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WAC 110-80-0240

What specific department requirements apply to outpatient counseling or mental health services not covered by medicaid?

(1) The department's adoption support program directly pays for a child's counseling or mental health services, when the following conditions apply:
(a) The adoptive parent must obtain written authorization from the department's adoption support program before the service is rendered;
(b) The adoptive parent must explain why these services are not available through the medicaid provider network or through private insurance;
(c) The adoptive parents' primary health care coverage must be billed prior to billing the department's adoption support program;
(d) The department will pay the adoption support program's preauthorized rate minus any payment made by the primary (and other) insurer;
(e) The department may grant verbal authorization for no more than three counseling sessions prior to providing the required written authorization; and
(f) The child's therapist or other treatment provider must submit a written treatment plan prior to authorization for continued treatment.
(2) The department may authorize counseling as follows:
(a) Up to six hours of outpatient counseling per month for up to twelve months;
(b) Up to a total of twenty hours per quarter when critical need warrants;
(c) For only one provider at a time unless a second provider is required for a different service; or
(d) Evidence based programs contracted by the department to help stabilize the child in the adoptive home if those programs are pertinent to the needs of the child and family.
(3) The department may extend the authorization for counseling (beyond the initial time period authorized) upon receipt of an updated treatment plan and documentation supporting the need for additional treatment from the treatment provider and a parent's request for continuing counseling.
(4) The provider must provide services to the client face-to-face, i.e., in the same room except where face-to-face services are not reasonably accessible to the child.
[WSR 18-14-078, recodified as § 110-80-0240, filed 6/29/18, effective 7/1/18. Statutory Authority: 42 U.S.C. § 671-675, RCW 26.33.340, 74.13A.020, 74.13A.030, 74.13A.040, 74.13A.045, 74.13A.047, 74.13A.060, 74.13A.075, 74.13A.085, 74.13A.100, 74.15.020, 45 C.F.R. § 1356.40. WSR 18-14-008, § 388-27-0255, filed 6/21/18, effective 7/22/18. Statutory Authority: RCW 74.13.031. WSR 01-08-045, § 388-27-0255, filed 3/30/01, effective 4/30/01.]
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