What are the limits on assistance?
Assistance is limited to the amount of out-of-pocket expenses or bills incurred by or on behalf of the victim or applicant that have not been reimbursed by other sources such as insurance, and the amount of lost wages or loss of support (based on the victim's income) if that benefit is applicable.
The limits of various types of benefits are described below. For crimes that occurred prior to January 1, 2001, the total of all benefits paid to one person could not exceed $46,000. For crimes that occurred on or after January 1, 2001, the maximum amount that can be reimbursed is $70,000.
California law authorizes the Board to establish maximum rates and service limitations for reimbursement of medical and medical-related services and for mental health and counseling services. Currently, the VCP has established the following rate limits for medical, medical-related and mental health services:
Medical and Dental Services:
- Eligible medical expenses are reimbursed:
- At the Medicare rate plus 20 percent for services covered by Medicare
- At 75 percent of the billed amount for services not covered by Medicare
- At the Medicare DME rate for durable medical equipment (DME)
- At 100 percent for cosmetic surgery, prosthetics, hearing aids and eyeglasses
- Eligible dental expenses are reimbursed at 75 percent of the amount billed. Dentists may be able to obtain preauthorized approval for treatment. For more information visit our provider information page.
Mental Health Services:
The following reimbursement rates are for dates of service on or after March 1, 2006. For a complete overview of the Board's current and past rates visit our provider information page.
- Reimbursement is set at $130 per hour for individual services provided by a licensed psychiatrist.
- Reimbursement is set at $110 per hour for individual services provided by a licensed clinical psychologist.
- Reimbursement is set at $90 per hour for individual services provided by a licensed clinical social worker, marriage and family therapist (MFT), mental health nurse, or clinical nurse specialist with a specialty in psychiatric mental health nursing. (psychology interns and associate clinical social workers are paid at the supervisor's rate)
- Group therapy is reimbursed at 40 percent of the maximum individual session rates above.
- Group therapy is reimbursed at 40 percent of the maximum individual session rates above.
- Family therapy is reimbursed at individual session rates above.
New mental health session limits became effective January 24, 2006, and apply to all dates of service on or after that date. For a complete overview of the Board's current and past session limits visit our provider information page.
- Initially, an eligible victim will receive up to 5 mental health counseling sessions per claim.
- No additional sessions will be allowed without the submission and approval of a Treatment Plan (TP) by the therapist.
- If the TP is approved, a total of 15, 30, or 40 sessions will be granted based on the victim's or derivative victim's initial session limitations.
- If the therapist determines additional treatment is necessary once a victim or derivative victim reaches the limits of 15, 30, or 40 sessions, an Additional Treatment Plan (ATP) must be submitted for review. If approved, a limited number of additional sessions may be authorized.
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What if I have reimbursements from other sources?
The VCP can only reimburse qualified expenses that have not or will not be paid by any other source such as health insurance, workers compensation, MediCal, or other benefits. By law, the VCP is the "payer of last resort." If any other sources of reimbursement are available for the applicant's crime-related losses, they must be used before VCP payment can be made. Other reimbursement sources that may be available include, but are not limited to:
- Medical/health, dental, or vision insurance
- Public program benefits (MediCal, unemployment insurance, or Department of Rehabilitation or other disability benefits, etc.)
- Auto insurance
- Workers' compensation benefits
- Court-ordered restitution
- Civil lawsuit recoveries
Applicants are responsible for informing the VCP of all available reimbursement sources for their losses. Applicants must repay the VCP for any payments for which it was later determined they were not eligible.
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