Mental Health Services

Authorization requirements

All mental health care requires prior authorization. Ongoing treatment may be approved for up to 90 days at a time.

How to request prior authorization for mental health services

Claims insured by L&I (the State Fund) Submit Preauthorization form (downloadable)

For an initial mental health evaluation — when the diagnosis has not been established — you can leave the form’s Diagnosis Description and Causal Relationship fields blank.

Self-Insured Claims

Contact the self-insured employer or their third party representative

Schedule for chart notes and reports

Every visit Chart notes

If chart notes include all required elements listed below, then 30-day or 60-day reports are not required.

Every 30 days Report When treating an unrelated mental health condition that is retarding recovery of an accepted condition.
Every 60 days Report When treating an accepted mental health condition.

Reporting requirements summary

Under workers’ compensation insurance, mental health treatment must focus on helping occupationally injured and ill workers heal and return to work. We require documentation that gives claim managers the information they need to make timely and fair decisions. These requirements apply to treatment for workers covered by L&I as well as by self-insured employers.

All reports must be legible, preferably electronic, and in a style that can be understood by non-medical personnel. Each report must contain at least the following:  

  1. Diagnosis, explicitly using DSM-5 criteria and the appropriate specifier (e.g., severe vs. mild, partial remission vs. in remission),
  2. Relationship of the diagnosis, if any, to the industrial injury or occupational disease,
  3. Summary of subjective complaints,
  4. Objective findings,
  5. Time limited, intensive treatment plan focusing on functional improvement,
  6. Medications prescribed,
  7. Assessment of functional status using WHODAS 2.0 (at baseline and every 30 days),
  8. Assessment of targeted symptoms using standardized instruments to measure symptom severity, when indicated (e.g., PHQ-9  or BDI for depression, GAD-7 or BAI for anxiety),
  9. Worker’s ability to work as it relates to the mental health condition, including specific targeted symptoms that are barriers to work. Include the treatment plan related to those barriers. Recommend work modifications when appropriate.

Detailed information about how to write reports and treatment plans


Billing Note:

Reimbursement requirements
Additional documentation may be required for reimbursement. For complete information, see Billing & Payment.

 

 

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