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.