1. (1) The mental health services covered in this section are different from the mental health services covered under community mental health and involuntary treatment programs in chapter 182-538D WAC.

2. (2) Inpatient and outpatient mental health services not covered under chapter 182-538D WAC may be covered by the medicaid agency under this section.

   Inpatient mental health services

3. (3) For hospital inpatient psychiatric admissions, providers must comply with chapter 182-538D WAC.

4. (4) The agency covers professional inpatient mental health services as follows:

   1. (a) When provided by a psychiatrist, psychiatric advanced registered nurse practitioner (ARNP), psychiatric mental health nurse practitioner-board certified (PMHNP-BC), or psychologist in conjunction with the prescribing provider;

   2. (b) The agency pays only for the total time spent on direct psychiatric client care during each visit, including services provided when making rounds. The agency considers services provided during rounds to be direct client care services and may include, but are not limited to:

      1. (i) Individual psychotherapy up to one hour;
      2. (ii) Family/group therapy; or
      3. (iii) Electroconvulsive therapy.

   3. (c) One electroconvulsive therapy or narcosynthesis per client, per day, and only when performed by a psychiatrist.

      Outpatient mental health services

5. (5) The agency covers outpatient mental health services when provided by the following licensed or certified health care practitioners who are eligible providers under chapter 182-502 WAC:

   1. (a) Advanced social worker;
   2. (b) Advanced social worker associate;
   3. (c) Certified behavioral health support specialist;
   4. (d) Independent clinical social worker;
   5. (e) Independent clinical social worker associate;
   6. (f) Marriage and family therapist;
   7. (g) Marriage and family therapist associate;
   8. (h) Mental health counselor;
   9. (i) Mental health counselor associate;
   10. (j) Psychiatric advanced registered nurse practitioner (ARNP);
   11. (k) Psychiatric mental health nurse practitioner-board certified (PMHNP-BC);
   12. (l) Psychiatrist;
   13. (m) Psychological associate; or
   14. (n) Psychologist.

6. (6) With the exception of child psychiatrists, as defined in RCW 71.34.020, qualified practitioners listed in subsection (5) of this section who diagnose and treat clients age 18 and younger must meet one of the following:

   1. (a) The education and experience requirements for a child mental health specialist found in WAC 182-538D-0200; or
   2. (b) Be working under the supervision of a practitioner who meets these requirements.
7. (7) The agency does not limit the total number of outpatient mental health visits a licensed health care professional can provide.
8. (8) The agency evaluates a request for covered outpatient mental health services in excess of the limitations in this section under WAC 182-501-0169.

9. (9) The agency covers outpatient mental health services with the following limitations:

   1. (a) Diagnostic evaluations. One psychiatric diagnostic evaluation, per provider, per client, per calendar year, unless significant change in the client's circumstances renders an additional evaluation medically necessary and is authorized by the agency.

      1. (i) For clients 20 years of age and younger, additional evaluations are paid for when medically necessary and authorized by the agency, per WAC 182-534-0100 and 182-501-0165.

      2. (ii) For clients five years of age and younger, the agency pays for the following without requiring prior authorization:

         1. (A) Up to five sessions to complete a psychiatric diagnostic evaluation; and
         2. (B) Evaluations in the home or community setting, including reimbursement for provider travel.
      3. (iii) For clients age five through age 20, the services in (a)(ii)(A) and (B) of this subsection are paid for when medically necessary and authorized by the agency.
   2. (b) Psychotherapy. One or more individual or family/group psychotherapy visits, with or without the client, per day, per client, when medically necessary.

   3. (c) Medication management. One psychiatric medication management service, per client, per day, in an outpatient setting when performed by one of the following:

      1. (i) Psychiatrist;
      2. (ii) Psychiatric ARNP; or
      3. (iii) PMHNP-BC.
10. (10) To receive payment for providing mental health services, providers must bill the agency using the agency's published billing instructions.

[Statutory Authority: RCW 41.05.021, 41.05.160, 2024 c 371, and chapter 246-929 WAC. WSR 25-22-061, s 182-531-1400, filed 10/30/25, effective 1/1/26. Statutory Authority: RCW 18.227.100, 41.05.021, and 41.05.160. WSR 25-04-011, s 182-531-1400, filed 1/23/25, effective 2/23/25. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-12-036, § 182-531-1400, filed 5/30/24, effective 7/1/24. Statutory Authority: RCW 41.05.021, 41.05.160, and 71.34.020. WSR 23-11-097, § 182-531-1400, filed 5/18/23, effective 6/18/23. Statutory Authority: RCW 41.05.021, 41.05.160 and 2021 c 126 § (2)(11). WSR 22-11-028, § 182-531-1400, filed 5/11/22, effective 6/11/22. Statutory Authority: RCW 41.05.021, 41.05.16 [ 41.05.160], and 2017 c 226. WSR 19-15-107, § 182-531-1400, filed 7/22/19, effective 8/22/19. Statutory Authority: RCW 41.05.021, 41.05.160, 2014 c 225. WSR 16-06-053, § 182-531-1400, filed 2/24/16, effective 4/1/16. Statutory Authority: RCW 41.05.021, 41.05.160. WSR 15-03-041, § 182-531-1400, filed 1/12/15, effective 2/12/15. WSR 11-14-075, recodified as § 182-531-1400, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.09.521. WSR 08-12-030, § 388-531-1400, filed 5/29/08, effective 7/1/08. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 01-01-012, § 388-531-1400, filed 12/6/00, effective 1/6/01.]