Expanding Access to Mental Health Counselors

TRICARE, the program through which military health system beneficiaries access health care services, provides coverage for most medically necessary mental health care delivered by qualified providers. Federal legislation in 2001 required the Department of Defense to conduct a demonstration project involving expanded access under TRICARE to a particular type of mental health service provider — the licensed or certified mental health counselor (LMHC). Under the demonstration, LMHCs could provide services to covered beneficiaries without physician referral or adherence to physician supervision requirements, both of which are otherwise required. This report describes and presents findings from RAND Corporation’s evaluation of the demonstration. The authors present detailed findings, based on surveys and interviews with various stakeholders, on the demonstration’s impact on health care utilization, cost, and outcomes of health care services. The authors examine and compare pre-demonstration and post-demonstration data, and compare results from military catchment areas that participated in the demonstration and catchment areas that did not participate but were studied for comparison purposes.