No. 28355 (Amendment): R270-1. Award and Reparations Standards

DAR File No.: 28355
Filed: 11/15/2005, 12:33
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

Changes were authorized by the Board to: 1) clarify rules on inpatient, residential and day treatment claims; 2) further define secondary victim inpatient eligibility benefits; 3) expand benefits to include nontraditional cultural services; 4) clarify rules on payment of child endangerment examinations; and 5) exclude wilderness programs as an appropriate treatment modality.

 

Summary of the rule or change:

The changes are: 1) adding a review of residential and day treatment claims by Board or contracted agency; 2) all inpatient, residential and day treatment cases less than $1000 can be reviewed by reparation officers; 3) parents, children, and siblings of homicide victims receive primary victim benefit for inpatient, residential and day treatment. This benefit excludes all other secondary victims of other crime types; 4) day treatment is capped at $10,000; 5) wilderness programs will not be considered as a benefit under the Crime Victim Reparations (CVR) program; 6) payment of child endangerment examinations will be considered if no other collateral resource is available to the victim; and 7) benefits are extended to include nontraditional cultural services.

 

State statutory or constitutional authorization for this rule:

Subsection 63-25a-406(c)

 

Anticipated cost or savings to:

the state budget:

The CVR program is funded through surcharges on fines, penalties, and forfeitures on the state and federal level. No State General Fund monies are appropriated. The proposed rule changes would provide an increased cost of approximately $37,000 that would be drawn from the CVR Trust Fund which is managed by the State Office of Crime Victim Reparations.

 

local governments:

The State Office of Crime Victim Reparations rules do not affect local government. Therefore, there are no costs or savings to local government.

 

other persons:

There would be an increase in services to some victims which would mean a savings to them because of the award payments made on their behalf.

 

Compliance costs for affected persons:

CVR does not have any compliance costs because the program does not impose fees on victims of crime for services provided.

 

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

There would not be a fiscal impact on businesses since funding comes from the existing CVR Trust Fund. Dan R. Davis, 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:

Connie Wettlaufer at the above address, by phone at 801-238-2371, 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:

01/03/2006

 

This rule may become effective on:

01/04/2006

 

Authorized by:

Dan Davis, Director

 

 

RULE TEXT

R270. Crime Victim Reparations, Administration.

R270-1. Award and Reparation Standards.

R270-1-4. Counseling Awards.

A. Pursuant to Subsections 63-25a-402(20) and 63-25a-411(4)(c), out-patient mental health counseling awards are subject to limitations as follows:

1. The reparation officer shall approve a standardized treatment plan.

2. The cost of initial evaluation and testing may not exceed $300 and shall be part of the maximum allowed for counseling. For purposes herein, an evaluation shall be defined as diagnostic interview examination including history, mental status, or disposition, in order to determine a plan of mental health treatment.

3. Primary victims of a crime shall be eligible for a $3500 maximum mental health counseling award.

(a) Parents, children and siblings of homicide victims shall be considered at the same rate as primary victims for inpatient and outpatient counseling.

4. Secondary victims of a crime shall be eligible for a $2000 maximum mental health counseling award.

5. Extenuating circumstances warranting consideration of counseling beyond the maximum may be submitted by the mental health provider after the maximum award has been reached.

6. Counseling costs will not be paid in advance but will be paid on an ongoing basis as victim is being billed.

7. Inpatient hospitalization, residential and day treatment shall be reviewed by the CVR Board or contracting agency who will make recommendations to the Reparation Officers regarding treatment. The CVR Board or contracting agency will review all levels of care and assign a reimbursement percentage based on the crime. All cases having less than a $1000 balance may be determined by the Reparation Officer. Outpatient cases shall be reviewed at the same rate as inpatient reviews.

[7]8. In-patient hospitalization shall only be considered when the treatment has been recommended by a licensed therapist in life-threatening situations. [In these cases the Crime Victim Reparations Board shall consider reimbursement of in-patient treatment or contract with a managed mental health care provider to make recommendations to the Reparations Officer regarding treatment. ]A direct relationship to the crime needs to be established. Acute in-patient hospitalization shall not exceed $600 per day, which includes all ancillary expenses, and will be considered payment in full to the provider. Inpatient psychiatric visits will be limited to one visit per day with payment for the visit made to the institution at the highest rate of the individuals providing therapy as set by rule. Reimbursement for testing costs may also be allowed. Parents, children and siblings of homicide victims shall be considered at the same rate as primary victims for inpatient hospitalization. All other secondary victims of other crime types are excluded.[Secondary victims shall not be considered for in-patient hospitalization.]

