The Roman Catholic Diocese of Portland Policy on Counseling Assistance Reimbursement
(Approved January 2, 2009 for Implementation March 1, 2009)
REVISED: February 13, 2018
Most Reverend Robert P. Deeley, JCD
STATEMENT OF POLICY
The policy of the Diocese of Portland is to offer reimbursement of the cost of outpatient counseling and expenses of spiritual assistance for anyone reporting to have been sexually abused by a representative of the Diocese. The Diocese offers reimbursement as part of its pastoral mission with the simple goal to promote emotional and spiritual healing. Regardless of when the abuse may have occurred, a victim/survivor and/or immediate family members may receive reimbursement without having to offer proof that the abuse occurred or that the Diocese was legally responsible. The following Guidelines are intended to inform victims/survivors and their treatment provider and/or spiritual director about the scope, duration and prerequisites for reimbursement. Reimbursement is an expression of the Church’s desire to promote the healing and wellness of its members and is not an admission of legal liability. Additionally, treatment assistance is provided for a limited time to assist victims/survivors or immediate family members through a particularly difficult period
Outpatient Clinical Mental Health Treatment: Initial Twelve Sessions
The Independent Clinician:
- is a licensed mental health professional experienced in sexual abuse treatment;
- is not an employee of the Diocese
- reviews treatment plans and requests for adjunct treatment;
- advises the Diocese on whether the treatment should be covered under this policy
- does not share the details of any consultation, treatment regimen or patient records with the Diocese.
Under special circumstances, these services might be provided through another consulting clinician or through a Sexual Assault Center.
The costs eligible for reimbursement under this policy are those reasonable and customary charges for outpatient mental health sessions that may not otherwise be reimbursed by an individual’s health insurance (e.g., deductibles, co-pays, charges for sessions exceeding the number allowed by the insurance policy, etc.).
After a victim/survivor has completed the initial twelve sessions of diocesan reimbursed mental health treatment, the Diocese will consider paying for additional sessions provided that the treatment provider first consults with the Independent Clinician. The purpose of the consultation is to confirm that the treatment is necessary, is related to the abuse, is productive, and is oriented toward an identified goal of wellness. It is the treatment provider’s responsibility to consult with the Independent Clinician and receive authorization prior to providing additional sessions pursuant to this policy.
If a victim/survivor returns to counseling within two years of the date of the last session, 4 sessions will be paid with no questions asked, other than simple notification to the Independent Clinician. Any additional sessions must receive pre-approval as outlined above.
If a victim/survivor has been away from treatment for over two years, then 8 sessions will be paid before pre-approval is necessary. Again, the Independent Clinician simply should be notified prior to the re-start of such treatment.
It is the responsibility of the counselor to ensure that the individual is indeed a victim of sexual abuse for which the Diocese has previously offered support.
If a victim/survivor changes clinician while in active treatment, 6 sessions will be paid for before further approval is necessary.
GENERALLY NON-REIMBURSABLE SERVICES
In an effort to provide assistance to the greatest number of victims/survivors, inpatient treatment generally is not covered. In very rare cases, with compelling circumstances and a substantial review by the Independent Clinician in consultation with other experts in the field, inpatient treatment may be covered on a limited basis. A request for inpatient treatment shall be presented to the Independent Clinician prior to starting treatment as pre-approval is required.
Travel and similar attendant costs associated with treatment are not covered. In cases of unusual hardship and with pre-approval through the Independent Clinician, travel costs may be covered.
Missed or Unauthorized Sessions:
Missed sessions and unauthorized sessions for treatment which requires pre-approval are not covered under this policy and will not be reimbursed.]Missed sessions and unauthorized sessions for treatment which requires pre-approval are not covered under this policy and will not be reimbursed.
When the Diocese has denied support for adjunct treatment of any kind, the victim/survivor may appeal this decision by having their treatment provider contact the Independent Clinician to request an appeal. The request for the adjunct treatment is then reviewed by a panel of three mental health professionals who are trained and experienced in sexual abuse treatment. One professional is selected by the victim/survivor and his/her treatment provider, one by the diocese, and the Maine Coalition Against Sexual Assault will be asked to provide the third professional. The victim/survivor must release his/her treatment provider to speak with this review panel and provide them with any reasonable information necessary for them to provide an informed recommendation. There are no appeals beyond this process.
Because this program is voluntary and offered as an expression of the Church’s compassion, in all cases the final decision remains with the Diocese.
GUIDELINES AND INFORMATION FOR TREATMENT PROVIDERS
The Diocese is not a health insurer, but as part of its pastoral mission offers reimbursement to individuals who have disclosed victimization by clergy or others associated with the Diocese.
Therapeutic Treatment Providers must be professionally licensed and reimbursable mental health treatment providers. Submission of a current curriculum vitae, copy of professional license and proof of current malpractice insurance to the Independent Clinician will be required. The Diocese encourages but does not require victims/survivors of abuse to seek treatment from treatment providers exhibiting expertise in treating the trauma associated with sexual abuse.
Coverage under this policy includes outpatient mental health treatment for up to a total of twelve (12) standard fifty minute sessions (one 90801 intake and subsequent 90806 or 90847 sessions). If additional outpatient therapy is necessary, the treatment provider should first consult with the Independent Clinician regarding the diagnosis, treatment goals, and prognosis of treatment and submit periodic written treatment updates as requested by the Independent Clinician.
All reasonable and customary charges for mental health treatment not reimbursable by the person’s health insurance are eligible for reimbursement by the Diocese (e.g., deductibles, co-pays, charges for sessions exceeding the number allowed by the insurance policy and the like) in accordance with its written Policy on Counseling Assistance Reimbursement. Insurance claims must be submitted according to your client’s carrier’s requirements for filing. Persons without health insurance will be eligible for coverage of all reasonable and customary charges for mental health treatment.
Any recommendations for treatment adjuncts (e.g., evaluation/prescription/ monitoring of psychotropic medication, inpatient treatment, highly specialized treatment treatments, etc.) shall be presented to the Independent Clinician and pre-approval is required.
Charges for missed sessions and unauthorized sessions for treatment which requires pre-approval are not covered under this policy and will not be paid.
Invoices for services sent to the diocese by the treatment provider should include: name and address of the treatment provider, name of client, dates of service, provider’s federal tax number or social security number, date additional sessions authorized by the Independent Clinician, and billed amount. The diagnosis should only be provided to the Independent Clinician. Invoices are to be submitted within 30 days of the treatment date unless other arrangements have been approved. Invoices exceeding 90 days of the treatment date will not be paid.
Invoices Mail to: