2005 California Government Code Sections 13957-13958 Article 4. Scope of Compensation

13957.  (a) The board may grant for pecuniary loss, when the board
determines it will best aid the person seeking compensation, as
follows:
   (1) Subject to the limitations set forth in Section 13957.2,
reimburse the amount of medical or medical-related expenses incurred
by the victim, including, but not limited to, eyeglasses, hearing
aids, dentures, or any prosthetic device taken, lost, or destroyed
during the commission of the crime, or the use of which became
necessary as a direct result of the crime.
   (2) Subject to the limitations set forth in Section 13957.2,
reimburse the amount of outpatient psychiatric, psychological, or
other mental health counseling related expenses incurred by the
victim or derivative victim, including peer counseling services
provided by a rape crisis center as defined by Section 13837 of the
Penal Code, and including family psychiatric, psychological, or
mental health counseling for the successful treatment of the victim
provided to family members of the victim in the presence of the
victim, whether or not the family member relationship existed at the
time of the crime, that became necessary as a direct result of the
crime, subject to the following conditions:
   (A) The following persons may be reimbursed for the expense of
their outpatient mental health counseling in an amount not to exceed
ten thousand dollars ($10,000):
   (i) A victim.
   (ii) A derivative victim who is the surviving parent, sibling,
child, spouse, fiancé, or fiancée of a victim of a crime that
directly resulted in the death of the victim.
   (iii) A derivative victim, as described in paragraphs (1) to (4),
inclusive, of subdivision (c) of Section 13955, who is the primary
caretaker of a minor victim whose claim is not denied or reduced
pursuant to Section 13956 in a total amount not to exceed ten
thousand dollars ($10,000) for not more than two derivative victims.
   (B) The following persons may be reimbursed for the expense of
their outpatient mental health counseling in an amount not to exceed
three thousand dollars ($3,000):
   (i) A derivative victim not eligible for reimbursement pursuant to
subparagraph (A), provided that mental health counseling of a
derivative victim described in paragraph (5) of subdivision (c) of
Section 13955, shall be reimbursed only if that counseling is
necessary for the treatment of the victim.
   (ii) A victim of a crime of unlawful sexual intercourse with a
minor committed in violation of subdivision (d) of Section 261.5 of
the Penal Code.  A derivative victim of a crime committed in
violation of subdivision (d) of Section 261.5 of the Penal Code shall
not be eligible for reimbursement of mental health counseling
expenses.  The total award to or on behalf of a victim of a crime
committed in violation of subdivision (d) of Section 261.5 of the
Penal Code may not exceed three thousand dollars ($3,000) for mental
health counseling expenses only.
   (C) The board may reimburse a victim or derivative victim for
outpatient mental health counseling in excess of that authorized by
subparagraphs (A) or (B) or for inpatient psychiatric, psychological,
or other mental health counseling if the claim is based on dire or
exceptional circumstances that require more extensive treatment, as
approved by the board.
   (D) Expenses for psychiatric, psychological, or other mental
health counseling related services may be reimbursed only if the
services were provided by either of the following individuals:
   (i) A person who would have been authorized to provide those
services pursuant to the provisions of former Article 1 (commencing
with Section 13959) as it read on January 1, 2002.
   (ii) A person who is licensed by the state to provide those
services, or who is properly supervised by a person who is so
licensed, subject to the board's approval and subject to the
limitations and restrictions the board may impose.
   (3) Reimburse the expenses of nonmedical remedial care and
treatment rendered in accordance with a religious method of healing
recognized by state law.
   (4) Subject to the limitations set forth in Section 13957.5,
authorize compensation equal to the loss of income or loss of
support, or both, that a victim or derivative victim incurs as a
direct result of the victim's or derivative victim's injury or the
victim's death.  If the victim or derivative victim requests that the
board give priority to reimbursement of loss of income or support,
the board may not pay medical expenses, or mental health counseling
expenses, except upon the request of the victim or derivative victim
or after determining that payment of these expenses will not decrease
the funds available for payment of loss of income or support.
