CurrentBeacon-Health-OptionsPolicy N/A

Electroconvulsive Therapy (ECT) and Psychiatric Consultation on an Inpatient Medical Unit — Service Preconditions and Goals

Service-specific performance specifications for provision of outpatient Electroconvulsive Therapy (ECT) and inpatient psychiatric consultation services; defines clinical, staffing, documentation, crisis response, quality management, discharge planning, and linkage requirements for contracted providers.

Policy Summary

PayerBeacon-Health-Options

PolicyElectroconvulsive Therapy (ECT) and Psychiatric Consultation on an Inpatient Medical Unit — Service Preconditions and Goals

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionComplete and document the pre-ECT clinical workup, obtain separate DMH informed consent, maintain 24/7 crisis on-call capability with a clinician response within 15 minutes, report adverse incidents within one business day, and ensure timely discharge planning and consultation documentation.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6-12typical number of ECT sessions per course

3x/weekcommon ECT treatment frequency

1-3 weekstypical maintenance ECT interval

15required maximum clinician response time to emergency after-hours ECT calls

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24timeframe to document psychiatric consultation progress note (hours)

Electroconvulsive Therapy (ECT) — Coverage Preconditions and Criteria

ECT — Components and Preconditions for Use

ECT is used only when documentation meets the following requirements:

ALL of the following

Documentation in the member's health record that ECT is being used to treat target symptoms in one of: severe depressive illness, prolonged or severe manic episode, affective components of schizophrenia and related psychotic disorders, catatonia, or neuro‑malignant syndrome (NMS).
Documentation that ECT is intended to achieve rapid and short‑term improvement after an adequate trial of other treatment options has proven ineffective, or when the condition is potentially life‑threatening.
Complete clinical workup prior to ECT including: medical history, physical exam, pre‑anesthetic lab work, psychiatric treatment history, psychopharmacology history including responses, and complete psychosocial history.
Written treatment plan projecting schedule of treatments and identifying available supports during treatment.
Separate written informed consent to ECT on DMH forms; informed consent process documented as dialogue or substituted judgment if unable to consent. Member (or guardian) and psychiatrist agree ECT is desirable after understanding risks, benefits, and alternatives.
Crisis response capability
- Initial crisis response available 24/7 to all members enrolled in ECT.
- During operating hours: clinician reachable by telephone and face‑to‑face emergent appointments if indicated.
- After hours: provide a telephone number with live person answering at all times (directly or via answering service) to allow access to a clinician.
- Calls identified as emergency triaged immediately to a clinician.
- Clinician must respond to emergency calls within 15 minutes and provide at least brief assessment/intervention by phone.
- Referral to Mobile Crisis Intervention (MCI) may be made based on initial crisis response.
Facility written plan for administration of ECT in compliance with JCAHO standards and American Psychiatric Association practice guidelines.
All procedures comply with DMH Regulations 104 CMR 2.04 through 3.10.
Staffing requirements met: multidisciplinary team including board‑certified psychiatrist privileged to administer ECT, anesthetist (with adolescent anesthesia by personnel experienced with adolescents), nurse skilled in care of unconscious members, and appropriate consultants (internist, neurologist, OB‑GYN, pediatrician for adolescents, radiologist, etc.).

ECT — Treatment Dose, Frequency, and Effects (Clinical Information)

Clinical considerations described:

ALL of the following

Seizure threshold varies widely (up to 40‑fold); electrode placement can be bilateral or unilateral (often non‑dominant side to reduce cognitive effects).
ECT may cause short‑ or long‑term retrograde and anterograde memory impairment.
Typical course: 6–12 sessions; commonly administered three times per week; maintenance ECT commonly at 1–3 week intervals.
Number and duration of sessions individualized based on clinical workup and need.

Documentation and Quality Requirements for ECT

Records and quality obligations include:

ALL of the following

Assessment of risks and potential benefits documented in health record.
Informed consent process documented; substituted judgment documented if applicable.
Quality management plan maintained with outcome measures and satisfaction surveys; clinical outcomes data available on request.
Reportable Adverse Incidents reported within one business day per Carelon policy and DMH requirements; adherence to DPH/DMH reporting requirements for serious incidents.

