The California Victim Compensation Board (CalVCB) has the authority, pursuant to Government Code section 13957.2, to establish maximum rates and service limitations for reimbursement of mental health and counseling services.

Reimbursement of mental health expenses by the California Victim Compensation Board (CalVCB) is based on the definitions, session limitations, documentation requirements and other criteria guidelines (guidelines) set forth below.

These guidelines are subject to the maximum reimbursement provisions of Government Code §13957 and other statutes governing the administration of the California Victim Compensation Board codified in Government Code §§13900, et seq.

CalVCB’s Glossary of Penal Code Definitions, is a document designed to assist in reviewing the Mental Health Guidelines and completing the Treatment Plan (TP) and Additional Treatment Plan (ATP). You may also access the Penal Codes at https://leginfo.legislature.ca.gov/faces/codes.xhtml.

The California Victim Compensation Board (CalVCB) 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: public and private health insurance (i.e., Medi-Cal, Blue Shield, etc.), civil suits, vehicle insurance, business insurance, home insurance, and/or Worker’s Compensation.

The insurance provider must be billed prior to submitting expenses to CalVCB for payment. If the expense is not covered, or is only partially covered, submit your billing with a copy of the explanation of benefits (EOB). Failure to do so will result in delays in payment. (Tit. 2, CCR § 649.31)

• Reimbursement rates for licensed or registered mental health providers are listed on the CalVCB website at https://victims.ca.gov/uploads/2024/06/CalVCB-Mental-Health-Provider-Rates-2024-06_L.pdf.
• Reimbursement for mental health treatment (bills) must be submitted on a Centers for Medicare & Medicaid Services (CMS) 1500 form. The CMS 1500 must be completed entirely according to the CalVCB CMS 1500 Instructions form. Each date of service must be listed individually. If the treating therapist is a registered associate with the Board of Behavioral Sciences or the Board of Psychology, the supervisor must sign the CMS 1500 form.
• Along with the first CMS 1500 form submitted for each claimant, a CalVCB Mental Health Billing Intake Form must be completed in its entirety and signed by the treating provider. Submission of this form is required before payment can be made.

Bills must be submitted within 90 days of each date of service provided. If multiple dates of service are included in one CMS 1500 form, then it must be submitted within 90 days from the first service date on the bill.

If bills are not submitted within 90 days of each date of service, reimbursement will be denied.

The below limitations pertain to standard individual/family/group psychotherapy, telehealth, and case management services. Sessions are based on hourly increments per the table below. Session limits are based on hourly increments.

When a claimant begins treatment, the following documents must be completed by the mental health provider:

1. Mental Health Billing Intake Form
2. Treatment Plan (TP)

The Treatment Plan (TP) must be completed in its entirety and kept in the claimant’s file except for the following circumstances when it must be submitted to CalVCB prior to the beginning of the fourth session:

1. Upon CalVCB’s request
2. If the treatment is less than 100% related to the qualifying crime;
3. There was a delay in treatment of three years or break in treatment over one year;
4. If the treatment is for a post-crime primary caretaker.
5. If the claimant was three years old or younger when treatment began.

If the TP is not submitted to CalVCB for the above circumstances, the bills may be denied until the document is submitted.

1. A description of the crime for which mental health sessions are being provided.
2. Reason(s) therapeutic intervention is needed if the victimization occurred more than three years ago or there was a break in treatment of more than one year.
3. The diagnosis and specifiers as described in the most recently published version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) and other conditions that may be the focus of clinical attention.
4. A description of presenting symptoms, behaviors and beliefs that are the focus of treatment
5. The Level 1 Cross-Cutting Symptom Measure results as described in the most recently published version of the DSM, as clinically indicated. The exceptions for completion are:
   1. Claimant is non-English speaking
   2. Claimant is less than six years of age
   3. Claimant is developmentally disabled
   4. Treatment is terminated
   5. Explanations provided in the “Other” box will be considered on a case-by-case basis
6. A description of the means by which progress will be measured.
7. For a Post-Crime Primary Caretaker, a list and description of the therapeutic interventions that are necessary for the treatment of the direct minor victim.
8. A declaration signed under penalty of perjury of the percentage of the treatment that is necessary as a direct result of the qualifying crime.

The Mental Health Billing Intake Form that is required to be submitted with the first billing, shall include all of the following:

1. Claimant Name
2. Crime Date
3. Type of crime with a brief description
4. The date the treatment began
5. The date the treatment will end, if applicable
6. If treatment is necessary as a direct result of the crime (a requirement of Government Code section 13957(a)(2))
7. If insurance or Medi-Cal cannot be billed, applicants are asked for the reason. If any of the reasons are selected, the applicant may be provided an exemption
8. Provider Organization Name
9. Treating Provider Name
10. Supervising Provider Name (if applicable)
11. Email address of Provider
12. Phone number of Provider
13. Provider License Number
14. Supervising Provider License Number (if applicable)
15. Provider Declaration Certification, signed under penalty of perjury
16. Claimant Declaration Certification, signed under penalty of perjury

Reimbursement for additional mental health sessions for a victim beyond the initial session limit may be approved if an Additional Treatment Plan (ATP) and TP are submitted and the documentation meets the criteria listed below.

