No. 41142 (Amendment): Section R270-1-20. Medical Awards

(Amendment)

DAR File No.: 41142
Filed: 01/09/2017 03:46:49 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The amendment establishes the percentage the agency can pay toward a victim's medical costs and may be adjusted to ensure viability of the victim's fund. The percentage will be decreased by 10% (from 70% to 60%) to address rising medical costs.

Summary of the rule or change:

The percentage of a victim's medical expense the agency can pay will be decreased by 10% (from 70% to 60%) to address rising medical costs.

Statutory or constitutional authorization for this rule:

• Subsection 63M-7-521.5(3)

Anticipated cost or savings to:

the state budget:

The change will not affect the state budget in that the savings will be reflected only in the Crime Victims Trust account as defined in Section 51-9-404 which is an expendable special revenue fund. The "fund" may realize an estimated $250,000 savings per calendar year. The exact costs and savings cannot be determined because medical costs will vary from case to case and circumstance to circumstance.

local governments:

Local government will not be affected because this change affects only medical service providers, crime victims, and the agency.

small businesses:

Small independent medical providers may experience a minimal decrease from the change. The agency assists crime victims with out-of-pocket, crime-related costs. This change will affect only victims who have no health insurance, Medicaid, Medicare, or other source of payment for medical expenses. Pursuant to this change, service providers will receive 60% of the amount billed rather than 70% of the amount billed. The exact costs and savings cannot be determined because medical costs will vary from case to case and circumstance to circumstance.

persons other than small businesses, businesses, or local governmental entities:

Hospitals and large medical service providers may encounter a minimal, proportionate discount to the payments they receive from the agency. The agency assists crime victims with out-of-pocket, crime-related costs. This change will affect only victims who have no health insurance, Medicaid, Medicare, or other source of payment for medical expenses. Pursuant to this change, service providers will receive 60% of the amount billed rather than 70% of the amount billed. The exact costs and savings cannot be determined because medical costs will vary from case to case and circumstance to circumstance.

Compliance costs for affected persons:

There will be no compliance costs that affect any group other than the agency. The agency is solely responsible for the implementation and compliance of the rule change.

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

Annually, the agency pays approximately $4,500,000 on medical expenses for services provided to victims of crime. Of that total, only the expenses for those persons that do not have insurances or other sources to cover medical expenses will be reduced. Medical co-payment and deductible amounts paid on behalf of a victim, will not be reduced in addition to the reductions made by the primary payer. The agency anticipates an approximate $250,000 annual savings from the rule change and that $250,000 savings would be generated from small contributions from each medical provider in the state that submits a bill for payment. The exact costs and savings cannot be determined because medical costs will vary from case to case and circumstance to circumstance.

Gary Scheller, Director

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

Crime Victim Reparations
AdministrationRoom 200
350 E 500 S
SALT LAKE CITY, UT 84111-3347

Direct questions regarding this rule to:

• Gary Scheller at the above address, by phone at 801-238-2362, 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:

03/03/2017

This rule may become effective on:

03/10/2017

Authorized by:

Gary Scheller, Director

RULE TEXT

R270. Crime Victim Reparations, Administration.

R270-1. Award and Reparation Standards.

R270-1-20. Medical Awards.

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 reparations officer reserves the right to audit any and all billings associated with medical care.

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

(4)(i) If the claimant has no medical insurance or other collateral source for payment of the victim's medical bill, the office shall pay 60%[70%] of billed charges for eligible medical bills.

(ii) If the claimant has medical insurance or another collateral source for payment of the victim's medical bills, the office shall pay the portion of the eligible medical bills that the claimant is obligated to pay pursuant to the insurance agreement.

(iii) This rule does not apply to expenses governed by R270-1-5 or R270-1-23.

(5) This rule supersedes any other agreements regarding payment of medical bills by the office.

(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: [November 21, 2016]2017

Notice of Continuation: June 15, 2016

Authorizing, and Implemented or Interpreted Law: Title 63M, Chapter 7, Part 5

 

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