidentiality, integrity, and availability of their protected health information, and similar rights

for other PII, in electronic, written, and spoken form. These rights include the right to be

informed when breaches of privacy occur, to the extent required by Federal law.

d. Provider Information. Patients have the right to receive information about the

individual(s) responsible for, as well as those providing, his or her care, treatment, and services.

The hospital may inform the patient of the names, and as requested, the professional credentials

of the individual(s) with primary responsibility for, as well as those providing, his or her care,

for autonomous decision making may be affected. When it is not medically advisable to give

such information to the patient due to vulnerabilities or other circumstances, the information

should be provided to a designated representative.

f. Informed Consent. Patients have the right to any and all necessary information in non-

clinical terms to make knowledgeable decisions on consent or refusal for treatments, or

participation in clinical trials or other research investigations as applicable. Such information is

to include any and all complications, risks, benefits, ethical issues, and alternative treatments as

may be available.

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h. Research Projects. Patients have the right to know if the MTF/DTF proposes to engage in

or perform research associated with their care or treatment. The patient has the right to refuse to

participate in any research projects.

i. Safe Environment. Patients have the right to care and treatment in a safe environment.

j. MTF/DTF Rules and Regulations. Patients have the right to be informed of the facility’s

l. Charges for Care. Patients have the right to understand the charges for their care and their

obligation for payment.

m. Advance Directive. Patients have the right to make sure their wishes regarding their

healthcare are known even if they are no longer able to communicate or make decisions for

themselves.

2. PATIENT RESPONSIBILITIES

a. Providing Information. Patients are responsible for providing accurate and complete

information about complaints, past illnesses, hospitalizations, medications, and other matters

of the property of other persons and of the MTF/DTF.

c. Adherence with Medical Care. Patients are responsible for adhering to the medical and

nursing treatment plan, including follow-up care, recommended by healthcare providers. This

includes keeping appointments on time and notifying MTF/DTF when appointments cannot be

kept.

d. Medical Records. Patients are responsible for returning medical records promptly to the

the purpose of medical appointments, consultations, or changes of duty location. All medical

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f. Refusal of Treatment. Patients are responsible for their actions if they refuse treatment or

do not follow the practitioner’s instructions.

g. Healthcare Charges. Patients are responsible for meeting financial obligations incurred

for their healthcare as promptly as possible.

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PROCEDURES AND MHS COMPLIANCE GUIDELINES

1. GENERAL. The DoD Patient Bill of Rights and Responsibilities in Enclosure 2 is intended

to accomplish three major goals:

professionals.

c. To reaffirm the critical role patients play in safeguarding their own health by establishing

both rights and responsibilities for all participants in improving health status.

2. GUIDELINES

a. Information Sharing. Each MTF/DTF shall provide patients with accurate, easily

understood information and assistance in making informed healthcare decisions about their

health plans, providers, and facilities. DoD facilities will promote quality and efficient

healthcare through the use of health information technology; transparency regarding healthcare

sharing arrangements.

(2) Each MTF/DTF shall make every reasonable effort to maintain scheduled

appointments. This includes providers keeping appointments on time and notifying the patient

when appointments cannot be kept.

(3) Each MTF/DTF shall maintain and have available a staff provider directory,

including information regarding each provider’s name, degree, licensure, specialty in which

privileges have been granted, and board certification. The directory shall be updated as required

to ensure a current listing of staff providers and be available to assist beneficiaries in the

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(5) To promote quality and efficient delivery of healthcare, each MTF/DTF shall provide

beneficiaries with information on how to access publicly available facility performance data as

appropriate.

(6) Upon enrollment to the MTF/DTF, patients shall be informed how to access facility

compliance data on the Joint Commission Quality Check® Website

(http://www.jointcommission.org) to include quality goals (ORYX measures), patient safety

provide beneficiaries with information similar to that described in subparagraph 2.a.(6) of this

enclosure in printed literature and facility Internet Websites as appropriate.

(8) All TRICARE regional offices will have full-time dedicated Beneficiary Counseling

and Assistance Coordinators (BCAC), and MTF/DTFs will have either full-time or collateral

duty BCAC positions. The BCACs are subject matter experts available to explain the TRICARE

health plan and options available to assist beneficiaries in their healthcare decisions.

(9) The MTF/DTF Commander shall ensure sustained, effective, two-way

communication exists between the medical facility and its beneficiary population through

meetings, publications, and various other media, as appropriate. Not only is it vital to keep

beneficiaries informed about access to care issues, service interruptions, new programs, and

healthcare.

(1) TRICARE Prime provider networks, coupled with the MTF/DTF capabilities, shall

provide access to sufficient numbers and types of providers to ensure that all covered services

are accessible within the TRICARE Prime access standards.

(2) TRICARE Prime access standards include emergency care 24 hours per day and 7

days per week, urgent care within 24 hours, routine primary care within 7 days, wellness and

health promotion within 28 days, and specialty care within 28 days.