PDFWAC 296-31-016
What treatment or services require authorization from the crime victims compensation program?
(1) The program must authorize the following mental health services and/or treatment:
(a) Consultations beyond what are allowed in WAC 296-31-065;
(b) Inpatient hospitalization;
(c) Concurrent treatment with more than one provider;
(d) Electroconvulsive therapy;
(e) Neuropsychological evaluation (testing);
(f) Day treatment for seriously ill children under eighteen years old;
(g) Referrals for services or treatment not in our fee schedule;
(h) Teleconsultations and other telehealth services.
(2) Your request for authorization must be in writing and include:
(a) A statement of the condition(s) diagnosed;
(b) Current DSM or ICD codes;
(c) The relationship of the condition(s) diagnosed to the criminal act; and
(d) An outline of the proposed treatment program that includes its length, components, procedure codes and expected prognosis.