DAR File No. 32673

Crime Victim Reparations, Administration

R270-1

Award and Reparation Standards

NOTICE OF PROPOSED RULE

DAR File No.: 32673
Filed: 05/14/2009, 04:36
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

In Section R270-1-4, the change establishes standards and payment limits for mental health counseling expenses and the amendment is a cost containing budget restriction. In Section R270-1-10, the change establishes standards and payment limits for relocation expenses and the amendment is a cost containing budget restriction. In Section R270-1-22, the change establishes standards and payment limits for Sexual Assault Forensic Exam expenses and the amendment is a cost containing budget restriction.

Summary of the rule or change:

In Section R270-1-4, the amendment reduces the maximum spending for primary victims from $3,500 to $2,500 and secondary victims from $2,000 to $1,250. The amendment also implements a cap on the number of counseling sessions for primary victims at 25 and secondary victims at 15. The cap on the number of sessions is added to ensure all applicants receive the same number of benefit sessions without regard of available collateral sources. The amendment makes the rule more equitable among applicants and allows the office to realize a more predictable savings than reducing only the monetary cap. In Section R270-1-10, the amendment reduces the maximum relocation benefit per claim from $2,000 to $1,000. Currently the office pays an estimated average of approximately $1,200 on relocation per claim. The amendment is not anticipated to cause a hardship on eligible recipients but does allow for a significant estimated savings to the budget. In Section R270-1-22, the amendment establishes consistency with current legislation and administrative rule, Section 63M-7-521.5 and Subsection R270-1-19(4)(a) respectively, by changing the percentage payable for eligible hospital services and supplies from 85% to 70%. The amendment also establishes a cap of $350 for the rental or use of the facility space.

State statutory or constitutional authorization for this rule:

Subsections 63M-7-506(1)(c) and 63M-7-511(4)(h)

Anticipated cost or savings to:

the state budget:

In Section R270-1-4, the amendment is projected to provide an estimated $200,000 savings to the Crime Victim Reparation Fund. The office does not access monies from the General Fund; accordingly there should be no effect. In Section R270-1-10, the amendment is projected to provide an estimated $100,000 savings to the Crime Victim Reparation Fund. The office does not access monies from the General Fund; accordingly there should be no effect. In Section R270-1-22, the amendment is projected to provide an estimated $190,000 savings to the Crime Victim Reparation Fund. The office does not access monies from the General Fund; accordingly there should be no effect.

local governments:

In Section R270-1-4, the amendment will have no quantifiable budget impact on local governments. In Section R270-1-10, the amendment will have no quantifiable budget impact on local governments. In Section R270-1-22, the amendment will have no quantifiable budget impact on local governments.

small businesses and persons other than businesses:

In Section R270-1-4, the amendment should not impose significant impact upon individual counseling service providers. The amendment essentially returns the expense cap to near the level they were prior to the 07/01/2004 increase. This office recognized no significant increase in overall payout of the benefit after the maximums were increased. The annual payout for the benefit in 2003 was $1,100,000, it rose to $1,200,000 in 2004 and returned to $1,100,000 were it stayed from 2005 through 2007. The 2008 payout for the benefit rose to $1,300,000. The projected $200,000 in annual savings to the victims' fund would be contributed to by the hundreds of counseling service providers statewide at a relatively minimal impact to each "small business" type provider. The session limitation implemented by this amendment provides a number of sessions which is above the industry standard and should not impose an undue hardship on any individual. In Section R270-1-10, the amendment should not impose noticeable impact upon small businesses. The estimated payout for this claim has remained consistent at the approximate $1,200 per claim level for the last several years. The estimated $100,000 annual savings to the victims' fund would be contributed to by the hundreds of small business statewide. Additionally, a significant portion of relocation expenses are paid directly individuals rather than businesses. The number of individuals contributing to the funds' savings is so expansive that the reduction created by the amendment will be a minor impact if any, on each individual receiving the benefit. In Section R270-1-22, the amendment will have minimal to no impact on small businesses in that currently, to our knowledge, there are no facilities qualified and/or providing this service that have fewer than 50 employees. This amendment pertains to hospitals and other facilities, no individuals or persons are anticipated to contribute to this savings.

Compliance costs for affected persons:

In Section R270-1-4, compliance costs of the amendment will be minimal and born only upon this office. The office will encounter minimal expenses when copying and distributing amended treatment plans. Service providers and benefit recipients will be notified of the amendment at the point of authorization of services and will simply need to remain within the limits and guidelines. Service providers and benefit recipients will only encounter costs by choosing to not remain in compliance with the amended limits. In Section R270-1-10, relocation: compliance costs of the amendment will be minimal and born only upon this office. The office will encounter minimal expenses when copying and distributing amended correspondence. Service providers and benefit recipients will be notified of the amendment at the point of authorization of services and will simply need to remain within the limits and guidelines. Service providers and benefit recipients will only encounter costs by choosing not to remain in compliance with the amended limits. In Section R270-1-22, compliance costs of the amendment will be minimal and born only upon this office. The office will encounter minimal expenses when copying and distributing amended correspondence. Service providers and benefit recipients will be notified of the amendment at the point of authorization of services and will simply need to remain within the limits and guidelines. Service providers and benefit recipients will only encounter costs by choosing to not remain in compliance with the amended limits.

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

In Section R270-1-4, the amendment should not impose significant impact upon individual counseling service providers. The amendment essentially returns the expense cap to near the level they were prior to the 07/01/2004 increase. This office recognized no significant increase in overall payout of the benefit after the maximums were increased. The annual payout for the benefit in 2003 was $1,100,000, it rose to $1,200,000 in 2004 and returned to $1,100,000 where it stayed from 2005 through 2007. The 2008 payout for the benefit rose to $1,300,000. The projected $200,000 in annual savings to the victims' fund would be contributed to by the hundreds of counseling service providers statewide at a relatively minimal impact to each "small business" type provider. The session limitation implemented by this amendment provides a number of sessions which is above the industry standard and should not impose an undue hardship on any individual. In Section R270-1-10, the amendment should not impose noticeable impact upon businesses. The estimated payout for this claim has remained consistent at the approximate $1,200 per claim level for the last several years. The estimated $100,000 annual savings to the victims' fund would be contributed to by the hundreds of small business statewide. Additionally, a significant portion of relocation expenses are paid directly to individuals rather than to businesses. In Section R270-1-22, the amendment will have minimal impact upon the effected businesses. The estimated annual $190,000 saving to the victims' fund will be contributed by the dozens of hospital and medical facilities statewide that provide the applicable service. The vast majority of the effected hospitals and facilities currently provide the specified services within the amended limits of the rule. The limits established within the amended rule are well in excess of the industry standard, are generously within the limits of "reasonable and customary" and exceed limits set forth by any other state in the country providing the same or similar coverage for the benefit. Gary Scheller, Assistant 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 cwettlaufer@utah.gov

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:

07/01/2009

This rule may become effective on:

07/08/2009

Authorized by:

Melvin C Wilson, Director

R270. Crime Victim Reparations, Administration.

R270-1. Award and Reparation Standards.

R270-1-4. Counseling Awards.

A. Pursuant to Subsections 63M-7-502(20) and 63M-7-511(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]the lesser of 25 aggregate individual and/or group counseling sessions or $2,500 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]the lesser of 15 aggregate individual and/or group counseling sessions or $1,250 maximum mental health counseling award.

5. Extenuating circumstances warranting consideration of counseling beyond the maximum may be submitted by the mental health provider when it appears likely that the maximum award will be 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.

8. In-patient hospitalization shall only be considered when the treatment has been recommended by a licensed therapist in life-threatening situations. 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.

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.

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

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.

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.

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

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.

