Board Reduces Payment Rates for Medical and Mental Health Expenses

At its meetings on December 16, 2010 and February 17, 2011, the three-member Victim Compensation and Government Claims Board voted unanimously to reduce the medical and mental health reimbursement rates. 

 At the December 16, 2010 meeting of the Victim Compensation and Government Claims Board, the Board reduced the rate of payment for mental health interns to $75 per (individual and family) session hour.  These rates are effective for dates of service and applications received on or after January 1, 2011.  Please note, in making this change effective for applications received on or after January 1, 2011, the new rates will apply to all applications beginning with A11-XXXXXXX that have services provided by interns prior to January 1, 2011.

At the February 17, 2011 meeting, the Board set the following rates for medical expenses provided on or after April 1, 2011:

• Medical Expenses: Pay at the Medicare rate for services covered by Medicare.
• Pay at 75 percent of the billed amount for services not covered by Medicare.
• Pay for durable medical equipment (DME) at the Medicare DME rate, except for prosthetics, eyeglasses, and foreign bills as noted below.
• Pay the following at 80 percent:
• Cosmetic surgery
• Prosthetics
• Hearing aids and eyeglasses
• Foreign providers without regard to the date of service, and accept bills in formats other than the standardized forms required of U.S. providers.
• Mental health treatment rates were reduced by 10 percent. Click here for the specific rate of payment for the different provider licenses.
• Chiropractic, physical and occupational therapies are combined with other Complementary and Alternative Medicines (CAM), also known as alternative treatments.  Other alternative treatment modalities include acupuncture, biofeedback, holistic medicine, massage therapy and other natural healing methods.
• For treatment beginning on or after April 1, 2011, the claimant is limited to a combined total of five sessions and a physician’s recommendation is required for additional sessions up to a maximum of 20 sessions for all alternative treatment modalities.
• The new limitation applies to all claimants for all dates of service on or after April 1, 2011, including those who were receiving any of the alternative treatment modalities prior to April 1, 2011.  In effect, claimants who were receiving CAM treatments prior to the effective date of April 1, 2011, start over with the new benefit limit and can receive a combined CAM total of five additional sessions and are required to obtain a physician’s recommendation for additional sessions up to a maximum of 20 sessions for all alternative treatment modalities. 
• Effective for all requests received on or after April 1, 2011, the maximum benefit for vehicle purchase, renovation and/or retrofit, per qualifying crime, is $30,000.
• Effective for all applications received on or after April 1, 2011, the maximum benefit for funeral and burial expenses is $5,000.
• Effective for all applications received on or after April 1, 2011, the maximum benefit amount per crime is $63,000.

The rate reductions were necessary in order to ensure that the California Victim Compensation Program can continue to provide assistance to victims of crime.