Discharge Planning for ECT

Discharge planning requirements include:

ALL of the following

Discharge planning must address member's identified concerns (housing, finances, healthcare, transportation, familial/occupational/educational/social supports).
Treatment team documents all discharge‑related activities in the medical record reflecting member participation.
Completed discharge form including referrals and emergency/crisis info provided to member and appropriate parties at discharge.
At least one initial aftercare appointment scheduled within 7 days of discharge and documented.
If discharged on medications, at least one psychiatric medication monitoring appointment scheduled within 14 days.

Psychiatric Consultation on an Inpatient Medical Unit — Service Preconditions and Goals

When consultation is requested, the following apply:

ALL of the following

Service applies to medically‑ill members hospitalized on inpatient medical units (not ED presentations).
Goals: ensure safety/stability in medical environment, collect history/medical data, conduct mental status exam, establish differential diagnosis, and initiate treatment plan.
Consultant ideally is a liaison psychiatrist as part of ward‑based multidisciplinary team; use of outside consultants unfamiliar with hospital discouraged.
Psychiatric consultation available 24/7/365.
Provider credentialing: consultation may be provided by board‑certified psychiatrist/child psychiatrist (meeting Carelon criteria), clinical psychologist, child‑trained Psychiatric Nurse Mental Health Clinical Specialist (board‑certified), or NP/Board‑Certified RN Clinical Specialist.

Psychiatric Consultation — Documentation and Linkages

Documentation and system linkages required:

ALL of the following

Consultation provided and documented in a progress note in the health record as soon as possible and no later than within 24 hours of consultation.
Consultation note should be brief, focused on referring physician's concerns, avoid jargon, and be titled with 'Psychiatry' and 'Consultation'.
Consultant ensures direct contact with the requesting clinician to obtain accurate information not always present in the health record.
Consultant familiar with how to access other professionals (neurology, pain, substance use, neuropsychology, PM&R, and allied disciplines) as needed.
Consultant familiar with medical necessity criteria for psychiatric inpatient admission and ability to determine medical stability for admission and outpatient follow‑up processes per Carelon policies.

Numeric and Operational Thresholds

Key Thresholds

ECT course length6–12 sessions

ECT routine frequencythree times per week

ECT maintenance interval1–3 weeks

Clinician emergency response time (after hours)within 15 minutes

Psychiatric consultation documentation timeframeas soon as possible and no later than within 24 hours

Initial aftercare appointment after dischargewithin 7 days

Medication monitoring appointment after dischargewithin 14 days

What Providers Must Do

Documentation Required

Complete pre‑ECT clinical workup and treatment plan

Document a complete pre‑ECT clinical workup in the member's health record that includes medical history, physical examination, pre‑anesthetic laboratory work, psychiatric treatment history, psychopharmacology history including responses to current and prior medications, and a complete psychosocial history. Also record an assessment of risks and potential benefits and a written treatment plan projecting the schedule of treatments and identifying available supports during treatment.

Medical history and physical exam
Pre‑anesthetic lab work
Psychiatric treatment and psychopharmacology history with treatment responses
Complete psychosocial history
Assessment of risks and potential benefits
Written treatment plan projecting treatment schedule and supports

Prior Authorization

Clinical and Administrative Background

Electroconvulsive Therapy (ECT) is a procedure in which an electric current briefly passes through the brain via scalp electrodes to induce a generalized seizure; the member is placed under general anesthesia and given muscle relaxants to prevent body spasms. Electrode placement may be bilateral or unilateral (often on the non‑dominant side to reduce cognitive side effects), and individual seizure threshold varies widely. ECT can cause short‑ or long‑term retrograde and anterograde memory impairment, and a typical acute course is 6–12 sessions, commonly administered three times per week, with maintenance ECT commonly at 1–3 week intervals. [

Key Definitions

Definitions

Reportable Adverse IncidentAn occurrence that represents actual or potential harm to the well‑being of a member, or to others by action of a member receiving services or recently discharged; must be reported within one business day.

