Crime Victims’ Compensation Conference Advanced Track

1. Crime Victims’ Compensation Conference Advanced Track Tracy Morales Ricky Sanchez Crime Victim Services Division • Views expressed are those of the presenters, do not constitute legal advice, and are not official opinions of the Office of the Texas Attorney General. 

2. Housekeeping • Please turn off cell phones and pagers or place in a silent mode. • Questions can be answered in the presentation

3. Crime Victim Services Mission Statement To assist in the compassionate and effective delivery of crime victim services by offering information resources, and financial assistance to crime victims and the organizations assisting them.

4. Enabling Legislation • Texas Code of Criminal Procedure • Article 56 subchapter B • Article 56.31 through 56.64 • Crime Victims’ Compensation Act

5. Crime Victims’ Compensation • Office of the Attorney General (OAG) administers Crime Victims’ Compensation Program (CVC) • Dedicated to ensuring that victims of violent crime are provided financial assistance for crime related expenses • Statutorily defined reimbursement • State law requires reimbursement first be sought from other sources

6. CVC Fiscal Year 2018 Highlights • Received a total of 34,706 applications and sexual assault exam reimbursement claims  • 24,465 were victim compensation applications • 10,241 were sexual assault reimbursement claims • $ 67.4 million in payments

7. CVC Funding • It is not a tax based or general revenue-funded program. No tax dollars are used. • Sources of funding in FY 2018 were: • Court fees • Federal VOCA grant • Restitution • Subrogation • Other receipts • Gifts

8. CVC Goal • The goal of CVC is to reimbursevictims of crime for certain out of pocket expenses not reimbursed by other sources. • The Attorney General shall award to victims and claimants compensation for pecuniary loss arising from criminally injurious conduct.

9. OAG Website for CVC OAG website for Crime Victims’ Compensation www.texasattorneygeneral.gov/cvs/crime-victims-compensation What is available on the CVC website? • General program information • Basic qualification requirements • Reimbursable expenses • How to apply • Forms and applications • Appealing a denial • CVMS Webportal • Information for service providers • Publications and materials order • Training

10. CVMS Webportal Login Page

11. Claim Search

12. Claim Search by SS & DOB

13. Claim Search By Claim #

14. Claim Notes Page

15. Helpful Definitions

16. All Bills screen

17. Paid Bills screen

18. Unpaid Bill screen

19. Profile screen

20. Support Page

21. CVC Application(Slide 1 of 3) • The CVC application (English and Spanish) is available on our web page. • The application is always reviewed after a legislative session to assure it meets statutory requirements.

22. CVC Application(Slide 2 of 3) An application is considered complete and will be processed when it: • Is filled out in its entirety • Is signed by a victim or a valid adult claimant • Provides law enforcement information • Provides any other information requested by the OAG

23. CVC Application (Slide 3 of 3)

24. Three CVC Application Types • Regular (via mail) • Priority Processing Request (via fax) • Presumptive Eligibility (via fax) Emergency Medical Care (EMC) application (via mail)

25. Business Process

26. Victim Who is a Victim? • An individual who suffers physical or mental harm or death as a result of criminally injurious conduct • Note that every application has to have one victim, and only one victim • Includes peace officers, firefighters or individuals whose employment duty is to protect the public

27. Claimant Who is a Claimant? • An authorized individual acting on behalf of a victim • An individual who legally or voluntarily assumes the obligation to pay expenses • A dependent of a deceased victim • An immediate family or household member who requires psychiatric care or counseling • An application can have multiple claimants, but only one victim.

28. Eligibility Requirements Who is eligible to receive CVC? • A Texas or U.S. RESIDENT who becomes a victim of crime in Texas • A Texas resident who becomes a victim in a country with no benefits • A Texas resident who becomes a victim of a crime defined as an act of terrorism committed outside the United States (as of September 1, 1997)

29. Eligibility (Slide 1 of 2) RESIDENT – as used in the Texas Code Criminal Procedure ART. 56.32(a)(11)(A)(ii), the term means a person who has a domicile in Texas or who lives for more than a temporary period in Texas, another state or the U.S., the Dist. Of Columbia, the Commonwealth of Puerto Rico, or a possession or territory of the U.S.

