HAR §17-1737-17. Psychiatric service and treatment

(a) Psychiatric service shall be allowed where: (1) It is provided under an individualized treatment or diagnostic plan which may be revised during treatment if necessary. (2) Psychiatric service furnished without a planned program of therapy does not constitute treatment and is not reimbursable; and (3) There is a reasonable expectation that service will improve the patient's condition. If the patient's condition is not altered after the authorized outpatient visits in the authorized period of treatment the frequency and number of subsequent outpatient visits requested may be reduced. (b) A psychiatrist shall serve as a source of information and guidance when psychiatric service is provided by authorized mental health therapeutic teams; (c) Drug management alone shall not be considered psychiatric care but shall be considered general medical care. Payments for drug management shall be made to: UNOFFICIAL 1737-15 (1) Authorized outpatient clinics for the cost of the drugs; or (2) Psychiatrists at a general medical visit rate when accepting referrals for the purpose of prescribing psychiatric medications or evaluation of psychiatric medications. (d) Psychiatric treatment shall be authorized for: (1) Individual therapy, in a behavioral or analytic framework; (2) New but non-experimental modes of therapy with prior authorization. The prior authorization will be granted if the provider can demonstrate adequate training and experience in that particular mode of therapy; (3) Group therapy or its variant, including family therapy, which can provide dimensions of treatment not available by other modes of treatment; (4) Combined therapy, a combination of group and individual psychotherapy, except that: (A) Visits shall be either for group or individual therapy, but not for both, on the same day; (B) The patient may have different therapists for group and individual psychotherapy; but (C) The involved therapists must be co-jointly responsible for coordinating the care and treatment of the patient; (5) Maintenance therapy, provided by physicians other than psychiatrists where: (A) The physician shall prescribe psychiatric medication and observe the patient for any changes in the patient's condition or behavior; (B) The physician shall provide supportive care, however, justification and prior authorization shall be required on the designated form requesting outpatient care if supportive care visits are made more frequently than monthly; (C) Psychiatric consultation by a psychiatrist shall be readily available to the physician providing maintenance therapy; and (D) Reimbursement for maintenance therapy shall be equivalent to that of a general medical office visit; and UNOFFICIAL 1737-16 (6) Patients with alcohol and drug problems may require monitoring by pertinent laboratory data. Such decisions regarding the monitoring of data will be decided after consultation and approval of the treating physician. (e) Exclusions for psychiatric care and treatment are those for: (1) Sex; (2) Marriage; (3) Diet; (4) Employment counseling; (5) Primal therapy; ( (6) Long term character analysis; (7) Marathon group therapy; (8) Consortiums; and (9) Other modalities as determined by the department. [Eff 08/01/94 ] (Auth: HRS §346-14; 42 C.F.R. §431.10) (Imp: 42 C.F.R. §405.231)