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Questions and Answers for Psychologists


Program Overview

What is the WSIB Community Mental Health Program?

The Community Mental Health Program is a structured approach to give people access to psychological assessment and evidence-informed, outcome-focused treatment. The WSIB and the Ontario Psychological Association (OPA) collaborated in developing the program.

The program will be delivered by psychologists registered in the WSIB’s Community Mental Health Network (see section on network below). For the purposes of the program, the term “psychologist” is used to describe members of the College of Psychologists of Ontario, which includes psychological associates. The program includes an intake and pre-authorization phase, an initial assessment, treatment provided within pre-authorized treatment blocks, and associated fees. Assessments and progress are documented with the Community Mental Health Program Assessment Form (PDF) and the Community Mental Health Program Progress Form (PDF) respectively.

What is the intake and pre-authorization phase?

The intake and pre-authorization phase requires the psychologist to briefly review basic information and determine whether a person needs assessment and treatment. The psychologist must confirm that the person meets the admission criteria for the Community Mental Health Program. The psychologist should then inform the WSIB by phone that the person is seeking care and obtain pre-authorization to assess and treat the person. The WSIB Case Management Team will then decide whether to authorize an assessment alone or an assessment and treatment if the appropriate criteria are met and the claim has been registered.

In what timeframe must the initial assessment be completed once there is authorization to proceed?

Timely assessment, treatment, and communication (i.e., submission of assessment and progress forms) are key features of this program. The initial assessment should be completed efficiently, and the assessment form must be submitted within five business days of the last assessment visit.

Do psychologists have to collect their patient’s consent when submitting information to the WSIB?

No. The Personal Health Information Protection Act, 2004, Section 43(1)(h) permits a health information custodian to disclose health information without consent as permitted or required by law, including section 37 of the Workplace Safety and Insurance Act, 1997. Section 37 of the Workplace Safety and Insurance Act 1997 states: “Every health care practitioner who provides health care to a worker claiming benefits under the insurance plan or who is consulted with respect to his or her health care shall promptly give the Board such information relating to the worker as the Board may require”. Therefore, when obtaining informed consent for services, the psychologist should inform their patient that the psychologist is required to provide information “relating to the worker as the Board may require”.

The Community Mental Health Program has an “Assessment Form” and “Progress Form” that need to be completed and submitted to the WSIB. Does the WSIB still need separate narrative psychological reports under the program?

No. Psychologists may prepare separate narrative psychological reports and progress notes, which they may share with the patient and her or his other treatment provider(s); however, these do not need to be submitted to the WSIB. Furthermore, narrative psychological reports will not be accepted as substitutions for the Community Mental Health Program assessment and progress forms.

Is there a minimum number of visits that must be delivered in the pre-authorized treatment blocks?

Yes. A treatment block is designed to allow six sessions of evidence-informed and goal-oriented psychological treatment over a maximum of eight weeks, with a progress form due after every sixth session or eighth week, whichever comes first. A maximum of three treatment blocks can be pre-authorized during the program. If the patient attended three or more treatment sessions within an eight-week period, the full treatment block fee will be paid. Where fewer than three treatment sessions were delivered, the fee will be reduced to 50 per cent of the full rate. For more information, please refer to the Community Mental Health Program Fee Schedule (PDF).

Are there specific interventions that must be delivered under the Community Mental Health Program?

While the program does not stipulate specific psychological interventions, interventions delivered to a patient must be evidence-informed and support identified treatment goals that are relevant to the overall recovery and return to occupational function goals.

How should the progress form be completed if the patient does not return or self-discharges from treatment?

In instances where the patient self-discharges from treatment or does not return, the progress form should be completed as fully as possible, relying on information available from the most recent visit. The treating psychologist should indicate on the form that the patient self-discharged from the program and the date of the last visit.

What steps should a psychologist take if the patient requires ongoing treatment after the third treatment block is complete?

The WSIB may authorize additional treatment block(s) if it is clinically justified and if further improvement is expected. The treating psychologist should contact the WSIB Case Management Team to discuss the case and request authorization to deliver care through additional treatment blocks. The Case Management Team will review the case with the treating psychologist and evaluate the need for a referral to a WSIB Specialty Program.

Who may deliver the Community Mental Health Program?

Psychologists who are registered in the Community Mental Health Network may deliver the Community Mental Health Program. Please refer to questions and answers in the WSIB Community Psychologist Network section for more information.

Eligibility and Admission Requirements

Who is the Community Mental Health Program for?

The Community Mental Health Program is designed for all people with a WSIB registered claim who require psychological assessment or treatment. This includes people who experience a psychological reaction secondary to a work-related physical injury, as well as people who experience a significant work-related psychological response to a workplace incident or cumulative incidents, such as chronic mental stress, traumatic mental stress, first responder PTSD.

Do people need a physician’s referral for entry into this program?

No. A referral from a physician is not required to enter the program; however, the psychologist must always obtain pre-authorization from the Case Management Team to proceed with assessment and treatment.

