Providing financial assistance to crime victims who need mental health treatment as an integral part of their recovery process is a basic service of the Crime Victims' Compensation Program (CVC). Assisting mental health providers who work with crime victims in ensuring access to quality, appropriate treatment is a commitment and responsibility of the CVC program. The Program is also charged with assuring that the services are related to the victimization and that they are necessary and reasonable.
Eligible providers must be licensed mental health providers limited to the following professions:
CVC does not maintain a "preferred provider list" that providers need to apply for eligibility or request to be added.
Experience in trauma issues and crisis counseling is preferred and would be beneficial to provide counseling to crime victims and their families who may be seeking services. Responsibility for securing training in these areas belongs to the mental health provider and may be accessed through their statewide association.
The counseling limit for each victim and/or eligible claimant is $3,000 per person. Family counseling (CPT 90847) may be applied to the $3,000 limit for each individual attending the sessions.
Collateral sources such as medical insurance, CHIPS, Medicaid, or Medicare, must be utilized when available. Providers are subject to the requirements of these individual programs such as authorization, network membership, etc. and should review requirements with each of the collateral sources that the victim has available.
Under extenuating circumstances an exception to the $3000 limit can be requested by the victim/claimant and provider of service along with supporting documentation.
Each Explanation of Benefits (EOB) from the collateral source insurance should be submitted with the itemized bill. Itemized bills should be submitted via a Center for Medicare & Medicaid Services (CMS) form 1500 which is commonly referred to as a CMS 1500. View a sample of this form. Providers may be asked to submit a bill showing client copay amounts; this allows CVC to reimburse victims or claimants for their paid deductible and co-pay amounts. The CVC nurse reviewers are available to answer your questions concerning collateral resources and billing.
Psychiatric medication, prescribed by a psychiatrist, can be reimbursed to the victim or claimant. This reimbursement stops after one year, or when the counseling has terminated, or when the counseling limit of $3,000 is reached. (Medication costs are not included in the $3,000 limit.)
To comply with the CVC Act, mental health providers will be asked to complete a mental health form (MHF) that will be mailed to them (or faxed, if requested) after the client has been seen for 2-4 sessions. This will document the diagnoses, symptoms, short term and long term goals. A MHF will be requested for all victims and claimants receiving therapy. This MHF will include additional billing information and general information for providers.
Mental health providers will be asked to complete an update on the claimant's progress. The "update" is a one (1) page form that will be mailed to the provider every six (6) months. This form is required for continued payments to the counselor or reimbursements to the victim or claimant. It is important that CVC verify that the continued treatment is related to the patient's status as a crime victim or claimant.
The Texas Code of Criminal Procedure Article 56.34 (c) requires the OAG to award compensation for health care services according to the medical fee guidelines prescribed by the Texas Department of Insurance, Division of Workers' Compensation (DWC).
These fee schedules change frequently and providers are encouraged to review the Texas Department of Insurance, Division of Workers' Compensation web site for the most current information.
The DWC is currently using the Medicare fee schedule with adjustments that vary depending on the provider's license, provider location (by county), and the conversion factor. The conversion factor is a multiplier that is based on the date of service and can be found at the DWC web site. The Medicare fee schedule can be found on line at www.novitas-solutions.com/. When accessing the Medicare Fee Schedule on Novitas, it is important to use the correct year (must correspond with the date of service), county, and DWC conversion factor.