Security Assistance Management Manual E-Change 834 
INTERNATIONAL MILITARY EDUCATION AND TRAINING (IMET) FUNDED STUDENT EMERGENCY MEDICAL COSTS

1. Update Section C9.1.3.1.1.:

   From:

   C10.9.1.3.1.1. The grant program will authorize a cost factor to be assessed per IMS training line for the payment of IMS medical care received from military and civilian healthcare facilities. For example, the IMET factor of $35 per IMS training line is authorized for programming purposes under generic code N7E (Training Military Articles and Services List (T-MASL) B365003, D365003, and P365003)). Grant program funds collected from each IMS training line at the Service level will be used to pay medical costs incurred by that countries IMET funded IMS. A separate country or IMS funded medical insurance policy or country indemnification will be required to pay for medical and dental care of all authorized dependents of IMS attending grant program funded training.

   To:

   C10.9.1.3.1.1. The grant program will authorize a cost factor to be assessed per IMS training line for the payment of IMS medical care received from military and civilian healthcare facilities. For example, the IMET factor of $35 per IMS training line is authorized for programming purposes under generic code N7E (Training Military Articles and Services List (T-MASL) B365003, D365003, and P365003)). Grant program funds collected from each IMS training line at the Service level will be used to pay medical costs incurred by that country's IMET funded IMS (See Section C10.9.1.3.3. for IMET funded student emergency medical costs). A separate country or IMS funded medical insurance policy or country indemnification will be required to pay for medical and dental care of all authorized dependents of IMS attending grant program funded training.

2. Add Section C10.9.1.3.3. and subsections as shown below, and renumber subsequent sections in Chapter 10 as required.

   C10.9.1.3.3. International Military Education and Training-Funded International Military Student Emergency Medical Costs. The IMET program will cover the cost of emergency medical care for the IMS. Emergency medical care is defined as only providing the medically necessary treatment, as determined by the attending medical staff, required to safely return IMS to training or back to their country. The schoolhouse also will ensure the IMS suitability to reintegrate into the course, if the medical staff clears the IMS to return to training. The following rules establish a tiered financial accountability structure and apply if a partner nation does not indemnify emergency medical bills.

   C10.9.1.3.3.1. Bills Less Than $10,000. For unpaid emergency medical bills less than $10,000, the sponsoring Military Department (MILDEP) will pay the cost using the partner nation's current-year IMET allocation. The MILDEP must notify the Department of State's Bureau of Political-Military Affairs, Office of Security Assistance (PM/SA), the servicing Combatant Command (CCMD), DSCA (Defense Security Cooperation University, Chief of Staff Directorate, International Military Training and Education Division (DSCU/COS/IMTE)), and DSCA (Office of Business Operations, Comptroller Directorate, Security Assistance Division (OBO/CMP/SA)) of the payment within one week of payment.

   C10.9.1.3.3.2. Bills $10,000 - $99,999. For unpaid emergency medical bills of $10,000 to $99,999, the sponsoring MILDEP must provide all appropriate documentation and seek formal approval from State (PM/SA) and DSCA (OBO/CMP/SA) prior to payment.

   C10.9.1.3.3.3. Bills $100,000 or Greater. For unpaid emergency medical bills of $100,000 or greater, if the partner nation fails to indemnify after engagement from the Military Group (MILGP), IMET funds will be used to pay the bill. The following stringent penalties will be applied to the partner nation.

   C10.9.1.3.3.3.1. Decrement. The partner nation's IMET account will be decremented in the following fiscal year by the full amount of the medical bill paid by the USG.

   C10.9.1.3.3.3.2. Ineligibility. The partner nation will become ineligible for additional IMET funding (e.g., End-of-Year and/or De-Ob/Re-Ob funds) for the current and following fiscal year. PM/SA also will examine repetitive violations of the healthcare policy by a country with ramifications for that country's IMET allocation in the future.