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Mental Health Service Providers

Quick facts for mental health providers

Overview for mental health providers

How to become a mental health provider for the California Victim Compensation Program

Any licensed mental health service provider can serve victims who are claimants with the California Victim Compensation Program (CalVCP). Providers may wish to contact the Victim/Witness centers in the counties surrounding their practice. Some Victim Witness Centers maintain referral lists that they give to victims.

There are just a few things needed to become a provider. You do not need to submit paperwork until you submit your first bill. At that time, please submit a completed W-9.

You may mail your documents to: California Victim Compensation Program, PO Box 3036, Sacramento, CA 95812.

CalVCP offers Provider Information Forums for mental health providers throughout California. Upon request, Program staff can come to your city to meet with your group of mental health providers, provide an overview of the Program, resolve issues and answer questions.

Reimbursable Mental health providers and when psychology interns can be reimbursed

The following mental health providers are eligible for reimbursement: Pursuant to CCR 649.29

* Note: Interns are not able to independently bill, only the supervising therapist or agency. Please contact your licensing board for information regarding restrictions for interns. The Board may pay for services provided by interns if those services are billed for by the supervising licensed mental health professional and if the interns are registered. Please refer to CalVCP billing procedures for mental health services for direction on how to complete the HCFA 1500 form when an intern provides services.

Exceptions on registration exist for psychology interns who are working in a university hospital or university medical school clinic. Refer to CCR 649.29j and Business and Professional Code 2910.

Please call the CalVCP Customer Service Department at (800) 777-9229 to verify that the intern qualifies.

Requirements for out-of-state provider reimbursement

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

Psychologists (PhDs) must submit documentation of their licensure for reimbursement. Other providers must be licensed in the state where they provide services and must be reimbursable under their own State Victim Compensation Program.

Types of reimbursable mental health treatment with Current Procedure Treatment codes

Typically, CalVCP covers individual, family, and group therapy that is necessary as a direct result of the qualifying crime.

Types of mental health expenses that are not reimbursable

The Board cannot pay for treatment that is unrelated to the crime, missed appointments, interest or similar administrative charges, accompanying the claimant to court hearings, travel time and expenses, or treatment related to child custody issues.

Only treatment related to the qualifying crime will be reimbursed

The California Victim Compensation Program (CalVCP) can only pay for the percentage of treatment that is necessary as a direct result of the qualifying crime for which the application was approved.

A provider may call customer service at (800)777-9229, to verify the focus of treatment is as a direct result of the qualifying crime. CalVCP requests the criminal courts order the offender to pay restitution to reimburse CalVCP for any expenses CalVCP has paid for the qualifying crime. Only reimbursement for mental health expenses that were necessary as a direct result of the qualifying crime may be requested.

If you are treating a claimant for multiple traumas such as, but not limited to, sexual assault, domestic violence, child abuse/molests perpetrated by more than one offender, additional application(s) may be filed for each additional crime.

An act or series of acts by one or more offenders that is a continuing series of events, even if the events occur over a long period of time, can be considered one crime. (CCR 649.41/649.42)

CalVCP has the authority to collect or off-set overpayments for any treatment that is not crime related to the qualifying crime.

CalVCP will allow the first five sessions submitted at 100% (note: if the claimant already saw another provider for this qualifying crime, the first five sessions may have already been used). If it is your professional opinion that treatment is not 100% related to the qualifying crime, it is your responsibility to inform CalVCP and the client of the percentage of treatment that is related to the qualifying crime. CalVCP payments will reflect the percentage that is indicated by you as crime related. In addition, the Treatment Plan

Dollar limits and maximum rates for mental health treatment

The dollar limit on payments for mental health treatment is $10,000 for direct victims, $5,000 for derivative victims and $5,000 for minor witnesses.

For applications filed prior to January 1, 2008 the dollar limit for derivative victims is $3,000.00

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

Maximum rates of payment for mental health treatment

California Government Code 13957.2 allows VCP to have authority to set maximum Program rates for mental health treatment. The rates are filed with the Secretary of State. Acceptance of this payment constitutes payment in full and no further collections can be made from the claimant.

