Wis. Admin. Code Department of Justice Jus 11.06

Current through August 26, 2024

Section Jus 11.06 - Mental health treatment

(1) ELIGIBLE PROVIDERS. Eligible providers of mental health treatment under this subchapter include a qualified treatment trainee under clinical supervision as defined by s. DHS 35.03(17m) or any of the following individuals licensed by the state in which he or she practices:

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

(e) A psychologist.

(f) A marriage and family therapist.

(g) A professional counselor.

(h) A clinical social worker.

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

(a) Inpatient psychiatric services provided within the psychiatric unit of a general hospital or a psychiatric facility.

(b) Outpatient psychotherapy services.

(d) Complementary mental health services may be considered for payment by the department if administered in conjunction with any of the above-listed treatments, prescribed by an eligible provider, and administered by an accredited practitioner.

(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 may 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 or claimant is seeking mental health treatment.

(c) A detailed summary of the diagnostic examination, including the severity of the victim's or claimant'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, and to what extent the treatment is directly related to the crime.

(f) A statement of the victim's or claimant's psychological condition 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.

Wis. Admin. Code Department of Justice Jus 11.06

Cr. Register, February, 1992, No. 434, eff. 3-1-92.

Amended by, CR 15-058: am. (1) (intro.), (2) (intro.) Register May 2016 No. 725, eff. 6/1/2016

Amended by, CR 19-136: am. (1) (intro.), (a), r. (1) (b) to (d), cr. (1) (e) to (h), am. (2) (a), (b), r. (2) (c), cr. (2) (d), am. (4) (intro.), (b), (c), (e), (f) Register September 2021 No. 789, eff. 10/1/2021