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11 Cards in this Set
- Front
- Back
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Stage I of Peer Review Law:
(Preliminary Disclosure) (Independent Peer Review Committee not involved) |
Request received from 3rd party payor. 14 Days to obtain authorization from client, 10 days to provide third party with limited client info marked "Confidential"
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Describe the Client Authorization:
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Must be in writing; nature of info to be disclosed; person authorized to disclose it; to whom it can be disclosed; specific purpose; ct aware of statutory priviledge protecting communication; consent may be revoked anytime; signed, dated by ct. (if 14 or older, ct & parent sign). Authorization valid for one year; ct gets copy.
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What is the limited info that can be provided in Stage I?
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Ct name, sex, address, educational status, insurance ID number, date of onset, date of initial consultation, dates of sessions, type of session (indiv or group), fees. DX (all 5 axes), Ct inpt or outpt, vol or invol, reason for continuing service limited to ct current level of impairment/distress--use terms none, mild, moderate, severe, extreme; Prognosis limited to estimate of minimal time tx might continue.
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Stage II Review:
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Notify Board within 10 days of request from 3rd party. Include theoretical orientation, area of specialization. Within 10 days Bd designates IPRC.
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What is provided to the IPRC in a Stage II Review?
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Directly to the IPRC and not the Bd: ct's authorization; ID #, Ct status; duration/freq of tx; 5 axis Dx; prognosis; reasons for continuing; judgement of impairment; level of distress (none,mild, mod, severe, extreme)
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In a Stage II Review, what do the IPRC do?
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examine material from licensee & third party; make independent assessment if services are usual, customary, reasonable. Confer; If U,C,or R, they inform third party; if they do not agree, notify Bd, proceed to Stage III.
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What is Usual, Customary, Reasonable?
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Usual is what the licensee usually does.
Customary is what others similar to the licensee do. Reasonable is that it is reasonable to believe ct will benefit from services. |
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What happens in Stage III Review?
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IPRC request written statement from licensee describing customary tx for dx and ct from their theoretical orientation. If IPRC assesses it is U,R,or C, notify third party. If not, notify Bd and proceed to Stage IV.
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What happens in Stage IV Review?
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Bd appoints 3rd reviewer. Licensee provides details of case. Original ct record, session notes, test data. Majority rules and notifies third party and Bd. Let third party know of dates and length of time reviewing case.
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What happens if 3rd party requests Bd to investigate IPRC conclusion?
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Bd may require IPRC to provide Bd with the complete file of review team.
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When is IPRC process not required? When is lawful access to ct tx records permitted?
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In case of ct mental condition in issue in Court, Ct consents to release of records to Court.
Licensee ordered by Ct. Third party party under PIPP, requests inspection of ct record or written report. 3rd party directs ct to submit to mental health exam-examinee submits findings. |
