Section 649.26 - Direct Payment to Providers(a) If the VCP authorizes direct payment to a healthcare provider of VCP services, the VCP may require the provider to submit bills using CMS 1450, CMS 1500 or American Dental Association bill forms for verification of services provided. Applicants are not required to use the above-noted forms to request reimbursement of eligible pecuniary losses that they paid.(b) The VCP shall inform the victim or derivative victim of his or her right to object to direct payments by VCP to providers of services in accordance with Government Code section 13957.7(c)(1). In the event that the victim or derivative victim asserts such right the VCP may reimburse pecuniary loss to the victim or derivative victim only in amounts equal to sums actually paid out by the victim or derivative victim to the service provider and only upon submission by the victim, the victim's survivors, or derivative victim of evidence of such payments, subject to the rates and limitations set by the Board in accordance with applicable law. Following such an objection, direct payment shall be made to the provider only upon a demonstration of good cause as determined by the board.(c) For consideration of payment for mental health counseling over the claimant's authorized session limit, mental health providers must submit the VCP Treatment Plan and the VCP Additional Treatment Plan for review and approval within 90 days of the date VCP receives the bill for sessions that exhaust the claimant's authorized session limit. If the VCP Treatment Plan and VCP Additional 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 VCP Treatment Plan and VCP Additional Treatment Plan are received may be considered if the VCP Additional Treatment Plan is approved and the authorized session limit is increased.Cal. Code Regs. Tit. 2, § 649.26
1. Change without regulatory effect renumbering former section 649.18 to section 649.26, including amendment of section and NOTE, filed 12-6-2007 pursuant to section 100, title 1, California Code of Regulations (Register 2007, No. 49). For prior history of section 649.26, see Register 2006, No. 4.
2. Amendment filed 6-12-2009; operative 7-12-2009 (Register 2009, No. 24).
3. Amendment of section heading and section filed 1-6-2011; operative 2-5-2011 (Register 2011, No. 1).
4. New subsection (c) filed 8-12-2014; operative 10-1-2014 (Register 2014, No. 33). Note: Authority cited: Section 13974, Government Code, Reference: Section 13957.7, Government Code.
1. Change without regulatory effect renumbering former section 649.18 to section 649.26, including amendment of section and Note, filed 12-6-2007 pursuant to section 100, title 1, California Code of Regulations (Register 2007, No. 49). For prior history of section 649.26, see Register 2006, No. 4.
2. Amendment filed 6-12-2009; operative 7-12-2009 (Register 2009, No. 24).
3. Amendment of section heading and section filed 1-6-2011; operative 2-5-2011 (Register 2011, No. 1).
4. New subsection (c) filed 8-12-2014; operative 10/1/2014 (Register 2014, No. 33).