Provider Type License or Certificate Services Rates Effective 3/1/06 Rates Effective 4/1/11

Licensed Psychiatrist (MD)

A, C, or G

Individual/Family therapy

Medication management

Group therapy

$130/hour

$130/hour

$52/hour

$117/hour

$117/hour

$46.80/hour

PhD Psychologist or Registered Psychologist

PSY

Individual/Family therapy

Group therapy

$110/hour

$44/hour

$99/hour

$39.60/hour

Psychology Assistant (must be supervised by a psychiatrist or PhD)

PSB

Individual/Family therapy

Group therapy

Paid at rates allowed for supervising therapist

*$75/hour

*$30/hour

Licensed Clinical Social Worker

LCS

Individual/Family therapy

Group therapy

$90/hour

$36/hour

$81/hour

$32.40/hour

ASW (must be supervised by a licensed therapist)

ASW

Individual/Family therapy

Group therapy

Paid at rates allowed for supervising therapist

*$75/hour

*$30/hour

Marriage Family Therapist

MFT

Individual/Family therapy

Group therapy

$90/hour

$36/hour

$81/hour

$32.40/hour

MFT Intern (must be supervised by a licensed therapist)

IMF

Individual/Family therapy

Group therapy

Paid at rates allowed for supervising therapist

*$75/hour

*$30/hour

Licensed Professional Clinical Counselor

LPCC

Individual/Family therapy

Group therapy

N/A

$81/hour

$32.40

Licensed Professional Clinical Counselor Intern

LPCCI

Individual/Family therapy

Group therapy

N/A

*$75/hour

*$30/hour

Clinical Nurse Specialist

CNS

Individual/Family therapy

Group therapy

$90/hour

$36/hour

$81/hour

$32.40/hour

Psychiatric Mental Health Nurse

PMH

Individual/Family therapy

Group therapy

$90/hour

$36/hour

$81/hour

$32.40/hour

Nurse Practitioner/Physician Assistant

NP, PA

Medication management

BRS Rate

Medicare rate

Licensed Physician

A, C, or G

Medication management

BRS Rate

Medicare rate

Peer Counselor

Certified by Rape Crisis Center

Individual therapy, no more than 10 weeks, plus one series of group sessions.

$15/hour

$15/hour

Out-of-State Provider

Varies per state

May provide services appropriate to licensure. Subject to MHS review.

Paid at rate for comparable licensure in California

Out-of-Country Provider

Varies

Subject to MHS review.

Paid at rate for comparable licensure in California

*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.

Billing procedures for mental health services

Mental Health bills must be submitted on CMS 1500 or 1450 forms.

In an effort to reduce administrative costs related to billing forms, please submit all CMS (HCFA) 1500 billing forms with at least 4 dates of service listed under section 24A of the HCFA 1500 form.

Before a bill can be considered “acceptable” for payment by the California Victim Compensation Program (CalVCP) all required sections must be completed correctly or the bill will be returned, and payment may be delayed or rejected. Please view the chart below for the CalVCP billing requirements (downloadable version):

Guidelines for filling out a CMS 1500

Box number

What do I need to enter into the space provided?

1A* & 23*

CalVCP Application Number/Insured’s ID Number

2

Claimant’s Name

3

Claimant’s Date of Birth

5

Claimant’s address/Phone number

11

Insurance Policy information

11A

Insured’s Date of Birth

11B

Employer’s Name or School Name

11C

Insurance Plan name or Program Name

11D

Additional Health Plans

17

Treating Mental Health Provider and Licensure

19

Supervisory Mental Health Provider Licensure; if applicable

21 & 24E

Diagnosis Codes from current Diagnostic Statistical Manual

24A

Dates of services (Please list a minimum of 4 dates of service per form)

24B

Identify place of treatment – Office (O) or Home (H)

24D

Procedure Codes

24E

Diagnosis Codes from current Diagnostic Statistical Manual

24F

Charges – Your customary rate for the service provided

24G

Units (please use hourly increments) for ½ hours please use .5 and for 60 minutes please use 1 (**)

24K

Intern’s Registration Number; if applicable

25

Tax Id/SSN/FEIN Number of payee as registered with IRS

28

Total Charges/Billed Amount

29

Amount paid by claimant, or another reimbursement source

30

Balance due

31

Provider/Treating/Supervising Therapist’s Name, License Number, Signature/Signature stamp, and date

32

Name & address where services rendered if different than box 33

33

Provider/Payee’s name as registered with IRS, address & phone number

**Note: It is CalVCP's standard to have mental health sessions billed in units, where a “1” entered in box 24G is equal to one standard hour of mental health treatment, and a “.5” is equal to a half hour of mental health treatment. Please refer to the chart below for further clarification on the specific session increments:

Individual/Family Therapy:

Session Units Session Length
1/2 Session Less than 45 minutes
1 Session 45-74 minutes
1 1/2 Session 75-104 minutes
2 Sessions 105-120 minutes

Group Therapy:

Session Units Session Length
1/2 Session 60 minutes
1 Session 120 minutes
1 1/2 Session 180 minutes
2 Sessions 240 minutes

You may mail your documents to: California Victim Compensation Program, PO Box 3036, Sacramento, CA 95812.

CalVCP is the payor of last resort

The California Victim Compensation Program (CalVCP) is the payor of last resort and can only pay for treatment that is not covered by any other reimbursement source. This applies to all reimbursement sources such as: Health insurance, civil suits, vehicle insurance, business insurance, home insurance, and/or Worker’s Compensation.

