DoD Considering Comments on TRICARE Independent Practice Proposal Prior To Implementation

The Department of Defense issued regulations at the end of 2011 (online at http://www.gpo.gov/fdsys/pkg/FR-2011-12-27/pdf/2011-33109.pdf) which would let licensed professional counselors practice independently within TRICARE, the health care program providing services for an estimated 9.6 million active duty service members, retirees, and their families. For many years, all other master's level mental health professionals have been allowed to practice independently, while TRICARE beneficiaries can only see licensed professional counselors under physician referral and supervision.

Under the regulations, counselors can apply for recognition as a "certified mental health counselor" and see TRICARE beneficiaries independently if they:

• are licensed at the highest level of licensure in their state; and
• have a minimum of 2 years of post-master's degree supervised mental health counseling practice which includes a minimum of 3,000 hours of supervised clinical practice and 100 hours of face-to-face supervision. Supervision must be provided by a mental health counselor who is licensed for independent practice in mental health counseling in the jurisdiction where practicing, and must be conducted in a manner that is consistent with guidelines for supervision of the American Mental Health Counselors Association (AMHCA);

…and either:

• possess a master's or higher-level degree from a mental health counseling program of education and training accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and have passed either the National Counselor Examination (NCE) or the National Clinical Mental Health Counselor Examination (NCMHCE); or
• possess a master's or higher-level degree from a mental health counseling program of education and training from a regionally accredited institution and have passed the NCMHCE.

Beginning January 1, 2015, counselors applying to become a TRICARE participating provider would be recognized only if they have a degree from "a mental health counseling program of education and training" from a CACREP-accredited school, and have passed the NCMHCE. Counselors who have signed on as participating providers before 2015 under the transition period criteria listed above can continue to practice independently. Beginning 2015, counselors who didn't become certified under the transition period criteria and who don't meet the CACREP/NCMHCE requirements won't be reimbursable by TRICARE at all, even under physician referral and supervision.

Current Referral and Supervision Requirements Still In Effect

Although the rule stated that it was "effective" on December 27, 2011, it appears that counselors will not be able to see TRICARE beneficiaries independently for a few months. According to staff with the TRICARE Management Activity (TMA, the agency charged with managing the program), the Department of Defense is maintaining existing requirements for physician referral and supervision of counselors' services until it has reviewed comments on the regulation and made any final changes in light of the comments it receives. Staff indicated that TMA expects to finish this process and begin implementing the regulations later this year.

ACA encourages counselors interested in this issue to submit comments. Comments must be submitted by February 27th. You can do this through the website http://www.regulations.gov. In the drop-down box in the middle of the page entitled "Select Document Type", select "Rule", and in the box next to it entitled "Enter Keyword or ID" type in "certified mental health counselors". Click "Search", and the top result listed on the page that comes up should be entitled "TRICARE: Certified Mental Health Counselors." You'll see a link for "Submit a Comment" on the right-hand side of the page.

ACA will be submitting comments as an organization, and we will be collaborating with both the National Board for Certified Counselors and the American Mental Health Counselors Association in developing our comments. ACA has worked closely with both NBCC and AMHCA over the years in advocating for independent practice authority for counselors within TRICARE.

ACA's comments are likely to include items such as the following:

• An expression of strong support for DoD's proposed transition period, during which counselors with degrees from programs that have not yet become CACREP-accredited can apply for certification as independently-practicing mental health counselors;
• A request that TRICARE recognize all relevant counseling master's degree titles for practice as a mental health counselor;
• A request that TRICARE recognize all supervised experience obtained by counselors that meets the criteria used by the licensure board for the jurisdiction in which they practice;
• A request that TRICARE consider extending the transition period—during which the agency will certify counselors with degrees from regionally-accredited institutions who have passed the NCMHCE, and counselors with degrees from CACREP-accredited programs who have passed the NCE—through December 31, 2015. This would be especially helpful if the DoD regulations aren't implemented until the end of 2012.

For more information, contact Scott Barstow with ACA at sbarstow@counseling.org.