TRICARE: Certified Mental Health Counselors, 80741-80744 [2011-33109]
Download as PDF
<![CDATA[
Federal Register / Vol. 76, No. 248 / Tuesday, December 27, 2011 / Rules and Regulations
In a similar fashion, employers who have
unique or changing first-aid needs in their
workplace may need to enhance their firstaid kits. The employer can use the OSHA 300
log, OSHA 301 log, or other reports to
identify these unique problems. Consultation
from the local fire/rescue department,
appropriate medical professional, or local
emergency room may be helpful to employers
in these circumstances. By assessing the
specific needs of their workplace, employers
can ensure that reasonably anticipated
supplies are available. Employers should
assess the specific needs of their worksite
periodically and augment the first aid kit
appropriately.
*
*
*
*
*
27. In § 1926.62, revise paragraph
(j)(2)(iv)(B) to read as follows:
■
§ 1926.62
Lead.
*
*
*
*
*
(j) * * *
(2) * * *
(B) The employer shall notify each
employee whose blood lead level is at
or above 40 mg/dl that the standard
requires temporary medical removal
with Medical Removal Protection
benefits when an employee’s blood lead
level is at or above the numerical
criterion for medical removal under
paragraph (k)(1)(i) of this section.
*
*
*
*
*
[FR Doc. 2011–32853 Filed 12–23–11; 8:45 am]
BILLING CODE 4510–26–P
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD–2011–HA–0134; RIN 0720–AB55]
TRICARE: Certified Mental Health
Counselors
Office of the Secretary,
Department of Defense.
ACTION: Interim final rule.
AGENCY:
This rule is submitted as an
interim final rule (IFR) in order to meet
the Congressional requirement set forth
in the National Defense Authorization
Act (NDAA) for Fiscal Year (FY) 2011,
Section 724, which required the
Department of Defense to prescribe
regulations by June 20, 2011, to
establish the criteria, as had previously
been studied in accordance with Section
717 of the NDAA 2008, that would
allow licensed or certified mental health
counselors to be able to independently
provide care to TRICARE beneficiaries
and receive payment for those services.
Under current TRICARE requirements,
mental health counselors (MHCs) are
authorized to practice only with
erowe on DSK2VPTVN1PROD with RULES
SUMMARY:
VerDate Mar<15>2010
14:56 Dec 23, 2011
Jkt 226001
physician referral and supervision. This
interim final rule establishes a transition
period to phase out the requirement for
physician referral and supervision for
MHCs and to create a new category of
allied health professionals, to be known
as certified mental health counselors
(CMHCs), who will be authorized to
practice independently under TRICARE.
During this transition period the
MHCs who do not meet the
requirements for independent practice
as established in this rule, may continue
to provide services to TRICARE
beneficiaries under the requirements of
physician referral and ongoing
supervision. This transition period,
ending December 31, 2014, will allow
time for those MHCs who seek to
continue providing services under the
TRICARE program to meet the
independent practice requirements as
outlined in this notice. After December
31, 2014, the Department of Defense
will no longer recognize those mental
health counselors who do not meet the
criteria for a CMHC and will no longer
allow them to provide services even
upon the referral and supervision of a
physician.
This rule is effective on
December 27, 2011. Written comments
received at the address indicated below
by February 27, 2012 will be accepted.
ADDRESSES: You may submit comments,
identified by docket number and or
Regulatory Information Number (RIN)
number and title, by either of the
following methods:
• Federal eRulemaking Portal:
www.regulations.gov. Follow the
instructions for submitting comments.
• Mail: Federal Docket Management
System Office, 4800 Mark Center Drive,
2nd Floor, East Tower, Suite 02G09,
Alexandria, VA 22350–3100.
Instructions: All submissions received
must include the agency name and
docket number or RIN for this Federal
Register document. The general policy
for comments and other submissions
from members of the public is to make
these submissions available for public
viewing on the Internet at https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
DATES:
Dr.
Patricia Moseley, TRICARE
Management Activity, Office of the
Chief Medical Officer, telephone (703)
681–0064.
SUPPLEMENTARY INFORMATION: TRICARE
serves over 9.6 million beneficiaries
comprised of active duty service
members, retirees, and their families,
FOR FURTHER INFORMATION CONTACT:
PO 00000
Frm 00013
Fmt 4700
Sfmt 4700
80741
among others. The nature of the
conflicts in Iraq and Afghanistan, their
duration, and the Department of
Defense’s appreciation and sensitivity to
the impact of combat on a service
member’s mental health have driven
strong efforts to ensure that quality
mental health care is available and
accessible to TRICARE beneficiaries.
One element of these efforts is ongoing
attention to increasing the number of
quality providers that can assess and
treat TRICARE beneficiaries.
