Outpatient mental health care services

The Mental Health Access Center (MHAC) provides and authorizes payment for mental health care, including addiction and recovery, that is medically necessary and covered by the member's medical coverage agreement. Eligible members initiate service by contacting the Mental Health Access Center.

Other support service available is Mind Phone.

Kaiser Permanente does not require prior authorization for outpatient therapy or psychiatry services provided by any provider in the member’s specific contracted network. For all other outpatient mental health services, or if you are a non-contracted provider, the Mental Health Access Center (MHAC) authorizes an initial number of sessions based on member diagnoses, prior service, etc., and sends verification paperwork to the practitioner and member. This written notification states the terms of service and provides billing information.

We pay for services based on:

• Type of service (mental health or substance use disorder)
• Modality (individual, family, group, medication management, testing)
• Level of intensity (outpatient, intensive outpatient, partial, residential, inpatient)
• Practitioner discipline (see Types of mental health care and practitioners)

We assign referrals to practitioners based on:

• Practitioner discipline and credentials needed to address the member's needs
• Member's health plan coverage and requirements, including network choice
• Member's place of residence

For most members, their personal physician is the central provider of all their care. The mental health provider must coordinate care with the member's personal physician.

Re-authorization
Kaiser Permanente does not require re-authorization for outpatient therapy or psychiatry services provided by any provider in the member’s specific contracted network. For all other outpatient mental health services, or if you are a non-contracted provider, we want to strongly encourage all providers to begin using the online provider portal, “OneHealthPort”, to enter requests for additional visits. When entered via the online provider portal, requests are automatically entered into the system and, if appropriate, may be authorized without review. If requests are submitted by fax, the request must be manually entered into the system and may take longer to process. To request additional visits (reauthorization), please go to the Kaiser Permanente provider site and click on “OneHealthPort Sign In” at the top right of the page to log in to your account. Once you’ve logged into your account, select “Referral/Order Entry” to enter your request. If you have any issues or questions regarding the use of OneHealthPort, please contact the Provider Assistance Unit at 509-241-7206 or 1-888-767-4670.

The Kaiser Permanente medical director or designee (mental health staff, supervisors, and medical staff) periodically review services that fall outside normative guidelines against the criteria adopted by Kaiser Permanente. We review care to assure that it is:

• Medically necessary (see Medically necessary mental health care)
• Appropriate, with interventions based on scientific evidence. When no scientific evidence is available, we base interventions on standards of practice generally held by the mental health community.
• Cost effective
• Provided with realistic, realizable, and measurable treatment goals and objectives

Once MHAC receives the necessary information, they generate a notification letter containing the information specific to the request. For re-authorization of routine care, MHAC will make a coverage decision within 5 days of obtaining all necessary information.

Kaiser Permanente Mental Health Access Center and our contracted mental health practitioners collaborate to effectively coordinate member care through the following administrative requirements, designed to meet regulatory standards.

Practitioners must provide accurate and timely treatment information for our members per the terms of the agreement and must inform members that they will share treatment reports with Kaiser Permanente in accordance with all applicable state and federal confidentiality laws.

For most of our members, their primary care provider or personal physician assumes responsibility for managing their overall care. To assure continuity and coordination of care, we ask that mental health providers communicate with a member's personal physician. At a minimum, this requires:

• Providing the personal physician, in writing or by phone, with the diagnosis, treatment plan, and other relevant clinical information following initial evaluation. Please make note of the communication in your clinical record.
• Notifying the personal physician of any relevant changes in the member's condition or treatment plan while in your care. You must communicate to the personal physician when starting or changing medication.
• In addition to coordinating with the primary care provider, Kaiser Permanente requires mental health practitioners to communicate with other relevant medical, mental health, and addiction and recovery practitioners. Communication on addiction and recovery care requires appropriate release of information documentation.

When a primary care provider is seeing a member and the complexity of the case warrants the care of a psychiatrist, call the Mind Phone toll-free at 1-888-844-4662 for a clinical consultation, or call the Mental Health Access Center directly toll-free at 1-888-287-2680 (206-901-6300) to request a psychiatric referral.

Prescriptions
When prescribing, use our drug formulary. To ensure coverage, please refer members with mental health drug benefits to a Kaiser Permanente-designated pharmacy.

Lab work and urinalysis
Prescribing practitioners may order lab work through our approved labs.

We cover urinalysis (UA) lab requests only when clinically necessary. UA can be used to verify assumptions in the course of treatment planning when a member is showing symptoms of continued substance use. We do not cover UA when requested by a court, school, parent, employer, or other entity for investigative purposes.