Mental Health Guidelines

Mental Health Expenses Government Code §13957.2(a)
Effective October 1, 2021

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 Program codified by Government Code §13900 et seq.

The CalVCB’s Glossary of Penal Code Definitions is a document for the purposes of assistance in reviewing the Mental Health Guidelines and completing the Treatment Plan (TP) and Additional Treatment Plan (ATP). You may also view California Codes for realtime updates at https://leginfo.legislature.ca.gov/faces/codes.xhtml.

Preface: 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. Failure to do so will result in delays in payment. (CCR 649.31)

  • 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 intern with the Board of Behavioral Sciences or the Board of Psychology, the supervising therapist must sign the CMS 1500 form.
  • Treating therapists (except interns) and supervising therapists must submit a complete CalVCB Mental Health Therapist Verification form and provide a copy of the current license issued by your licensing board annually (by October 1st of each year). You should include any registered interns that you supervise in the provided space at the bottom of the document, attaching additional sheets if necessary.
  • The California Victim Compensation Board (CalVCB) requests documents or files to verify that mental health treatment is necessary as a direct result of the crime for which an application was filed pursuant to Government Code Section 13954(a). You have 10 business days to submit items requested. Failure to do so will result in denial of reimbursement of applicable services.

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

Session Lengths and Equivalencies

LENGTH OF TIMESESSION EQUIVALENT
Individual and Family Mental Health SessionLess than 45 minutes.50
45 to 74 minutes1.0
75 to 104 minutes1.5
105 to 120 minutes2.0
One Group Mental Health SessionOne half of an individual session of the same length1
Case Management Services Sessions215 minutes.25
30 minutes.50
45 minutes.75
60 minutes1.0
1 Group mental health sessions should be billed based on the length of time for the services. Similarly, group mental health sessions should represent the amount of time provided in hourly units on treatment plan forms.
2 Case management is defined as a service that assists a direct victim with accessing needed medical, educational, social, prevocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, referral and coordination.

Case Management

  • CalVCB may reimburse up to five case management session hours for claimants, which will not be counted as part of the mental health session limit.

Telehealth

  • Telehealth is delivering mental health treatment via communication technologies while the patient is at the originating site and the mental health provider is at a distant site. Services provided via telehealth modality must meet the statutory and regulatory requirements established by the licensing board overseeing the treating mental health provider.
  • CalVCB may reimburse up to five telehealth therapy session hours, which will be counted as part of the mental session limit.
  • Additional mental health sessions via telehealth modality beyond the initial limit of five session hours may be allowed if the claimant requires telehealth due to clinical necessity or lives in an area where no other clinical resources are available. Authorization for provision of more than five telehealth sessions requires that the Telehealth Therapy Verification form be submitted and approved.

VICTIM CLASSIFICATIONMENTAL HEALTH SESSION(S)CASE MANAGEMENT SESSION(S)
Direct
Survivor3Up to 404Up to 5
Derivative5
– AdultUp to 15 4Up to 5
– MinorUp to 30 4Up to 5
– Minor WitnessUp to 30 4Up to 5
– Primary Caretakers (at time of crime)Up to 30 4Up to 5
– Post-Crime Primary CaretakersUp to 15 4Up to 5
3 Survivors include parent, sibling, child, spouse, fiancé, grandparent, grandchild or registered domestic partner as defined in Family Code §297.
4 These are not counted against the mental health session limits.
5 A derivate victim in more than one category may only use the most favorable category.

Primary Caretakers (at the time of crime) apply to those caring for minor direct victims. This classification is only eligible to recover up to $10,000 as a shared payment between up to two Primary Caretakers.

Post-Crime Primary Caretakers apply to those who began caring for a minor direct victim after the crime. This classification is only eligible for treatment that benefits the direct minor victim and shall not exceed $5,000.

The TP must be completed according to the following steps:

Step 1: Treating therapist must complete the TP prior to the beginning of the fourth session.
Step 2: The TP Declaration Page (Page 7) must be completed, signed, and submitted in all cases before the beginning of the fourth session.

The 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 any of these requirements are not met, dates of service from the fourth session until the submission of the TP or TP Declaration Page (as applicable) will be denied reimbursement.

  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. 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: 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.
  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.

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

The ATP must not be completed until the claimant is within eight sessions from reaching his or her authorized session limit.

If claimant exceeds their authorized session limit all of dates of service that exceed the authorized session limit will be denied.

