Wash. Admin. Code § 296-31-012 - What mental health treatment and services are not authorized?

(1) The crime victims compensation program will not authorize services and treatment:

(a) Beyond the point that the accepted condition becomes fixed and stable (i.e., maintenance care);

(b) After a client is determined to be permanently totally disabled and while receiving financial support for lost wages except if the treatment is deemed medically necessary for previously accepted condition(s);

(c) When services are not considered proper and necessary. Services that are inappropriate to the accepted condition, which present hazards in excess of the expected benefit, are controversial, obsolete, or experimental are presumed not to be proper and necessary, and shall only be authorized on an individual case basis with written authorization for the service from the department;

(d) That are not considered to be evidence-based and curative treatment; or

(e) For any therapies which focus on the recovery of repressed memory or recovery of memory which focuses on memories of physically impossible acts, highly improbable acts for which verification should be available, but is not, or unverified memories of acts occurring prior to the age of two.

(2) We will not pay for services or treatment, including medications:

(a) On rejected claims;

EXCEPTION:

We will pay for assessments or diagnostic services used as a basis for the department's decision.

(b) After the date a claim is closed.

EXCEPTION:

Therapy for eligible survivors of victims of homicide can be provided on closed claims.

(c) After the maximum benefit has been reached.

Notes

Wash. Admin. Code § 296-31-012

Statutory Authority: Chapter 7.68 RCW. 12-23-085, § 296-31-012, filed 11/20/12, effective 1/1/13. Statutory Authority: RCW 7.68.030, 51.04.030, 51.36.010. 00-10-003, § 296-31-012, filed 4/20/00, effective 5/22/00; 99-20-031, § 296-31-012, filed 9/29/99, effective 11/1/99.