Crime Victims’ Compensation - PowerPoint Presentation

Crime Victims’ Compensation Conference Advanced Track Tracy Morales Ricky SanchezCrime 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. 

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

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.

Texas Code of Criminal Procedure Article 56 subchapter BArticle 56.31 through 56.64Crime Victims’ Compensation Act Enabling Legislation

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

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

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

CVC Goal The goal of CVC is to reimburse victims 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.

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 OAG Website for CVC

CVMS Webportal Login Page

Claim Search

Claim Search by SS & DOB

Claim Search By Claim #

Claim Notes Page

Helpful Definitions

All Bills screen

Paid Bills screen

Unpaid Bill screen

Profile screen

Support Page

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.

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

CVC Application (Slide 3 of 3)

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

Business Process

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

Claimant Who is a Claimant? An authorized individual acting on behalf of a victimAn 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.

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)

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.

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 .

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

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 )

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

Denial or Reduction Behavior FactorsIf 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

CVC Requirements There is no requirement that a suspect beIdentifiedApprehended 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.

CVC Reporting Requirements Reporting the crime to law enforcement72 hours prior to September 1, 1997On 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

CVC Filing Requirements Filing requirements to CVC ProgramPrior to September 1, 1997, one yearOn 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

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 Emergency Medical Care Application

Examples of medical care costs associated with the exam EMS Transport, if necessary, to the facility where exam was conductedEmergency Room Facility FeePhysician's FeesDischarge 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 Emergency Medical Care Application

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

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%

Award Types Medical (Includes psychiatric care/counseling and dental)Loss of earningsLoss of supportFuneral and burial Relocation and rental Child or dependent care Crime scene clean-up Property seized as evidence Travel

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 Collateral Sources

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

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.

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 providersPrescription 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 Submitting bills to CVC

A complete bill should contain the following information:Patient Information(Name, Date of Birth, Claim Number) Date of Service(s)CPT Procedure CodesICD10 Diagnosis CodesFee Billed for each procedureTotal Amount Billed and Balance DueAny payments, discounts or adjustments Physician's NameProvider’s Billing AddressProvider’s Tax Identification Number What is a complete bill?

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. Explanation of Benefits(EOB)

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. Estimates

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 Mental Health Counseling

CVC EligibleMental Health Providers CVC currently covers mental health counseling provided by: Psychiatrist, and other M.D. Clinical Psychologist Clinical Nurse Specialists in Psychiatry (CNS) Licensed Professional Counselor (LPC) Licensed Marriage and Family Therapist (LMFT) Licensed Clinical Social Worker (LCSW) List of eligible providers is maintained and located on the CVC website. CVC does not make referrals to victims seeking treatment; they are referred to their local resources.

In-patient hospital treatment, residential treatment center care, including partial day programs or intensive outpatient programs are available only for victims and for a maximum of 30 days, unless good cause is shown. Inpatient and Intensive Psychiatric Care expenses are paid according to the Division of Worker’s Compensation medical fee guidelines(MFG) Inpatient and Intensive Psychiatric Care

CVC reimburses for the forensic costs related to a sexual assault exam of an alleged victim.Reimbursement for reasonable costs associated with a forensic medical examination of a victim is as follows: Not to exceed $1,000 for dates of crime on or after 7/15/16 Not to exceed $700 for dates of crime before 7/15/16.Must be requested by law enforcement in connection with the investigationCVC can reimburse for the forensic costs related to a sexual assault exam of an alleged adult victim that was not reported to law enforcement if: Victim arrived at the facility within 120 hours of the assault Victim consents to the examination Sexual Assault Reimbursement

CVC will reimburse for costs such as:Examiner fees Place of service feeExam feesSexual assault kitLaboratory procedures For a full list of reimbursable costs and limits, please see the OAG Website. Victim cannot be billed for any of the forensic costs related to the sexual assault exam Sexual Assault Reimbursement

House Bill 616 - amends Chapter 56 of the Code of Criminal Procedure to allow the Office of the Attorney General (OAG) to compensate health care facilities, sexual assault examiners, and sexual assault nurse examiners directly for the forensic portion of a sexual assault medical exam. Exams before to 9/1/19Medical providers bill Law Enforcement Agency(LEA) for the costs of the forensic medical examLEA pays the medical provider LEA mails an paper application for reimbursement from OAG Includes copies of the bills and proof of payment Sexual Assault Reimbursement

Exams after 8/31/19 Medical provider bills OAG for the costs of the forensic medical exam and the OAG reimburses provider directly Provider submits an online application via CVC online portal.Requests for reimbursement must include the forensic bill(s) and copy of the LEA Request for Sexual Assault Exam formDoes not cover medical costs. Expenses other than the forensic costs such as medical treatment are not reimbursed under this program but may eligible under CVC or Emergency Medical application. Sexual Assault Reimbursement

Loss of earnings related to medical Physical or emotional disability While seeking medical treatment for crime-related injury Care for a medically incapacitated adult/minor child by claimant Loss of earnings related to the criminal justice system Police investigation appointments Protective order court appointment Criminal proceedings Post-convictions Post-adjudication proceedings (executions) Loss of earnings related to victim’s funeral Loss of Earnings (Slide 1 of 2)

Loss of Earnings(Slide 2 of 2) If employed, weekly net earnings multiplied by the disability period.Limited to $700 per weekIf unemployed, will consider situations that demonstrate the victim would have been employable. Benefit would be based on anticipated loss of future earnings.

