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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.

Table of Contents

  • Chapter One


  • Chapter Two

    Evaluating the Impact of the Demonstration: Implementation, Objectives, Framework, and Methods

  • Chapter Three

    Impact on Beneficiaries

  • Chapter Four

    Impact on Providers

  • Chapter Five

    Impact on TRICARE

  • Chapter Six

    Implication of Findings, Caveats, and Conclusions

  • Appendix A

    Demonstration Materials

  • Appendix B

    Evaluation Tasks and Methods

  • Appendix C

    Beneficiary Survey: Background and Survey Instrument

  • Appendix D

    Beneficiary Survey: Supplemental Data Tables

  • Appendix E

    Administrative Claims Data: Supplemental Data Tables

The research described in this report was sponsored by the Office of the Secretary of Defense (OSD). The research was conducted jointly by RAND Health’s Center for Military Health Policy Research and the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center supported by the OSD, the Joint Staff, the unified commands, and the defense agencies.

This report is part of the RAND Corporation Monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND monographs undergo rigorous peer review to ensure high standards for research quality and objectivity.

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