15. 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.

 

R270-1-10. Moving, Transportation Expenses.

A. Pursuant to Subsection 63M-7-511(4)(a), victims of violent crime who suffer a traumatic experience or threat of bodily harm are allowed moving expenses up to [$2000]$1,000. Board approval is needed where extenuating circumstances exist.

B. Transportation expenses up to $1000 are allowed for crime-related travel including, but not limited to, participation in court hearings and parole hearings as well as medical or mental health visits for primary and secondary victims. The Board may approve travel expenses in excess of $1000 where extenuating circumstances exist.

 

R270-1-22. Sexual Assault Forensic Examinations.

A. Pursuant to Subsections 63M-7-502(20) and 63M-7-511(4)(i), the cost of sexual assault forensic examinations for gathering evidence and providing treatment may be paid by the CVR office in the amount of $300.00 without photo documentation and up to $600.00 with a photo examination. Pursuant to Section 63M-7-521.5, the[The] CVR office may also pay for the cost of medication and [up to 85%]70% of the eligible hospital [expenses]services and supplies. Payment to the hospital or other eligible facility for the rent or use of an examination room or space for the purpose of conducting a sexual assault forensic exam shall not exceed $350.00. The following agency guidelines need to be adhered to when making payments for sexual assault forensic examinations:

1. A sexual assault forensic examination shall be reported by the health care provider who performs the examination to law enforcement.

2. Victims shall not be charged for sexual assault forensic examinations.

3. Victims shall not be required to participate in the criminal justice system or cooperate with law enforcement or prosecuting attorneys as a condition of being provided a sexual assault forensic examination or as a condition of payment being made pursuant to this rule.

4. The agency may reimburse any licensed health care facility that provides services for sexual assault forensic examinations.

4. The agency may reimburse licensed medical personnel trained to gather evidence of sexual assaults who perform sexual assault forensic examinations.

5. CVR may pay for the collection of evidence and not attempt to prove or disprove the allegation of sexual assault.

6. A request for reimbursement shall include the law enforcement case number or be signed by a law enforcement officer, victim/witness coordinator or medical provider.

7. The application or billing for the sexual assault forensic examination must be submitted to CVR within one year of the examination.

8. The billing for the sexual assault forensic examination shall:

a. identify the victim by name, address, date of birth, Social Security number, telephone number, patient number;

b. indicate the claim is for a sexual assault forensic examination; and

c. itemize services and fees for services.

9. All collateral sources that are available for payment of the sexual assault forensic examination shall be considered before CVR Trust Fund monies are used. Pursuant to Subsection 63-25a-411(i), the Director may determine that reimbursement for a sexual assault forensic examination will not be reduced even though a claim could be recouped from a collateral source.

10. Evidence will be collected only with the permission of the victim or the legal guardian of the victim. Permission shall not be required in instances where the victim is unconscious, mentally incapable of consent or intoxicated.

11. Restitution for the cost of the sexual assault forensic examination may be pursued by the CVR office.

12. Payment for sexual assault forensic examinations shall be considered for the following:

a. Fees for the collection of evidence, for forensic documentation only, to include:

i. history;

ii. physical; and

iii. collection of specimens and wet mount for sperm.

b. Emergency department services to include:

i. emergency room, clinic room or office room fee;

ii. cultures for gonorrhea, chlamydia, trichomonas, and tests for other sexually transmitted disease;

iii. serum blood test for pregnancy;

iv. morning after pill or high dose oral contraceptives for the prevention of pregnancy; and

v. treatment for the prevention of sexually transmitted disease up to four weeks.

13. The victim of a sexual assault that is requesting payment by CVR for services needed or rendered beyond the sexual assault forensic examination needs to submit an application for compensation to the CVR office.

 

KEY: victim compensation, victims of crimes

Date of Enactment or Last Substantive Amendment: [January 21]July 8, 2009

Notice of Continuation: July 3, 2006

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