3 Miss. Code R. § 1-03-301

Current through May 31, 2024

Section 3-1-03-301 - Medical Expenses

1. Some examples of medical expenses include, but are not limited to, hospital, physicians, prescriptions, ambulance, prosthetics, medically necessary equipment, rehabilitation, medical supplies, dental and chiropractic services. Expenses may also include rehabilitative occupational services, including treatment for the purpose of training or retraining for employment based on the victim's medical and employment history.

a. Other limitations do apply and are discussed further in this chapter.

2. Verification: Supporting documentation as determined by the Division shall be submitted to verify and substantiate the expense eligibility. The following shall apply:

a. The victim/claimant shall provide an itemized statement indicating date of service, type of service, diagnostic code, treatment code and charge for each service, product or treatment.

b. The victim/claimant shall provide collateral source information.

c. Additional information and supporting documentation may be requested for further determination on an as-needed basis.

3. Dental care - dental care and services may be eligible if treatment is directly related to the crime injury. Expenses for routine dental checkup, cleaning or pre-existing conditions are not eligible.

4. Medically necessary equipment - may be eligible if the item became necessary as a direct result of the injury, is prescribed by the victims physician and is necessary to facilitate the victims physical recovery. Equipment includes, but is not limited to, wheelchair, bed, walker and crutches.

5. Medical supplies - supplies not prescribed by a physician may be eligible if medically necessary for victims physical recovery and costs are supported with an itemized receipt that clearly indicates the item. Medical supplies include, but are not limited to, over-the-counter medications and bandages.

6. Prosthetic devices, eyeglasses, hearing aids and dentures - may be eligible if the item(s) was destroyed during the crime or became necessary as a direct result of the crime injury and is prescribed by the victims physician.

7. Medical/MHC Transportation for non-emergency services - transportation for non-emergency services may be eligible. The following shall apply:

a. Transportation costs shall be limited for (1) victim to attend doctor appointments and/or mental health counseling sessions; and (2) claimant and/or victims family member(s) to attend appointments for mental health counseling and care.

b. Needed medical attention and/or mental health counseling is not available in the victim's/claimant's community.

c. Travel to a medical or mental health counseling facility is at least forty-five (45) miles, one way from the victim's/claimant's residence.

d. Award for transportation costs shall be limited to mileage and bus, train, and air fare.

e. Award for mileage shall be reimbursed at thirty five-cents (.35) per mile.

f. If there is more than one (1) claimant per request for transportation costs, the amount of compensation shall be prorated among the claimants and the total amount of the award may not exceed Five Hundred Dollars ($500.00).

g. The victim/claimant shall submit a copy of the bill substantiating office visit and date of travel.

h. The victim/claimant shall submit a travel reimbursement request form as prescribed by the Division.

i. Overall maximum amount allowable for travel reimbursement may not exceed $500.00.

8. In-patient mental health services and hospitalization - these expenses are considered mental health expenses. See § 302 below for guidelines and limitations.

9. Sexual Assault/Rape Exams Authorized expenses for the medical examination conducted for the procurement of evidence will be paid directly to the medical provider/facility conducting the sexual assault medical forensic examination. Treatment provided for crime related injuries may be considered for payment if the claim is otherwise eligible for victim compensation. For the purposes of this chapter, the following shall apply:

a. Sexual Assault Forensic Medical Examination sexual assault medical forensic examination expenses include, but are not limited to: rape kit, authorized medical personnel fees, emergency room fees, venipuncture services and lab tests conducted (sexually transmitted disease tests, pregnancy tests, etc.). Costs such as emergency room fees and physician fees will be prorated.

b. Medications - medications, as part of the examination, will be considered for payment if the claim is otherwise eligible.

c. Future Medical Expenses - medications and subsequent tests, administered after the date of the initial medical examination, may be considered for payment if the claim is otherwise eligible.

d. Personal Injuries Sustained During the Sexual Assault - medical services provided during the medical examination for treatment of crime related injuries may be considered for payment through victim compensation if the claim is otherwise eligible.

e. Other treatment, services and/or expenses as a part of the sexual assault medical forensic examination not previously mentioned above will be considered on a case-by-case basis.

f. See § 600-605 for comprehensive guidelines for payment of sexual assault medical forensic examinations including payment limitations.

10. Health Insurance Premiums-the victims health insurance premium may be eligible for payment if the victim was covered at the time of the crime. The following shall apply:

a. The victim is unable to return to work due to crime related injuries.

b. Premiums paid by someone other than the victim or the victims employer will not be considered.

c. If the premium includes additional individuals or family members, only the victims portion is eligible.

d. The victim or claimant shall provide verification of the health insurance coverage and monthly premium payment amount.

e. Payment of health insurance premiums shall be limited to the disability duration or up to twelve months, whichever occurs first and shall be based upon a reasonable charge as determined by the Division of Victim Compensation.

f. The victim or claimant shall provide a disability statement from the victims attending licensed medical doctor or doctor of osteopathy licensed to practice medicine (See Exception in § 301 [10] [g]) indicating the duration of the victims disability.

g. The disability statement shall be signed by a licensed medical doctor or doctor of osteopathy licensed to practice medicine. Disability statements signed by any other provider, such as therapist, shall not be accepted for consideration. Exception: Victim/Claimant may submit a Statement of Disability Report form completed and signed by an (certified) advanced practice registered nurse in lieu of a licensed medical doctor or doctor of osteopathy licensed to practice medicine. If the disability period appears to be unreasonable, then the victim/claimant will be required to have a licensed medical doctor or doctor of osteopathy licensed to practice medicine complete the form. This will be determined on a case-by-case basis.

11. Limitations for medical expenses include, but are not limited to the following:

a. Compensation for medical expenses may not exceed Fifteen Thousand Dollars ($15,000.00).

b. For victims who have a pre-existing condition(s) and the crime related injuries have exacerbated the pre-existing condition(s), expenses will be paid at the following rates: 1^st three months (from date of crime) reimbursed at 100%; 2^nd three months reimbursed at 50%. Thereafter, expenses are not eligible for reimbursement unless the attending medical doctor or doctor of osteopathy licensed to practice medicine (see § 301 [10] [g] for exception) can verify continued crime related injuries exacerbation of a pre-existing condition(s).

c. Expenses for treatment which is not directly related to crime injuries and/or provided by a non-licensed medical professional or facility (if applicable) shall not be eligible.

d. The medical expenses of a deceased victim shall not be eligible if the claimant does not have legal obligation or liability of losses incurred by the victim. However, the expenses may be eligible, if the claimant signed for financial responsibility of the expenses or made voluntary payments.

e. Medical Transportation B Claimant travel to visit victim in hospital/other facility or sit with victim in hospital/other facility is not eligible.

f. Medical and Mental Health Counseling transportation have a combined cap of Five Hundred Dollars ($500.00). This amount is in addition to the Fifteen Thousand Dollars ($15,000.00) Medical maximum or Three Thousand Five Hundred Dollars ($3,500.00) Mental Health Counseling maximum.

3 Miss. Code. R. § 1-03-301