WAC 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. Note: The consultant must meet provider registration requirements per WAC 296-31-030 .