The National Defense Authorization
Act for Fiscal Year 2006 Conference
Report, No. 109–360, p. 753–4,
requested from DoD a report to Congress
on actions taken to improve the
efficiency and effectiveness of
procedures to facilitate physician
referral and supervision of licensed
professional counselors (LPCs),
including a description of ‘‘best
practices’’ employed throughout the
military health system to ensure access
to services provided by mental health
counselors under the TRICARE
Program. That report concluded that
there remained significant variability
among the States in training programs
and requirements for licensure as a
mental health counselor and that while
there was evidence that the extent of
training variability had decreased over
time, it continued to be evident that
professional counselors licensed to
practice had quite varying exposure to
classroom education and supervised
clinical experiences in the assessment
and treatment of persons with mental
disorders. In conclusion the report
noted: ‘‘Given the practical obstacles to
physician supervision of LPCs and the
perceived impediment to accessing
services caused by the physician referral
requirement, it would be prudent to
explore issues of supervision, referral,
provider credentialing, and scope of
practice to develop options that would
preserve quality of care, safeguard the
health and well-being of Service
members and maximize access to
mental health care for all beneficiaries.
An examination of these issues would
certainly support other activities having
the goal of improving mental health care
to veterans, active duty service members
and their families, including the recent
creation of the DoD Task Force on
Mental Health.’’
Section 717 of the National Defense
Authorization Act of Fiscal Year 2008
directed the Secretary of Defense to
study the credentials, preparation, and
training of individuals practicing as
licensed mental health counselors and
to make recommendations for
permitting licensed mental health
counselors to practice independently
E:\FR\FM\27DER1.SGM
27DER1
erowe on DSK2VPTVN1PROD with RULES
80742
Federal Register / Vol. 76, No. 248 / Tuesday, December 27, 2011 / Rules and Regulations
under the TRICARE program. The study,
completed by the Institute of Medicine
of the National Academies of Science,
recommended allowing LMHCs who
meet certain training, education,
experience, certification, and licensure
requirements to practice independently
under the TRICARE program. This
interim final rule implements changes
to 32 CFR part 199 based on those
recommendations.
The certification criteria established
in this IFR are largely consistent with
the recommendations found in
‘‘Provision of Mental Health Counseling
Services under TRICARE,’’ a study
funded by DoD and completed in 2010
by the Institute of Medicine (IOM) of the
National Academies of Science https://
www.iom.edu/Reports/2010/Provisionof-Mental-Health-Counseling-ServicesUnder-TRICARE.aspx.
The IOM recommendations specify
that independent practice of mental
health counselors (MHCs) in TRICARE
should occur under certain
circumstances: ‘‘A master’s or higherlevel degree in counseling from a
program in mental health counseling or
clinical mental health counseling that is
accredited by Council for Accreditation
of Counseling and Related Educational
Programs (CACREP); a state license in
mental health counseling at the
‘‘clinical’’ or the higher or highest level
available in states that have tiered
licensing schemes; the passage of the
National Clinical Mental Health
Counseling examination (NCMHCE);
and a well-defined scope of practice for
practitioners.’’ The new rule will
implement these standards over time
while preserving the requirement for
3,000 hours of supervised clinical
practice and 100 hours of face-to-face
supervision. TRICARE is committed to
ensuring that the quality standards
recommended by the IOM are adopted
by TRICARE, but understands that the
availability of CACREP accredited
mental health counseling training
programs and the use of the NCMHCE
as a quality standard are not yet
widespread in the field. Therefore, with
this rule, TRICARE will adopt new
quality standards for the independent
practices of mental health counselors as
of January 1, 2015, and in addition will
recognize mental health counselors as
independent providers who have met
certain currently recognized quality
standards on or before December 31,
2014. Specifically, in order to practice
independently, those mental health
counselors must have met, in part, one
of the following two quality standards
on or before December 31, 2014: (1)
Possess a master’s or higher-level degree
from a mental health counseling
VerDate Mar<15>2010
14:56 Dec 23, 2011
Jkt 226001
program of education and training
accredited by CACREP and must have
passed the National Counselor
Examination (NCE); or (2) possess a
master’s or higher-level degree from a
mental health counseling program of
education and training from either a
CACREP or regionally accredited
institution and have passed the
NCMHCE. The many professional
mental health counselors who meet
these quality standards are a resource
that TRICARE is anxious to make
available to Service members, retirees
and their families and their inclusion as
independent practitioners under the
TRICARE program will ensure that
ready access to quality providers is
preserved for TRICARE beneficiaries.
Independent practice by mental
health counselors would mean a change
from working under the supervision and
referral of a physician to autonomous
practice and third party reimbursement.
While access to care was not a direct
focus of the IOM study, increasing the
availability of fully qualified providers
would benefit TRICARE beneficiaries.
This interim final rule establishes a
transition period to phase out the
requirement for physician referral and
supervision for mental health
counselors and to create a new category
of allied health professionals, to be
known as certified mental health
counselors (CMHCs), who will be
authorized to practice independently
under TRICARE.
During this transition period the
MHCs who do not meet the
requirements for independent practice
as established in this rule, may continue
to provide services to TRICARE
beneficiaries under the requirements of
physician referral and ongoing
supervision. This transition period,
ending December 31, 2014, will allow
time for those MHCs who seek to
continue providing services under the
TRICARE program to meet the
independent practice requirements as
outlined in this notice. After that date
persons who do not meet the
requirements for being a CMHC will no
longer be recognized by TRICARE and
payment for their services will no longer
be allowed even if they work under the
supervision of a physician.
