Behavioral Health - Psychotropic Medication funding for indigent consumers

Objective: The objective of the psychotropic medication funding policy is to establish a consistent and objective set of criteria to determine eligibility for financial assistance for medications that are recommended by a psychiatrist.

Policy: It is the policy of Rusk County Health and Human Services that mentally ill consumers of behavioral health services be offered limited and temporary financial assistance with medications that are prescribed by a psychiatrist if they meet both financial and clinical criteria. Assistance will be in the form of pre-payment and consumers will be responsible for repayment of total cost to the County.

Criteria for determining eligibility:

  • Consumer must be a resident of Rusk County
  • Consumer must be an open case of Rusk County Health and Human Services through our contracted outpatient provider
  • Consumer must have no medication coverage, and no eligibility to be covered by insurance, WI MA, Family Health Center or any other 3rd party pay source.
  • Consumer must demonstrate there are no other financial resources available to pay for the medication
  • Consumer will stop taking the medication if not provided by the program and this will have a severe negative clinical impact on the consumer (as established by a written statement from the psychiatrist's office and the MD's signature)
  • Medications covered will only include medications designed to treat psychiatric disorders and related side effects, and the treatment of acute withdrawal and will not include medications that are either designed to address other physical symptoms/illness.

  • Procedure:

    1. Individuals who receive the financial assistance benefit for psychotropic medications will be responsible for repayment of the total cost of the medication to Rusk County Health & Human Services. Reference should be made to the Behavioral Health Uniform Fee Policy and Procedures in terms of financial application/eligibility, billing, collections, hardship determination and administrative review.
    2. A new referral will be considered for authorization when the outpatient provider submits a request for authorization form, and an accurately completed HSRS form, and the consumer completes appropriate financial eligibility forms. Health and Human Services will review these items and determine authorization for services. Cases that are authorized will be opened.
    3. Once a case is opened, a referral for psychiatry must be requested by a counselor, therapist or Behavioral Health case manager. This request must be documented in the outpatient treatment plan or in the Behavioral Health care plan.
    4. At the psychiatric appointment, the psychiatrist will document a decision regarding the negative clinical impact on the consumer if the consumer did not take the recommended psychotropic medication. See attached authorization form.
    5. Wherever possible, RCHHS will look to our contracted provider to provide samples of medications to consumers, particularly for an emergency or trial basis, or while awaiting approval from an indigent medication program. The provider will also be responsible for assisting consumers in applying for pharmaceutical patient assistant programs. Any financial eligibility information that the County possesses will be available to the provider in this process. These expectations will be referenced in our provider contract for services.
    6. RCHHS will receive a request from our outpatient provider for medication advance payment assistance when the above steps have been taken and County financial assistance is still necessary. Included in the request will be the authorization form including documentation from the psychiatrist of negative clinical impact, and a copy of a completed indigent medication program application, where available.
    7. If RCHHS approves the request for advance payment assistance for medications, a Behavioral Health Services representative will phone or fax in the authorization to one of the pre-selected pharmacies.
    8. When the bill is received for the medications, it will be paid and copied to the consumers billing file for reimbursement by the consumer. See Behavioral Health U>niform Fee Policy for details.
    9. The time frame for County advance payment assistance with medications will be limited to 30 days, with exceptions possible at the discretion of RCHHS.

    • For more information call 1-800-535-RUSK or email us at  info@ruskcounty.org
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