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PDFWAC 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.
The consultant must meet provider registration requirements per WAC 296-31-030.
[Statutory Authority: Chapter 7.68 RCW. WSR 12-23-085, § 296-31-065, filed 11/20/12, effective 1/1/13. Statutory Authority: RCW 7.68.030 and 51.04.030. WSR 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. WSR 95-15-004, § 296-31-065, filed 7/5/95, effective 8/5/95. Statutory Authority: Chapter 7.68 RCW. WSR 94-02-015, § 296-31-065, filed 12/23/93, effective 1/24/94. Statutory Authority: RCW 43.22.050. WSR 92-23-033, § 296-31-065, filed 11/13/92, effective 12/14/92.]
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