Sessions allowed as a result of the Additional Treatment Plan review can only be reimbursed for dates of service that occur after the review was completed and approved.

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, or minor witness and is necessary as a direct result of the qualifying crime including, but not limited to, legible session notes pursuant to 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, or minor witness, 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. At least one of the following factors is present:

a. The qualifying crime resulted in permanent and substantial disfigurement.

b. The qualifying crime resulted in serious bodily injury as defined in Penal Code §243(f)(4).

c. The qualifying crime constituted a plausible and credible threat of serious harm to bodily integrity.

d. The qualifying crime is a sexual assault offense involving conduct described in Penal Code §11165.1(b)(1), (2) or (3).

e. The victim initiated mental health treatment within three months of being scheduled to testify in a criminal or dependency proceeding related to the qualifying crime.

f. The victim initiated mental health treatment within three months of learning that the perpetrator will be, or was, released from custody.

  1. The treatment is focused on symptoms, behaviors, or beliefs that are directly attributable to the qualifying crime and could be remediated by the proposed treatment.
  2. The treatment has progressed, as evidenced by:

a. Improvement in the Level 1 Cross-Cutting Symptom Measure results, as clinically indicated; and
b. 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
c. Symptom progress rating score provided by the treating therapist based on the status of claimant’s symptoms/behaviors; and
d. 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.

Additional sessions for a minor victim may be approved if the above “Direct Victim” section criteria are met. Otherwise, a minor victim can be authorized additional sessions if the following criteria are successfully met.

  1. One of the following circumstances are present:

a. The qualifying crime is a sexual assault offense involving conduct described in Penal Code §11165.1(a), (b)(4) or (b)(5) and at least one of the following applies:

  1. The perpetrator of the qualifying crime was a person in a position of trust or authority with the victim, including, but not limited to a parent, teacher, or religious leader; or
  2. The victim was removed from the home as a result of the qualifying crime; or
  3. The victim’s parent minimizes the significance of the qualifying crime, blames the victim for the qualifying crime, fails to acknowledge that the suspect committed the qualifying crime, or does not believe the qualifying crime occurred; or
  4. Another minor in the victim’s immediate family was also a victim of the same qualifying crime of sexual abuse committed by the same perpetrator.

b. The victim reaches a developmental stage or a stage of cognitive development that results in impairment as a direct result of the qualifying crime; or

c. The perpetrator persists in making uninvited and unwelcome contact with the victim that is not authorized by a court.

  1. The treatment is focused on symptoms, behaviors, or beliefs that are directly attributable to the qualifying crime and could be remediated by the proposed treatment.
  2. The treatment has progressed, as evidenced by:

a. Symptom progress rating score provided by the treating therapist based on the status of claimant’s symptoms/behaviors; and

b. Improvement in the Level 1 Cross-Cutting Symptom Measure results, as clinically indicated; and

c. 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

d. 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.

Derivative claimants may qualify for additional sessions (dependent on approval) under one of the three below subsections a.), b.), c.):

a. Reimbursement for additional mental health counseling sessions for a derivative victim beyond the initial session limit may be approved if an ATP is submitted and the circumstances of the application that demonstrate the need for additional treatment meets the criteria listed below:

  1. Either:

a. The qualifying crime resulted in the death of the victim; or

b. The derivative victim, excluding Post-Crime Caretakers (new caretakers of a minor victim after the qualifying crime), initiated mental health treatment within three months of being scheduled to testify in a criminal or dependency proceeding related to the qualifying crime; and

  1. The treatment is focused on behaviors or beliefs that are directly attributable to the qualifying crime and could reasonably be remediated by the proposed treatment; and
  2. Treatment has progressed, as evidenced by:

a. Improvement in the Level 1 Cross-Cutting Symptom Measure Scores; and

b. 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 TP; and

c. Symptom progress rating score provided by the treating therapist based on the status of claimant’s symptoms/behaviors; and

d. 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.

b. Reimbursement for additional mental health counseling sessions for a derivative victim beyond the initial session limit may be approved if an ATP is submitted and the circumstances of the application that demonstrate the need for additional treatment meets the criteria listed below:

Please note: This is the only subsection that a Post-Crime Caretaker (a new caretaker of a minor victim after the qualifying crime) may be eligible for additional sessions.

