Request to Revise Mental Health Guidelines

December 15, 2016

Action Requested

The Mental Health Section of the California Victim Compensation Board (Board) requests that the Board adopt the following proposed revisions to the Mental Health Guidelines (Guidelines) currently filed with the California Secretary of State.

Background

Revisions to the Guidelines are recommended to improve access to services for direct and derivative victims and to clarify current language.

Proposed Revisions

  1. Revise the Guidelines to allow telehealth as a treatment modality as defined in Business and Professions Code sections 686, 2904.5, and 2290.5, set forth by the Board of Behavioral Sciences and the Board of Psychology.
    • Current Provision:  None.
    • Proposed Revision:  Allow up to five (5) telehealth therapy sessions as a reimbursable expense.  This service would be included in the claimant’s authorized session limit. Additional mental health sessions via telehealth modality beyond the initial limit of five (5) sessions may be allowed if the claimant requires telehealth due to clinical necessity or lives in an area where no other clinical resources are available.
    • Justification:  Allowing telehealth would bring the Mental Health Guidelines up to date with current practices and increase access for claimants who live in rural areas or have conditions, either physical or emotional, that prevent them from leaving home to receive therapy.  There is no change to benefit limits; therefore, this revision is projected to have no additional cost.
  2. Revise the Guidelines to allow case management services as a reimbursable expense for derivative victims.
    • Current Provision:  A mental health provider may be reimbursed for up to five (5) case management sessions for direct victims only.
    • Proposed Revision:  Allow up to five (5) case management sessions for all claimants as a reimbursable expense.
    • Justification:  Case management services enable mental health providers to assist claimants to obtain needed medical, educational, social, housing, prevocational, vocational, rehabilitative, or other community services.  At the December 10, 2015, Board meeting, the Board approved case management services for direct victims.  The utilization of this service is significantly lower than estimated; therefore, it is recommended that we expand the coverage to derivative victims.  The projected annual cost to reimburse case management for derivative victims is $2,400.  The factors used to determine the projected costs include program utilization of case management by direct victims and the projected number of derivative victims who may utilize this service.
  3. Revise the Guidelines to measure progress of treatment based on four (4) criteria for the allowance of additional mental health sessions.
    • Current Provision:  Treatment progress is required in order to allow additional mental health sessions.  To determine progress, both criteria must be met:
      • Improvement in the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) Level 1 Cross-Cutting Symptom Measure Scores, and
      • The treating therapist’s rating and explanation of the claimant’s therapeutic progress in relation to the diagnosis and treatment goals and other progress measurements identified in the initial Treatment Plan.
    • Proposed Revision:  Include two (2) additional criteria for a total of four (4) separate criteria that will cumulatively measure progress.
      • Intervention ratings provided by the treating therapist based on the status of claimant’s symptoms/behaviors; and
      • The treating therapist’s percentage estimation of overall treatment that has been completed to meeting the claimant’s treatment goal(s) in relation to the qualifying crime.
    • Justification:  The new criterion enables Board staff to use additional clinical information to make a recommendation on the request for additional mental health sessions.  This revision is projected to have no additional cost.
  4. Amend language to provide clarification within the Guidelines for mental health treatment for derivative victims.
    • Current Provision:  Additional Sessions for Derivative Victims, Section VI (b)(2) states that treatment for the derivative victim is necessary for the recovery of the victim.
    • Proposed Revision:  Add “direct” so that the Guidelines will read as follows:
      • Treatment for the derivative victim is necessary for the recovery of the direct victim.
    • Justification:  This revision clarifies that treatment of the derivative victim is required for alleviating the symptoms of the direct victim.  This revision is projected to have no additional cost.