Current through Register No. 40, October 3, 2024
(a) The commission
shall award compensation for medical expenses if the underlying facts of the
claim meet the requirements of
Jus
605.01 and none of the circumstances resulting in
ineligibility described in
Jus 605.02
applies.
(b) A claimant submitting
a request for compensation for or payment of medical expenses shall submit the
following information and documentation to support the request:
(1) The name and address of each medical
provider who provided crime-related treatment as identified on any bills or
invoices received for such treatment;
(2) A detailed description of any insurance
coverage or collateral financial source available;
(3) A completed "Insurance and Other
Collateral Financial Source Information for Vehicle Crimes" form as described
in
Jus
604.03, if the claim involves a vehicle
crime;
(4) An authorization for the
release of medical and related billing information that complies with all
applicable federal requirements for each provider;
(5) Documentation of denial of free or
reduced fee hospital care, if the victim did not have health insurance at the
time of treatment of the injuries sustained as a direct result of the crime;
and
(6) Proof of all out-of-pocket
health care expenses incurred by or on behalf of the victim and which were
incurred as a direct result of the crime.
(c) Once the unit has received the
information and documentation required pursuant to (b) above, the unit shall
contact the appropriate providers to obtain the following directly from such
providers:
(1) A treating physician's report
that describes the injuries sustained as a direct result of the
crime;
(2) An itemized list of all
medical costs incurred for treatment of the injuries sustained as a direct
result of the crime; and
(3) Proof
of payment of hospital costs made by or on behalf of the victim.
(d) The following kinds of
expenses shall be eligible for compensation under the category of medical
expenses, reimbursed at the established fee for service Medicaid rate where
applicable:
(1) The actual cost of reasonable
and necessary medical treatment provided by licensed health-care personnel,
after first applying any available insurance or other available collateral
financial source;
(2) The portion
of the cost of all prescription medications prescribed to treat the victim's
physical and mental health injuries;
(3) The cost of reasonable and necessary
physical assistance equipment, including modifications to buildings such as
ramps;
(4) Replacement of lost or
badly damaged existing physically assistive devices such as:
a.Hearing aids;
b.Dentures;
c.Prosthetic and other devices;
d.Wheelchairs;
e.Prescription eyeglasses and other
corrective lenses, including contact lenses; and
f.Any other crime-related medical
expense;
(5) Mileage to
and from appointments with licensed health care providers, at the rate used by
Medicaid to compensate mileage. Mileage shall be paid for trips over 10 miles
round trip and is capped at 100 miles round trip;
(6) Hospital expenses paid by or on behalf of
the victim;
(7) The portion of the
cost for which the claimant is responsible, including co-pays, of all
prescription medications prescribed to treat the victim's mental health issues
that were directly caused by the crime;
(8) The portion of the cost for which the
claimant is responsible, including co-pays, of the actual amount billed for
medication management services if the amount billed is consistent with usual
and customary charges for such services in that geographical area;
(9) All other directly crime-related medical
expenses incurred, including out-of-pocket expenses; and
(10) The commission shall award compensation
for all medication management services provided, including medication
prescribed, by the provider licensed to provide such services, at the fee for
service Medicaid rate.
(e) Awards for compensation of medical
expenses shall be limited pursuant to the following, subject to the statutory
cap:
(1) The commission shall not award
compensation for medical treatment provided by health-care personnel who do not
hold appropriate licensure for the kind of treatment provided;
(2) The commission shall not award
compensation for hospital care if:
a.The
victim had health insurance at the time of treatment for injuries sustained as
a direct result of the crime; and
b.Free or reduced fee care has not been
denied by the hospital;
(3) Notwithstanding (e)(2) above, the
commission shall award compensation for hospital care, but only to the extent
that care was actually paid for out of pocket, if:
a.The victim did not have health insurance at
the time of treatment for injuries sustained as a direct result of the crime;
and
b.Free or reduced fee care has
been denied by the hospital and payment by or on behalf of the victim has been
made to the hospital, but only in the amount of the actual total payment made;
and
(4) The commission
shall award compensation at the fee for service Medicaid rate, where
applicable, for inpatient hospital care, with 100% of the out-of-pocket
expenses being reimbursed first, and any remaining sum used for others'
reimbursement.
(f) In
circumstances in which a balance remains after applying insurance, other
collateral financial sources, and compensation awards under this part, the unit
shall contact the person or entity to whom the balance is owed and encourage
that person or entity to write off such balance.
#4864, eff 7-13-90; amd by #5430, eff 7-1-92, EXPIRED:
7-1-98
New. #7117, eff 10-8-99, EXPIRED:
10-8-07
New. #9553, eff
9-25-09
