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Resources for Crime Victim Compensation Providers
- Insurer Activity Prescription Form (APF).
- Billing Crime Victims.
- Reimbursement rates.
- Sexual assault examinations.
- Laws and regulations.
- Crime Victims Compensation Program Forms.
- Mental health and dental fees reduced to Medicaid rates.
- Mental health reporting forms.
- Mental health billing information.
- Related resources at other Web sites.
- Burial and funeral information.
- Grief and loss information.
- Helping children and teens understand.
Insurer Activity Prescription Form (APF)
Health-care providers who treat crime victims need to complete the Activity Prescription Form (APF) to Treat Crime Victims.
Billing Crime Victims
Simplified Provider Registration & Billing.
A victim can't be billed for services:
"a client must not be billed for treatment of his or her accepted condition. All copayments, deductibles or out of pocket expenses not covered by primary insurance should be included in your billings to the department" WAC 296‑30‑085(3) (www.leg.wa.gov).
"Providers must determine if any public or private insurance benefits are available before billing the department. Available public or private insurance must be billed first and a copy of the insurance explanation of benefits must be attached to billings submitted to the department" WAC 296‑30‑085(2) (www.leg.wa.gov).
A victim isn't responsible for costs even if they are higher than what L&I pays:
"When treating a crime victim who comes under our jurisdiction, you agree to accept and comply with the department's rules and fees" WAC 296‑30‑081(1) (www.leg.wa.gov).
"You must inform the victim of his or her rights under the Crime Victims Act and give whatever assistance is necessary for the victim to apply for compensation and provide proof of other matters required by our rules. Providers may not charge the victim for these services" WAC 296‑30‑081(2) (www.leg.wa.gov).
Helping Providers Understand the Crime Victims Program (F800‑102‑000).
Use Provider Accounts Change Form for Crime Victims Compensation (F800‑089‑000) for changes such as Tax ID address or name, business address, billing address, name, or termination of account.
Provider training on billing issues
Critical Billing Issues (858 KB PDF / 2 min).- Provider's Request for Adjustment (858 KB PDF / 2 min).
- Pharmacy (858 KB PDF / 2 min).
- Statement for Crime Victim Misc Svcs (858 KB PDF / 2 min).
- Mental Health Providers (858 KB PDF / 2 min).
- Chiropractic Providers (858 KB PDF / 2 min).
- Dental Providers (858 KB PDF / 2 min).
- Hospital Emergency Rooms and Sexual Assault (858 KB PDF / 2 min).
- Forensic Evaluation Clinics (SAFE) Reimbursement Rates (858 KB PDF / 2 min).
- Provider Registration (858 KB PDF / 2 min).
Get Help Downloading Files (files open in a new window).
Reimbursement rates
The Crime Victims Compensation Program will reimburse mental health providers at L&I rates for effective dates of service May 1, 2006 through October 18, 2009. The Crime Victims Comp Mental Health Fee Schedule will be used to reimburse mental health providers.
All other provider types, with the exception of providers performing sexual assault forensic examinations, will continue to be reimbursed at Medicaid rates until further notice. Visit Health Care Assistance in Washington State (hrsa.dshs.wa.gov) to find Medicaid reimbursement rates.
Sexual assault examinations
The Crime Victims Compensation Program is the primary payer for all sexual assault examinations done for collection of evidence and possible prosecution in accordance with RCW 7.68.170 (www.leg.wa.gov).
Refer to Billing Guidelines for Sexual Assault Examinations (F800‑100‑000) for complete billing instructions. Included in this guide are the specific codes and forms to use when billing for these examinations.
Laws and regulations
- WAC 296-30 (www.leg.wa.gov)
Rules for the administration of the crime victims compensation program. - WAC 296-31 (www.leg.wa.gov)
Crime victims compensation mental health treatment rules and fees. - WAC 296-20 (www.leg.wa.gov)
Medical aid rules. - WAC 296-17 (www.leg.wa.gov)
General reporting rules, audit and recordkeeping, rates and rating system for Washington workers' compensation insurance. - WAC 296-33 (www.leg.wa.gov)
Attendant services. - WAC 296-23A (www.leg.wa.gov)
Hospitals. - WAC 296-21 (www.leg.wa.gov)
Reimbursement policies: Psychiatric services, biofeedback, physical medicine. - WAC 296-23B (www.leg.wa.gov)
Ambulatory surgery center payment. - WAC 296 (www.leg.wa.gov)
All Sections. - RCW 7.68 (www.leg.wa.gov)
Victims of crimes — compensation, assistance.
Crime Victims Compensation Program Forms
Mental health and dental fees reduced to Medicaid rates
- Crime Victims Compensation Program (CVCP) will immediately reduce the reimbursement rate for dentists and mental‑health providers treating crime victims.
- The CVCP spending level had to be reduced because of the state's budget shortfall.
- This reduction helps CVCP to provide benefits to an increasing number of crime victims. Over the last year, an additional 1,900 crime victims applied for benefits (25% percent increase).
Mental health reporting forms
- Form I: Initial Response and Assessment (F800‑080‑000). Use when treatment is completed within six visits.