Lastly, although this rule sets forth
the currently accepted and
recommended criteria for an individual
to be recognized as a CMHC, Section
199.6(c)(3)(iii)(N)(3) has been added to
allow the Director, TRICARE
Management Activity to amend or
modify existing requirements or add
other qualifications or criteria in the
future to accommodate professional
PO 00000
Frm 00014
Fmt 4700
Sfmt 4700
quality and licensing standards as they
may change over time.
The rule meets DoD’s goal to balance
the implementation of quality standards
for mental health counselors with
beneficiary access to their services. The
implementation period of the provider
requirements elaborated in this rule
permits DoD to preserve patient access
to experienced and well-trained mental
health professionals while permitting
other providers to meet those standards
by January 1, 2015. This rule is expected
to encourage greater participation of
MHCs in the TRICARE network, result
in improved access to quality mental
health treatment for TRICARE
beneficiaries, and sets provider quality
standards typical of other mental health
providers authorized under TRICARE.
Regulatory Procedures
Executive Order 12866, ‘‘Regulatory
Planning and Review’’ and Executive
Order 13563, ‘‘Improving Regulation
and Regulatory Review’’
Section 801 of Title 5, United States
Code, Executive Order (E.O.) 12866, and
E.O. 13563 require certain regulatory
assessments and procedures for any
major rule or significant regulatory
action, defined as one that would result
in an annual effect of $100 million or
more on the national economy or which
would have other substantial impacts. It
has been certified that this rule is not
economically significant, and has been
reviewed by the Office of Management
and Budget as required under the
provisions of E.O. 12866 and E.O.
13563.
Public Law 104–4, Section 202,
‘‘Unfunded Mandates Reform Act’’
Section 202 of Public Law 104–4,
‘‘Unfunded Mandates Reform Act,’’
requires that an analysis be performed
to determine whether any federal
mandate may result in the expenditure
by State, local, and tribal governments,
in the aggregate, or by the private sector
of $100 million in any one year. It has
been certified that this rule does not
contain a Federal mandate that may
result in the expenditure by State, local
and tribal governments, in aggregate, or
by the private sector, of $100 million or
more in any one year, and thus this rule
is not subject to this requirement.
Public Law 96–354, ‘‘Regulatory
Flexibility Act’’ (RFA) (5 U.S.C. 601)
Public Law 96–354, ‘‘Regulatory
Flexibility Act’’ (RFA) (5 U.S.C. 601),
requires that each Federal agency
prepare a regulatory flexibility analysis
when the agency issues a regulation
which would have a significant impact
E:\FR\FM\27DER1.SGM
27DER1
Federal Register / Vol. 76, No. 248 / Tuesday, December 27, 2011 / Rules and Regulations
on a substantial number of small
entities. This rule is not an
economically significant regulatory
action, and it has been certified that it
will not have a significant impact on a
substantial number of small entities.
Therefore, this rule is not subject to the
requirements of the RFA.
Public Law 96–511, ‘‘Paperwork
Reduction Act’’ (44 U.S.C. Chapter 35)
This rule does not contain a
‘‘collection of information’’
requirement, and will not impose
additional information collection
requirements on the public under Public
Law 96–511, ‘‘Paperwork Reduction
Act’’ (44 U.S.C. chapter 35).
Executive Order 13132, ‘‘Federalism’’
E.O. 13132, ‘‘Federalism,’’ requires
that an impact analysis be performed to
determine whether the rule has
federalism implications that would have
substantial direct effects on the States,
on the relationship between the national
government and the States, or on the
distribution of power and
responsibilities among the various
levels of government. It has been
certified that this rule does not have
federalism implications, as set forth in
E.O. 13132.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care,
Health insurance, Individuals with
disabilities, Military personnel.
Accordingly, 32 CFR Part 199 is
amended as follows:
PART 199—[AMENDED]
1. The authority citation for Part 199
continues to read as follows:
■
Authority: 5 U.S.C. 301; 10 U.S.C. chapter
55.
2. Section 199.4 is amended by
revising paragraph (c)(3)(ix)(A)
introductory text to read as follows:
■
§ 199.4
Basic program benefits.
erowe on DSK2VPTVN1PROD with RULES
*
*
*
*
*
(c) * * *
(3) * * *
(ix) * * *
(A) Covered diagnostic and
therapeutic services. Subject to the
requirements and limitations stated,
CHAMPUS benefits are payable for the
following services when rendered in the
diagnosis or treatment of a covered
mental disorder by a CHAMPUSauthorized, qualified mental health
provider practicing within the scope of
his or her license. Qualified mental
health providers are: psychiatrists or
other physicians; clinical psychologists,
certified psychiatric nurse specialists,
VerDate Mar<15>2010
14:56 Dec 23, 2011
Jkt 226001
certified clinical social workers,
certified marriage and family therapists,
certified mental health counselors,
pastoral counselors under a physician’s
supervision, and until December 31,
2014, mental health counselors under a
physician’s supervision. No payment
will be made for any service listed in
paragraph (c)(3)(ix)(A) of this section
rendered by an individual who does not
meet the criteria of § 199.6 of this part
for his or her respective profession,
regardless of whether the provider is an
independent professional provider or an
employee of an authorized professional
or institutional provider.