[8]9. Residential and day treatment shall only be considered when the treatment has been recommended by a licensed therapist to stabilize the victim's behavior and symptoms. Only facilities with 24 hour nursing care or 24 hour on call nursing care will be compensated for residential and day treatment. Residential and day treatment shall not be used for extended care of dysfunctional families and containment placements. A direct relationship to the crime needs to be established. Residential treatment shall not exceed $300 per day and will be considered payment in full to the provider. Residential treatment shall be limited to 30 days, unless there are extenuating circumstances requiring extended care. All residential clients shall receive routine assessments from a psychiatrist and/or APRN at least once a week for medication management. Day treatment shall not exceed $200 per day and will be capped at $10,000. These charges will be considered payment in full to the provider. Parents, children and siblings of homicide victims shall be considered at the same rate as primary victims for residential and day treatment. All other secondary victims of other crime types are excluded.[Secondary victims shall not be considered for residential or day treatment.]

10. Wilderness programs shall not be covered as an appropriate treatment modality when considering inpatient hospitalization, residential or day treatment.

[9]11. Child sexual abuse victims under the age of 13 who become perpetrators shall only be considered for mental health treatment awards directly related to the victimization. Perpetrators age 13 and over who have been child sexual abuse victims shall not be eligible for compensation. The CVR Board or contracting agency for managed mental health care shall help establish a reasonable percentage regarding victimization treatment for inpatient, residential and day treatment. Out-patient claims shall be determined by the Reparation Officer on a case by case basis upon review of the mental health treatment plan.

[10]12. Payment for mental health counseling shall only be made to licensed therapists; or to individuals working towards a license that provide certified verification of satisfactory completion of an education and earned degree as required by the State of Utah Department of Commerce, Division of Professional and Occupational Licensing, working under the supervision of a supervisor approved by the Division. Student interns otherwise eligible under 58-1-307(1)(b) Exceptions from licensure, and/or the institution/facility/agency responsible for the supervision of the student, shall not be eligible for payment under this rule for counseling services provided by the student.

[11]13. Payment of hypnotherapy shall only be considered when treatment is performed by a licensed mental health therapist based upon an approved Treatment Plan.

[12]14. The following maximum amounts shall be payable for mental health counseling:

(a) up to $130 per hour for individual and family therapy performed by licensed psychiatrists, and up to $65 per hour for group therapy;

(b) up to $90 per hour for individual and family therapy performed by licensed psychologists and up to $45 per hour for group therapy;

(c) up to $70 per hour for individual and family therapy performed by a licensed master's level therapist or an Advanced Practice Registered Nurse, and up to $35 per hour for group therapy. These rates shall also apply to therapists working towards a license and supervised by a licensed therapist;

(d) The above-mentioned rates shall apply to individuals performing treatment, and not those supervising treatment.

[13]14. Chemical dependency specific treatment will not be compensated unless the Reparation Officer determines that it is directly related to the crime. The CVR Board may review extenuating circumstance cases.

 

R270-1-19. Medical Awards.

A. Pursuant to Subsection 63-25a-411(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.

5. 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.

 

R270-1-27. Nontraditional Cultural Services.

Cultural services rendered in accordance with recognized spiritual or religious methods of healing, legally available in the state of Utah, may be considered for payment. Since a reasonable and customary schedule of charges has not been established, the reparation officer may require the following: a written itemized description of each procedure, function and/or activity performed and an explanation of its benefit to the victim; the location and time involved to perform such services; and a summary of qualifications and experience which allows the service provider to perform the services. Services shall be requested in lieu of traditional treatment methods. Awards shall be deducted from the claimant's outpatient mental health award and shall remain within the allowed limits set upon that benefit. The fund will not pay for intoxicating or psychotropic substances unless prescribed by a medical practitioner licensed to do so. Claim will be denied if no healing benefit can be identified.

 

KEY: victim compensation, victims of crimes

[July 2, 2004]January 3, 2006

Notice of Continuation December 10, 2001

63-25a-401 et seq.