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Update on L&I Pilot Project: November 2018

December 09, 2018 8:28 AM | Emily Fell

Laura Groshong, LICSW, WSSCSW Legislative Consultant

It has been a major frustration that for the past 20 years LICSWs have not been eligible to provide mental health services for people who are injured on jobs which are covered by Workman’s Compensation.  Many of us have had calls from people who have this coverage and cannot find psychologists or psychiatrists, the only clinicians covered, who will see them. Labor and Industries (L&I), the oversight agency for Workman’s Compensation, has finally agreed to set up a pilot project to give LICSWs and other Master’s level clinicians a chance to provide these services.  I have attended four 3-hour meetings this year and will attend several more to develop the project which will start in 2019 and will go until 2021, at which time it will hopefully become permanent.

L&I is a system unlike any other.  The closest system that parallels it is EAP work but even that is not a perfect comparison. Anyone providing psychotherapy will have to communicate with the attending physician, the claims manager, and the employer. Another difference is that the codes that are used will be the HBAI codes, not the DSM codes, which are based on functionality, not a disorder. One more difference - reimbursement is calculated is in 15 minute increments, not by CPT codes.

HIPAA does not apply to L&I; they have an exemption.  This may lead to some of us deciding to pass as the confidentiality we generally expect does not protect patient communications in this plan.  On the other hand, we are entering the brave new world of Integrated Care where many of these changes will also apply, e.g., there will have to be reports every session to the rest of the 'team' on how the initial goals are being achieved.

As for coverage in L&I,  six sessions will be provided without prior authorization, another six if progress is being made.  Another six will be allowed if needed. Any more than 18 sessions will push the patient into the Independent Medical Evaluation (IME) system which is something that L&I wants to avoid, as it is much more expensive. It thus causes increased expenses for the L&I and employers.

In short, there will be a steep learning curve for anyone wants to be part of the pilot project (which should be somewhere in the 200-300 range for LICSWs in the pilot project).  There will be several trainings before the project goes ‘live’ next year. I will keep you posted.

Laura Groshong, LICSW is a Legislative Consultant for WSSCSW. She can be contacted at lwgroshong@comcast.net.

Washington State Society for Clinical Social Work
PO Box 252 • Everett, WA  98206 • admin@wsscsw.org

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