*
*
*
*
*
■ 3. Section 199.6 is amended by adding
paragraph (c)(3)(iii)(N) and revising
(c)(3)(iv)(C) to read as follows:
§ 199.6
TRICARE—authorized providers.
*
*
*
*
*
(c) * * *
(3) * * *
(iii) * * *
(N) Certified mental health counselor.
For the purposes of CHAMPUS, a
certified mental health counselor
(CMHC) must be licensed for
independent practice in mental health
counseling by the jurisdiction where
practicing. In jurisdictions with two or
more licenses allowing for differing
scopes of independent practice, the
licensed mental health counselor may
only practice within the scope of the
license he or she possesses. In addition,
a CMHC must meet all of the
requirements contained in this
paragraph (c)(3)(iii)(N)(1) or the
requirements of paragraph
(c)(3)(iii)(N)(2) of this section.
(1) The requirements of this paragraph
are that the CMHC:
(i) Must have passed the National
Clinical Mental Health Counselor
Examination (NCMHCE) or its successor
as determined by the Director, TMA;
and
(ii) Must possess a master’s or higherlevel degree from a mental health
counseling program of education and
training accredited by the Council for
Accreditation of Counseling and Related
Educational Programs (CACREP); and
(iii) Must have a minimum of two (2)
years of post-master’s degree supervised
mental health counseling practice
which includes 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
PO 00000
Frm 00015
Fmt 4700
Sfmt 4700
80743
consistent with the guidelines for
supervision of the American Mental
Health Counselors Association.
(2) The requirements of this paragraph
are that the CMHC, prior to January 1,
2015:
(i) Possess a master’s or higher-level
degree from a mental health counseling
program of education and training
accredited by CACREP and must have
passed the National Counselor
Examination (NCE); or
(ii) Possess a master’s or higher-level
degree from a mental health counseling
program of education and training from
either a CACREP or regionally
accredited institution and have passed
the NCMHCE; and
(iii) Must have a minimum of two (2)
years of post-master’s degree supervised
mental health counseling practice
which includes 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.
(3) The Director, TRICARE
Management Activity may amend or
modify existing or specify additional
certification requirements as needed to
accommodate future practice and
licensing standards and to ensure that
all CMHCs continue to meet
educational, licensing and clinical
training requirements considered
appropriate.
(iv) * * *
(C) Supervised mental health
counselor. For the purposes of
TRICARE, a supervised mental health
counselor is an individual who does not
meet the requirements of a certified
mental health counselor in paragraph
(c)(3)(iii)(N) of this section, but meets
the requirements of this paragraph
(c)(3)(iv)(C). After December 31, 2014,
this category of provider will no longer
be recognized by TRICARE and no
reimbursement may be made to any
person for services provided by this
category of provider. However, prior to
January 1, 2015, a supervised mental
health counselor is one who meets all of
the following requirements and
conditions of practice:
(1) Minimum of a master’s degree in
mental health counseling or allied
mental health field from a regionally
accredited institution; and
(2) Two years of post-masters
experience which includes 3,000 hours
E:\FR\FM\27DER1.SGM
27DER1
80744
Federal Register / Vol. 76, No. 248 / Tuesday, December 27, 2011 / Rules and Regulations
of clinical work and 100 hours of faceto-face supervision; and
(3) Is licensed or certified to practice
as a mental health counselor by the
jurisdiction where practicing (see
paragraph (c)(3)(iv)(D) of this section for
more specific information); and
(4) May only be reimbursed when:
(i) The TRICARE beneficiary is
referred for therapy by a physician; and
(ii) A physician is providing ongoing
oversight and supervision of the therapy
being provided; and
(iii) The mental health counselor
certifies on each claim for
reimbursement that a written
communication has been made or will
be made to the referring physician of the
results of the treatment. Such
communication will be made at the end
of the treatment, or more frequently, as
required by the referring physician
(refer to § 199.7 of this part); and
(iv) The date of services provided is
on or before December 31, 2014.
*
*
*
*
*
Dated: December 21, 2011.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2011–33109 Filed 12–23–11; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[DOD–2010–OS–0043; RIN 0790–AI62]
32 CFR Part 222
DoD Mandatory Declassification
Review (MDR) Program
Department of Defense.
Final rule.
AGENCY:
ACTION:
This part implements policy
established in DoD Instruction 5200.01.
It assigns responsibilities and provides
procedures for members of the public to
request a declassification review of
information classified under the
provisions of Executive Order 13526, or
predecessor orders.
DATES: Effective Date: This rule is
effective January 26, 2012.
FOR FURTHER INFORMATION CONTACT:
Robert Storer, (571) 372–0483.
SUPPLEMENTARY INFORMATION: The
Department of Defense published a
proposed rule on September 27, 2010
(75 FR 59176–59179). Three sets of
comments were received and are
addressed below.
