Provision of Mental Health Counseling Services Under TRICARE (2010) / Chapter Skim
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1 Introduction
1 Introduction
Pages 15-46
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From page 15... ...
TRICARE'S RESPONSIBILITIES AND STRuCTuRE1 TRICARE is the US Department of Defense (DOD) health-care benefits program for all seven uniformed services -- the Army, the Navy, the Marine Corps, the Air Force, the Coast Guard, the Commissioned Corps of the Public Health Service, and the Commissioned Corps of the General information in this section is derived from the TRICARE Beneficiary Handbook 1 (TRICARE, 2009b)
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-- referred to as the direct-care component -- with networks of civilian health-care professionals, medical facilities, and suppliers -- the purchased-care component. TRICARE operates as a single-payer system and covers most inpatient and outpatient medical care that is deemed necessary by a medical professional, including emergency and urgent care, medical and surgical procedures received on an inpatient basis and an outpatient basis, home health care, hospice care, clinical preventive services, maternity care, pharmacy services, and behavioral health care services (TRICARE, 2009b)
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Coverage for active-duty service members, their families, and retirees under 65 years old is provided by TRICARE Prime, a managedcare option in which MTFs are the principal source of health care; TRICARE Extra, a preferred-provider option; and TRICARE Standard, a fee-for-service option. TRICARE for Life provides supplementary health-care coverage for TRICARE beneficiaries 65 years old and older who are entitled to Medicare Part A and enrolled in Medicare Part B; it offers full coverage for many services only partially covered by Medicare.
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treatment facility TRICARE Extra TRICARE Standard Active-duty member of the Reserves TRICARE Prime TRICARE Prime Remote Family of a Reserve member activated for more TRICARE Prime than 30 days TPRADSM TRICARE Extra TRICARE Standard Retired National Guard or Reserve member, TRICARE Prime familyb TRICARE Extra TRICARE Standard TRICARE For Life (TFL) if 65 years old or older Medicare-eligible beneficiary under 65 years old TRICARE Prime TRICARE Extra TRICARE Standard Medicare-eligible beneficiary 65 years old or TFL older Congressional Medal of Honor recipient, TRICARE Prime immediate family TRICARE Extra TRICARE Standard Unremarried former spouse of active or retired TFL (if 65 years old or older)
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, and by instructions contained in TMA documents, such as the TRICARE operations, policy, reimbursement, and systems manuals.4 Specific policies regarding behavioral health care are discussed in greater detail in the following section and chapters. MENTAL HEALTH–CARE SERvICES AND PROvIDERS uNDER TRICARE A number of mental health services are covered under TRICARE; most of them are subject to limitations regarding the time, duration, or number of sessions covered per episode, admission, benefit period, or fiscal year (TRICARE, 2009a)
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Authorized providers recognized under TRICARE are defined in 32 CFR Part 199 and, generally, the TRICARE Policy Manual 6010.54-M, Chapter 11, Section 1.1. For mental health services, they comprise psychiatrists and other physicians, clinical psychologists, certified psychiatric nurse specialists, clinical social workers, certified marriage and family therapists, pastoral counselors, and mental health counselors (32 CFR § 199.4(c)
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. Authorization under TRICARE requires a medical or osteopathic degree, completion of an approved psychiatric residency program, and licensure by the state in which the person practices (TRICARE Policy Manual 6010.54-M, Chapter 11, Addendum A(2)
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a If supervisee is not able to work toward licensure with discipline of supervisor, supervisor b cannot supervise under TRICARE standards; supervisor must also be working within scope of his or her practice/license/certification.
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. To be certified under TRICARE, clinical psychologists must be licensed or certified in psychology by the state in which they practice and have 2 years of supervised clinical experience in psychological health services, or they must be credentialed by the National Registry of Health Service Providers in Psychology (TRICARE Policy Manual 6010.54-M, Chapter 11, Section 3.7, 2002)
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Licensing requirements vary by state; however, most require at least 2 years or 3,000 hours of post–master's degree clinical social-work practice under the supervision of a master's-level social worker in a clinical setting, which satisfies TRICARE requirements (TRICARE Policy Manual 6010.54-M, Chapter 11, Section 3.5, 2002)
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Licensure or certification requires 2 years of post–master's degree supervised clinical experience. Training requirements include a combination of 200 hours of approved supervision and 1,000 hours of supervised clinical experience in the practice of marriage and family counseling, or a combination of 150 hours of approved supervision in the practice of psychotherapy that includes at least 50 hours of approved individual supervision in the practice of marriage and family counseling and 750 hours of supervised clinical experience in the practice of psychotherapy that includes at least 250 hours of clinical practice in marriage and family counseling.
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Certification by the American Association of Pastoral Counselors requires that people obtain a 3-year professional degree from a seminary and a specialized master's or doctoral degree in a mental health or behavioral health discipline. Postgraduate training includes at least 1,375 hours of supervised clinical experience and 250 hours of direct approved supervision (American Association of Pastoral Counselors, 2009)
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Educational requirements include a master's degree in mental health counseling or an allied mental health discipline from a graduate program in counseling and 2 years of post–master's degree clinical experience under the supervision of a licensed or certified mental health professional. Most states also require a minimum of 60 hours of graduate study and 3,000 hours of supervised experience to apply for licensure, but these criteria vary by state.
