Student Services Manual (SSM)

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Effective: 8/1/1993

Revised: 7/1/2013

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SSM 1201–04: Student-Athlete Medical Care

Purpose

To provide the best medical care within available resources for members of the intercollegiate athletic teams

Sources

Federal and state laws regarding medical practice, prescription of pharmaceuticals, and patient rights
National Collegiate Athletic Association
Pacific-12 Conference
ASU Health Services
Sun Devil Athletics

Policy


Eligibility for Professional Services

ASU Health Services (ASUHS) provides services to all students on any athletic team sanctioned by Sun Devil Athletics (SDA) as an intercollegiate sport and to post-eligibility student-athletes who require continued treatment for an injury or illness documented at the time of their exit physical. This policy covers SDA sports only.

Each semester, SDA must provide the team physicians and ASUHS with a revised list of those student-athletes who are authorized to receive SDA medical benefits.

Exceptions

Any non-ASU student-athlete participating in National Collegiate Athletic Association (NCAA) competition who sustains an injury or illness while visiting ASU for competition may receive treatment but is responsible for the entire cost of his or her medical care.

Upon completion of a student-athlete’s eligibility or cessation of participation as a student-athlete, SDA will not pay for any medical services for any injury or illness incurred as a result of participating in intercollegiate sports, unless:

  1. the athlete is an enrolled student
  2. the illness or injury was reported at the time of the injury, documented in the medical record of the athlete, and reported at the time of the athlete’s exit physical examination

    and

  3. the illness/injury is treated within one year from the date of the illness or injury.

Student-athletes are required to see the team physician for an exit physical immediately after the completion of their academic eligibility or the cessation of their participation as student-athletes. During the exit physical the team physician will document any and all injuries sustained due to participation as a student-athlete. The team physician will outline a treatment plan for any injuries that require further treatment. SDA will only be financially responsible for the treatment of such injuries. Upon cessation of their participation as student-athletes at ASU, the student-athletes will be responsible for any and all healthcare for medical problems and injuries that did not occur due to their participation as student-athletes and that were not documented at the time of their exit physical examinations.

Practice players are eligible to receive treatment from the team physicians and athletic staff for injuries related to their participation as practice players. They are required to have a physical by the team physicians or their designee prior to their participation. They are required to carry and show proof of health insurance that provides coverage for injuries and medical care. ASU will act as the secondary insurance for all injuries sustained by students resulting from their participation as practice players.


Authorization for Professional Services

The ASUHS provides the services of team physicians funded by SDA to coordinate and manage medical services to student-athletes.

Authorization for all medical services provided to student-athletes must be coordinated through the ASUHS if any part of the services are in any way paid for or provided on behalf of ASU.

Referrals

All medical services provided to student-athletes must be coordinated with the team physician if any part of the services are paid for or provided on behalf of ASU. Consultant referrals will be made primarily to Sports Medicine Advisory Team (SMAT) members, unless the required specialty is not covered. Notification of authorization from the head athletic trainer must precede each referral.

Close communication between the team physicians and all consultants is mandatory. Each party must be kept updated of current conditions in case the head coach requests information from either the team physician or consultant.

Second opinion referrals will be made only after consultation with the head team physician. All documentation from the primary referral will accompany the patient to the provider for a second opinion.

No coach or other SDA employee may refer a student-athlete to a health professional; only the team physician or certified athletic trainer in consultation with the team physician may do so.

Athletic Trainer Referral to Team Physician

  1. Athletic trainers provide student-athlete evaluations in the case of injury or illness occurring during practice or competition on the ASU campus, in-state or out-of-state.
  2. The athletic trainer determines the urgency and necessity of obtaining additional consultation from the team physician(s).
  3. In all cases, an injury or illness report will be completed, dated, and initialed by the athletic trainer.
  4. This report will be given to the team physician for review, counter signature, and filing in the medical record within five working days of the event’s occurrence. Verbal reporting to the team physician is strongly recommended as soon as possible after the event occurrence.

Sports Medicine Advisory Team (SMAT) Membership

SDA or ASUHS staff may nominate licensed certified healthcare professionals for SMAT to the director of ASUHS for team membership selection. Members will be selected and retained on the basis of appropriate licensure, evidence of malpractice coverage, previously demonstrated performance, compliance with NCAA rules, patient need, compliance with SMAT policy guidelines, and experience and training in sports medicine. The director of the ASUHS will submit a list of selected nominees to SDA for comment before final nominee notification of their selection to SMAT.