Comment 1: As an initial matter, this
proposed rule contains no paragraph (j),
and there appears to be no current
erowe on DSK2VPTVN1PROD with RULES
SUMMARY:
VerDate Mar<15>2010
14:56 Dec 23, 2011
Jkt 226001
paragraph (j) to which this could be
referring. While it is entirely reasonable
for the DoD to amend this rule later to
cover the issue of fees, it is improper for
the DoD to include a reference now to
a potential later amendment that will
itself have to go through the notice and
comment rulemaking procedure. It is far
more reasonable to leave this
subparagraph out of the current iteration
and add it when the actual paragraph (j)
is added to the rule.
Response 1: Paragraph revised to be
consistent with section 2001.33(e) of 32
CFR (see section 222.10).
Comment 2: It is entirely proper that
a requester shall not be given MDR
appeal rights for records withheld
pursuant to FOIA exemptions. However,
it is not proper for records to be
withheld pursuant to FOIA exemptions
as part of the MDR process without
providing the proper appeal rights that
accompany all FOIA withholding
decisions.
Response 2: The FOIA and MDR
process are separate and distinct
processes. A MDR is not a FOIA
Request; a requester does not have the
right to appeal MDR’s denied under
FOIA exemptions without having filed a
FOIA Request. If a requester is denied
under the rules of FOIA, the requester
must submit a FOIA request for those
records in order to have the exemptions
examined. (See par 4 and par 5(c)3(d) of
section 222.5.)
Comment 3: Proposed Section
222.5(a)(vii) reads as follows: ‘‘This
section shall not apply to any request
for a review made to an element of the
Intelligence Community that is made by
a person other than an individual as that
term is defined by 5 U.S.C. 552a(a)(2),
or by a foreign government entity or any
representative thereof.’’
This language differs meaningfully
from the interpretive guidance rules in
Section 32 CFR 2001.33(i), which say, in
part, ‘‘requests for mandatory
declassification review made to an
element of the Intelligence Community
by anyone other than a citizen of the
United States or an alien lawfully
admitted for permanent residence may
be denied by the receiving Intelligence
Community element.’’
Response 3: Section removed from
final rule.
4: Comments from DoD Internal
review of proposed rule:
a. Change the Executive Order in the
last line of Paragraph 1 from 12958 to
13526.
b. Appoint an appellate authority and
process MDR appeals for information
originating in the OSD, the Office of the
Chairman of the Joint Chiefs of Staff and
PO 00000
Frm 00016
Fmt 4700
Sfmt 4700
the Joint Staff, and DoD components not
listed in the Appendix to Enclosure 2.
c. Insert reference to DoD 5200.1–R so
the paragraph reads ‘‘The DoD
Components shall process MDR requests
* * * in accordance with DoD 5200.1–
R and Part 2001 of title 32 * * *’’
d. Replace paragraph 7.b with the
following (or similar) statement: ‘‘The
DoD Component shall consult with DOS
as necessary to determine whether the
information is subject to a treaty or
international agreement that would
prevent its declassification. The office to
consult is * * *’’ (U//FOUO) The
purpose of the statement is to allow DoD
intelligence organizations that have
existing, authorized agreements for
coordinating actions on FGI to continue
to use those arrangements with
counterpart organizations of foreign
governments for the purposes of
coordinating Mandatory Declassification
actions.
e. Updated all DoD Component
contact information.
Response to Internal Comments:
Internal comments from staffing reviews
were incorporated as appropriate.
Changes were made in the following
sections: references, paragraph (d),
§ 222.5 MDR processing procedures of
the final in response to the comments
received.
Executive Order 12866, ‘‘Regulatory
Planning and Review’’ and Executive
Order 13563, ‘‘Improving Regulation
and Regulatory Review’’
It has been certified that 32 CFR part
222 does not:
(1) Have an annual effect on the
economy of $100 million or more or
adversely affect in a material way the
economy; a section of the economy;
productivity; competition; jobs; the
environment; public health or safety; or
State, local, or tribunal governments or
communities;
(2) Create a serious inconsistency or
otherwise interfere with an action taken
or planned by another Agency;
(3) Materially alter the budgetary
impact of entitlements, grants, user fees,
or loan programs, or the rights and
obligations of recipients thereof; or
(4) Raise novel legal or policy issues
arising out of legal mandates, the
President’s priorities, or the principles
set forth in these Executive Orders.
Sec. 202, Public Law 104–4, ‘‘Unfunded
Mandates Reform Act’’
It has been certified that 32 CFR part
222 does not contain a Federal mandate
that may result in the expenditure by
State, local and tribunal governments, in
aggregate, or by the private sector, of
$100 million or more in any one year.
E:\FR\FM\27DER1.SGM
27DER1
]]>Agencies
[Federal Register Volume 76, Number 248 (Tuesday, December 27, 2011)]
[Rules and Regulations]
[Pages 80741-80744]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-33109]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2011-HA-0134; RIN 0720-AB55]
TRICARE: Certified Mental Health Counselors
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Interim final rule.