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(K) and TRICARE Policy Manual 6010.54-M, Chapter 11, Section 3.1.
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reported that military spouses most often received their mental health care from PCPs rather than from specialty mental health professionals. PCPs may refer patients to counselors for treatment and supervise their work under the current TRICARE system.
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None of these proposals has been adopted into law. Summary and Review of Expanding Access to Mental Health Counselors -- Evaluation of the TRICARE Demonstration The 2001 NDAA directed DOD to implement a 1-year demonstration project in which access to qualified LMHCs was expanded by not requiring documentation of referral and supervision by a physician.
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However, that the finding was not present in later analyses that controlled for characteristics of beneficiaries who were more likely to see LMHCs suggests that it was unrelated to LMHC care. In the overall beneficiary population, there was a decrease in the likelihood of seeing another mental health provider or non–mental health physician provider.
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Furthermore, the observation that, in unadjusted analyses, psychotropic-medication use among patients seeing LMHCs declined by nearly 11% in the demonstration area and 3% in the comparison area suggests that the unadjusted results are consistent with the adjusted (i.e., patients seeing LMHCs have a lower likelihood of receiving psychotropic medication than those seeing other mental health providers)
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While there is evidence that the extent of training variability has decreased over time, it remains a reality that professional counselors licensed to practice have an unevenness of exposure to classroom education and supervised clinical experiences in the assessment and treatment of persons with mental disorders. The report states (p.
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conducting an independent study of the credentials, preparation, and training of individuals practicing as licensed mental health counselors; FFSPs provide a variety of support services to Navy personnel and their families, 10 including employment, financial, relocation, transition, and counseling assistance; they are not medical-care facilities.
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The assessment shall examine requirements in the areas of education, training, examination, continuing education, and ethical standards, and shall include an evaluation of the extent to which States autho rize members of the licensed mental health counselor profession to diagnose and treat mental illnesses, including illness such as major depressive disorder, schizophrenia, post-traumatic stress disorder, bipolar disorder, mental disorders due to a general med ical condition, somatoform disorders and delirium, dementia, amnestic, substance use and other disorders regularly associated with head trauma. Clinical experience requirements -- The report shall provide • for an analysis of the requirements for clinical experience for a licensed mental health counselor to be recognized under regula tions for the TRICARE program, and the extent to which such
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Historical review of regulations -- The report shall provide for a • review of the history of regulations prescribed by the Department of Defense regarding which members of the mental health profes sion are recognized as providers under the TRICARE program as independent practitioners, whether such regulations and/or other applicable policies were at the direction of Congress, and an examination of the recognition by the Department of third-party certification for members of such profession. Clinical exposure and capabilities studies -- The report shall • include a review and synthesis of available data describing the proportion of all patients under the care of licensed mental health counselors with major depressive disorder, schizophrenia, post-traumatic stress disorder, bipolar disorder, mental disorders due to a general medical condition, somatoform disorders and delirium, dementia, amnestic, substance use and other disorders
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Conclusions and recommendations -- The report shall include • conclusions and recommendations for permitting licensed mental health counselors to practice independently under the TRICARE program including recommendation regarding modifications of current policy for the TRICARE program with respect to allow ing licensed mental health counselors to practice independently in the TRICARE program, paying particular attention to the preparedness of licensed mental health counselors to diagnose, treat and appropriately refer persons with disorders of particular importance to TRICARE beneficiaries including major depres sive disorder, post-traumatic stress disorder, mental disorders due to a general medical condition, somatoform disorders and delirium, dementia, amnestic, substance use and other disorders regularly associated with head trauma. Limitations to practice -- The report shall include any recom • mendations [regarding]
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IOM Studies Addressing the Delivery of Mental Health Services The IOM committee responsible for Managing Managed Care: Quality Improvement in Behavioral Health (IOM, 1997) was charged with developing a framework for performance indicators, accreditation standards, and quality-improvement mechanisms that could be used for managed behavioral health care.
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It concluded that the framework is applicable to behavioral health care and that improving US health care overall requires attending to M/SU health-care quality issues and delivering care with an understanding of mind–body interactions. The report recommended that M/SU clinicians and organizations use process and outcome measures to improve the quality of care.
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It strongly recommended that PTSD be diagnosed through a face-to-face clinical interview by a health professional trained in diagnosing psychiatric disorders. The report did not draw specific conclusions regarding the training of mental health professionals who perform the diagnosis and assessment.
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The report recommended that DOD conduct predeployment and postdeployment screenings for medical conditions and psychosocial status to identify at-risk personnel, implement interventions, and measure long-term consequences of deployment. Other IOM Studies In 2009, IOM released Redesigning Continuing Education in the Health Professions.
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Appendix D presents excerpts of salient sections of the United States Code that describe the scope of practice and the training, experience, and licensing requirements imposed on mental health professionals who practice in the TRICARE system. Excerpts of the regulation that defines the scope of practice and supervision requirements for licensed counselors in the US Army are presented in Appendix E
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2006. Aspects of the use of licensed professional counselors in the Military Health System.
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2005. Guidance on TRICARE standards/ regulations: Qualified mental health professionals scope of practice & supervision.
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From page 45... ...
2009b. TRICARE beneficiary handbook.
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