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:
• The complete name and address
(home and business) of the applicant.
• A routine and emergency phone
number for the applicant.
• Legible photocopies of:
• Current
state license which includes the expiration date and the original
issue date of licensure.
• Transcripts
of professional education to include name and address of institution.
• 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.
• 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 calendar
days of receipt by the certifying authority of a complete application.
3.4 Rejected application. An applicant
shall be notified in writing that he or she is no longer considered
an applicant for certification when a pending incomplete application
is not made complete within 60 calendar 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 calendar
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 (e.g., provider did not meet education
criteria), was made during their certification process, the designated
certifying authority must notify the provider in accordance with
the TOM.