The insurance provider must be billed prior to submitting expenses to CalVCP for payment. If the expense is not covered, or is only partially covered, submit your billing with a copy of the explanation of benefits. Failure to do so will result in delays in payment or rejection of the bill. (CCR 649.31)

The following are examples of how CalVCP will reimburse a bill that has an insurance payment:

Example 1: Provider is an LCSW with a customary rate of $150 per hour and the provider is contracted with the insurance carrier of the claimant. Provider provides one hour of treatment and bills the insurance and receives $60.00 which is their contracted rate. The claimant has a $20.00 responsibility for the co-pay. CalVCP will, pay the claimant $20.00 if they paid the provider the co-pay. If the co-pay remains due to the provider, then the provider will be reimbursed the $20.00.

Example 2: Provider is an LCSW with a customary rate of $150 per hour and the provider is not contracted with the insurance carrier of the claimant. Provider provides one hour of treatment and bills the insurance and is denied because they are not an in-network provider. The claimant is responsible for the bill. CalVCP will pay the claimant $90.00 if they paid the provider. If the bill remains due to the provider, then the provider will be reimbursed the $90.00.

These examples demonstrate how CalVCP is the payor of last resort and only the pecuniary loss of the claimant is reimbursable.

Clinical Reviews

Statue requires the CalVCP to verify that the treatment provided is necessary as a direct result of the crime for which the application was filed and that the treatment is the best aid for the claimant’s recovery.

To ensure statutory compliance, the CalVCP periodically conducts clinical reviews of mental health providers who provide treatment to crime victims and who have received payment from the CalVCP. The CalVCP’s Mental Health Section selects a sample size of the provider’s CalVCP claimant files and performs the review.

In the event your agency is selected for review you will receive a letter requesting copies of the following documents from randomly selected claimants:

The timeframe for the submission of the documents will usually be from ten days to two weeks.

For each selected file an analysis is conducted of the CalVCP’s electronic file and your file, including treatment plans and session notes. The clinical review is focused on the following areas:

All documents submitted for the clinical review are handled with extreme confidentiality and sensitivity. The documents are secured in the Mental Health Section and access is limited to staff assigned to conduct the review. Following conclusion of the clinical review, at your preference the documents will either be returned to you or destroyed at CalVCP.

After completion of the clinical review, you will be notified in writing of the results. Areas of the reviews falling under 85% compliance will result in a Corrective Action Plan, the details of which are based on the review findings. If excessive issues are found then CalVCP may unauthorize the provider from receiving reimbursement from CalVCP.

CalVCP’s mental health guidelines for initial and additional mental health sessions

CalVCP has filed Mental Health Guidelines with the Secretary of State that provide detailed information on the definitions, session limitations, documentation requirements and other criteria for outpatient mental health and counseling expenses. To review a copy of the Mental Health Guidelines click here

Mental health session limits

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

For applications filed on or after January 24, 2006:

For applications filed prior to January 24, 2006:

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.

Immediate family members of a deceased victim are defined as: Spouse, domestic partner, parent, sibling, or child of the direct victim.

*Derivative victims of this specific crime code are not eligible for compensation.

Documentation required by CalVCP

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 (TP), an Additional Treatment Plan (ATP), or session notes.

Treatment Plan

Providers are required to complete a Treatment Plan (TP) before the client’s 6th session. The TP is to be retained in the client's file, and must be submitted to CalVCP upon request, at the time the ATP is submitted, or if treatment is less than 100% related to the qualifying crime.

A TP outlines the focus of treatment, the treatment methods being utilized, and the means of measuring progress.

Please note that the initial sessions of a post crime caretaker must be for the benefit of the direct victim. All other derivative victims may utilize the initial sessions for their own recovery.

Additional Treatment Plan

If a therapist believes the claimant 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:

Please note that additional sessions for derivative victims must be for the benefit of the direct victim.

Session Notes

Session notes may be requested by the CalVCP during a review to determine if treatment focus is related to the qualifying crime. CCR 649.7(b)(1) and GC 13957.2

Procedures to request additional mental health sessions

Approximately six weeks before a claimant reaches his/her initial session limit, the TP and an Additional Treatment Plan (ATP) are to be submitted by the provider. The ATP must be reviewed and approved before additional sessions can be considered for payment. The ATP provides CalVCP information on the progress of the treatment provided, the circumstances of the crime, the continued or new focus of treatment, the methods being utilized, and information on factors that may have a significant impact on the course of treatment. Additional information may be requested in order for CalVCP to make a determination on authorization of additional sessions.

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 or derivative victim is called to testify in a criminal court hearing related to the qualifying crime.

Please note that sessions provided past the authorized session limit are subject to denial if the ATP is not approved.

How to 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.