Who should psychologists call to obtain pre-authorization for assessment and/or treatment?

The WSIB Case Management Team may pre-authorize assessment and/or treatment. Psychologists should call the WSIB General Line at 1-800-387-0750 or 416-344-1000 to speak with the Case Management Team.

What should a psychologist do if a person wants an assessment and treatment but has not registered a claim with WSIB?

The psychologist must screen the person to determine whether she or he meets the program intake criteria, which includes having a registered WSIB claim. In cases where the person does not have a registered claim, the psychologist should refer to the Psychologist Intake Guide document (PDF) for recommendations on how to proceed. The psychologist may also provide the person with the Worker’s Guide to Registering a Claim, which provides steps someone can take to register their claim.

Community Mental Health Network

Who is eligible to register for the Community Mental Health Network and how?

The Community Mental Health Network is open to all psychologists and psychological associates in good standing with their college. Psychologists must be authorized in autonomous or interim autonomous practice. They must review all program materials available on the WSIB website, review a brief webinar (available on the WSIB and OPA websites), and obtain an electronic billing number. Once these activities are complete, the psychologist must submit a completed Community Mental Health Network Psychologist Registration Form (PDF) to the WSIB.

Does a psychologist have to be a member of the Ontario Psychological Association (OPA) to complete the training?

No. Training materials are available to all psychologists on the WSIB website and the OPA website.

What are the benefits of joining the Community Mental Health Network?

People who need psychological assessment or treatment for a work-related psychological injury will be able to access care within the program, which will facilitate timely and effective care with less potential for delay or disruption. Additional benefits for psyhchologists include better remuneration, easier reporting, faster and simpler billing and payment, and online listing in the network.

Can psychologists who are part of the Community Mental Health Network still provide service and bill using the WSIB Psychology Fee Schedule?

As a registered provider with the Community Mental Health Network, a psychologist must provide services under the Community Mental Health Program and bill using the associated fees for services provided to people who are eligible for the program. Network psychologists may not bill using the general WSIB Psychology Fee Schedule for people who are eligible for the Community Mental Health Program.

Will there be a quality assurance process for Community Mental Health Program providers?

Yes. To ensure they are meeting program standards, psychologists who deliver the Community Mental Health Program will be monitored and evaluated for adherence to program delivery guidelines and quality of services. The WSIB will contact providers to discuss feedback about program delivery, quality of services and form completion, and/or billing.

Can psychologists who are not part of the Community Mental Health Network still treat people with a WSIB claim?

Yes. Psychologists who are not registered under the Community Mental Health Network can still treat people with a WSIB claim. However, they will not be able to provide treatment under the Community Mental Health Program and will not be eligible to bill Community Mental Health Program fees. Psychologists not registered under the Community Mental Health Network must bill using the WSIB Psychology Fee Schedule (PDF).

Billing

Where can I find information about billing under the Community Mental Health Program?

Please see the Community Mental Health Program Fee Schedule (PDF) and billing instructions for details. Assessment and progress forms are paid upon receipt; no separate online billing is required. Treatment blocks are billed electronically by the provider. The assessment and treatment blocks are only payable when the corresponding forms have been received.

What will happen if the psychologist does not submit the assessment form or the progress form on time?

Psychologists must submit Community Mental Health Program assessment and progress forms within five business days of the completing the assessment or treatment block. If the assessment or progress form is submitted after five business days, the associated fees will be reduced. Failure to submit the forms may impact payment for services. In addition, the block treatment payments will be withheld until the WSIB has received the progress form.

Why would a psychologist not receive payment for the initial assessment and assessment form OR for treatment blocks?

Payment for the assessment form is included in the fee for the initial assessment. The WSIB will only process payment for the initial assessment and assessment form will only be processed once it has received the assessment form.

The WSIB will pay treatment blocks once it has received the corresponding progress form.

Does the WSIB require health professionals to bill electronically?

Yes, health professionals must submit bills for treatment services electronically for efficient payment. Please bill electronically through the WSIB’s payment processor, TELUS Health Solutions. Please do not bill electronically for the initial assessment, the assessment form or the progress form. Forms are pre-populated with billing information, and the WSIB will process payment if the form is completed in full.

For further information on electronic billing, please contact the TELUS Health Solutions Support Centre at 1-866-240-7492 or visit www.telushealth.com/wsib.

Who can a psychologist call with questions about payment?

The health professional can contact the WSIB at 1-800-387-0750 or 416-344-1000 and ask for the Health Care Payment Inquiry Line.

Where can I find more information about the Community Mental Health Program?

Visit our Community Mental Health Program web page for more information about the program. Health professionals can call the WSIB Health Care Practitioner Access Line at 1-800-569-7919 or 416-344-4526 to discuss any general questions about the Community Mental Health Program.

Resources

Are other resources and tips available?

Yes. Additional information, tips and resources, including the Community Mental Health Program Reference Guide, are available on the Community Mental Health Program web page and the Ontario Psychology Association (OPA) website.

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