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WAC 296-31-060

What reports are required from mental health providers?

The crime victims compensation program requires the following reports from mental health providers:
(1) Initial response and assessment: Form I: This report is required if you are seeing the client for six sessions or less, and must contain:
(a) The client's initial description of the criminal act for which they have filed a crime victims compensation claim;
(b) The client's presenting symptoms/issues by your observations and the client's report;
(c) If the claimant is unable to work as a result of the crime injury, provide an estimate of when the claimant will return to work and why they are unable to work; and
(d) What type of intervention(s) you provided.
EXCEPTION:
If you will be providing more than six sessions it is not necessary to complete Form I, instead complete Form II.
(2) Initial response and assessment: Form II: This report is required if more than six sessions are anticipated. Form II must be submitted no later than the sixth session, and must contain:
(a) The client's initial description of the criminal act for which they have filed a crime victims compensation claim;
(b) A summary of the essential features of the client's symptoms related to the criminal act, beliefs/attributions, vulnerabilities, defenses and/or resources that lead to your clinical impression (refer to current DSM and crime victims compensation program guidelines);
(c) Any preexisting or coexisting emotional/behavioral or health conditions relevant to the crime impact if present, and how they may have been exacerbated by the crime victimization;
(d) Specific diagnoses with current DSM or ICD code(s), including axes 1 through 5, and the highest GAF in the past year;
(e) Treatment plan based on diagnoses and related symptoms, to include:
(i) Specific treatment goals you and the client have set;
(ii) Treatment strategies to achieve the goals;
(iii) How you will measure progress toward the goals; and
(iv) Any auxiliary care that will be incorporated.
(f) A description of your assessment of the client's treatment prognosis, as well as any extenuating circumstances and/or barriers that might affect treatment progress; and
(g) If the claimant is unable to work as a result of the crime injury, provide an estimate of when the claimant will return to work and why they are unable to work.
(3) Progress note: Form III: This report must be completed after session fifteen has been conducted, and must contain:
(a) Whether there has been substantial progress towards recovery for the crime related condition(s);
(b) If you expect treatment will be completed within thirty visits (for adults) or forty visits (for children); and
(c) What complicating or confounding issues are hindering recovery.
(4) Treatment report: Form IV: This report must be completed for authorization for treatment beyond thirty sessions for adults or forty sessions for children, and again for authorization if treatment will go beyond fifty sessions for adults or sixty sessions for children. Form IV must contain:
(a) The diagnoses at treatment onset with current DSM or ICD code(s), including axes 1 through 5, and the highest GAF in the past year;
(b) The current diagnoses, if different now, with current DSM or ICD code(s), including axes 1 through 5, and the highest GAF in the past year; and
(c) Proposed plan for treatment and number of sessions requested, and an explanation of:
(i) Substantial progress toward treatment goals;
(ii) Partial progress toward treatment goals; or
(iii) Little or no progress toward treatment goals.
(5) Termination report: Form V: If you discontinue treatment of a client for any reason, a termination report should be completed within sixty days of the client's last visit, and must contain:
(a) Date of last session;
(b) Diagnosis at the time client stopped treatment;
(c) Reason for termination (e.g., goals achieved, client terminated treatment, client relocated, referred to other services, etc.); and
(d) At this point in time do you believe there is any permanent loss in functioning as a result of the crime injury? If yes, describe symptoms based on diagnostic criteria for a DSM diagnosis.
(6) Reopening application:This application is required to reopen a claim that has been closed more than ninety days, to demonstrate a worsening of the client's condition and a need for treatment. If the claimant has met or exceeded the maximum benefit, we will be unable to pay for reopening exams or diagnostic tests. If the benefits paid on this claim are less than the maximum benefit, we will reimburse you for filing the application, for an office visit, and diagnostic studies needed to complete the application up to the maximum benefit. No other benefits will be paid until a decision is made on the reopening. If the claim is reopened, we will pay benefits for a maximum of sixty days prior to the date we received the reopening application.
[Statutory Authority: Chapter 7.68 RCW. WSR 15-12-066, § 296-31-060, filed 5/29/15, effective 7/1/15; WSR 12-23-085, § 296-31-060, filed 11/20/12, effective 1/1/13. Statutory Authority: RCW 7.68.030, 51.04.030 and 51.36.060. WSR 99-20-031, § 296-31-060, filed 9/29/99, effective 11/1/99. Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030. WSR 95-15-004, § 296-31-060, filed 7/5/95, effective 8/5/95. Statutory Authority: Chapter 7.68 RCW. WSR 94-02-015, § 296-31-060, filed 12/23/93, effective 1/24/94. Statutory Authority: RCW 43.22.050. WSR 92-23-033, § 296-31-060, filed 11/13/92, effective 12/14/92.]
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