No. 31950: R270-1-19. Medical Awards

DAR File No.: 31950
Filed: 11/18/2008, 01:15
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

During the comment period, the Crime Victim Reparations (CVR) Board recognized changes that needed to be made to the proposed rule in order to clarify the proposal and to hold victims harmless.

Summary of the rule or change:

The change removes language that restricts CVR's ability to pay portions of a medical bill for which the victim is responsible by terms of an insurance contract. The change also provides clarifying language. (DAR NOTE: This change in proposed rule has been filed to make additional changes to a proposed amendment that was published in the October 1, 2008, issue of the Utah State Bulletin, on page 13. Underlining in the rule below indicates text that has been added since the publication of the proposed rule mentioned above; strike out indicates text that has been deleted. You must view the change in proposed rule and the proposed amendment together to understand all of the changes that will be enforceable should the agency make this rule effective.)

State statutory or constitutional authorization for this rule:

Section 63M-7-521.5

Anticipated cost or savings to:

the state budget:

In some circumstances, CVR will pay more on a medical bill than would have been the case with the original proposal. This rule change will allow CVR to pay the entire portion of the medical bill that the victim is obligated to pay according to the terms of the medical insurance agreement (e.g. the victim's copay or deductible). Under the original proposal, CVR could have paid no more than the difference between 70% of the billed charges and the amount that the insurance paid. CVR estimates that the increased payments resulting from this change will be less than $150,000 per year.

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:

In some circumstances, medical providers that bill CVR directly for the victim's copay or deductible will receive more money that would be the case under the original proposal. This change will permit CVR to pay the entire amount of the copay or deductible whereas the original proposal would have limited payment of the copay or deductible to no more than the difference between 70% of the billed charges and the amount that the insurance paid.

Compliance costs for affected persons:

This change will not involve any additional compliance costs.

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

It is my understanding that the business affected by this change may actually receive more money than under the original proposal. Robert Yeates, Executive Director, Commission on Criminal and Juvenile Justice

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:

01/14/2009

This rule may become effective on:

01/21/2009

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.[ ]a. If the claimant has no medical insurance or other collateral source 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].

c. This subsection (4) does not apply to expenses governed by R270-1-4 or R270-1-22.

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

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: [2008]2009

Notice of Continuation: July 3, 2006

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