   (5) Authorize a cash payment to or on behalf of the victim for job
retraining or similar employment-oriented services.
   (6) Reimburse the expense for installing or increasing residential
security, not to exceed one thousand dollars ($1,000), with respect
to a crime that occurred in the victim's residence, upon verification
by law enforcement to be necessary for the personal safety of the
victim or by a mental health treatment provider to be necessary for
the emotional well-being of the victim.  Installing or increasing
residential security may include, but need not be limited to, both of
the following:
   (A) Home security device or system.
   (B) Replacing or increasing the number of locks.
   (7) Reimburse the expense of renovating or retrofitting a victim's
residence or a vehicle, or both, to make the residence, the vehicle,
or both, accessible or the vehicle operational by a victim upon
verification that the expense is medically necessary for a victim who
is permanently disabled as a direct result of the crime, whether the
disability is partial or total.
   (8) Authorize a cash payment or reimbursement not to exceed two
thousand dollars ($2,000) to a victim for expenses incurred in
relocating, if the expenses are determined by law enforcement to be
necessary for the personal safety of the victim or by a mental health
treatment provider to be necessary for the emotional well-being of
the victim.  When a relocation payment or reimbursement is provided
to a victim of sexual assault or domestic violence and the identity
of the offender is known to the victim, the victim shall agree not to
inform the offender of the location of the victim's new residence
and not to allow the offender on the premises at any time, or shall
agree to seek a restraining order against the offender.  The cash
payment or reimbursement made under this subdivision shall only be
awarded once to any victim, except that the board may, under
compelling circumstances, award a second cash payment or
reimbursement to the same victim if both of the following conditions
are met:
   (A) The crime occurs more than three years from the date of the
crime giving rise to the initial relocation cash payment or
reimbursement.
   (B) The crime does not involve the same offender.
   (9) When a victim dies as a result of a crime, the board may
reimburse any individual who voluntarily, and without anticipation of
personal gain, pays or assumes the obligation to pay any of the
following expenses:
   (A) The medical expenses incurred as a direct result of the crime
in an amount not to exceed the rates or limitations established by
the board.
   (B) When the crime occurs in a residence, the reasonable costs to
clean the scene of the crime in an amount not to exceed one thousand
dollars ($1,000).  Services reimbursed pursuant to this subdivision
shall be performed by persons registered with the State Department of
Health Services as trauma scene waste practitioners in accordance
with Chapter 9.5 (commencing with Section 118321) of Part 14 of
Division 104 of the Health and Safety Code.
   (C) The funeral and burial expenses incurred as a direct result of
the crime, not to exceed seven thousand five hundred dollars
($7,500).
   (b) The total award to or on behalf of each victim or derivative
victim may not exceed thirty-five thousand dollars ($35,000), except
that this amount may be increased to seventy thousand dollars
($70,000) if federal funds for that increase are available.
13957.2.  (a) The board may establish maximum rates and service
limitations for reimbursement of medical and medical-related services
and for mental health and counseling services.  The adoption,
amendment, and repeal of these service limitations and maximum rates
shall not be subject to the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1).  An informational copy
of the service limitations and maximum rates shall be filed with the
Secretary of State upon adoption by the board.  A provider who
accepts payment from the program for a service shall accept the
program's rates as payment in full and shall not accept any payment
on account of the service from any other source if the total of
payments accepted would exceed the maximum rate set by the board for
that service.  To ensure service limitations that are uniform and
appropriate to the levels of treatment required by the victim or
derivative victim, the board may review all claims for these services
as necessary to ensure their medical necessity.