Mobile Crisis Intervention (MCI)A provider for emergency behavioral health assessment, crisis intervention, and stabilization used when an ECT provider refers after initial crisis triage.

Policy Summary

PayerBeacon-Health-Options

PolicyElectroconvulsive Therapy (ECT) and Psychiatric Consultation on an Inpatient Medical Unit — Service Preconditions and Goals

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

SourceLink

On This Page

An answering machine/service that only directs callers to 911, MCI, or ED does not meet after‑hours on‑call requirements.

Consultant must have specialized training/experience evaluating mental health in medically ill patients, formulating problems/diagnosis, and implementing treatment plans.

Consultant able to evaluate psychiatric effects on medical/surgical condition and vice versa, and experienced evaluating causes of acute agitation (e.g., psychosis, intoxication, withdrawal, dementia, delirium) including medical etiologies.

Consultant experienced assessing requests for hastened death/physician‑assisted suicide/euthanasia and competency to consent to medical/surgical treatment, when applicable.

Consultant knowledgeable about pain types, assessment, management, and impact if consultation concerns adequacy of pain management.

Consultant with child/adolescent consultations must be trained in child/adolescent psychiatry and familiar with developmental/family and pediatric medical issues.

6-12typical number of ECT sessions per course

3x/weekcommon ECT treatment frequency

1-3 weekstypical maintenance ECT interval

15 minutesmax clinician response time to emergency after-hours ECT calls

24 hourstimeframe to document psychiatric consultation progress note

Informed consent and DMH forms requirement

Obtain a separate written informed consent to ECT using the forms provided by DMH and document the informed consent process in the health record as dialogue when the member can consent or document substituted judgment when the member cannot consent.

Use DMH consent forms (consent to other psychiatric treatment does not include ECT)
Document informed consent discussion as dialogue or document substituted judgment if member unable to consent

Documentation Required

Crisis on‑call capability

Maintain a 24/7 crisis response for all members enrolled in ECT with a telephone number answered by a live person at all times (direct or via answering service); ensure clinician triage and that emergency calls are responded to by a clinician within 15 minutes with at least a brief phone assessment/intervention. An answering machine/service that only directs callers to 911, MCI, or an ED does not meet the after‑hours requirement.

During operating hours: clinician reachable by phone and face‑to‑face emergent appointments if indicated
After hours: live person must answer the clinician access phone number
Clinician must respond to emergency calls within 15 minutes and provide brief assessment/intervention by phone
Referral to Mobile Crisis Intervention (MCI) may follow initial triage
Answering service that only directs callers to 911/MCI/ED is insufficient

Note

Adverse incident reporting

Report all Reportable Adverse Incidents within one business day of their occurrence per Carelon policy and DMH licensing requirements, and adhere to DPH/DMH reporting requirements for serious incidents.

Reportable Adverse Incidents defined as occurrences representing actual or potential harm to the member or others
Comply with all DPH/DMH serious incident reporting rules

Documentation Required

Discharge scheduling and documentation

Provide a completed discharge form (including referrals and emergency/crisis information) to the member and appropriate parties at discharge; schedule and document at least one initial aftercare appointment within 7 days of discharge, and if the member is discharged on medications, schedule a psychiatric medication monitoring appointment within 14 days. Document all discharge‑related activities in the medical record reflecting member participation.

Completed discharge form given to member and, when appropriate, family/guardian or referral source
At least one aftercare appointment scheduled within 7 days and documented
If discharged on medications, at least one medication monitoring appointment scheduled within 14 days
Document all discharge activities and member participation in the medical record

Documentation Required

Psychiatric consultation note timing and content

Document all psychiatric consultations in the member's health record as a progress note as soon as possible and no later than within 24 hours of the consultation; the note should be brief, focused on the referring physician's concerns, clinician‑focused, and clearly titled with 'Psychiatry' and 'Consultation' or equivalent.

Progress note completed ASAP and within 24 hours
Brief, focused on referring clinician's concerns and avoiding jargon
Title the note with 'Psychiatry' and 'Consultation' or equivalent