The Department of Defense (DoD) has finally issued regulations allowing licensed professional counselors to practice independently within the TRICARE program, which provides health care coverage to more than 9 million military service members, retirees and their dependents. The agency’s regulations were released in the Federal Register of Dec. 27, 2011, and took effect immediately.

The American Counseling Association has worked for years to establish independent practice authority for counselors within TRICARE, and the new regulation is an important step for the profession. The regulation also establishes a transition period during which more flexible requirements will be in place — something for which ACA has consistently pushed. However, not all LPCs will be eligible for independent practice authority under the new TRICARE regulation, and significant questions and concerns remain about how they will be implemented. ACA will continue working to address these concerns and to push for recognition of all highly qualified LPCs.

During a transition period lasting until Jan. 1, 2015, professional counselors at the independent level of licensure in their state may practice independently under TRICARE if they:

1) 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 and have passed the National Counselor Examination; OR

2) Possess a master’s or higher-level degree from a mental health counseling program of education and training from either a CACREP-accredited or regionally accredited institution and have passed the National Clinical Mental Health Counselor Examination (NCMHCE); AND

3) Have at least two years of post-master’s supervised practice, including a minimum of 3,000 hours of supervised clinical practice and 100 hours of face-to-face supervision. This 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 the guidelines for supervision of the American Mental Health Counselors Association.”

Beginning Jan. 1, 2015, counselors (referred to as “certified mental health counselors” under the rule) seeking to participate in TRICARE will be required to:

1) Pass the NCMHCE;

2) Possess a master’s or doctoral degree from a mental health counseling program accredited by CACREP; and

3) Meet the supervision hours requirements listed above.

Beginning Jan. 1, 2015, counselors who do not meet these requirements (and who have not already qualified as certified mental health counselors with TRICARE under the transition period rules) will not be allowed to provide services to TRICARE beneficiaries, even under physician referral and supervision.

It is not yet clear how the requirement that degrees be awarded in a “mental health counseling program of education and training” will be interpreted, nor is it clear how DoD will verify that supervision is conducted in a manner that meets AMHCA standards. ACA is seeking clarification on these and other aspects of the regulations and will be submitting comments to DoD prior to the comment deadline of Feb. 27. DoD states that it expects the rule “to encourage greater participation of MHCs [mental health counselors] in the TRICARE network.”

Counselors are encouraged to read the regulations and provide comments as individuals. The regulations are posted online at gpo.gov:80/fdsys/pkg/FR-2011-12-27/pdf/2011-33109.pdf. For follow-up questions, contact ACA at 800-347-6647

 

Congress finalizes spending, still working on Medicare

Before going home for the holidays, Congress approved and President Barack Obama signed into law a spending package for the Department of Education and other federal agencies for Fiscal Year 2012. The legislation includes $52.295 million in funding for the Elementary and Secondary School Counseling Program, which represents a victory for ACA and other school counseling advocates. Funding for the program had been in serious jeopardy because it was zeroed out under previous versions of the legislation developed by the House of Representatives. According to staff with the Department of Education, a new round of grant applications for FY 2012 is likely to be solicited within weeks. ACA will share information on grant announcements on its website and through email.

The spending bill maintained the Pell Grant maximum level at $5,550 but made significant eligibility changes. Students must now have a GED certificate or high school diploma to be eligible, and eligibility is limited to 12 semesters, which is down from 18 semesters.

Although spending decisions for the fiscal year have been made (even if only weeks before the next budget cycle begins), other big issues remain unresolved, including billions of dollars in pending cuts to physician payment rates under Medicare. Although legislators failed to agree on a long-term package in December, the House ultimately approved a bipartisan Senate bill extending current Medicare physician payment rates and including other major tax provisions through the end of February. Congress is again facing a looming deadline for action on these issues. Significantly, the Medicare portion of the temporary extension did not include Medicare coverage of counselors or many other benefit improvements.

Letters to the editor: ct@counseling.org