N.H. Admin. Code § Jus 605.03

Current through Register No. 45, November 7, 2024

Section Jus 605.03 - Medical Expenses Awards

(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.

N.H. Admin. Code § Jus 605.03

#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

Amended by Volume XL Number 2, Filed January 9, 2020, Proposed by #12938, Effective 12/9/2019, Expires 12/9/2029.