   (b) The board may request an independent examination and report
from any provider of medical or medical-related services or
psychological or psychiatric treatment or mental health counseling
services, if it believes there is a reasonable basis for requesting
an additional evaluation.  The victim or derivative victim shall be
notified of the name of the provider who is to perform the evaluation
within 30 calendar days of that determination.  In cases where the
crime involves sexual assault, the provider shall have expertise in
the needs of sexual assault victims.  In cases where the crime
involves child abuse or molestation, the provider shall have
expertise in the needs of victims of child abuse or molestation, as
appropriate.  When a reevaluation is requested, payments shall not be
discontinued prior to completion of the reevaluation.
   (c) Reimbursement for any medical or medical-related services
shall, if the application has been approved, be paid by the board
within an average of 90 days from receipt of the claim for payment.
Payments to a medical or mental health provider may not be
discontinued prior to completion of any reevaluation.  Whether or not
a reevaluation is obtained, if the board determines that payments to
a provider will be discontinued, the board shall notify the provider
of their discontinuance within 30 calendar days of its
determination.
13957.5.  (a) In authorizing compensation for loss of income and
support pursuant to paragraph (4) of subdivision (a) of Section
13957, the board may take any of the following actions:
   (1) Compensate the victim for loss of income directly resulting
from the injury, except that loss of income may not be paid by the
board for more than five years following the crime, unless the victim
is disabled as defined in Section 416(i) of Title 42 of the United
States Code, as a direct result of the injury.
   (2) Compensate an adult derivative victim for loss of income,
subject to all of the following:
   (A) The derivative victim is the parent or legal guardian of a
victim, who at the time of the crime was under the age of 18 years
and is hospitalized as a direct result of the crime.
   (B) The minor victim's treating physician certifies in writing
that the presence of the victim's parent or legal guardian at the
hospital is necessary for the treatment of the victim.
   (C) Reimbursement for loss of income under this paragraph may not
exceed the total value of the income that would have been earned by
the adult derivative victim during a 30-day period.
   (3) Compensate an adult derivative victim for loss of income,
subject to all of the following:
   (A) The derivative victim is the parent or legal guardian of a
victim who at the time of the crime was under the age of 18 years.
   (B) The victim died as a direct result of the crime.
   (C) The board shall pay for loss of income under this paragraph
for not more than 30 days from the date of the victim's death.
   (4) Compensate a derivative victim who was legally dependent on
the victim at the time of the crime for the loss of support incurred
by that person as a direct result of the crime, subject to both of
the following:
   (A) Loss of support shall be paid by the board for income lost by
an adult for a period up to, but not more than, five years following
the date of the crime.
   (B) Loss of support shall not be paid by the board on behalf of a
minor for a period beyond the child's attaining the age of 18 years.
   (b) The total amount payable to all derivative victims pursuant to
this section as the result of one crime may not exceed seventy
thousand dollars ($70,000).
13957.7.  (a) No reimbursement may be made for any expense that is
submitted more than three years after it is incurred by the victim or
derivative victim.  However, reimbursement may be made for an
expense submitted more than three years after the date it is incurred
if the victim or derivative victim has affirmed the debt and is
liable for the debt at the time the expense is submitted for
reimbursement, or has paid the expense as a direct result of a crime
for which a timely application has been filed.
   (b) Compensation made pursuant to this chapter may be on a
one-time or periodic basis.  If periodic, the board may increase,
reduce, or terminate the amount of compensation according to the
applicant's need, subject to the maximum limits provided in this
chapter.
   (c) (1) The board may authorize direct payment to a provider of
services that are reimbursable pursuant to this chapter and may make
those payments prior to verification.  However, the board may not,
without good cause, authorize a direct payment to a provider over the
objection of the victim or derivative victim.
   (2) Reimbursement on the initial claim for any psychological,
psychiatric, or mental health counseling services shall, if the
application has been approved, be paid by the board within 90 days of
the date of receipt of the claim for payment, with subsequent
payments to be made to the provider within one month of the receipt
of a claim for payment.
