On Friday, July 25, 2008, Dr. James Kent addressed attendees at the SCV-CAMFT luncheon, held at Los Gatos Lodge. He spoke about California’s Victim Compensation Program (VCP), and its current outreach effort to providers.
James Kent received his Ph.D. in child psychology from the University of Michigan. Since 1991 he has worked in Sacramento as a consulting psychologist with the VCP. Two representatives from the Santa Clara County Office were also in attendance at the presentation: David Tran, Victim Advocacy Unit Supervisor, and Tiffany Stevens, Senior Compensation Analyst.
The VCP was established in 1965; every state has a similar program. By federal law, VCP is the payer of last resort for non-reimbursed out-of-pocket losses resulting from crime. It is not necessary for a claimant to exhaust Medi-Cal or Medicare benefits before qualifying for VCP services. The program is funded not by taxes, but by state and federal penalties and fines paid by criminals.
Kent emphasized that the purpose of the program is to provide services to as many clients as possible (unlike insurance programs, whose goal is to minimize their expenses). With a new electronic billing program coming on-line, claims for qualified cases should be paid within 30 days, much faster than in the past.
Covered crimes include murder, robbery, battery, physical and sexual assaults, child abuse/molest, domestic violence (DV), elder abuse, and vehicular offenses (DUI, hit and run, vehicular manslaughter, fleeing the scene of a crime, and assault with a vehicle). Victims are eligible for services if the crime occurred in California, or to a California resident victimized in another state. The individual must have no involvement or participation in the crime, and must cooperate with law enforcement authorities and the Victims Compensation Board (VCB).
An individual requesting services may qualify as a direct/primary victim. The victim must have been subjected to a crime, an injury, or threat of injury, and typically be named on the crime report, child protective services report, or on the declaration page of a restraining order. All that is necessary to qualify for services is to be a victim of a crime — no clinical diagnosis is required. An Axis I Diagnosis is not necessary; V-codes are reimbursable. Note: New CPT codes are available. Go to http://www.camft.org to download the new information.
Services are also available to derivative/secondary victims. Members of this category include the immediate family of the primary victim, members of the household at the time of the crime, and others in close relationship to the victim. Problems with immigration status will not disqualify an applicant.
In child abuse and neglect cases, where neglect/endangerment is sustained, services to the child are reimbursable. In DV cases, the child living in the home where DV took place is eligible; the child does not have to be present when the reported incident occurred. The non-offending parent of a victim of child sexual abuse (CSA) or physical abuse also qualifies as a derivative victim.
Kent stated that if an application for services is refused, an appeal process exists.
In certain cases, a Late Filing Application is appropriate. An adult victim of CSA can file if he or she: (1) never previously received compensation from VCP for the crime in question, and (2) has some supporting documentation. Documentation might be a police report, but could also be a Child Protective Services (CPS) report, a social worker’s records, a restraining order with a statement from the victim, or other documents. If no documentation exists, the applicant can, through the appeal process, say “I am the only one who can speak, as no documentation or evidence exists.” A victim can apply at any time, even many years later in certain circumstances (consult with a Victim Advocate at the VCP office in your county).
Benefits covered by the program include but are not limited to:
- Medical/dental/mental health services
- Income/support loss
- Crime scene cleanup
- Relocation expenses
- Funeral and burial expenses
A direct victim is eligible for 40 therapy sessions without challenge. A derivative victim may receive up to 30 sessions. A foster parent may receive 15 sessions. If a client has qualified as a derivative victim, and later it emerges that the client has actually been a direct victim, the category can be changed.
Providers are no longer required to complete a treatment plan (TP) at the end of their client’s fifth session. However, providers are expected to have a TP in the client’s file and readily available, if requested by the VCB. A TP outlines the focus of treatment, the methods to be used, and the means of measuring progress. The TP may be revised at intervals if appropriate.
The client may apply for additional sessions if he or she has exhausted the approved number of sessions. The therapist will submit the TP and an additional treatment plan (ATP) in support of that application.
There are limits to the total value of services provided ($70,000), as well as to mental health services ($10K for direct victim, $3K-$5K for indirect). In an especially severe case, one can apply for additional sessions (detailed documentation will be required). Even if full recovery is not expected, a victim may receive continuing maintenance treatment.
If the victim has insurance, the therapist submits a claim to the insurer first. Once the insurer pays (or doesn’t), VCP will cover co-payments, out-of-network provider fees, etc. For a faster turnaround in processing bills, the therapist should include an explanation of benefits (EOB), a document showing what the insurer has/has not paid; VCP can also verify this information by contacting the insurer. VCP’s reimbursement rates for an insured client are based on the insurer’s rate structure.
Visit http://www.vcgcb.ca.gov/ for rates and details about which practitioners may be reimbursed for what kinds of services. Note that certain services are non-reimbursable, including court appearances and related expenses, note taking, billing, research on the client’s condition, missed/canceled appointments, travel time, and treatment not necessary as a direct result of the crime. Pre-existing conditions are also not covered — except that often, pre-existing conditions come as part of the package. VCP deals with this ambiguity by refusing to consider this problem during the first 30-40 sessions; thereafter, they will look at pre-existing conditions or “downstream effects” (e.g. child has to change schools as a result of mother being a victim of DV) more carefully.
Therapists should contact their local VCP office to make sure the office has their current and correct address information. The VCP is in the process of converting to a new system. Payment procedures and address updates may take a little extra time, but once the transition is complete, updates to the referral list and payment of claims will be processed more quickly.
Visit http://www.victim.org/ and http://www.vcgcb.ca.gov/ to learn more about the program and to download forms and manuals.
Santa Clara County claims should be filed at 777 N. 1st St., Ste. 220, San Jose, CA 95112; or faxed to 408/289-5430. David Tran, 408/295-2656 ext. 335, is the Victim Advocacy Unit Supervisor, and Saher Stephan, 408/295-2656 ext. 316 is the Compensation Unit Supervisor.
San Mateo County claims should be filed at the San Mateo County District Attorney’s Office, Victim/Witness Assistance Center, 650/599-7479. San Mateo County has two locations: North County Municipal Court Building, 1050 Mission Rd. South San Francisco, CA 94080. South County Hall of Justice, 400 County Center, 3rd Floor, Redwood City, CA 94063.
Author: Melissa Miller, MFT
Presented by: Dr. James Kent, Ph.D.