The ATP should be completed when the claimant is eight (8) sessions from reaching their authorized session limit. The complete ATP must be submitted within 90 days after the date a bill for sessions that exhaust the authorized session limit is submitted to CalVCB. If the completed ATP and TP are not submitted within the 90-day timeframe, bills for all dates of service that exceed the authorized session limit will be returned and will not be considered for payment.

Bills for dates of service provided after the ATP and TP are submitted, but before the ATP is approved, may be considered for payment subject to approval of the ATP.

If there is a change of therapists within the same provider organization, the succeeding therapist is not considered a new provider and must assess the claimant’s therapeutic progress since treatment began with the organization.

1. A description of the crime for which mental health sessions is being provided.
2. Reason(s) therapeutic intervention is needed if the victimization occurred more than three years ago or there was a break in treatment of more than one year.
3. The diagnosis and specifiers as described in the most recently published version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) and other conditions that may be the focus of clinical attention.
4. For a Post-Crime Caretaker, a list and description of the therapeutic interventions that are necessary for the treatment of the direct minor victim.
5. A description of the current symptoms, behaviors and beliefs that are the focus of continued treatment.
6. The treating therapist’s rating of the therapeutic progress in relation to the diagnosis and treatment goals and other progress measurements identified in the initial TP and ATP.
7. The Level 1 Cross-Cutting Symptom Measure results as described in the most recently published version of the DSM, as clinically indicated. Acceptable reasons for results of this measurement to not be reported, include:
   • Claimant is non-English speaking
   • Claimant is less than six years of age
   • Claimant is developmentally disabled
   • Treatment is terminated
   • Explanations provided in the “Other” box will be considered in a case-by-case basis
8. A description of the means by which progress will continue to be measured.
9. A description of factors that may adversely affect treatment progress.
10. An explanation of the claimant’s involvement with the legal system concerning criminal or dependency hearings resulting from the qualifying crime, if applicable.
11. An explanation of the claimant learning of the perpetrator’s release from custody, if applicable.
12. If a direct minor victim, reporting if the perpetrator has made unwelcome and unauthorized contact with the claimant, if applicable.
13. A declaration signed under penalty of perjury of the percentage of the treatment that is necessary as a direct result of the qualifying crime.

CalVCB may require the submission of additional information needed to determine whether the treatment will best aid the victim, derivative victim, minor witness, or Good Samaritan and is necessary as a direct result of the qualifying crime including, but not limited to, legible session notes pursuant to Title 2, California Code of Regulations § 649.7(b)(1).

CalVCB shall not reimburse additional outpatient mental health counseling sessions unless the below requirements for the claimant’s applicable filing classification are met; or in the CalVCB’s sole discretion, it determines that additional treatment will best aid the victim, derivative victim, minor witness, or Good Samaritan and is necessary as a direct result of the qualifying crime.

When evaluating a request for additional sessions, objective assessment measures with demonstrated reliability and validity in peer review literature will be given significant weight.

When evaluating a request for additional treatment, independent corroborative information may be given significant weight.

If additional sessions are needed to address treatment goals:

• Submit a new, complete, signed, and certified ATP.
• Submit the ATP within eight sessions of reaching the Mental Health Session limit.
• Certification by the treating therapist of treatment progress that has been made.
  • If treating therapist is unable to certify progress of previous treatment, the treating therapist must certify that hindering factors can be overcome.
• For subsequent requests for additional sessions, certification by the treating therapist on the continuing progress.
  • If the treating therapist is unable to certify that treatment progress has been made, the therapist must certify that hindering factors will be successfully overcome with additional sessions.

CalVCB may not allow additional sessions if one of the following applies:

• The treating therapist indicates that hindering factors can’t be overcome with additional sessions.
• Treating therapist certifies that progress has been made but accompanying documentation does not support that certification.

In such cases, an Independent Mental Health Examination may be required.

If inadequate progress has been determined against the below requirements for the claimant’s applicable filling classification, CalVCB may, in its sole discretion, authorize additional treatment with a different treatment modality, method, or provider.

Additional sessions beyond the claimant’s applicable initial session limit may be approved providing specified criteria are met for the following claimant classifications.

1. Reimbursement for additional mental health counseling sessions for a Good Samaritan beyond those identified in Section II may be approved if an Additional Treatment Plan is submitted and the circumstances of the application that demonstrate the need for additional treatment meets the criteria listed below:
   1. The treatment for the Good Samaritan is focused on behaviors or beliefs that are directly attributable to the qualifying event and could reasonably be remediated by the proposed treatment; and
   2. The treatment has progressed, as evidenced by:
      1. Improvement in the Level 1 Cross-Cutting Symptom Measure Scores; and
      2. 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; and
      3. Intervention ratings provided by the treating therapist based on the status of claimant’s symptoms/behaviors; and
      4. 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.
   3. The Good Samaritan is scheduled to testify as a witness in any criminal or dependency proceeding related to the qualifying event. To be reimbursed, the mental health counseling must be initiated within three months of being scheduled to testify.
2. If the Board previously approved reimbursement for additional sessions under subsection (a), any subsequent requests are stringently reviewed and may be reimbursed only if the Board determines that the proposed treatment is reasonably likely to successfully overcome the factors that hindered the progress of treatment and treatment has significantly progressed.
3. 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.

Additional sessions beyond the claimant’s maximum monetary statutory limit for mental health expenses [specified in Government Code § 13957(a)(2)(A) or (B)] may be approved if it is determined that dire or exceptional circumstances that require more extensive treatment is met per Government Code § 13957(a)(2)(C).