CurrentmhnPolicy N/A

Family psychotherapy treatment boundaries and authorization

Guidance governing roles and authorization for psychotherapists treating families, clarifying who is the identified client(s) and limits on concurrent individual therapy for multiple family members; applies to Health Net behavioral health providers and affected patients.

Policy Summary

Payermhn

PolicyFamily psychotherapy treatment boundaries and authorization

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 9, 2007

Next Review DateN/A

Key ActionClarify at the start of therapy who the client(s) are and their relationship to the therapist; refer individuals needing ongoing treatment to other providers who collaborate with the designated family therapist.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2007-01-09effective date

06/11/2020committee approval

06/16/2020db update

1guidance count

Coverage Criteria

Authorization and referral criteria

Covered when the following practice and authorization expectations are met

Family therapy primary: There should be a family therapist designated to treat the family unit when multiple family members require treatment.

If multiple members need treatment, family therapist treats unit

Individual therapy adjunct: Individual sessions with one family member may be used as an adjunct to family treatment.

Adjunct individual sessions acceptable

Limit on multiple individual therapies: Ongoing individual therapy for more than one family member should not, as a rule, be authorized; individuals requiring ongoing treatment should be referred to other Health Net behavioral health providers who collaborate with the designated primary therapist.

Authorization generally denied for multiple concurrent ongoing individual therapies within same family

Policy Summary

Payermhn

PolicyFamily psychotherapy treatment boundaries and authorization

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 9, 2007

Next Review DateN/A

SourceLink

On This Page

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Covered when the following practice and authorization expectations are met: designate a family therapist to treat the family unit when multiple family members require treatment; individual sessions with one family member may be used as an adjunct to family treatment; and ongoing individual therapy for more than one family member should not, as a rule, be authorized — individuals needing ongoing individual treatment should be referred to other Health Net behavioral health providers who collaborate with the designated primary therapist.

Therapists must clarify at the start of treatment which person or persons are the identified client(s) and specify the nature of the therapist’s relationship with each person involved. When multiple family members require care, the policy favors treating the family unit as the primary modality and using individual sessions only as adjunctive support; concurrent ongoing individual therapy for multiple family members is generally not authorized.

Provider Actions and Authorization Guidance

Documentation Required

Client identification and relationship documentation

Psychotherapists must clarify at the start of treatment who is the client and the nature of the therapeutic relationship with each person involved. Document explicitly whether the unit (family/couple) or an individual is the client, and note any dual relationships or consent arrangements.

Document at therapy initiation: who is the client (unit or specific individual(s)), roles, and consent for any dual/triadic treatment.

Prior Authorization

Limit on authorizing concurrent individual therapy

The plan recommends that individual sessions be used as an adjunct to family treatment for one member only. Ongoing individual therapy for more than one family member generally will not be authorized. When multiple family members need treatment, the family therapist should treat the unit; individuals requiring ongoing individual therapy should be referred to other MHN behavioral health providers who will collaborate regularly with the designated primary family therapist.

Ongoing individual therapy should not be authorized for more than one family member.
If multiple family members need ongoing individual care, refer those individuals to other MHN providers who must coordinate with the family therapist.

Denial Risk

Authorization guidance and denial risk

Prior authorization and authorization decisions should consider the clinical conflict between family-level and individual-level treatment goals. The provider must show clinical justification in the record for any deviation from the rule against ongoing individual therapy for multiple family members.

Clinical records must document the rationale for concurrent individual treatment when requested.
Absent clear clinical justification, authorization for ongoing individual therapy for more than one family member is at high risk for denial.

Note

Role of the designated family therapist

When multiple members of a family require treatment, there should be a designated family therapist responsible for treating the unit and coordinating care. Individual clinicians providing ongoing treatment to family members must collaborate regularly with that designated primary therapist.

Designate a primary family therapist when treating the family unit.
Other treating providers must document regular collaboration with the primary family therapist.

Background

Psychotherapists should be alert to potential conflicts between the family unit and individual members and manage these proactively. To reduce role confusion and fragmentation of care, the policy recommends (1) clarifying client identity and the therapist’s relationship(s) at therapy commencement, (2) designating a primary family therapist when multiple family members need treatment, and (3) avoiding authorization for ongoing individual therapy for more than one family member; instead, refer individuals needing continued individual treatment to other behavioral health providers who will collaborate with the designated primary therapist.

Definitions

inv-09: primary therapist — define designated primary therapist as key/value

DefinitionDesignated primary therapist: the family therapist identified to treat the family unit when multiple family members require treatment.

RoleTreat the family unit and coordinate care when multiple family members need treatment; serve as the primary point of collaboration for other providers.

Coordination expectationOther Health Net behavioral health providers who provide ongoing individual treatment to family members should collaborate regularly with the designated primary therapist.

ScopeApplies when multiple members of a family require treatment and a family therapist is needed to treat the unit rather than authorizing concurrent, ongoing individual therapy for multiple members.

Documentation implicationTherapists should clarify at the commencement of therapy which person(s) are clients and the nature of the therapist’s relationship(s) with each person involved in treatment.

Level of Care Criteria

Treatment Modalities

Family therapy

Family therapy as primary modality: When multiple family members need treatment, the family therapist should treat the unit and other providers should handle ongoing individual treatment as needed in collaboration.

Modality preference: family therapy as primary