WSR 23-08-059
PROPOSED RULES
HEALTH CARE AUTHORITY
[Filed April 3, 2023, 3:50 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 23-05-038.
Title of Rule and Other Identifying Information: WAC 182-531-1400 Psychiatric physician-related services and other professional mental health services.
Hearing Location(s): On May 9, 2023, at 10:00 a.m. In response to the coronavirus disease 2019 (COVID-19) public health emergency, the health care authority (HCA) continues to hold public hearings virtually without a physical meeting place. This promotes social distancing and the safety of the residents of Washington state. To attend the virtual public hearing, you must register in advance https://us02web.zoom.us/webinar/register/WN_hBvwLAwGQNaCbfhRKR7ciw. If the link above opens with an error message, please try using a different browser. After registering, you will receive a confirmation email containing information about joining the public hearing.
Date of Intended Adoption: No later than May 10, 2023.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, by May 9, 2023, by 11:59 p.m.
Assistance for Persons with Disabilities: Contact Johanna Larson, phone 360-725-1349, fax 360-586-9727, telecommunication[s] relay service 711, email Johanna.Larson@hca.wa.gov, by April 28, 2023.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is amending WAC 182-531-1400(6) to update the requirements in subsection (6)(a) with a cross-reference to WAC 182-538D-0200 and to align requirements for professionals treating children with RCW
71.34.020 and WAC 182-538D-0200.
Reasons Supporting Proposal: See purpose.
Rule is not necessitated by federal law, federal or state court decision.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Not applicable.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Jason Crabbe, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-9563; Implementation and Enforcement: Christine Cole, P.O. Box 45506, Olympia, WA 98504-5506, 360-725-1368.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is not required under RCW
34.05.328. RCW
34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
Scope of exemption for rule proposal from Regulatory Fairness Act requirements:
Is not exempt.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The revised rule does not impose more-than-minor costs on small businesses.
April 3, 2023
Wendy Barcus
Rules Coordinator
OTS-4442.1
AMENDATORY SECTION(Amending WSR 22-11-028, filed 5/11/22, effective 6/11/22)
WAC 182-531-1400Psychiatric physician-related services and other professional mental health services.
(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 ((professionals))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) Independent clinical social workers;
(g) Advanced social workers; or
(h) Marriage and family therapists.
(6) With the exception of ((
licensed psychiatrists and psychologists))
child psychiatrists, as defined in RCW 71.34.020, qualified ((
health care professionals))
practitioners listed in subsection (5) of this section who
diagnose and treat clients age 18 and younger must
meet one of the following:
(a) ((Have a minimum of 100 actual hours of specialized study of child development and treatment and a minimum of one year of supervised experience in the diagnosis and treatment of clients age 18 and younger))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 ((professional))practitioner who meets these ((criteria))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.