Active duty service members (ADSMs) must have prior authorization before seeking behavioral health care. We do not want to discourage you from getting help, but we want 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 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.
       

Active Duty Family Members

You may see a network provider for the first eight outpatient behavioral health care visits per fiscal year (FY) (October 1–September 30) without a referral or authorization. After the first eight visits, your behavioral health care provider must obtain prior authorization from Humana Military. If you obtain care from a non-network provider without a referral from your PCM and Humana Military, point-of-service fees will apply.
          

Authorized Behavioral Health Providers

The following types of behavioral health providers may be authorized byTRICARE:

Certified psychiatric nurse specialists are licensed, master’s-level psychiatric nurses with an additional American Nurses Association certification in behavioral health. They perform psychotherapy and manage medications.

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 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. If you are unsure which type of provider would best meet your needs, contact your PCM or Humana Military for assistance. ADSMs and active duty family members (ADFMs) may also call the Behavioral Health Care Provider Locator and Appointment Assistance Line. See Figure 4.4 for regional contact information. This service helps eligible ADSMs and ADFMs find behavioral health care providers and schedule timely appointments for urgent and routine outpatient behavioral health care. Prior to calling the appointment assistance line, ADSMs must have a referral from their military treatment facility (MTF) PCM, SPOC, or MTF behavioral health care clinic to obtain civilian behavioral health care. Note: ADSMs calling this service without an appropriate referral or authorization will only be provided with MTF points of contact.

TRICARE access standards for urgent and routine medical care apply to all behavioral health care services, including appointments made through the appointment assistance line. The wait time for an initial urgent, behavioral health care appointment shall generally not exceed 24 hours. The wait time for an initial routine, behavioral health care appointment shall not exceed one week. After the initial appointment, the behavioral health care provider’s medical judgment will determine the wait time for any follow-up appointments.