Obtaining outpatient mental health care, including addiction and recovery

Kaiser Permanente of Washington is no longer requiring 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 of Washington is no longer requiring 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.