The Therapist
March/April 2010

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The California Victim Compensation Program (“VCP”) is a program that provides compensation to victims of violent crime who have been injured (physically and/or emotionally). If a victim meets certain criteria, the VCP will compensate many types of services, including mental health services.¹

The VCP will cover mental health treatment that is necessary as a direct result of the qualifying crime, however the VCP will not cover treatment unrelated to the crime, missed appointments, or administrative charges.

For a patient to be eligible for VCP mental health service reimbursement, the general eligibility requirements are:

• The patient must be a victim of a violent crime including, but are not limited to, domestic violence, child abuse, sexual and physical assault, homicide, robbery, drunk driving, and vehicular manslaughter;
• The patient must be a victim of a crime involving physical injury, threat of physical injury, death, and in some circumstances emotional injury;²
• The crime must have been reported to the police, sheriff, child protective services, or some other law enforcement agency;
• Generally, the patient must have applied to VCP within one year of the time the crime happened;³
• The patient cannot have been a participant in the crime; and,
• The patient must cooperate with VCP by providing the information needed to review the application.

Requirements for MFTs as Providers
In California, both Marriage and Family Therapists (“MFTs”) and Marriage and Family Therapist Registered Interns (“MFT Interns”), as well as Licensed Clinical Social Workers and Associates, can serve as mental health service providers for VCP. The process to become a provider is simple: Once an eligible client goes to an MFT or MFT Intern, the provider submits the bill to the VCP and they are then listed in the VCP’s system as an eligible provider.

When submitting your initial claim for reimbursement to the VCP, include verification of licensure and a completed IRS W-9 form. The claims for reimbursements must be submitted on VCP CMS 1500 or 1450 forms, which can be obtained at: http://www.boc.ca.gov/providers/formspubs.aspx.

Like with other third party payers, providers are required to fill out treatment plans for reimbursement. Treatment plans are required to be turned over to the VCP upon completion of the client’s fifth session, but providers should maintain regularly updated treatment plans within their files (which must be submitted to the VCP upon request).

Treatments limitations are as follows⁴:

• Direct victims initially have 40 sessions;
• Immediate family members of deceased victims, primary caretakers of minor victims, minor indirect victims, and minor witnesses initially have 30 sessions; and,
• Indirect adult victims initially have 15 sessions.

If after the initial treatment sessions, the provider believes additional sessions are medically necessary, the provider can request (six weeks prior to session limit end) additional services by sending the VCP an “Additional Treatment Plan” which can be assessed at: http://www.boc.ca.gov/providers/formspubs.aspx. Make sure to include within you, the treatment focus, level of impairment (directly related to the crime), and the progress in treatment. If the additional services are not approved, the provider and patient can determine whether to continue services without VCP reimbursement with patient direct payment to provider.

Reimbursement of MFTs as Providers
The VCP reimbursement rates are as follows:

• MFT/LCSW: $90/hour (Individual/Family), $36/hour (Group)
• MFT Intern/LCSW Associate (must be supervised by a licensed therapist): Paid at rates allowed for supervising therapist (see above).

Providers are paid within 30-90 days of submitting the claim for reimbursement.⁵ To check the status of your claim for reimbursement request, you can use the VCP link: http://www.vcgcb.ca.gov/providers/statusrequest.aspx.

Once a claim is approved, providers will be sent the VCP-provider payment. If you cash the payment received from the VCP (see fee schedule above), you are agreeing to limit your fee-for-service charge to that specific VCP-provider amount.⁶ If you disagree with the amount paid by the VCP, do not cash the payment, but instead call the VCP at (800) 777-9229 to discuss that claim with a VCP claim representative.

The VCP is generally to be used only after other third party payers have reached limit maximums and/or denied services. Meaning, if a patient has another third party payer source (such as insurance or Medi-Cal), and the provider is an in-network provider of the insurer, the insurer must be billed prior to submitting the claim to the VCP.  The VCP does not require a patient to seek a provider within the client’s insurance network, nor does it require the claimant to seek approval of out-of-network service.  CAMFT suggests that the provider be certain that he/she knows what the patient’s reimbursement sources are and state on the bill that he/she is not a network provider, “if” that is the case.  However, if the provider is an in-network provider, then the client will need to bill the third party payer first before receiving funds from the VCP.

If the claim for reimbursement is denied by the VCP, the patient is liable for the fee for the service provided. If the claim for reimbursement amount is reduced because the treatment was only partially related to the crime, the patient is liable for the remainder of the fee for the service not paid for by VCP. Note: We recommend getting patients to sign acknowledgments of your policy regarding these two situations.

If the claim is denied, it will likely be due to the fact that the claim/claimant was ineligible (e.g., services not related to the crime itself, health care insurance was available to patient, or the claimant is not eligible for services). Providers may not appeal denials, but should encourage patients to call the VCP to learn how to appeal denials. Note: Denials of reimbursement go directly to the client, not the provider. It is a good idea, if you have an unresponsive client, to utilize the claim reimbursement status form discussed below.

To determine where to submit a claim for reimbursement, a provider will need to know whether the local VCP office or VCP’s central office is handling a particular client’s case. If the client does not know, or it is unclear, a provider may call the VCP to obtain that information.

Additional information regarding the laws and regulations that guide the VCP, and reimbursement guidelines can be found at: http://www.boc.ca.gov/providers/careguide.aspx and http://www.boc.ca.gov/docs/references/2010VCPRegs.pdf.

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Catherine L. Atkins, JD, is the Deputy Executive Director at CAMFT. Cathy is available to answer members’ questions regarding business, legal, and ethical issues.

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References

1. Funding for the VCP comes from restitution fines and orders, penalty assessments levied on persons convicted of crimes and traffic offenses, and federal matching funds.
2. Minors who suffer emotional injuries from witnessing a violent crime may be eligible for up to $5,000 in mental health counseling through VCP.
3. If applying after one year, one can inform VCP in writing why the application is late, and an extension of the time limit may be granted for certain reasons. In most cases, if the victim was under 18 when the crime happened, he/she has until the victim’s 19th birthday to apply. If the specified crime involves sex with a minor, claims may be filed any time prior to the victim’s 28th birthday.
4. The payments are generally capped at: $10,000 for direct victims, and $5,000 for indirect victims and minor witnesses.
5. The VCP will not pay claim reimbursements after three years.
6. Government Code § 13957.2(a).