Behavioral Health Care Services
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Active Duty Service Members
Active duty service members (ADSMs) must have a referral and prior authorization before seeking behavioral health care. TRICARE does not want to discourage you from getting help but wants to make sure that your condition does not adversely affect your health and your ability to perform worldwide duty. Your primary care manager (PCM) will coordinate all of your behavioral health care referrals and authorizations.
Note: In the event of a behavioral health emergency, go immediately to the nearest emergency room or call 911.
All Others Enrolled in TRICARE Prime or TPRADFM
You may see a network provider authorized under TRICARE regulations to see patients independently for the first eight outpatient behavioral health care services per fiscal year (FY) (October 1– September 30) for a medically diagnosed and covered condition without a PCM referral or authorization from Humana Military. Independent behavioral health providers generally include psychiatrists or other physicians, clinical psychologists, certified psychiatric nurse specialists, clinical social workers, and certified marriage and family therapists. The first eight visits without a referral only apply to an initial appointment and any follow-on visits that are related to a diagnosed medical or behavioral condition. If you need non-medical counseling not covered under TRICARE, you may be eligible for services through a military family support center or counseling services in your community. Although a PCM referral is never required for behavioral health services, your behavioral health care provider must obtain prior authorization from Humana Military for visits exceeding eight in a fiscal year (FY). If you obtain care from a non-network provider without prior authorization from Humana Military, point-of-service (POS) fees will apply.
Authorized Behavioral Health Care Providers
You may seek outpatient behavioral health care from TRICARE-authorized network providers. The following types of behavioral health providers may be authorized providers under TRICARE:
- Certified psychiatric nurse specialists are licensed, master’s-level psychiatric nurses with an additional American Nurses Association certification in behavioral health. Certified psychiatric nurse specialists include both psychiatric clinical nurse specialists and psychiatric nurse practitioners. Psychiatric clinical nurse specialists mainly perform psychotherapy while psychiatric nurse practitioners generally provide medication management.
- Mental health, licensed professional, and pastoral counselors have a master’s degree in counseling. They perform counseling and psychotherapy services but cannot prescribe medication. In order to provide services to TRICARE beneficiaries, these providers require written physician referral and ongoing clinical supervision from a doctor of medicine (MD) or doctor of osteopathic medicine (DO) prior to your initial visit.
- Certified marriage and family therapists have a master’s degree in counseling, with an emphasis on family and marriage therapy. They perform individual counseling and family and marriage therapy but cannot prescribe medication.
- Licensed clinical social workers have a master’s level degree in social work, with additional training in psychotherapy and counseling. They perform psychotherapy and counseling services but cannot prescribe medication.
- Clinical psychologists have a doctoral-level degree (doctor of philosophy or doctor of psychology) in psychology. They perform psychotherapy, psychological testing, and counseling services but usually cannot prescribe medication.
- Psychiatrists are physicians who have a general medical degree (MD or DO) and have completed advanced residency training in psychiatry. Most psychiatrists treat persons with more serious disturbances for which medication is helpful (e.g., major depression, bipolar disorder, attention deficit/hyperactivity disorder). Psychiatrists perform psychotherapy, manage medication, and work in collaboration with the provider types listed above.
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