-----------------------------------------------------------------------
SUMMARY: This rule is submitted as an interim final rule (IFR) in order
to meet the Congressional requirement set forth in the National Defense
Authorization Act (NDAA) for Fiscal Year (FY) 2011, Section 724, which
required the Department of Defense to prescribe regulations by June 20,
2011, to establish the criteria, as had previously been studied in
accordance with Section 717 of the NDAA 2008, that would allow licensed
or certified mental health counselors to be able to independently
provide care to TRICARE beneficiaries and receive payment for those
services. Under current TRICARE requirements, mental health counselors
(MHCs) are authorized to practice only with physician referral and
supervision. This interim final rule establishes a transition period to
phase out the requirement for physician referral and supervision for
MHCs and to create a new category of allied health professionals, to be
known as certified mental health counselors (CMHCs), who will be
authorized to practice independently under TRICARE.
During this transition period the MHCs who do not meet the
requirements for independent practice as established in this rule, may
continue to provide services to TRICARE beneficiaries under the
requirements of physician referral and ongoing supervision. This
transition period, ending December 31, 2014, will allow time for those
MHCs who seek to continue providing services under the TRICARE program
to meet the independent practice requirements as outlined in this
notice. After December 31, 2014, the Department of Defense will no
longer recognize those mental health counselors who do not meet the
criteria for a CMHC and will no longer allow them to provide services
even upon the referral and supervision of a physician.
DATES: This rule is effective on December 27, 2011. Written comments
received at the address indicated below by February 27, 2012 will be
accepted.
ADDRESSES: You may submit comments, identified by docket number and or
Regulatory Information Number (RIN) number and title, by either of the
following methods:
Federal eRulemaking Portal: www.regulations.gov. Follow
the instructions for submitting comments.
Mail: Federal Docket Management System Office, 4800 Mark
Center Drive, 2nd Floor, East Tower, Suite 02G09, Alexandria, VA 22350-
3100.
Instructions: All submissions received must include the agency name
and docket number or RIN for this Federal Register document. The
general policy for comments and other submissions from members of the
public is to make these submissions available for public viewing on the
Internet at https://www.regulations.gov as they are received without
change, including any personal identifiers or contact information.
FOR FURTHER INFORMATION CONTACT: Dr. Patricia Moseley, TRICARE
Management Activity, Office of the Chief Medical Officer, telephone
(703) 681-0064.
SUPPLEMENTARY INFORMATION: TRICARE serves over 9.6 million
beneficiaries comprised of active duty service members, retirees, and
their families, among others. The nature of the conflicts in Iraq and
Afghanistan, their duration, and the Department of Defense's
appreciation and sensitivity to the impact of combat on a service
member's mental health have driven strong efforts to ensure that
quality mental health care is available and accessible to TRICARE
beneficiaries. One element of these efforts is ongoing attention to
increasing the number of quality providers that can assess and treat
TRICARE beneficiaries.
The National Defense Authorization Act for Fiscal Year 2006
Conference Report, No. 109-360, p. 753-4, requested from DoD a report
to Congress on actions taken to improve the efficiency and
effectiveness of procedures to facilitate physician referral and
supervision of licensed professional counselors (LPCs), including a
description of ``best practices'' employed throughout the military
health system to ensure access to services provided by mental health
counselors under the TRICARE Program. That report concluded that there
remained significant variability among the States in training programs
and requirements for licensure as a mental health counselor and that
while there was evidence that the extent of training variability had
decreased over time, it continued to be evident that professional
counselors licensed to practice had quite varying exposure to classroom
education and supervised clinical experiences in the assessment and
treatment of persons with mental disorders. In conclusion the report
noted: ``Given the practical obstacles to physician supervision of LPCs
and the perceived impediment to accessing services caused by the
physician referral requirement, it would be prudent to explore issues
of supervision, referral, provider credentialing, and scope of practice
to develop options that would preserve quality of care, safeguard the
health and well-being of Service members and maximize access to mental
health care for all beneficiaries. An examination of these issues would
certainly support other activities having the goal of improving mental
health care to veterans, active duty service members and their
families, including the recent creation of the DoD Task Force on Mental
Health.''
Section 717 of the National Defense Authorization Act of Fiscal
Year 2008 directed the Secretary of Defense to study the credentials,
preparation, and training of individuals practicing as licensed mental
health counselors and to make recommendations for permitting licensed
mental health counselors to practice independently
[[Page 80742]]
under the TRICARE program. The study, completed by the Institute of
Medicine of the National Academies of Science, recommended allowing
LMHCs who meet certain training, education, experience, certification,
and licensure requirements to practice independently under the TRICARE
program. This interim final rule implements changes to 32 CFR part 199
based on those recommendations.
The certification criteria established in this IFR are largely
consistent with the recommendations found in ``Provision of Mental
Health Counseling Services under TRICARE,'' a study funded by DoD and
completed in 2010 by the Institute of Medicine (IOM) of the National
Academies of Science https://www.iom.edu/Reports/2010/Provision-of-Mental-Health-Counseling-Services-Under-TRICARE.aspx.
