February 12, 2010 - IOM Panel Recommends Independent Practice for LMHCs Serving TRICARE Beneficiaries
Alexandria, VA – February 12, 2010 – Today, with the release of its report titled Provision of Mental Health Counseling Services under TRICARE, the Institutes of Medicine (“IOM”) has recommended to Congress that licensed mental health counselors be able to independently treat and diagnose TRICARE patients, thus eliminating the physician supervision and referral requirement that has for so long defined mental health counselors’ work with TRICARE beneficiaries.
W. Mark Hamilton, Ph.D., AMHCA’s executive director & CEO, extols the IOM’s recommendation as “a most welcome development for AMHCA membership and the mental health counseling profession.”
Elimination of the physician supervision and referral requirement for licensed mental health counselors is long overdue. Beginning in 1977, physician supervision and referral became required of all master’s level mental health professionals seeing TRICARE beneficiaries. In 1983, licensed clinical social workers attained the right to treat and diagnose TRICARE beneficiaries independently, thus without a supervision and referral requirement. Similarly, in 1991, licensed marriage and family therapists treating TRICARE beneficiaries were stripped of a supervision and referral requirement.
Currently, licensed mental health counselors, like licensed clinical social workers and licensed marriage and family therapists, are licensed in all 50 states and the District of Columbia. Licensed mental health counselors have achieved licensure with the most rigorous of standards, having passed a national examination, having taken a minimum of 48 hours of graduate coursework in counseling, with many states requiring as many as 60 hours, and having amassed several thousand hours of supervised clinical experience.
AMHCA commends the comprehensive investigation into the profession of mental health counseling undertaken over the course of the past year by the IOM panel. For over a year, an IOM panel comprised of America’s most respected mental health educators, providers, and leaders, has met monthly to explore the need for retaining a supervision and referral requirement unique to mental health counselors. After hearing from directors of both private and public behavioral health plans, professors of mental health counseling, and leaders of the professional organizations representing licensed mental health counselors, the IOM panel is recommending to Congress that licensed mental health counselors be able to independently treat TRICARE beneficiaries.
AMHCA’s president, Linda Barclay, Ph.D., LPCC/S, NCC, LICDC, says, “We commend the work of the IOM panel to uncover the education and skills of the mental health counseling profession, as well as this profession’s great desire to serve members of America’s military and their families.” AMHCA’s director of legislative affairs, Julie A. Clements, J.D., praises the recommendation, saying it will enhance the efficiency of TRICARE’s mental health system. Clements claims, “Removal of the TRICARE supervision and referral requirement will permit licensed mental health counselors to have unimpeded access to the soldiers and their families in greatest demand of their extraordinary services. Elimination of the requirement also promises reduction in TRICARE costs. Current practice mandates a medical doctor be consulted, even when a TRICARE beneficiary presents a mild to moderate mental health issue, before a LMHC can even be accessed.”
The IOM recommends to Congress and the Department of Defense that LMHCs be permitted to practice independently under TRICARE if they have satisfied the following:
"1. A Master's or higher level degree in counseling from a program in mental health counseling or clinical mental health counseling that is accredited by CACREP.
2. A state license in mental health counseling at the 'clinical' or the higher or highest level available in states that have tiered licensing schemes.
3. Passage of the National Clinical Mental Health Counseling Examination.
4. A well-defined scope of practice for practitioners."
In addition to the IOM’s recommendation, AMHCA is grateful to Representative Thomas J. Rooney of Florida (R-16th) who has introduced legislation, known as the CARES Act. If enacted, the CARES Act would amend TRICARE legislation so it no longer requires licensed mental health counselors to have received physician supervision and referral as a condition precedent to treating TRICARE beneficiaries. Presently, AMHCA, in conjunction with other organizations, is in talks with a Senate sponsor to introduce legislation mirroring Representative Rooney’s CARES Act.
View the complete IOM Report
Attention now shifts to House-Senate negotiations to reconcile their chambers’ versions of the parity legislation. Like the business community, the Bush administration argued in favor of the weaker Senate version, issuing a statement of policy expressing opposition to H.R. 1424. Despite this, AMHCA, ACA and other mental health and addictive disorder advocates are now working to build upon the strong bipartisan support for H.R. 1424 and the unanimous passage last year of the Senate’s bill, to encourage the development and enactment of parity legislation that provides consumer protections that are as strong as possible.