[Federal Register Volume 67, Number 176 (Wednesday, September 11, 2002)]
[Notices]
[Pages 57581-57582]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-23029]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


Office of the Secretary of Defense (Health Affairs)/TRICARE 
Management Activity; Notice of a Demonstration Project for Expanded 
Access to Mental Health Counselors

AGENCY: Department of Defense.

ACTION: Notice of a demonstration project.

-----------------------------------------------------------------------

SUMMARY: This notice is to advise interested parties of a Military 
Health System (MHS) demonstration project entitled Demonstration 
Project for Expanded Access to Mental Health Counselors. The National 
Defense Authorization Act (NDAA) of Fiscal Year (FY) 2001, Public Law 
(PL) 106-398, section 731 has directed the Secretary of Defense to 
conduct a demonstration project for expanded access to mental health 
counselors under TRICARE. According to the legislation, the Secretary 
of Defense shall conduct a demonstration project under which licensed 
and certified professional mental health counselor who meet eligibility 
requirements for participation as providers under the TRICARE program 
may provide services to covered beneficiaries under Chapter 55 of Title 
10, United States Code, without referral by physicians or adherence to 
supervision requirements.

EFFECTIVE DATE: This demonstration project applies to all covered 
beneficiaries 18 years of age or older under chapter 55 of Title 10, 
United States Code who receive mental health services within the 
demonstration region and a non-demonstration region following full 
implementation of the demonstration, which will occur upon announcement 
of this notice and will be in effect for two years.

FOR FURTHER INFORMATION CONTACT: CAPT Mark Paris, Office of the 
Assistant Secretary of Defense (Health Affairs)--TRICARE Management 
Activity, (703) 681-0064.

SUPPLEMENTARY INFORMATION:

A. Background

    Section 731 of the National Defense Authorization Act for Fiscal 
Year 2001 directs the Department to conduct a demonstration project 
under which licensed and certified professional mental health 
counselors who meet eligibility requirements for participation as 
providers under the Civilian Health and Medical Program of the 
Uniformed Services (CHAMPUS) or the TRICARE program may provide 
services to covered beneficiaries under chapter 55 of Title 10, U.S.C., 
without referral by physicians or adherence to supervision 
requirements.
    Currently, licensed or certified mental health counselors must meet 
several eligibility and administrative requirement to be an authorized 
Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS)/TRICARE provider. These requirements include documentation of 
a referral from a physician, ongoing supervision of their services by a 
physician, and certification of written communication and follow-up 
with the physician following each service visit. Services provided by 
other mental health professionals, including licensed clinical social 
workers, clinical psychologists, and psychiatric nurse specialists, are 
currently reimbursed

[[Page 57582]]

independent of referral or supervision by a physician.
    The NDAA for FY 2001 requires the Department of Defense to conduct 
a demonstration project for expanded access to mental health counselors 
under TRICARE. The Secretary of Defense has been directed to conduct a 
demonstration project under which licensed and certified professional 
mental health counselors who meet eligibility requirements for 
participation as providers under the TRICARE program may provide 
services to covered beneficiaries under chapter 55 of Title 10, United 
States Code, without referral by physicians or adherence to supervision 
requirements.
    The legislation further requires an assessment of the extent to 
which independent reimbursement of licensed or certified mental health 
counselors impacts utilization and reimbursement costs for such 
services, and affects the confidentiality of and treatment outcomes for 
covered beneficiaries seeking mental health services. The legislation 
also directs a description of the administrative costs associated with 
documenting referrals and supervision, and an assessment of the impact 
of independent reimbursement on the willingness of providers to 
participate in TRICARE.

B. Description of Demonstration Project

    Location of Project: The Demonstration will be conducted in the 
TRICARE Central Region because of the relatively high utilization of 
mental health counselors in that region. Comparison data will be 
gathered from the Central Region and if necessary, from another TRICARE 
region.
    Project Components: The Project will include implementation and 
evaluation components.

I. Implementation

    Licensed and/or certified mental health counselors in the Colorado 
Springs and Omaha catchment areas who are members of the Central Region 
TRICARE network will be invited to participate in this two year 
demonstration. Under the demonstration, participating counselors will 
be allowed to provide services to TRICARE beneficiaries without receipt 
of either a physician referral or physician case supervision. 
Counselors will be asked to sign a participant agreement form 
acknowledging the temporary nature of the demonstration. Potential 
beneficiaries/clients of these counselors will be provided with 
information about the demonstration and be asked to sign an informed 
consent form to acknowledge their understanding of the demonstration 
and the potential risks of participation. There will be no other 
changes to the normal treatment processes for beneficiaries. Claims 
submitted by participating counselors will be flagged and processed for 
independent reimbursement by TRICARE (to allow for processing without 
the supervision and referral).

II. Evaluation

    Rand Corporation will be responsible for gathering data on:
    A. Utilization and reimbursement regarding non-physician mental 
health professionals other than licensed or certified professional 
mental health counselors under CHAMPUS and the TRICARE program.
    B. Utilization and reimbursement regarding physicians who make 
referrals to, and supervise mental health counselors.
    C. Administrative costs incurred as a result of the requirement for 
documentation of referral to mental health counselors and supervision 
activities for such counselors.
    D. A comparison of data for a one-year period for the area in which 
the demonstration is being conducted with corresponding data for a 
similar area in which the demonstration project is not being 
implemented.
    E. A description of the ways in which allowing for independent 
reimbursement of licensed or certified professional mental health 
counselors affects the confidentiality of mental health and substance 
abuse services for covered beneficiaries under CHAMPUS and the TRICARE 
program.
    F. A description of the effect, if any, of changing reimbursement 
policies on the health and treatment of covered beneficiaries under 
CHAMPUS and the TRICARE program, including a comparison of the 
treatment outcomes of covered beneficiaries who receive mental health 
services from licensed or certified professional mental health 
counselors acting under physician referral and supervision, other non-
physician mental health providers recognized under CHAMPUS and the 
TRICARE program, and physicians, with treatment outcomes under the 
demonstration project allowing independent practice of professional 
counselors on the same basis as other non-physician mental health 
providers.
    G. The effect of policies of the Department on the willingness of 
licensed or certified professional mental health counselors to 
participate as health care providers in CHAMPUS and the TRICARE 
program.
    H. Any policy requests or recommendations regarding mental health 
counselors made by health care plans and managed care organizations 
participating in CHAMPUS or the TRICARE program.

    Dated: August 4, 2002.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 02-23029 Filed 9-10-02; 8:45 am]
BILLING CODE 5001-08-M