TRICARE
NBCC is committed to supporting service members, veterans and their families and ensuring access to qualified mental health counselors. NBCC pursues numerous legislative and government affairs priorities for this purpose, as well as its own programs.
NBCC is pleased to announce that the Department of Defense (DOD) released the final rule on July 14, 2014, establishing standards for counselor participation in the TRICARE program. The DOD released an interim final rule (IFR) in December 2011, which created the initial criteria for counselor independent practice under TRICARE. The final rule modifies the IFR in response to comments and concerns expressed by the public.
NBCC has been an active proponent of independent practice rights for counselors in TRICARE for over a decade, and this rule is the final culmination of that effort. The IFR granted independent practice authority to counselors but contained a number of limitations and requirements that were burdensome to the counseling profession. The final rule is a significant improvement over the IFR, and NBCC is pleased to see that many of our recommendations were incorporated. The entirety of the rule can be read here, but highlights of the changes include:
- Extension of the transition period to 2017.
- Previously, the IFR was scheduled to end December 31, 2014, but the final rule extends the transition period for two years, until January 1, 2017. Additionally, TRICARE clarified that any counselor meeting the transition criteria before January 1, 2017, could apply at any time under those standards (including after the transition period closes). Many organizations, including NBCC, have advocated for a longer transition period. With this extension, the transition period is five years.
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The transition period educational and test requirements include:
- Possession of a master’s degree or higher from a mental health counseling program accredited by the Council for Accreditation of Counseling & Related Educational Programs and passage of the National Counselor Examination (NCE)
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- Possession of a master’s degree or higher in counseling from a regionally accredited institution and passage of the National Clinical Mental Health Counseling Examination (NCMHCE).
Indefinite continuation of the supervised counselor status.
The IFR allowed counselors to continue to practice under physician supervision as supervised mental health counselors (SMHCs) until January 1, 2015. After that date, the SMHC status would no longer be reimbursed. The final rule removes the expiration date and extends the SMHC status indefinitely. Therefore, counselors currently practicing under supervision may continue to do so for the foreseeable future.
For years, professional counselors were excluded from the DOD, reducing the availability of needed mental health care providers. NBCC has had great success in its government affairs efforts to open the military health systems to counselors, but there is still work to do before counselors are employed on equal terms with other professions.
Previously, counselors were required to obtain physician referral and supervision when serving TRICARE beneficiaries, a burdensome requirement not placed on other mental health professions.
NBCC, in coalition with other counseling organizations, passed legislation to remove those restrictions and allow for independent practice. After further encouragement, the DOD released an interim final rule establishing qualifications for independent practice in December 2011 and a final rule in July 2014.
Not only did the lack of independent practice recognition subject counselors to unnecessary and wasteful physician supervision requirements, it also created problems for counselors seeking employment throughout the DOD, as other programs base their hiring on TRICARE regulations.
The effort encompassed several bills, two laws (public law 110-181 and public law 111-383) and two federally mandated studies, including the Institute of Medicine’s Provision of Mental Health Counseling Services Under TRICARE and a report by the RAND Corporation. After further endorsement by NBCC, the National Defense Authorization Act (NDAA) for Fiscal Year 2011 directed the DOD to establish requirements for counselor independent practice under TRICARE. While Congress mandated that the DOD establish such requirements by June of that year, it left the specifics to the DOD. In December 2011, the DOD finally released an interim final rule establishing these requirements.
Credentialing for the newly created provider category—TRICARE certified mental health counselor (TCMHC)—began mid-2012 and is administered by four separate TRICARE regional contractors: North, South, West, and Overseas.
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