Provision of Mental Health Counseling Services under TRICARE

摘要

In 2008, Congress directed the Department of Defense (DOD) to ask the Institute of Medicine (IOM) to conduct a study of the credentials, preparation, and training of people who were practicing as licensed mental health counselors and to make recommendations for permitting these counselors to practice independently under the TRICARE program. In response, IOM formed and convened the Committee on the Qualifications of Professionals Providing Mental Health Counseling Services under TRICARE. In TRICARE, independent practice frees providers from requirements that state that a beneficiary must be referred for therapy by a physician and that the referring physician must actually see the patient to evaluate and diagnose the condition to be treated prior to referring the beneficiary and provide ongoing oversight of the course of referral related treatment throughout the period during which the beneficiary is being treated, including ongoing communication between the referring and treating provider (32 CFR 199.6). TRICARE recognizes psychiatrists and other physicians, clinical psychologists, certified psychiatric nurse specialists, clinical social workers, and certified marriage and family therapists working under a participation agreement as independent providers of mental health services. DOD provided the committee with a statement of task that requested assessments of the educational, licensing, and clinical-experience requirements imposed on mental health counselors and the extent to which they are authorized to practice independently under other federal health-care programs. The statement of task also asked for a review of the history of regulations under which mental healthcare providers are recognized under TRICARE, data on the percentage of patients under the care of counselors, and a review of studies of the comparative outcomes and effectiveness of care provided by counselors. Finally, it requested that the committee offer conclusions and recommendations for permitting counselors to practice independently under TRICARE, including any limitations on that practice. DOD did not ask for an analysis of and the committee did not address issues surrounding access to mental health care.