The Board’s mental health guidelines provide an incremental approach to outpatient mental health service limitations.
For applications filed on or after Jan. 1, 2016:
- 40 sessions (initial limit):
- Children who are victims.
- Adults who are victims.
- Immediate family members of a deceased victim (Includes a fiancé(e), parent, sibling, child, spouse, domestic partner, grandparent or grandchild.)
- Victims of statutory rape (penal code section 261.5(d)).
- 30 sessions (initial limit):
- Minor derivative victims, minor witnesses.
- Good Samaritan.
- Primary caretakers of a minor direct victim at the time of the crime (maximum two primary caretakers.)
- 15 sessions (initial limit):
- Other derivative victims and post-crime caretakers.
For applications filed prior to 2016, contact Customer Service for session limits 800-777-9229
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.
Approximately eight sessions before a claimant reaches their initial session limit, the provider must submit the Treatment Plan and an Additional Treatment Plan. CalVCB must approved the ATP before considering additional sessions for payment. The ATP provides CalVCB 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. CalVCB may request additional information to make a determination.
CalVCB will consider the same 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.
CalVCB 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.
Sessions provided past the authorized session limit are subject to denial if the ATP is not approved.
Pursuant to California Code of Regulations 649.26 subsection (c), if a claimant has exhausted their mental health session limit and continues to require additional sessions, mental health providers must submit a TP and ATP within 90 days. If the TP and ATP are not submitted within 90 days, any bills received will be returned and will not be considered for payment.