3.0 POLICY CONSIDERATIONS
3.1 Application.
A complete application for certification as a certified marriage
and family therapist consists of an application signed and dated
by the requesting provider which provides:
3.1.1 The complete name and address (home and
business) of the applicant.
3.1.2 A routine and emergency phone number for
the applicant.
3.1.3 Legible photocopies of:
3.1.3.1 Current state
license which includes the expiration date and the original issue
date of licensure.
3.1.3.2 Transcripts
of professional education to include name and address of institution.
3.1.3.3 Documentation
of proof of supervised clinical experience which includes name and address
of institution, dates of experience, name of supervisor, and signed
certification that the applicant has successfully completed the
required training hours.
3.1.3.4 In the absence
of jurisdictional licensure/certification, proof of full clinical
membership (or eligibility for such) in the American Association
for Marriage and Family Therapy (AAMFT). Proof may be either a copy
of the formal response from the AAMFT acknowledging full clinical
membership (or eligibility for such) in their Association, or listing
in the current AAMFT Directory as a full clinical member.
3.2 Development.
The certifying authority shall make at least one request for information
missing from an application.
3.3 Decision notice. The certification
decision shall be rendered within 60 days of receipt by the certifying
authority of a complete application.
3.4 Rejected application. An applicant
shall be notified in writing that he/she is no longer considered
an applicant for certification when a pending incomplete application
is not made complete within 60 days of the date a written notice
to the applicant of the deficiencies of the applicant’s application
unless the certifying authority has extended the response time for
good reason.
3.5 Denied application. An applicant
shall be notified in writing of the specific reason(s) that certification
is not granted.
3.6 Certification process.
3.6.1 Authorization
of an applicant as an authorized certified marriage and family therapist
shall be made only after the certifying authority has verified that:
3.6.1.1 The information
provided in the complete application is true and current.
3.6.1.2 The applicant
complies in all respects with the requirements of the 32 CFR 199.
3.6.1.3 The applicant
is not otherwise barred from provider status.
3.6.1.4 The applicant
has returned a signed participation agreement.
3.6.1.5 The applicant
has used their Social Security Number (SSN) or their Employer’s
Identification Number (EIN) as the billing number.
3.6.2 Amended application.
An applicant has amended a pending or approved application within
30 days of a change in any of the information required for application.
3.6.3 Compliance
verification. The certifying authority shall maintain contemporary documentation
that the currency of each approved certified marriage and family
therapist has been verified at least at 24-month intervals following
initial approval as an individual provider.
3.6.4 Certified
marriage and family participation agreement. The text of the participation agreement
for certified marriage and family therapists is at
Addendum A.
The
contractor is not authorized to make any change in the language
of this agreement. Applicant specific changes to this agreement
will not be considered by DHA.
3.7 Recertification. The claims processor is
to follow the TRICARE Operations Manual (TOM),
Chapter 4, Section 1, and the above outlined
process for recertification of currently authorized marriage and
family counselors and previously authorized pastoral counselors
desiring to become certified marriage and family therapists. Previously
authorized pastoral counselors or new applicants for pastoral counseling
choosing to be an authorized certified marriage and family therapist
must meet all the regulatory requirements for a certified marriage
and family therapist including licensure, national association membership
requirements and provisions of participation (see
Sections 3.9 and
3.10).
3.8 Unassigned claims
submitted by providers:
3.8.1 Who are marriage and family counselors
or previously identified pastoral counselors who have elected to
become certified marriage and family therapists and who have signed
a participation agreement should be denied.
3.8.2 Who have not
signed a participation agreement should be denied by the claims
processors as “provider not authorized” and offered information
on how to become an authorized provider.
3.8.3 Who are marriage and family counselors
or pastoral counselors who have elected to become a certified marriage
and family therapist and who had entered into a participation agreement with
DHA and subsequently terminated the agreement should be denied as
“provider not authorized”.
3.9 Unassigned claims submitted by beneficiaries:
3.9.1 For care rendered
by a marriage and family counselor or previously identified pastoral counselors
who have elected to become certified marriage and family therapists
and have signed a participation agreement should be returned uncontrolled
to the beneficiary with instructions that the provider must submit
the claim before payment can be made.
3.9.2 For care rendered by a marriage and family
counselor or pastoral counselor not signing a participation agreement
should be denied as “provider not authorized” and offered information
on how to become an authorized provider.
3.9.3 For care rendered by a marriage and family
counselor or pastoral counselor who has elected to become a certified
marriage and family therapist and who had entered into a participation agreement
and subsequently terminated the agreement should be denied as “provider
not authorized” and returned to the beneficiary.
3.10 Administrative
error.
Should the designated DHA certifying authority
authorize a provider as a certified marriage and family therapist
and subsequently realize that an administrative error (i.e., provider
did not meet education criteria, etc.), was made during their certification
process, the designated certifying authority must notify the provider
in accordance with the TOM.