(Updated March 2011)
LEGISLATION
H.R. 208 [Sponsor: Rep. Tom Rooney (R-FL)]
Cosponsors (as of March 7, 2011): 1
LATEST INFORMATION
For many years, licensed professional counselors have been the only mental health service professionals required to operate under physician referral and supervision within the TRICARE program. Congress included language in the National Defense Authorization Act for fiscal year 2011, which was signed into law in January, directing the Department of Defense to adopt regulations to allow counselors to practice independently. The law gives the Department of Defense (DoD) until June 20th of this year to do this.
ACA is encouraging the Department of Defense to adopt regulations which let all TRICARE participating counselors practice independently, in order to make it easier for beneficiaries to get the help they need. Conversely, if DoD adopts restrictive regulations which screen out the majority of licensed professional counselors, beneficiaries will lose out on an opportunity to benefit from improved access to care.
WHAT YOU CAN DO
We encourage counselors to contact their Representative to ask him or her to cosponsor H.R. 208, bipartisan legislation to establish independent practice authority within TRICARE for licensed professional counselors. Although the Department of Defense may do this via regulations later this year, H.R. 208 would allow all TRICARE-participating counselors to practice independently. The more cosponsors we can gain on H.R. 208, the stronger the signal this sends to DoD to adopt inclusive, rather than restrictive, regulations regarding recognition of counselors.
All Representatives' D.C. offices can be reached by calling the Capitol Switchboard at 202-225-3121 (or 202-224-3121) and asking for a particular congressperson's office. You can also find out who your members of Congress are, or send them an e-mail, by visiting the ACA internet legislative action center at http://capwiz.com/counseling.
SAMPLE MESSAGE
"As a constituent, I am calling to ask the Representative to cosponsor H.R. 208, bipartisan legislation to give TRICARE beneficiaries direct access to licensed professional mental health counselors, the same way they are allowed to see other mental health service providers. Currently, beneficiaries must first get a physician referral and have counseling services supervised by the physician. This is an outdated and unnecessary requirement, and getting rid of it is a no-cost way of making it easier for TRICARE beneficiaries to get mental health treatment. The bill is sponsored by Congressman Tom Rooney from Florida."
BACKGROUND
TRICARE is the health insurance program operated by the Department of Defense for service members, military retirees, and their dependents, and covers more than 9 million people. Although counselors have been TRICARE providers for many years, they still lack independent practice authority under the program.
Instead of being able to pick up the phone and call a licensed professional counselor to make an appointment, TRICARE beneficiaries must first see a doctor, who can refer them to the counselor and who can supervise the provision of counseling services. Requiring physician referral and supervision makes it harder for counselors to see TRICARE clients, setting up an unnecessary obstacle to care for a beneficiary population that is frequently hesitant to seek out mental health services in the first place. Service members continue to fear for their career advancement if they seek mental health treatment. The physician referral requirement also means mental health services are often overseen by a physician who has had no education, training, or experience in the use of therapy in treating mental and emotional disorders.
In 2010, the Institute of Medicine (IOM) released a report (Provision of Mental Health Counseling Services Under TRICARE) recommending that counselors be allowed to practice independently, provided they had:
1) a master's degree in mental health counseling from a program accredited by the Council on Accreditation of Counseling and Related Educational Programs (CACREP), and
2) passed the National Clinical Mental Health Counselor Examination (NCMHCE). If adopted, this recommendation would prohibit most licensed professional counselors from practicing independently in TRICARE.
IOM's recommendation is not surprising, given the IOM panel's broader concerns regarding the effectiveness of education and licensure for mental health professionals in general:
Education, accreditation, licensure, certification, and clinical-experience requirements for mental health professionals are components of a quality-management system. However, they have little specificity with regard to knowledge of and experience with particular health problems or evidence-based practices. That generally limits the confidence that can be placed in the preparation of any of these professionals to diagnose and treat disorders that may be found in the TRICARE beneficiary population. Research regarding the quality of care for M/SU [mental health and substance use] conditions indicates that there are widespread deficiencies in the training of providers and in the infrastructure that supports their practice. (IOM, p. 9)
Nevertheless, IOM's report states that "The committee did not identify any evidence that distinguishes mental health counselors from other classes of practitioners in ability to serve in an independent professional capacity or to provide high-quality care consistent with education, licensure, and clinical experience" (IOM, p.9).
IOM's endorsement of independent practice authority for counselors tracks the findings of a demonstration project conducted by the Department of Defense in 2003, under which counselors in the Colorado Springs, Colorado and Omaha, Nebraska catchment areas were allowed to practice independently. In a comprehensive report on the results of the demonstration project, completed in 2005, the RAND Corporation found that beneficiaries in these areas reported having better access to mental health services, with no adverse effect on quality of care.
ACA is urging the Department of Defense to allow all counselors meeting current TRICARE participation requirements to practice independently, and to reject the more restrictive standards recommended by the Institute of Medicine.
STATISTICS / FINDINGS
- Licensed professional counselors' education and training requirements are nearly identical to other master's level practitioners: typically, a licensed professional counselor possesses a master's or doctoral degree in counseling, completion of 3,000 hours of supervised clinical experience, passage of a national or state-recognized counseling exam, and adherence to a strict code of ethics. In addition to* licensure, TRICARE requires its mental health service providers to have a minimum level of experience. TRICARE and DOD allow full, independent practice and reimbursement of all other master's-level providers with similar education and training requirements, including clinical social workers and marriage and family therapists.
- There are more than 120,000 mental health counselors licensed nationwide. Allowing independent practice authority of counselors could help address staffing shortages and oppressive waiting lists for mental health services, especially in remote locations and underserved areas.
- Making beneficiaries see their physicians before they can see a mental health specialist adds an administrative obstacle, the additional cost of a doctor's visit, and a longer waiting period before a service member can receive therapy, further discouraging TRICARE beneficiaries from seeking treatment.
- Data from the Post Deployment Health Re-assessment indicate that 38% of Soldiers and 31% of Marines report psychological symptoms. Among members of the National Guard, the figure rises to 49%. (An Achievable Vision: Report of the DoD Task Force on Mental Health)
- Prolonged deployments and increased exposure to danger are raising suicide rates and rates of post-traumatic stress disorder among service members. Research from Walter Reed Army Institute of Research found depression, anxiety, and stress disorders rose sharply among troops sent to Iraq and Afghanistan (Combat Duty in Iraq and Afghanistan, Mental Health Problems and Barriers to Care, July, 2004).
FOR MORE INFORMATION
—ACA Legislative Action Center: http://capwiz.com/counseling
Information Contact:
Scott Barstow
American Counseling Association
Office of Public Policy and Legislation
(800) 347-6647 Ext. 234
sbarstow@counseling.org