Policy Statement for SMAT

  1. The consultant will contact the team physician via telephone when possible immediately following the consultation.
  2. The student-athlete must deliver a written consultation report (ASU consult form or written letter) to the team physician after the consultation. The consultant must also mail a follow-up written formal letter regarding the visit to the team physician within seven days following the consultation.
  3. The consultant will see the student-athlete preferentially and within a timely manner.
  4. Consultants will bill the student-athlete’s primary insurance (if the student-athlete has primary insurance) first. The uninsured student-athlete’s billing charges will be sent to ASU SDA for services rendered in accordance with this policy.
  5. The consultant will not refer the student-athlete to other consultants or for diagnostic testing without the approval of the head team physician or designee.
  6. A SMAT consultant covering a specific sport or sport event, as team physician, may self-refer for further treatment. Consultation with the head team physician or head athletic trainer is mandatory within 72 hours if prior approval was not given.

Professional Services

Professional services provided for all student-athletes may include, but are not limited to, medical evaluation and treatment, psychological and psychiatric services and referral, laboratory tests, diagnostic radiology procedures, supplies and materials normally furnished by the ASUHS in the provision of medical care to the general student body, physical therapy referral, consultative services, outpatient surgery, coordination of inpatient care, and rehabilitation services. Professional services must be funded without negatively impacting medical services to the general student population.

No team physician, designee, consultant, or allied health care professional may overrule another professional without first having consulted directly with that professional. However, in any medical situation in which a difference of opinion results among the team physicians, certified specialty consultants, allied health care professionals (i.e., athletic trainer or physical therapist), or other designees of the team physician, the opinion of the head team physician will prevail unless directed otherwise by the director of the ASUHS in consultation with the chief of the medical staff. If further resolution is required, refer to the appeals process.

Except as provided to the contrary in this policy, SDA will not pay for any outside referrals for testing or consultation unless the head athletic trainer and the head team physician are given prior notice of the request for referral and approve payment for the referral.


Authorization for Medical Services

Team Physicians

The ASUHS provides the services of team physicians funded by SDA to coordinate and manage medical services to student-athletes.

The scope of medical coverage provided specifically by the team physician includes:

  1. event coverage of all home men’s and women’s basketball, women’s soccer, gymnastics, wrestling, Sun Angel Track Classic, preseason football camp, all home and away varsity football games, NCAA-sponsored championship events, Pac-12 championships, and additional events at the request of SDA; coverage of events shall be reviewed annually by the ASUHS and SDA
  2. official office hours determined each semester by the athletic administration and the ASUHS director, and the head team physician

    and

  3. being “on call” or having a designee on call for 24 hours a day with a pager or cellular phone.

Diagnostic Studies, Treatment, and Medications

All diagnostic or monitoring studies not done by the ASUHS must be authorized for payment by the head athletic trainer or head team physician. This authorization is not necessary in emergency situations; however, the head athletic trainer or his designee must be notified the next business day by the team physician.

Diagnostic studies not available at the ASUHS may be ordered by referral consultants after consultation with the team physician.

The team physician or designee dispenses all prescriptions at the ASUHS or SDA. All medications at SDA must be obtained through the ASUHS Pharmacy or other licensed pharmacy agreed upon by the director of ASUHS, the head team physician, and the head athletic trainer. If the ASUHS Pharmacy is not open, prescriptions may be obtained at a designated licensed pharmacy.


Medical Clearance for Athletic Participation

All students who are trying out for a sanctioned SDA team must sign a medical release form and receive a physical exam by a licensed physician in the state of Arizona. All student-athletes who are members of a sanctioned SDA team must be medically authorized to participate and have passed an athletic physical examination. Student-athletes must complete and sign health history, insurance information, medical release, drug policy statement, sports medicine liability forms, and other documents as identified by SDA and the ASUHS.

The complete athletic preparticipation medical evaluation consists of, but is not limited to:

  1. health history
  2. vision
  3. musculoskeletal evaluation
  4. medical evaluation
  5. cardiovascular screening
  6. special women’s health care questionnaire and follow-up consultation as appropriate

    and

  7. further testing, at the discretion of the examining physician.

General Participation

Team physicians may delegate evaluations of athletically related injury or illness to allied health care professionals through established protocols, written in consultation with these professionals. These protocols will be easily accessible, easily understood, and rely on professional judgments of those using them. They will be updated at least yearly.

Special Conditions

  1. “Pre-existing conditions”—A condition that has been identified at the preparticipation medical evaluation to exist or have existed by medical history or direct physical examination or testing.
  2. “Athletically related illness or injury”—The head team physician or designee is responsible for the medical determination of an athletically related illness or injury. The head athletic trainer is responsible for payments incurred for an athletically related illness or injury.

Participation Denial

An athlete may not participate in practice or competition until given clearance by team physicians, designees, or allied health care professionals using predetermined protocols approved by the director of the ASUHS.

Appeals
Appeals for decisions made regarding pre-existing conditions, participation denial, or an athletically related illness or injury may be made according to the appeals process.

