DHS 107.13(2)(a)1.d. d. The recipient’s strengths, and current and past psychological, social, and physiological data; information related to school or vocational, medical, and cognitive function; past and present trauma; and substance abuse.

DHS 107.13(2)(a)1.e. e. The recipient’s unique perspective and own words about how he or she views his or her recovery, experience, challenges, strengths, needs, recovery goals, priorities, preferences, values and lifestyle, areas of functional impairment, and family and community support.

DHS 107.13(2)(a)1.f. f. Barriers and strengths to the recipient’s progress and independent functioning.

DHS 107.13(2)(a)1.g. g. Necessary consultation to clarify the diagnosis and treatment.

DHS 107.13(2)(a)3. 3. Psychotherapy is furnished by:

DHS 107.13(2)(a)3.a. a. A provider who is a licensed physician, licensed psychologist, or a licensed and certified advanced practice nurse prescriber who is individually certified under s. DHS 105.22 (1) (a), (b), or (bm) and who is working in an outpatient mental health clinic certified under s. DHS 105.22 or in private practice.

DHS 107.13(2)(a)3.b. b. A provider under s. DHS 105.22 (3) who is working in an outpatient mental health clinic that is certified under s. DHS 105.22 to participate in MA.

DHS 107.13(2)(a)4. 4. Psychotherapy is performed only in any of the following:

DHS 107.13(2)(a)4.a. a. The office of a provider for providers who may bill directly.

DHS 107.13(2)(a)4.b. b. A hospital outpatient mental health clinic on the hospital’s physical premises.

DHS 107.13(2)(a)4.c. c. An outpatient mental health clinic.

DHS 107.13(2)(a)4.d. d. A nursing home.

DHS 107.13(2)(a)4.e. e. A school.

DHS 107.13(2)(a)4.f. f. A hospital.

DHS 107.13(2)(a)4.g. g. The home.

DHS 107.13(2)(a)4.h. h. Via telehealth when the provider is in a location that ensures privacy and confidentiality of recipient information and communications.

DHS 107.13(2)(a)5. 5. The provider who performs psychotherapy shall engage in contact with the recipient in person, via real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed under MA.

DHS 107.13(2)(c) (c) Other limitations.

DHS 107.13(2)(c)1. 1. Collateral interviews shall be limited to members of the recipient’s immediate family. These are parents, spouse and children or, for children in foster care, foster parents.

DHS 107.13(2)(c)2. 2. No more than one provider may be reimbursed for the same psychotherapy session, unless the session involves a couple, family group or is a group therapy session. In this subdivision, “group therapy session” means a session not conducted in a hospital for an inpatient recipient at which there are more than one but not more than 10 individuals receiving psychotherapy services together from one or 2 providers. Under no circumstances may more than 2 providers be reimbursed for the same session.

DHS 107.13(2)(c)3. 3. Emergency psychotherapy may be performed by a provider for a recipient without a prescription for treatment or prior authorization when the provider has reason to believe that the recipient may immediately injure himself or herself or any other person. A prescription for the emergency treatment shall be obtained within 48 hours of the time the emergency treatment was provided, excluding weekends and holidays. Services shall be incorporated within the limits described in par. (b) and this paragraph, and subsequent treatment may be provided if par. (b) is followed.

DHS 107.13(2)(c)4. 4. Strength-based assessment, including a differential diagnostic evaluation for mental health, day treatment and substance abuse services shall be limited to 8 hours every calendar year per recipient as a unique procedure before prior authorization is required.

DHS 107.13(2)(c)5. 5. Services under this subsection are not reimbursable if the recipient is receiving community support program services under sub. (6) or psychosocial services provided through a community-based psychosocial service program under sub. (7).

DHS 107.13(2)(c)6. 6. Professional psychotherapy services provided to hospital inpatients in general hospitals, other than group therapy and medication management, are not considered inpatient services. Reimbursement shall be made to the psychiatrist, psychologist, or advanced practice nurse prescriber billing providers certified under s. DHS 105.22 (1) (a), (b), or (bm) who provide mental health professional services to hospital inpatients in accordance with requirements of this subsection.

DHS 107.13(2)(d) (d) Non-covered services. All of the following services are not covered services:

DHS 107.13(2)(d)1. 1. Collateral interviews with persons not stipulated in par. (c) 1., and consultations, except as provided in s. 49.45 (29y), Stats., and s. DHS 107.06 (4) (d).

DHS 107.13(2)(d)2. 2. Psychotherapy for individuals with the primary diagnosis of developmental disabilities, including intellectual disabilities, except when they experience psychological problems that necessitate psychotherapeutic intervention.

DHS 107.13(2)(d)3. 3. For individuals age 21 and over, psychotherapy provided in a person’s home.

DHS 107.13 Note Note: Section 49.45 (45), Stats., provides for in-home community mental health and alcohol and other drug abuse (AODA) services for individuals age 21 and over. However, these services are available to an individual only if the county, city, town or village in which the individual resides elects to make the services available and agrees to pay the non-federal share of the cost of those services.