Medical holdover (MHO) is a generic term referring to mobilized National Guard and Reserve soldiers who redeployed early with serious wounds and who are currently non-deployable.  These soldiers might have pre-existing conditions, aggravated pre-existing conditions, or new conditions as a result of mobilization and duty in the combat zone.  Active Duty Medical Extension (ADME) is the Title 10 authority that allows National Guard and Reserve soldiers on active duty to remain on active duty for medical treatment.  Medical Retention Processing (MRP) is the Title 10 authority that allows National Guard and Reserve soldiers to remain on active duty to continue/complete their medical treatment and/or medical boards.  Most of these soldiers are moved to a CBHCO after initial treatment unlike our Regular Army soldiers who are held at the MTF like WRAMC for complete outpatient treatment of serious wounds (TBI, Amputees, PTSD, etc.) 

The Army has made a commitment to: 1) Provide high quality, expert medical care, administrative support, and command & control to ill and injured Soldiers; 2) Administratively process with speed and compassion those who will leave the Army; 3) Facilitate transition of separating and releasing from active duty or Medical separation via the PEDS (MEB & PEB) these National Guard and Reserve Soldiers to VHA or TRICARE for follow-on care and 4) ensure that mobilized National Guard and Reserve Soldiers will receive "optimum hospital and medical treatment benefits" (DoDI 1332.38) before final determination of fitness for duty.

The Community Based Health Care Initiative was designed (in 2004) to 1) Increase the Army's medical treatment, command & control, and billeting capacity; 2) Allow Soldiers to return to their families, homes and communities; and 3) Provide flexible and scalable contingency capability.  The CBHCO applies only to those activated (for OIF & OEF) National Guard and Reserve soldiers.  However, appropriate medical care must be available within the community.  The Wounded Warrior must live within commuting distance from medical care and place of duty (CBHCO) and must comply with rules of the program (keep appointments). 

However, a different kind of medical attention is required for 100% special needs Guard & Reserve Wounded Warriors and their families. CBHCOs / MRPUs are not your normal troop units.  There is no substitute for laying eyes/hands on Soldiers; long-distance communication is less efficient and less reliable.  The complexity of wounds and WW cases requires intensive case management and care coordination and certainly some functions cannot be replicated off-installation and must be supported by installation activities and a major MTF like Walter Reed Army Medical Center.  It is apparent and according to the Army's own "Lessons Learned" on CBHCO's that everything takes longer off of normal installations and that the PEDS (MEB/PEB) functions must be moved from CBHCO to Army MTFs.