Obtaining outpatient mental health care, including addiction and recovery
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 of their care. The mental health provider must coordinate care with the member's personal physician. See Coordination of member mental health care.
Kaiser Permanente Washington has received feedback from community providers regarding the impending change to the authorization process for outpatient mental health therapy and CPT code 90834. Please note, we have added the CPT code 90791 to the 90834 authorization. This allows the provider to complete an initial evaluation for the member and bill accordingly. If the provider determines that they need to bill CPT codes other than 90834 for outpatient treatment, the provider can submit a reauthorization request for 90837 (PDF) and follow the standard process for authorization and reauthorization. Additionally, we have updated the authorization request form for 90834 (PDF) and it will be active beginning January 1, 2020.
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 measureable treatment goals and objectives
To facilitate this review, the practitioner must complete a re-authorization form requesting continuing care and mail or fax it to the Mental Health Access Center using the information on the form. The form must include sufficient information to make a decision about medically necessary care. See Forms on the mental health page.
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.
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