SDA Authorization for and Payment of Medical Service and Related Expenses for Student-Athletes

The ASUHS and SDA are responsible for enforcing written policies and procedures authorizing SDA payment for medical services. SDA will provide copies of the written payment policies and procedures to the team physician and the ASUHS at least yearly, or when changes are made in policy.

The head team physician and the head athletic trainer are responsible for approval of payment for medical services and related expenses. If payment is denied, the decision and basis for nonpayment must be given in writing. Authorization for payment will be completed in a timely manner. The purpose of prepayment approval is to ensure compliance with applicable NCAA and Pac-12 Conference rules and is not intended to override medical judgment as to the necessity of referral testing or consultation.

The cost of services (e.g., x-rays, laboratory studies, appointments) to be paid by SDA to the ASUHS will be equal to the cost of the services provided for non-athletes. The head athletic trainer must be able to review service charges prior to payment.

Student-athletes may appeal payment decisions following the appeals process.


Patient Confidentiality and Medical Records

The medical record is the property of the ASUHS and the information contained in the medical record is the property of the student-athlete.

The ASUHS is responsible for the maintenance and management of the medical records, and SDA may provide personnel to assist with this responsibility. All records are held for 10 years after competition. Microfilm is an acceptable storage medium.

The team physician, head athletic trainer, or head coach may not release general medical information regarding injury or illness of a student-athlete through SDA’s media relations office unless a Medical Release to the Media form covering the information to be released has been signed by the student-athlete.

The head athletic trainer will treat information used for payment of insurance documentation or verification and proper compliance with SDA policy and NCAA bylaws as privileged and confidential and must not release this information to anyone without written permission from the student-athlete.


Compliance with NCAA Regulations

The team physicians, designees, and allied health care professionals are responsible for knowing and complying with all applicable NCAA rules and regulations.

SDA will provide an NCAA regulations manual to team physicians on a yearly basis.

SDA’s compliance coordinator in consultation with the faculty athletic representative are available to advise team physicians, designees, or allied health care professionals on interpretations and compliance with these rules and regulations. The team physicians, designees, or allied health care professionals are responsible for actively seeking an official interpretation of NCAA rules from the SDA compliance coordinator in consultation with the faculty athletic representative when uncertain of a rule. This uncertainty would include whether to prescribe medication for an athlete in the off season or a major procedure for a questionably athletics-related illness or injury.


Supervision and Quality Assurance

The director of the ASUHS is ultimately responsible for the quality of medical services provided to student-athletes and for supervising the services of team physicians and designees to student-athletes.

The team physicians and designees report to the director of the ASUHS and the chief of the Medical Staff. Team physicians must maintain a close reporting and working relationship with the director of SDA or designated administrative staff.

The director of the ASUHS ensures that a yearly performance evaluation of team physicians is completed and shares this confidential evaluation with the director of SDA. The director of SDA may add additional comments to this evaluation before it is entered into a team physician’s ASUHS personnel file.

A team physician must inform SDA and ASUHS directors or designees of any absence due to illness as well as any vacation requests.

Quality assurance audits are performed periodically on the quality of medical services performed by the team physicians, consultants, and allied health care professionals. These audits may include direct services, medication usage, medical records, and cost benefit studies. All audits involving SDA medical services are shared with the director of SDA or their designee.


Student Rights and Responsibilities

Preference of Service

A student-athlete always has the right to change physicians, to refuse to see a particular physician, and to refuse treatment. The team physician and the certified athletic trainer must be informed of this decision. SDA is under no obligation, however, to pay for services rendered by non-ASUHS approved clinicians unless the service would ordinarily be covered by SDA and the severity of the injury or illness required immediate treatment by a non-ASUHS clinician. However, if the athlete is treated by a non-ASUHS clinician in these circumstances, the team physician or head athletic trainer must be notified before the athlete participates in the next practice or competition.

Appeals Process

An athlete, physician, consultant, or health professional may appeal any of the following to the executive committee of the Sports Medicine Section of SDA for any of the following after all other appeals have been exhausted:

  1. payment denial for medical services
  2. “pre-existing condition” determination
  3. participation denial (temporary or permanent)
  4. “athletically related illness” determination or denial

    and

  5. management of medical condition.

The executive committee of the Sports Medicine Section of SDA is composed of the following:

  1. associate athletic director, operations chair
  2. head team physician
  3. head athletic trainer
  4. compliance coordinator
  5. ex officio (nonvoting):
    1. other team physicians
    2. director of SDA or designee
    3. director of the ASUHS or designee

      and

    4. the Faculty Athletic representative.

This committee may call in others to advise them or add information in order to reach a decision. Decisions may be appealed to the director of the ASUHS and the director of SDA whose joint decision shall be binding.


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