- Form II: Initial Response and Assessment (F800‑081‑000). Authorization request for use when treatment will go beyond six visits.
- Form III: Progress Notes (F800‑082‑000). Used to request preauthorization for payment of additional sessions.
- Form IV: Treatment Report (F800‑083‑000). Used to request preauthorization for payment of additional sessions.
- Form V: Treatment Report (F800‑084‑000). Used to request preauthorization for payment of additional sessions.
- Form VI: Termination Report (F800‑085‑000). Used to inform L&I that you are no longer conducting treatment to the client.
Mental health billing information
Mental Health Fee Schedule and Billing Guidelines (F800‑105‑000).
For an alternate format, e-mail Nolan Thompson at thoo235@Lni.wa.gov.
Related resources at other Web sites
- Crime Victim Compensation Directory (www.ojp.usdoj.gov)
Office for Victims of Crime (OVC), U.S. Department of Justice. - Office for Victims of Crime (OVC) (www.ojp.usdoj.gov)
U.S. Department of Justice. - National Criminal Justice Reference Service (www.ncjrs.gov)
Office of Justice Programs, U.S. Department of Justice. - King County Prosecuting Attorney's Office (www.kingcounty.gov).
- Office of Crime Victims Advocacy (OCVA) (www.commerce.wa.gov)
Washington State Department of Commerce. - Victim Services (www.srb.wa.gov)
Washington State Indeterminate Sentence Review Board. - Other state crime victim compensation Web sites (nacvcb.org)
National Association of Crime Victim Compensation Boards (NACVCB). - Victim/Witness Notification Program (www.dshs.wa.gov)
The Victim Witness Notification Program of the Department of Social and Health Services is a confidential program that assists victims and witnesses of sexual assault or violent crimes track the location of the person who victimized them. - Victim Services Program (www.doc.wa.gov)
The Department of Corrections' Victim Services Program started in 1983, making it the oldest corrections-based victims program in the United States. The program serves as an advocate for victims and witnesses, and provides direct services by notifying enrolled victims and witnesses when offenders convicted of violent, sex, felony harassment, and serious drug crimes move through the prison system. - Washington Coalition of Crime Victim Advocates (www.wccva.org)
Established in 1984, this group of individuals, agencies, and organizations work to improve services for victims of crime and to strengthen victims' rights in Washington State by offering services to individuals and organizations advocating on behalf of crime victims in Washington State. - Washington Coalition of Sexual Assault Programs (www.wcsap.org).
- The Washington Violence Against Women Network (WAVAWNet) (www.wavawnet.org).
Burial and funeral information
Funeral directors are required to give customers a price list of goods and services. For consumer concerns regarding burial and funeral expenses we have included a link to some Web sites that may be of interest.
- Visit "Dealing with Death" at the Washington State Office of the Attorney General (www.atg.wa.gov) or by call 1‑800‑551‑4636.
- Another resource is the Funeral and Cemetery Licensing Unit (www.dol.wa.gov) at the Washington State Department of Licensing; you may call at 360-586-4905.
- Federal Trade Commission - Funerals: Consumer Rights Under the Funeral Rule (www.ftc.gov).
Grief and loss information
There are a number of books available on grief and loss for adults and children. We have listed only a few and our list is by no means exhaustive. However, the first book listed below specifically addresses the concerns of survivors and victims of traumatic loss such as homicide.
- What To Do When the Police Leave: A Guide to the First Days of Traumatic Loss, Second Edition, by Bill Jenkins. WBJ Press: Richmond, VA 1999.
- A Journey Through Grief, by Alla Renee Bozarth. Hazelden: Center City, MN 1990.
- When Good-Bye is Forever: Learning to Live Again After the Loss of a Child, by John Bramblett. Ballentine: New York, 1991.
- When Bad Things Happen to Good People, by Harold S. Kushner. Avon: New York, 1983.
- A Grief Observed, by C.S. Lewis. Bantam: New York, 1983.
- No Time For Goodbyes, Forth Edition, by Janice Harris Lord. Pathfinder: Ventura, CA 1991.
- Don't Take My Grief Away From Me: How to Walk Through Grief and Learn to Live Again, by Doug Manning. In-Sight Books: Oklahoma City, OK 1999. Also reprinted by HarperCollins as Don't Take My Grief Away.
- How to Go On Living When Someone You Love Dies, by Therese A. Rando. Bantam: New York, 1988.
Helping children and teens understand
- When Dinosaurs Die: A Guide to Understanding Death, by Laurie K. Brown and Marc Brown. Little, Brown and Co.: Boston, 1996. (Elementary and middle school ages).
- The Fall of Freddie the Leaf: A Story of Life for All Ages, Leo Buscaglia, Ph.D. Slack: Thorofare, NJ 1982. (Elementary and middle school ages).
- Talking About Death: A Dialogue Between Parent and Child, by Earl A. Grollman. Beacon Press: Boston, 1991.
- Help for the Hard Times: Getting Through Loss, by Earl Hipp. Hazelden: Center City, MN 1995 (For teens).
