Current through Register Vol. 24-18, September 15, 2024
(1)
The mental health services covered in this section are different from the
mental health services covered under community mental health and involuntary
treatment programs in chapter 182-538D WAC.
(2) Inpatient and outpatient mental health
services not covered under chapter 182-538D WAC may be covered by the agency
under this section.
Inpatient mental health services
(3) For hospital inpatient psychiatric
admissions, providers must comply with chapter 182-538D WAC.
(4) The agency covers professional inpatient
mental health services as follows:
(a) When
provided by a psychiatrist, psychiatric advanced registered nurse practitioner
(ARNP), psychiatric mental health nurse practitioner-board certified
(PMHNP-BC), or psychologist in conjunction with the prescribing
provider;
(b) The agency pays only
for the total time spent on direct psychiatric client care during each visit,
including services provided when making rounds. The agency considers services
provided during rounds to be direct client care services and may include, but
are not limited to:
(i) Individual
psychotherapy up to one hour;
(ii)
Family/group therapy; or
(iii)
Electroconvulsive therapy.
(c) One electroconvulsive therapy or
narcosynthesis per client, per day, and only when performed by a
psychiatrist.
Outpatient mental health services
(5) The agency covers outpatient mental
health services when provided by the following licensed health care
practitioners who are eligible providers under chapter 182-502 WAC:
(a) Psychiatrists;
(b) Psychologists;
(c) Psychiatric advanced registered nurse
practitioners (ARNP);
(d)
Psychiatric mental health nurse practitioners-board certified
(PMHNP-BC);
(e) Mental health
counselors;
(f) Mental health
counselor associates;
(g)
Independent clinical social workers;
(h) Independent clinical social worker
associates;
(i) Advanced social
workers;
(j) Advanced social worker
associates;
(k) Marriage and family
therapists; or
(l) Marriage and
family therapist associates.
(6) With the exception of child
psychiatrists, as defined in
RCW
71.34.020, qualified practitioners listed in
subsection (5) of this section who diagnose and treat clients age 18 and
younger must meet one of the following:
(a)
The education and experience requirements for a child mental health specialist
found in WAC
182-538D-0200; or
(b) Be working under the supervision of a
practitioner who meets these requirements.
(7) The agency does not limit the total
number of outpatient mental health visits a licensed health care professional
can provide.
(8) The agency
evaluates a request for covered outpatient mental health services in excess of
the limitations in this section under WAC
182-501-0169.
(9) The agency covers outpatient mental
health services with the following limitations:
(a) Diagnostic evaluations. One psychiatric
diagnostic evaluation, per provider, per client, per calendar year, unless
significant change in the client's circumstances renders an additional
evaluation medically necessary and is authorized by the agency.
(i) For clients 20 years of age and younger,
additional evaluations are paid for when medically necessary and authorized by
the agency, per WAC
182-534-0100 and
182-501-0165.
(ii) For clients five years of age and
younger, the agency pays for the following without requiring prior
authorization:
(A) Up to five sessions to
complete a psychiatric diagnostic evaluation; and
(B) Evaluations in the home or community
setting, including reimbursement for provider travel.
(iii) For clients age five through age 20,
the services in (a)(ii)(A) and (B) of this subsection are paid for when
medically necessary and authorized by the agency.
(b) Psychotherapy. One or more individual or
family/group psychotherapy visits, with or without the client, per day, per
client, when medically necessary.
(c) Medication management. One psychiatric
medication management service, per client, per day, in an outpatient setting
when performed by one of the following:
(i)
Psychiatrist;
(ii) Psychiatric
advanced registered nurse practitioner (ARNP); or
(iii) Psychiatric mental health nurse
practitioner-board certified (PMHNP-BC).
(10) To receive payment for providing mental
health services, providers must bill the agency using the agency's published
billing instructions.
11-14-075, recodified as §182-531-1400, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.09.521. 08-12-030, § 388-531-1400,
filed 5/29/08, effective 7/1/08. Statutory Authority:
RCW
74.08.090,
74.09.520. 01-01-012, §
388-531-1400, filed 12/6/00, effective
1/6/01.
