Wash. Admin. Code § 296-31-065 - Can my client be referred for a consultation?

(1) There may be instances when the department or the claimant's mental health provider may want to refer the claimant for a consultation. For example, if the claimant's accepted mental health condition presents a diagnostic or therapeutic challenge, or if the department needs additional information to make a decision on the claim.

(2) There are two levels of consultations that can be performed: Limited and extensive. Descriptions and procedure codes are included in the Crime Victims Compensation Program Mental Health Fee Schedule and Billing Guidelines.

(3) The consultant will be required to submit a report to the department that contains the following elements:

(a) The reason(s) for the consultation referral;

(b) Consultants related recommendations;

(c) Other information as requested by the department.

(4) Authorization from the department is required for:

(a) More than two consultations before the thirtieth session for adults or fortieth session for children; and

(b) More than one consultation between thirty and fifty sessions for adults or between forty and sixty sessions for children.

(5) You may not make a referral for a consultation if:

(a) An independent medical examination has been scheduled;

(b) A consultation has been scheduled by the department;

(c) Claim reopening is pending; or

(d) The claim is closed.

Note:

The consultant must meet provider registration requirements per WAC 296-31-030.

Notes

Wash. Admin. Code § 296-31-065

Statutory Authority: Chapter 7.68 RCW. 12-23-085, § 296-31-065, filed 11/20/12, effective 1/1/13. Statutory Authority: RCW 7.68.030 and 51.04.030. 99-20-031, § 296-31-065, filed 9/29/99, effective 11/1/99. Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030. 95-15-004, § 296-31-065, filed 7/5/95, effective 8/5/95. Statutory Authority: Chapter 7.68 RCW. 94-02-015, § 296-31-065, filed 12/23/93, effective 1/24/94. Statutory Authority: RCW 43.22.050. 92-23-033, § 296-31-065, filed 11/13/92, effective 12/14/92.