Mental Health

Mental Health Services

How do I become a mental health provider for the Victim Compensation Program?

Any licensed mental health service provider can serve victims who are claimants with the Victim Compensation Program (VCP). Once an eligible victim goes to a licensed mental health provider for treatment and the provider submits a bill to the VCP, the provider is listed in our system as a provider of services. To speed processing, please include verification of licensure and a completed IRS Form W-9 with the first bill submitted to the VCP.

All needed forms are available on this website. Providers may wish to contact the Victim/Witness centers in the counties surrounding their practice. Some of them maintain referral lists that they give to victims.

Mental Health Bills

Mental Health bills must be submitted on CMS 1500 or 1450 forms and must contain:
Patient’s name and address
Date(s) of service
Type(s) of service(s) provided (diagnosis and procedure)
Billed amount
Provider’s license number, federal tax identification number (FEIN or SSN), business address, telephone number, signature or signature stamp, and billing date

What types of mental health providers can be paid?

The following mental health providers are eligible for reimbursement:

Licensed Psychiatrist (Must have an MD license and must have
- completed their residency in psychiatry OR
- be certified in field of psychiatry with the American Medical Association)
Licensed Psychologist (PhD)
Licensed Clinical Social Worker (LCSW)
Marriage Family Therapist (MFT)
Registered Psychologist (Registered with Board of Psychology)
Psychology Intern - See Below
Psychological Assistant
Associate Social Worker (ASW)
MFT Intern
Peer Counselor (Only for rape crisis counseling)
Psychiatric Mental Health Nurse
Clinical Nurse Specialist

Under what conditions can a psychology intern provide services?

The Board may pay for services provided by interns if those services are provided under the supervision of a licensed mental health professional and if the interns are registered. Exceptions on registration exist for psychology interns who are working in a university hospital or university medical school clinic. Please call Customer Service at (800) 777-9229 to verify that the intern qualifies.

What if I am an out-of-state provider?

Out-of-state psychiatrists (MDs) must submit a copy of their license and documentation that shows they:

Have completed a residency in psychiatry, or
Are certified in the field of psychiatry.

Psychologists (PhDs) must submit documentation of their licensure for reimbursement.

Other providers must be licensed in the state where they provide services.

What are the maximum rates of payment for mental health treatment?

Provider	License or Certificate	Services	Rates effective for dates of service on or after 3/1/2006
Licensed Psychiatrist (MD)	A, C, or G	Individual/family therapy Medication management Group therapy	$130/hour $130/hour $52/hour
PhD Psychologist or Registered Psychologist	PSY	Individual/family therapy Group therapy	$110/hour $44/hour
Psychology Assistant (must be supervised by a psychiatrist, psychologist, or registered psychologist)	PSB	Individual/family therapy Group therapy	Paid at rates allowed for supervisor
LCSW	LCS	Individual/family therapy Group therapy	$90/hour $36/hour
MFT	MFT	Individual/family therapy Group therapy	$90/hour $36/hour
ASW (must be supervised by a licensed therapist)	ASW	Individual/family therapy Group therapy	Paid at rates allowed for supervising therapist
MFT Intern (must be supervised by a licensed therapist)	IMF	Individual/family therapy Group therapy	Paid at rates allowed for supervising therapist
Clinical Nurse Specialist	CNS	Individual/family therapy Group therapy	$90.00/ hour $36.00/ hour
Psychiatric Mental Health Nurse	PMH	Individual/family therapy Group therapy	$90.00/ hour $36.00/ hour
Peer Counselor	Certified by Rape Crisis Center	Rape crisis intervention. Individual therapy for no more than 10 weeks, plus one series of group sessions.	$15/hour
Out-of-State Provider	Varies per state	May provide services appropriate to licensure. See below.	Paid at rate for comparable licensure in California.
Out-of-Country Provider	Varies	Subject to QAMH review.	Paid at rate for comparable licensure in California.

What types of mental health treatment are covered?

The compensation program covers mental health treatment that is necessary as a direct result of the qualifying crime.