The IOM recommendations specify that independent practice of mental
health counselors (MHCs) in TRICARE should occur under certain
circumstances: ``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 Council for Accreditation of
Counseling and Related Educational Programs (CACREP); a state license
in mental health counseling at the ``clinical'' or the higher or
highest level available in states that have tiered licensing schemes;
the passage of the National Clinical Mental Health Counseling
examination (NCMHCE); and a well-defined scope of practice for
practitioners.'' The new rule will implement these standards over time
while preserving the requirement for 3,000 hours of supervised clinical
practice and 100 hours of face-to-face supervision. TRICARE is
committed to ensuring that the quality standards recommended by the IOM
are adopted by TRICARE, but understands that the availability of CACREP
accredited mental health counseling training programs and the use of
the NCMHCE as a quality standard are not yet widespread in the field.
Therefore, with this rule, TRICARE will adopt new quality standards for
the independent practices of mental health counselors as of January 1,
2015, and in addition will recognize mental health counselors as
independent providers who have met certain currently recognized quality
standards on or before December 31, 2014. Specifically, in order to
practice independently, those mental health counselors must have met,
in part, one of the following two quality standards on or before
December 31, 2014: (1) Possess a master's or higher-level degree from a
mental health counseling program of education and training accredited
by CACREP and must have passed the National Counselor Examination
(NCE); or (2) possess a master's or higher-level degree from a mental
health counseling program of education and training from either a
CACREP or regionally accredited institution and have passed the NCMHCE.
The many professional mental health counselors who meet these quality
standards are a resource that TRICARE is anxious to make available to
Service members, retirees and their families and their inclusion as
independent practitioners under the TRICARE program will ensure that
ready access to quality providers is preserved for TRICARE
beneficiaries.
Independent practice by mental health counselors would mean a
change from working under the supervision and referral of a physician
to autonomous practice and third party reimbursement. While access to
care was not a direct focus of the IOM study, increasing the
availability of fully qualified providers would benefit TRICARE
beneficiaries.
This interim final rule establishes a transition period to phase
out the requirement for physician referral and supervision for mental
health counselors and to create a new category of allied health
professionals, to be known as certified mental health counselors
(CMHCs), who will be authorized to practice independently under
TRICARE.
During this transition period the MHCs who do not meet the
requirements for independent practice as established in this rule, may
continue to provide services to TRICARE beneficiaries under the
requirements of physician referral and ongoing supervision. This
transition period, ending December 31, 2014, will allow time for those
MHCs who seek to continue providing services under the TRICARE program
to meet the independent practice requirements as outlined in this
notice. After that date persons who do not meet the requirements for
being a CMHC will no longer be recognized by TRICARE and payment for
their services will no longer be allowed even if they work under the
supervision of a physician.
Lastly, although this rule sets forth the currently accepted and
recommended criteria for an individual to be recognized as a CMHC,
Section 199.6(c)(3)(iii)(N)(3) has been added to allow the Director,
TRICARE Management Activity to amend or modify existing requirements or
add other qualifications or criteria in the future to accommodate
professional quality and licensing standards as they may change over
time.
The rule meets DoD's goal to balance the implementation of quality
standards for mental health counselors with beneficiary access to their
services. The implementation period of the provider requirements
elaborated in this rule permits DoD to preserve patient access to
experienced and well-trained mental health professionals while
permitting other providers to meet those standards by January 1, 2015.
This rule is expected to encourage greater participation of MHCs in the
TRICARE network, result in improved access to quality mental health
treatment for TRICARE beneficiaries, and sets provider quality
standards typical of other mental health providers authorized under
TRICARE.
Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review'' and Executive
Order 13563, ``Improving Regulation and Regulatory Review''
Section 801 of Title 5, United States Code, Executive Order (E.O.)
12866, and E.O. 13563 require certain regulatory assessments and
procedures for any major rule or significant regulatory action, defined
as one that would result in an annual effect of $100 million or more on
the national economy or which would have other substantial impacts. It
has been certified that this rule is not economically significant, and
has been reviewed by the Office of Management and Budget as required
under the provisions of E.O. 12866 and E.O. 13563.
Public Law 104-4, Section 202, ``Unfunded Mandates Reform Act''
Section 202 of Public Law 104-4, ``Unfunded Mandates Reform Act,''
requires that an analysis be performed to determine whether any federal
mandate may result in the expenditure by State, local, and tribal
governments, in the aggregate, or by the private sector of $100 million
in any one year. It has been certified that this rule does not contain
a Federal mandate that may result in the expenditure by State, local
and tribal governments, in aggregate, or by the private sector, of $100
million or more in any one year, and thus this rule is not subject to
this requirement.
Public Law 96-354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 601)
Public Law 96-354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C.
601), requires that each Federal agency prepare a regulatory
flexibility analysis when the agency issues a regulation which would
have a significant impact
[[Page 80743]]
on a substantial number of small entities. This rule is not an
economically significant regulatory action, and it has been certified
that it will not have a significant impact on a substantial number of
small entities. Therefore, this rule is not subject to the requirements
of the RFA.
Public Law 96-511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35)
This rule does not contain a ``collection of information''
requirement, and will not impose additional information collection
requirements on the public under Public Law 96-511, ``Paperwork
Reduction Act'' (44 U.S.C. chapter 35).
