Source: http://victims.ca.gov/providers/mhguidelines.aspx
Timestamp: 2019-04-19 16:37:26+00:00

Document:
Reimbursement of outpatient mental health and counseling expenses by the California Victim Compensation Board (Board) 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 Board codified by Government Code §13900 et seq.
An individual mental health counseling session lasting less than 45 minutes is one-half session.
An individual mental health counseling session lasting 45 to 74 minutes is one session.
An individual mental health counseling session lasting 75–104 minutes is one and one-half sessions.
An individual mental health counseling session lasting 105–120 minutes is two sessions.
One group mental health counseling session is the equivalent of one-half of an individual mental health counseling session of the same length.
Case management is a service that assists claimant’s access to needed medical, educational, social, prevocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, referral and coordination.
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.
Direct Victims: An eligible victim may be reimbursed for up to 40 initial mental health counseling sessions. The Board may reimburse up to 5 case management sessions, which will not be counted as part of the mental health session limit. The Board may reimburse up to five (5) telehealth therapy sessions, which will be counted as part of the mental session limit.
Derivative Victims/Minor Witnesses/Good Samaritans: An eligible derivative victim, minor witness or Good Samaritan may be reimbursed under these guidelines for the number of initial sessions set forth in one of the categories that follow. A derivative victim eligible in more than one category may use only the most favorable category. The Board may reimburse up to 5 case management sessions for claimants, which will not be counted as part of the mental health session limit. The Board may reimburse up to five (5) telehealth therapy sessions, which will be counted as part of the mental session limit.
An adult derivative victim may receive up to 15 mental health counseling sessions.
A minor derivative victim, or minor witness, or Good Samaritan may receive up to 30 mental health counseling sessions.
Each derivative victim who is the direct victim’s primary caretaker at the time of the crime may receive up to 30 mental health counseling sessions, for up to two primary caretakers.
Each derivative victim who is a post-crime primary caretaker may receive up to 15 mental health sessions for up to two post-crime primary caretakers. The initial sessions must be for benefit of the direct victim pursuant to Government Code §13957(a)(2)(B)(i).
If the qualifying crime resulted in the death of the victim, a surviving parent, sibling, child, spouse, fiancé, fiancée, grandparent, grandchild, or registered domestic partner as defined in Family Code §297, may receive up to 40 mental health counseling sessions.
A victim, derivative victim, minor witness or Good Samaritan who is eligible for outpatient mental health counseling expenses may be reimbursed for the service provider’s first three mental health counseling sessions within the session limit without completion of a Treatment Plan.
If the claimant is the post-crime primary caretaker.
A declaration of the percentage of the treatment that is necessary as a direct result of the qualifying crime.
Requests for reimbursement beyond those described in Section II require submission of an Additional Treatment Plan and approval of additional treatment by the Board. The initial Treatment Plan must be submitted with the Additional Treatment Plan if the service provider is the continuing therapist. The Additional Treatment Plan should not be completed before the claimant is within eight (8) sessions from reaching his or her authorized session limit and must be submitted within 90 days after the date a bill for sessions that exhaust the authorized session limit is received by the Board. If the Additional Treatment Plan and Treatment Plan 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. However, bills for dates of service provided after the Additional Treatment Plan and Treatment Plan are received may be considered for payment, subject to approval of the Additional Treatment Plan. 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.
If the claimant is a derivative victim of a surviving direct victim, a list and description of the therapeutic interventions for the claimant that are aimed at alleviating the direct victim’s symptoms.
The Board may require the submission of any other information required 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 California Code of Regulations § 649.7(b)(1).
The Board shall not reimburse additional outpatient mental health counseling sessions unless the requirements of Section V, VI VII, or VIII are met; or, in the Board'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.
Notwithstanding Section V, subsections (b)(3) and (d)(2), Section VI, subsections (a)(3) and (c)(2), Section VII, subsections (a)(2) and (b), and Section VIII, subsections (a)(2) and (b), if inadequate progress has been shown in treatment, the Board may, in its sole discretion, authorize additional treatment with a different treatment modality, method, or provider.
Reimbursement made in excess of the limits in Government Code § 13957(a)(2)(A) or (B) must comply with this section and must be based on a finding that dire or exceptional circumstances require more extensive treatment.
Reimbursement for additional mental health counseling sessions for a victim 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 in subsections (b) and (c) below.
The perpetrator is released from custody. To be reimbursed, the mental health counseling must be initiated within three months of learning that the perpetrator will be, or was, released from custody.
The treatment must be focused on symptoms, behaviors, or beliefs that are directly attributable to the qualifying crime and could reasonably be remediated by the proposed treatment.
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.
The alleged suspect persists in making uninvited and unwelcome contact with the victim that is not authorized by a court.
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.
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.
The Additional Treatment Plan for the derivative victim demonstrates improvement in the victim’s symptoms, behaviors, or beliefs attributable to the derivative victim’s treatment.
If the Board previously approved reimbursement for additional sessions under subsection (a), (b), or (c) 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.
The minor witness is scheduled to testify as a witness in any criminal or dependency proceeding related to the qualifying crime. To be reimbursed, the mental health counseling must be initiated within three months of being scheduled to testify.
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.
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.

References: §13957
 §13900
 §13957
 §297
 § 649
 § 13957