30. Eligibility (Slide 2 of 2) • A Social Security Number is not required for a victim to apply and be eligible for the CVC Program. • A tax ID or Social Security Number is a requirement to receive a payment.

31. Criminally Injurious Conduct “Criminally injurious conduct” refers to crimes that: • Are attempted or occur • Pose a substantial threat of personal injury • Would be punishable by fine or imprisonment

32. CIC CrimesEligible for Reimbursement • Criminal injurious conduct (CIC) crimes are violent crimes against persons. • CIC crimes range from simple assault to homicide, and include such crimes as family violence and child sexual assault. • CIC vehicular-related crimes are: • Crimes of intentional injury with an automobile, boat, or plane • Failure to stop and render aid (Hit and Run) • Vehicular crimes involving drugs or alcohol • Intoxication-related crimes (assault, manslaughter, or criminally negligent homicide)

33. Applications Received byType of Crime FY 2018 • Assault / Aggravated Assault 48.9 % • Sexual Abuse of a Child 14.3 % • Sexual Assault 9.8 % • Robbery 5.0 % • Homicide 5.1 % • DWI 3.1 % • Failure to stop and render aid 3.1 % • All other types of crime 10.7 % • Examples of other types of crime include: Stalking Human Trafficking Kidnapping Physical Abuse of a Child Arson Criminally Negligent Homicide Vehicular Assault Vehicular Manslaughter

34. DenialorReduction Behavior Factors • If the person • Was engaged in illegal activity (deny or reduce) • Shares in the responsibility for the crime (deny or reduce) • Fails to cooperate with law enforcement and prosecution efforts (deny) • Possible factors • Entire situation is reviewed

35. CVC Requirements • There is no requirement that a suspect be • Identified • Apprehended • Charged • Convicted …for a victim to apply for and be awarded compensation. • There is a requirement for the victim to cooperate throughout the criminal justice process.

36. CVC Reporting Requirements • Reporting the crime to law enforcement • 72 hours prior to September 1, 1997 • On or after September 1, 1997, a reasonable period of time but not so late as to interfere with or hamper the investigation and prosecution • The program has the discretion • The victim is a child. • Extraordinary circumstances hampered the reporting

37. CVCFiling Requirements • Filing requirements to CVC Program • Prior to September 1, 1997, one year • On or after September 1,1997, three years • Exceptions • Good cause • Child victim through age 18 (pre-1997) • Child victim age 18 to 21 (1997-present) • Victim physically incapacitated

38. Emergency Medical Care Application • An Emergency Medical Care(EMC) application is for a victim of an alleged sexual assault who received medical care at a hospital associated to a sexual assault exam after August 31, 2015. • The examination must be performed in accordance with Texas Health and Safety Code Section 323.004 (Minimum Standards for Emergency Services) • To receive compensation for these costs, you do not need to meet CVC eligibility requirements such as reporting to law enforcement or continuing with the investigation. • Victims may choose to seek the full range of CVC benefits available at a later time

39. Emergency Medical Care Application • Examples of medical care costs associated with the exam • EMS Transport, if necessary, to the facility where exam was conducted • Emergency Room Facility Fee • Physician's Fees • Discharge Medication(Ex: HIV Prophylaxis) • Victim is not required to utilize private insurance but does need to use Medicaid, Medicare of CHIP is available • EMC does not cover other CVC benefits such as: • Follow up care • Mental Health Counseling • Lost wages • Relocation

40. Awards • Up to: • $25,000 for crimes prior to September 1, 1997 • $50,000 for crimes on or after September 1,1997 • For reimbursement of medical costs, counseling, lost wages, funeral costs, and other costs resulting from the crime • Does not include property loss or damage

