No. 31950 (Amendment): R270-1-19. Medical Awards.

DAR File No.: 31950
Filed: 09/15/2008, 03:30
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Crime Victim Reparations Board is evaluating options for implementation of a medical fee schedule or medical bill review. The purpose of the fee schedule or bill review is to bring the Office of Crime Victim Reparations (CVR) inline with what other third party payors pay and to ensure the continued viability of the CVR program by reducing overall payments. That process may involve several additional months of analysis and implementation. While the Crime Victim Reparations Board continues to analyze the issue, it proposes this amendment as an interim medical payment schedule.

Summary of the rule or change:

The amendment provides that CVR shall pay medical bills at 70% of billed charges. If the victim has medical insurance, CVR will pay the portion of the billed charges for which the victim is responsible except that payment from all sources shall not exceed 70% of billed charges.

State statutory or constitutional authorization for this rule:

Section 63M-7-521.5

Anticipated cost or savings to:

the state budget:

As stated above, one of the purposes of the amendment is to reduce overall payments made from the Crime Victim Reparations Fund. If this payment schedule had been used during the last three fiscal years, the average savings would have been approximately $650,000 per year. CVR assumes a similar savings for future years. This will have no impact on the General Fund.

local governments:

These payments are not made to local government nor are these payments made on behalf of local government. Therefore, this change will have not impact local government.

small businesses and persons other than businesses:

This amendment will impact all medical providers, including providers with less than 50 employees. Nonhospital medical providers are currently receiving 100% of eligible billed charges. Under this amendment, they would receive 70% of eligible billed charges. Some victims who have medical insurance and pay their copay to the medical provider may receive a smaller reimbursement from CVR if the payments by insurance and their copays exceed 70% of billed charges.

Compliance costs for affected persons:

The only additional cost would be due to increased work for medical providers who must now decide whether to accept payment from CVR because state law prohibits medical providers from balance-billing the victim once payment from CVR has been accepted. This cost cannot be quantified. CVR anticipates that most medical providers will simply continue to bill CVR as they have in the past without performing extra work to determine whether they will accept payment from CVR.

Comments by the department head on the fiscal impact the rule may have on businesses:

I have reviewed the analysis from the Office of Crime Victim Reparations to implement the proposed regulation change on Medical Awards (R270-1-19). Based on my review I have concluded that the estimated cost to medical providers (this includes all hospitals and nonhospital medical providers providing services to victims of crime) as a result of this change will be $435,000 in FY 2009 and $650,000 in FY 2010. Robert Yeates, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Crime Victim Reparations
Administration
350 E 500 S
SALT LAKE CITY UT 84111-3347

Direct questions regarding this rule to:

Ronald B Gordon at the above address, by phone at 801-238-2367, by FAX at 801-533-4127, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/31/2008

This rule may become effective on:

11/07/2008

Authorized by:

Ronald B Gordon, Director

RULE TEXT

R270. Crime Victim Reparations, Administration.

R270-1. Award and Reparation Standards.

R270-1-19. Medical Awards.

A. Pursuant to Subsection 63M-7-511(4)(b), medical awards are subject to limitations as follows:

1. All medical costs must be related directly to the victimization and all treatment must be considered usual and customary.

2. The reparation officer reserves the right to audit any and all billings associated with medical care.

3. The reparation officer will not pay any interest, finance, or collection fees as part of the award.

4. [After the effective date of this rule, in-patient hospital medical bills shall be reimbursed at a rate established between the CVR office and individual hospitals and shall be considered payment in full. A Memorandum of Agreement shall be signed and kept on file.]a. If the claimant has no medical insurance for payment of the victim's medical bill, the Office of Crime Victim Reparations shall pay 70% of billed charges for eligible medical bills.

b. If the claimant has medical insurance or another collateral source for payment of the victim's medical bills, the Office of Crime Victim Reparations shall pay the portion of the eligible medical bills that the claimant is obligated to pay pursuant to the insurance agreement except that payment from all sources including insurance shall not exceed 70% of billed charges.

5. This rule supersedes any other agreements regarding payment of medical bills by the Office of Crime Victim Reparations.

[5]6. Child endangerment examinations for children that have been exposed to drugs shall be paid for when the health and safety of the child is at risk and no other collateral source is available. The cost of the exam needs to be an expense incurred by the victim. The writing of evidentiary reports and any form of lab testing shall not be covered as part of the examination.

 

KEY: victim compensation, victims of crimes

Date of Enactment or Last Substantive Amendment: [January 2], 2008

Notice of Continuation: July 3, 2006

Authorizing, and Implemented or Interpreted Law: 63M-7-501 et seq.