   (d) Payments for peer counseling services provided by a rape
crisis center may not exceed fifteen dollars ($15) for each hour of
services provided.  Those services shall be limited to in-person
counseling for a period not to exceed 10 weeks plus one series of
facilitated support group counseling sessions.
   (e) The board shall develop procedures to ensure that a victim is
using compensation for job retraining or relocation only for its
intended purposes.  The procedures may include, but need not be
limited to, requiring copies of receipts, agreements, or other
documents as requested, or developing a method for direct payment.
   (f) Compensation granted pursuant to this chapter shall not
disqualify an otherwise eligible applicant from participation in any
other public assistance program.
   (g) The board shall pay attorney's fees representing the
reasonable value of legal services rendered to the applicant, in an
amount equal to 10 percent of the amount of the award, or five
hundred dollars ($500), whichever is less, for each victim and each
derivative victim.  An attorney receiving fees from another source
may waive the right to receive fees under this subdivision.  Payments
under this subdivision shall be in addition to any amount authorized
or ordered under subdivision (b) of Section 13960.  An attorney may
not charge, demand, receive, or collect any amount for services
rendered in connection with any proceedings under this chapter except
as awarded under this chapter.
   (h) A private nonprofit agency shall be reimbursed for its
services at the level of the normal and customary fee charged by the
private nonprofit agency to clients with adequate means of payment
for its services, except that this reimbursement may not exceed the
maximum reimbursement rates set by the board and may be made only to
the extent that the victim otherwise qualifies for compensation under
this chapter and that other reimbursement or direct subsidies are
not available to serve the victim.
13957.9.  (a) Notwithstanding Section 13954, the board shall develop
a simplified and expedited procedure for paying claims of a
qualified provider of mental health services.
   (b) A simplified and expedited procedure for paying claims
specified in subdivision (a) shall include all of the following:
   (1) An agreement by the provider to subject its claims to audit
procedures established by the board and to request payment only for
qualified services.
   (2) An agreement by the board to pay claims on a regular and
timely basis to a qualified provider for services without requiring
further documentation beyond that required to initially qualify the
claim.
   (3) Additional methods of simplifying the claims process as agreed
upon between the board and the qualified provider.
   (c) Simplified and expedited procedures for mental health services
may be instituted when both of the following conditions are met:
   (1) The board has determined that the crime has occurred and that
the victim qualifies for compensation pursuant to this chapter.
   (2) Services to the victim or derivative victim, or both, are
being provided by a qualified provider.
   (d) A nonprofit agency may apply to the board for a determination
that the nonprofit agency is a qualified provider for purposes of
this section.  The board shall approve or reject an application from
a qualified provider for participation in an agreement pursuant to
this section within 90 days of receipt of a complete application as
required by the board.
   (e) An agreement made pursuant to this section shall not be deemed
to be a contract subject to the requirements of Part 2 (commencing
with Section 10100) of Division 2 of the Public Contract Code.
   (f) For purposes of this section, "qualified provider" means a
nonprofit agency with extensive experience in providing mental health
services and that has utilized reimbursement from the Restitution
Fund at a significant level on a regular and constant basis.  Upon
request of a nonprofit agency, the board shall determine if the
nonprofit agency is a qualified provider for purposes of this
section.
13958.  The board shall approve or deny applications, based on
recommendations of the board staff, within an average of 90 calendar
days and no later than 180 calendar days of acceptance by the board
or victim center.
   (a) If the board does not meet the 90-day average standard
prescribed in this subdivision, the board shall, thereafter, report
to the Legislature, on a quarterly basis, its progress and its
current average time of processing applications.  These quarterly
reports shall continue until the board meets the 90-day average
standard for two consecutive quarters.
   (b) If the board fails to approve or deny an individual
application within 180 days of the date it is accepted, pursuant to
this subdivision, the board shall advise the applicant and his or her
representative, in writing, of the reason for the failure to approve
or deny the application.