41. Applications Paid by Type of Crime FY 2018 • Assault / Aggravated Assault 57.1% • Sexual Abuse of a Child 2.7% • Sexual Assault 2.0% • Robbery 8.1% • Homicide 12.7% • DWI 5.4% • Failure to stop and render aid 7.9% • All other types of crime are less than 4.1%

42. Award Types • Medical (Includes psychiatric care/counseling and dental) • Loss of earnings • Loss of support • Funeral and burial • Relocation and rental • Child or dependent care • Crime scene clean-up • Property seized as evidence • Travel

43. Collateral Sources By law, CVC is considered the payor of last resort, and all available collateral resources must be utilized first Examples of collateral resources include: • Medicaid and Medicare • Health insurance • Texas Workers’ Compensation • Auto insurance • Civil Settlements

44. Covered Medical Expenses Some examples of medical expenses which may be covered by CVC include, but are not limited to: • Hospital Bills • Physician bills • Prescription medication • In-patient and outpatient psychiatric bills • Durable medical equipment(Ex: Wheelchairs, prosthetics) • Glasses replacement • Ambulance • Rehabilitation • Nursing home • Dental

45. Payment of Medical Expenses • Medical expenses are paid according to the Division of Worker’s Compensation medical fee guidelines(MFG) and are based on the CPT procedure code, location, and year services were rendered. • By law, the victim is not responsible for the difference, unless victim had benefits reduced or the claim is found to be a “med max”, then the victim is only responsible up to the MFG. • Services must be rendered before the bill can be considered for payment. • Reimbursements for medical expenses must be submitted within three years of the date of service, unless extenuating circumstances exist.

46. Submitting bills to CVC • In order for CVC to process a medical bill for payment, a complete billing form or statement is required along with an explanation of benefits(EOB) if insurance is available. • Some examples of complete bills include: • CMS-1500 - standardized billing form used by physicians or clinics • UB-04 - standardized billing form used by hospitals(required for payment on hospital bills) • ADA - standardized billing form used by dental providers • Prescription Label or Pharmacy Printout – for prescription reimbursements • “Super Bill” – an itemized, detailed billing statement which includes all the necessary information needed to process a bill

47. What is a complete bill? A complete bill should contain the following information: • Patient Information(Name, Date of Birth, Claim Number) • Date of Service(s) • CPT Procedure Codes • ICD10 Diagnosis Codes • Fee Billed for each procedure • Total Amount Billed and Balance Due • Any payments, discounts or adjustments • Physician's Name • Provider’s Billing Address • Provider’s Tax Identification Number

48. Explanation of Benefits(EOB) • CVC is considered a payor of last resort so an explanation of benefits(EOB) from the insurance should be provided for processing all medical expenses when a collateral source is readily available. • EOB must indicate a patient responsibility. CVC will only consider payment up to the patient responsibility on the EOB. • Payments to a provider will be processed at the patient responsibility or MFG, which ever is less. • In special circumstances, an out of network request may be granted upon review and approval by CVC.

49. Estimates • Providers may request an estimate of payment for Dental and DME services. • Pre-estimates are not performed for any other medical procedures. • If provider agrees to the allowed fee, a complete bills must be submitted once services are rendered, along with a copy of the estimate. • The estimate provided by CVC is not a guarantee of payment but an estimate of CVC allowed rates. CVC does not pre-authorize services. • All available collateral sources should be utilized and an Explanation of Benefits should be provided when the patient has insurance.

50. Mental Health Counseling • The counseling limit for each victim and/or eligible claimant is • 60 sessions. • Mental health counselors will be asked to complete an update on the victim and/or claimant’s progress. This Mental Health Form (MHF) will be mailed to the provider every six months. • In certain circumstances, exceptions may be made to the 60 session limit • Compensation is generally limited to one session per week.  • Missed appointments will not be paid by CVC • Telehealth sessions are eligible for reimbursement if appropriately billed