  1. One of the following direct victim factors are present:

a. The qualifying crime resulted in permanent and substantial disfigurement; or

b. The qualifying crime resulted in serious bodily injury as defined in Penal Code §243(f)(4); or

c. The qualifying crime constituted a plausible and credible threat of serious harm to bodily integrity; or

d. The qualifying crime is a sexual assault offense involving conduct described in Penal Code §11165.1(b)(1), (2) or (3); or

e. The direct victim initiated mental health treatment within three months of being scheduled to testify in a criminal or dependency proceeding related to the qualifying crime.; or

f. The direct victim initiated mental health treatment within three months of learning that the perpetrator will be, or was, released from custody.

g. Penal Code §11165.1 (a), (b)(4), or (b)(5), Penal Code §243(f)(4); and at least one of the following applies:

  1. The perpetrator of the qualifying crime was a person in a position of trust or authority with the victim, including, but not limited to a parent, teacher, or religious leader; or
  2. The minor victim was removed from the home as a result of the qualifying crime and is still out of the home at the time of treatment; or
  3. The minor victim’s parent minimizes the significance of the qualifying crime, blames the victim for the qualifying crime, fails to acknowledge that the suspect committed the qualifying crime, or does not believe the qualifying crime occurred; or
  4. Another minor in the minor victim’s immediate family was also a victim of the same qualifying crime of sexual abuse committed by the same perpetrator.

2. Treatment for the derivative victim is necessary for the recovery of the direct victim; and

3. Treatment for the derivative victim is focused on the direct victim’s behaviors or beliefs that are directly attributable to the qualifying crime and could reasonably be remediated by the proposed treatment; and

4. Treatment of the derivative victim has resulted in the direct victim’s progress as evidenced by one of the following:

A. The ATP for the direct victim exhibits improvement in the symptoms, behaviors, or beliefs as shown by improvement in the Level 1 Cross-Cutting Symptom Measure and the progress rating by the treating therapist in relation to the claimant’s treatment for the diagnosis and goals, and other progress measurements identified in the TP; or

B. The ATP for the derivative victim demonstrates improvement in the direct victim’s symptoms, behaviors, or beliefs attributable to the derivative victim’s treatment.

c. Reimbursement for additional mental health counseling sessions for a derivative victim, excluding Post-Crime Caretakers (new caretakers of a minor victim after the qualifying crime), beyond the initial session limit may be approved if an ATP is submitted and the circumstances of the application that demonstrate the need for additional treatment meets the criteria listed below:

1. The derivative victim is a Primary Caretaker, such as a parent caretaker or step-parent at the time of the qualifying crime, or sibling of a minor victim of sexual or severe physical abuse specified within either of the below subsections A. or B.:

A. Penal Code §11165.1 (b)(1), (2), (3), Penal Code §243(f)(4); or

B. Penal Code §11165.1 (a), (b)(4), or (b)(5); and at least one of the following applies:

  1. The perpetrator of the qualifying crime was a person in a position of trust or authority with the victim, including, but not limited to a parent, teacher, or religious leader; or
  2. The minor victim was removed from the home as a result of the qualifying crime and is still out of the home at the time of treatment; or
  3. The minor victim’s parent minimizes the significance of the qualifying crime, blames the victim for the qualifying crime, fails to acknowledge that the suspect committed the qualifying crime, or does not believe the qualifying crime occurred; or
  4. Another minor in the minor victim’s immediate family was also a victim of the same qualifying crime of sexual abuse committed by the same perpetrator.

2. Treatment for the derivative victim is focused on behaviors or beliefs that are directly attributable to the qualifying crime and could reasonably be remediated by the proposed treatment; and

3. The treatment has progressed, as evidenced by:

A. Improvement in the Level 1 Cross-Cutting Symptom Measure Scores; and

B. 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 TP; and

C. Symptom progress rating scores provided by the treating therapist based on the status of claimant’s symptoms/behaviors; and

D. 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.

Reimbursement for additional mental health sessions for a minor witness beyond the initial session limit may be approved if an ATP is submitted and the documentation meets all the criteria listed below:

  1. The treatment is focused on symptoms, behaviors or beliefs that are directly attributable to the qualifying crime; and
  2. The treatment has progressed, as evidenced by:

a. Improvement in the Level 1 Cross-Cutting Symptom Measure results, as clinically indicated; and

b. 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

c. Symptom progress rating score provided by the treating therapist based on the status of claimant’s symptoms/behaviors; and

d. 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.

  1. The minor witness initiated mental health treatment within three months of being scheduled to testify in a criminal or dependency proceeding related to the qualifying crime.

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).

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