Executive Order 13132, ``Federalism''
E.O. 13132, ``Federalism,'' requires that an impact analysis be
performed to determine whether the rule has federalism implications
that would have substantial direct effects on the States, on the
relationship between the national government and the States, or on the
distribution of power and responsibilities among the various levels of
government. It has been certified that this rule does not have
federalism implications, as set forth in E.O. 13132.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
Accordingly, 32 CFR Part 199 is amended as follows:
PART 199--[AMENDED]
0
1. The authority citation for Part 199 continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
0
2. Section 199.4 is amended by revising paragraph (c)(3)(ix)(A)
introductory text to read as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(c) * * *
(3) * * *
(ix) * * *
(A) Covered diagnostic and therapeutic services. Subject to the
requirements and limitations stated, CHAMPUS benefits are payable for
the following services when rendered in the diagnosis or treatment of a
covered mental disorder by a CHAMPUS-authorized, qualified mental
health provider practicing within the scope of his or her license.
Qualified mental health providers are: psychiatrists or other
physicians; clinical psychologists, certified psychiatric nurse
specialists, certified clinical social workers, certified marriage and
family therapists, certified mental health counselors, pastoral
counselors under a physician's supervision, and until December 31,
2014, mental health counselors under a physician's supervision. No
payment will be made for any service listed in paragraph (c)(3)(ix)(A)
of this section rendered by an individual who does not meet the
criteria of Sec. 199.6 of this part for his or her respective
profession, regardless of whether the provider is an independent
professional provider or an employee of an authorized professional or
institutional provider.
* * * * *
0
3. Section 199.6 is amended by adding paragraph (c)(3)(iii)(N) and
revising (c)(3)(iv)(C) to read as follows:
Sec. 199.6 TRICARE--authorized providers.
* * * * *
(c) * * *
(3) * * *
(iii) * * *
(N) Certified mental health counselor. For the purposes of CHAMPUS,
a certified mental health counselor (CMHC) must be licensed for
independent practice in mental health counseling by the jurisdiction
where practicing. In jurisdictions with two or more licenses allowing
for differing scopes of independent practice, the licensed mental
health counselor may only practice within the scope of the license he
or she possesses. In addition, a CMHC must meet all of the requirements
contained in this paragraph (c)(3)(iii)(N)(1) or the requirements of
paragraph (c)(3)(iii)(N)(2) of this section.
(1) The requirements of this paragraph are that the CMHC:
(i) Must have passed the National Clinical Mental Health Counselor
Examination (NCMHCE) or its successor as determined by the Director,
TMA; and
(ii) Must 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 (CACREP); and
(iii) Must have a minimum of two (2) years of post-master's degree
supervised mental health counseling practice which includes 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.
(2) The requirements of this paragraph are that the CMHC, prior to
January 1, 2015:
(i) Possess a master's or higher-level degree from a mental health
counseling program of education and training accredited by CACREP and
must have passed the National Counselor Examination (NCE); or
(ii) Possess a master's or higher-level degree from a mental health
counseling program of education and training from either a CACREP or
regionally accredited institution and have passed the NCMHCE; and
(iii) Must have a minimum of two (2) years of post-master's degree
supervised mental health counseling practice which includes 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.
(3) The Director, TRICARE Management Activity may amend or modify
existing or specify additional certification requirements as needed to
accommodate future practice and licensing standards and to ensure that
all CMHCs continue to meet educational, licensing and clinical training
requirements considered appropriate.
(iv) * * *
(C) Supervised mental health counselor. For the purposes of
TRICARE, a supervised mental health counselor is an individual who does
not meet the requirements of a certified mental health counselor in
paragraph (c)(3)(iii)(N) of this section, but meets the requirements of
this paragraph (c)(3)(iv)(C). After December 31, 2014, this category of
provider will no longer be recognized by TRICARE and no reimbursement
may be made to any person for services provided by this category of
provider. However, prior to January 1, 2015, a supervised mental health
counselor is one who meets all of the following requirements and
conditions of practice:
(1) Minimum of a master's degree in mental health counseling or
allied mental health field from a regionally accredited institution;
and
(2) Two years of post-masters experience which includes 3,000 hours
[[Page 80744]]
of clinical work and 100 hours of face-to-face supervision; and
(3) Is licensed or certified to practice as a mental health
counselor by the jurisdiction where practicing (see paragraph
(c)(3)(iv)(D) of this section for more specific information); and
(4) May only be reimbursed when:
(i) The TRICARE beneficiary is referred for therapy by a physician;
and
(ii) A physician is providing ongoing oversight and supervision of
the therapy being provided; and
(iii) The mental health counselor certifies on each claim for
reimbursement that a written communication has been made or will be
made to the referring physician of the results of the treatment. Such
communication will be made at the end of the treatment, or more
frequently, as required by the referring physician (refer to Sec.
199.7 of this part); and
(iv) The date of services provided is on or before December 31,
2014.
* * * * *
Dated: December 21, 2011.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-33109 Filed 12-23-11; 8:45 am]
BILLING CODE 5001-06-P
