Delaware Administrative Code
Title 1 - Authorities, Boards and Commissions
300 - Victim's Compensation Assistance Program Advisory Council
301 - Victims' Compensation Assistance Program Rules and Regulations
Section 301-29.0 - Payment of Mental Health Claims
Current through Register Vol. 28, No. 3, September 1, 2024
29.1 Mental health assessment and counseling expenses shall be paid on behalf of the victim to a qualified mental health practitioner at a rate set by VCAP. If VCAP accepts a claim, the mental health treatment practitioner shall accept the VCAP payment as payment in full, and may not attempt to collect from the victim or third parties any amount exceeding the amount of reimbursement made by VCAP. In the absence of an existing provider agreement, VCAP payments may be accompanied by a notice that provider acceptance constitutes acknowledgment of payment in full.
29.2 VCAP will pay a mental health provider at the rate of 80% of the usual and customary charge for such services. When a third party has made payment, and the victim is responsible for a co-payment, VCAP may reimburse for the amount of the co-payment. VCAP may pay a lesser amount if payment under this section would exceed a statutory or regulatory cap.
29.3 If the usual and customary charge cannot readily be established, or in special circumstances, VCAP may, in its discretion, determine the reasonable charge for the procedure performed or the service rendered.
29.4 If a victim has Medicaid or Medicare benefits, VCAP will pay the mental health provider at the rates established by Medicaid or Medicare regardless of whether the provider is paneled with Medicaid or Medicare. The provider shall accept VCAP's payment as payment in full, and may not attempt to collect from the victim or third parties any amount exceeding the amount of reimbursement made by VCAP.
