Section 11.06. Mental health treatment.

 

(1)   Eligible providers. Eligible providers of mental health treatment under this subchapter include:

(a) A licensed physician who has completed a residency in psychiatry.

(b) A licensed psychologist who is listed or eligible to be listed in the National Register of Health Service Providers in Psychology.

(c) A person with a masters degree who is certified eligible as a psychotherapy provider under the Wisconsin medical assistance program, if providing services under the supervision of a licensed psychologist or psychiatrist certified as a psychotherapy provider under the Wisconsin medical assistance program.

(d) A crisis counselor employed by a recognized crisis counseling agency who works under the supervision of a licensed psychologist or psychiatrist certified as a psychotherapy provider under the Wisconsin medical assistance program.

(2)   Eligible services. Eligible types of mental health treatment under this subchapter include:

(a) Inpatient psychiatric services when prescribed by a physician and when provided within the psychiatric unit of a general hospital or a psychiatric facility.

(b) Outpatient psychotherapy services when provided by a psychiatrist, licensed psychologist, or an eligible masters level provider who meets the supervision requirements.

(c) Crisis intervention services when provided under the aegis of a community facility recognized by the county unified services board or as a component of services provided in a general hospital when such services are provided under the supervision of the psychiatrist or licensed psychologist.

(3)   Limitations on eligible services. Limitations on eligible services include:

(a) Collateral interviews are limited to the non-offending family members.

(b) Group psychotherapy sessions are limited to those in which not more than 10 individuals receive psychotherapy services together from an eligible provider.

(c) Court appearances or evaluations are not eligible services.

(4)   Authorization process. The department shall require eligible providers of services to submit an authorization request which shall include the following information:

(a) The name, address, and medical assistance or identification number of the provider conducting the diagnostic examination and performing the psychotherapy services.

(b) A detailed summary of the problems for which the victim is seeking mental health treatment.

(c) A detailed summary of the diagnostic examination, including the severity of the victim's mental illness, medically significant emotional or social dysfunctions, the medical necessity for treatment and the suggested outcome of treatment.

(d) A statement of the estimated frequency of treatment sessions and the estimated cost of treatment.

(e) A statement of the relationship between the crime and the need for treatment.

(f) A statement of the victim's psychological condition during the 6 months prior to the crime.

(5)   Review process.

(a) Department claims specialists shall review authorization requests for mental health claims. The department may appoint persons who meet the same minimum requirements that providers are expected to meet to review authorization requests.

(b) The department shall review the progress of the treatment periodically as the department determines it is reasonable to do so. Progress reports shall describe the victim's current symptoms, problem changes in symptoms since the last report, progress made toward each treatment goal, a list of impediments to progress, and a plan to address impediments.

History: Cr. Register, February, 1992, No. 434 , eff. 3-1-92; CR 15-058 : am. (1) (intro.), (2) (intro.) Register May 2016 No. 725 , eff. 6-1-16.