Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 7.68.030, 7.68.070, 51.04.020(1), 51.04.030, 51.32.110.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: (1) Victims need to know that their independent assessments are being ordered according to established criteria and not arbitrarily. The amendment informs victims of that criteria.

(2) Minimum requirements are needed for independent assessment reports so that the department obtains the information needed to act on mental health claims.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: None.

Process for Developing New Rule: Executive Order 97-02 priority review.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Cletus Nnanabu, CVC Program Manager, P.O. Box 44520, Olympia, WA 98504-4520, phone (360) 902-5340, fax (360) 902-5333, e-mail nnan235@Ini.wa.gov. Other opportunities for participation: (1) CVC Advisory Committee; and (2) public hearing (to be scheduled).

June 25, 1998

Gary Moore

Director

AMENDATORY SECTION (Amending WSR 95-15-004, filed 7/5/95, effective 8/5/95)

WAC 296-31-069  ((Independent assessments.)) For what reasons may independent mental health or independent medical assessments be obtained? (((1) Independent assessments may be ordered by the department or requested of the department by the attending provider. Such assessments are usually ordered or requested after consultations for one of the following purposes:

(a) To establish a diagnosis. Prior diagnoses may be controversial or ill-defined.

(b) To outline the treatment rationale, where treatment or progress is vague or controversial.

(c) To establish therapeutic data to determine if the condition requiring treatment is related to conditions sustained and allowed by the department as a result of a specific criminal act.

(d) To determine the extent and duration of aggravation of any preexisting mental health condition.

(e) To establish when the claimant has reached maximum benefit from treatment.

(f) To establish a percentage rating of any permanent impairment, for mental health conditions when maximum recovery is reached.

(g) To determine indications for reopening of a claim for further treatment on basis of the aggravation of the accepted condition.

(h) To determine eligibility qualifications of claimants applying under RCW 7.68.060(3), the repressed memory provision of the Crime Victims Act.

(2) Independent assessments for mental health conditions may be ordered by claims adjudicators without supervisory approval to rate permanent impairment when treatment has been completed, to determine the department's responsibility for treatment that has been rendered retroactively where significant causal relationship questions exist and to determine eligibility qualifications of claimants applying under RCW 7.68.060(3), the repressed memory provision of the Crime Victims Act. All other reasons for ordering independent assessments for mental health conditions require supervisory approval.

(3) The following shall be reported by the assessing practitioner:

(a) Independent assessments must be specific and factual.

(b) The claimant's medical and mental health history must be checked for accuracy, variation or exaggeration compared to documented history provided to the examiner for this assessment.

(c) Diagnosis: Must be specific and describe the mental health condition and symptomatology found using DSM III-R, or DSM IV, and be substantiated by history.

(d) Conclusions: Must be specific and must definitely express an opinion concerning the purpose for which the assessment was requested, and should be consistent with the history and diagnosis reported.

(e) Permanent disability: Ratings must be supported by sufficient data to establish the category disability rating; also the report must demonstrate and articulate a definite causal relationship to the accepted condition(s) on a more probable than not basis.)) What is required in independent assessment reports?

(1) Independent mental health assessments may be obtained when requested by the provider, or on the department's initiative, for the following reasons:

(a) To rate permanent impairment when treatment has been concluded; or

(b) To evaluate an application to reopen a claim; or

(c) To determine if there are conditions related to the effects of the crime for which the claim was filed and if treatment remains necessary for those conditions; or

(d) To determine if crime-related treatment is still necessary and if present treatment is effective; or

(e) To determine if treatment is still leading to recovery; or

(f) To obtain other information that may be necessary for the department to make decisions on the victim's claim.

(2) Practitioners participating in an independent assessment ordered by the department must provide us with a report within thirty days following the last assessment date. The report must:

(a) Be identified as an independent assessment report;

(b) Be specific and factual;

(c) Specify the mental health condition(s) and symptoms found and their relationship to the crime for which the claim was filed. Use the codes contained in the currently accepted DSM;

(d) Provide specific conclusions drawn from the assessment and state opinions that respond to the questions included in the examination request;

(e) If applicable, include the category of permanent impairment that the assessor finds most nearly describes his or her findings.

[Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030. 95-15-004, § 296-31-069, filed 7/5/95, effective 8/5/95. Statutory Authority: RCW 43.22.050. 92-23-033, § 296-31-069, filed 11/13/92, effective 12/14/92.]