What types of mental health expenses are not reimbursed?

The Board cannot pay for treatment unrelated to the crime, missed appointments, interest or similar administrative charges, or treatment related to custody issues.

What are the mental health session limits?

The Board's mental health regulations provide an incremental approach to outpatient mental health service limitations.

For applications filed on or after January 24, 2006:

Children who are victims have an initial limit of 40 sessions.
Adults who are victims have an initial limit of 40 sessions.
Immediate family members of a deceased victim are limited to 30 sessions. (Includes fiancé(e)s who witness the crime)
Primary caretakers of a minor direct victim, at the time of the crime, are limited to 30 sessions each.
Minor derivative victims are limited to 30 sessions.
Other derivative victims are limited to 15 sessions.

For applications filed prior to January 24, 2006:

Children who are victims have an initial limit of 40 sessions.
Adults who are victims have an initial limit of 30 sessions.
Immediate family members of a deceased victim are limited to 30 sessions. (Includes fiancé(e)s who witness the crime)
Other derivative victims are limited to 15 sessions.

Victims of statutory rape (penal code section 261.5(d)) are limited to 30 sessions. Derivative victims of this are not eligible for compensation.

A derivative victim is generally a spouse or domestic partner, sibling, child, grandparent, or grandchild of victim. Former spouses or domestic partners also qualify. An unrelated household member can also be considered a derivative victim, as can any primary caretaker of a child who is a victim. If the fiancé(e) of the victim or any other family member witnessed the crime, he or she is considered a derivative victim.

Providers may be required to submit specified mental health documentation prior to payment. Depending on the length of the treatment, required documents may include a Treatment Plan or an Additional Treatment Plan. Board staff must review and approve the documentation in order for the Board to pay for more than the first five mental health sessions.

How do session limits work?

Providers are required to complete a treatment plan (TP) at the end of their clients' fifth session. The TP must be maintained in the client's file and submitted to the board upon request. Once a provider has submitted a TP, and that plan is approved, no further reports are required unless the provider needs to request additional treatment beyond the initial session limits. Once a claimant reaches his/her initial session limit, an Additional Treatment Plan (ATP) must be submitted by the provider and approved before additional sessions can be recommended for payment.

What is a Treatment Plan?

A Treatment Plan (TP) outlines the focus of treatment, the methods to be used, and the means of measuring progress. Providers are required to complete a TP at the end of their client's fifth session. The TP must be maintained in the client's file and submitted to the board upon request.

What is an Additional Treatment Plan?

If a therapist believes his/her patient needs additional treatment, beyond the initial session limits, an Additional Treatment Plan (ATP) can be filed to request treatment beyond the session limitations of 15, 30, or 40. In an ATP review, the following information is considered:

Circumstances of the crime;
Treatment focus;
Level of impairment that is directly attributable to the crime; and
Progress in treatment.

While all four factors are considered, the most heavily weighted is the circumstances of the qualifying crime, including whether the crime resulted in substantial impairment to the applicant's activities of daily living. This form will be reviewed in conjunction with the previously submitted mental health treatment form. Additional information may be requested.

What about subsequent requests for additional treatment?

The Board will consider the same four factors mentioned above for the ATP, but will review each subsequent request with increased rigor, with an emphasis on any extreme circumstances of the qualifying crime. The Board may also authorize payment for a limited number of additional sessions in specific situations not addressed above, such as when a victim is called to testify in a criminal court hearing related to the qualifying crime.

What is the dollar limit on payments for mental health treatment?

The dollar limit on payments for mental health treatment is $10,000 for direct victims and $3,000 for derivative victims. For applications filed on or after January 1, 2008 the dollar limit for derivative victims has increased to $5,000.

If you feel that your patient or client requires treatment beyond the statutory dollar limit, you must fill out another ATP and demonstrate dire or exceptional circumstances exist that call for more extensive treatment.

How can I find out more about the Child Crime Victims Standards of Care Guidelines?

You can download a copy of the Standards of Care Task Force Guidelines: Mental Health Care for Child Crime Victims by using the links in that section of our website.