Name and address of employer Printout of federal income tax return directly from IRS for all self-employed victims Name and address of treating physician If for time off work for medical/criminal justice appointments, a completely Travel / Appointment Verification Form Verification of all collateral sources: Social Security, workers’ compensation, short/long-term disability benefits, settlements Loss of Earnings Requirements

To dependents of a murder victim Up to $50,000 To dependents of surviving victims Usually family violence Limited to 90 days To dependents of a medically disabled victim During disability period Limited to $700 per week Loss of Support

Verification of dependency A person who is dependent, within the meaning of the IRS code: Income tax return Court order Marriage license Proof of informal marriage Divorce decree Birth certificate Verification of support lost Verification of all collateral sources Loss of Support Requirements

Funeral and Burial(Slide 1 of 2) Funeral and burial expenses maximum of $6,500 Additional funds available to transport the body Burial transit permit / apostille issued by the Texas Secretary of State Air bill Copies of bills for services paid to other funeral homes for transporting the body

Funeral and Burial(Slide 2 of 2) What is covered: Funeral services Casket, urn Graveside services Cemetery expenses Marker/headstone Cremation charges Additional costs: flowers, musician fees, burial clothing for the deceased victim, exhumation and reburial

Signed funeral purchase agreement Cemetery bills Receipts for payment Death certificate (only if we need to relate death to crime) Verification of collateral sources Tax ID of the funeral home Funeral Payment Requirements

Relocation For victims of :Family violence (June 19, 1999)Sexual assault in their residence (September 1, 2001)Human trafficking (September 1, 2013) Stalking (September 1, 2015) $3,800 Total Benefit Up to $2,000 for applicable relocation cost Transportation Deposits and fees Moving van and storage 3 Months rent up to $1800 One time award 3 year time limit to apply for relocation

Completed / signed CVC Relocation Expense Worksheet Completed / signed CVC Relocation Acknowledgment FormCompleted / signed CVC Letter of Intent or a letter of intent from the landlord or a signed and dated lease Completed / signed Payment Affirmation Form (if victim/claimant is requesting the landlord to be paid directly for the deposit or the first month’s rent) Estimates from professional moving company or car/van rental if used Tax ID for landlord if paid directly Relocation Requirements

Child or Dependent Care Only available as a new expense resulting from the crimeChildren (14 years and under) or dependent adults Care must be provided by licensed or registered provider $300 per week per child or dependent Crime dates after May 7, 2005 child care is limited to 90 days Crime dates on or after July 15, 2016 child care is limited to 1 year 90 day child care exception for dependents of deceased victims

Itemized bill A written statement from the victim/claimant explaining the need for childcare as a result of the crime.Copy of the daycare licenseCopy of the daycare fee schedule Proof of child/dependent care need may be requested Employment verification School enrollment verification Medical statement Child / Dependent Care Requirement

Crime Scene Clean-Up Reasonable and necessary costs of cleaning the crime scene $2,250 limitCommercial cleaning company Will reimburse for cleaning supplies when work is done by volunteers What is required? Itemized bill for cleanup from the commercial cleaning company and receipt if paid by claimant Receipts for payment of cleaning supplies Verification of collateral sources (home owners’ insurance)

Property Seized as Evidence Reasonable replacement costs for clothing, bedding, or property of the victim seized as evidence or rendered unusable as a result of the criminal investigation $1,000 limit This is the only property for which reimbursement can be paid by CVC. What is required? List of clothing, bedding or property taken Reasonable replacement cost of items Law enforcement verification of items seized

Travel(Slide 1 of 2) Travel expenses due to participation in or attendance at:The investigation prosecution, or judicial processes; also post-conviction and post-adjudication-involvement The execution of the perpetrator Seeking necessary medical treatment and counseling services The funeral of the victim for immediate family and household members Traveling distance must be more than 20 miles one way.

Travel(Slide 2 of 2) Exceeds 20 miles (one way)Necessary and reasonable transportationCommercial transportation Personal vehicle/state mileage reimbursement rate Exceeds 60 miles (one way) Meals ($36 per day) Lodging expenses ($85 per night) Meals and lodging are per diem state rate Commercial transportation Personal vehicle/state mileage reimbursement rate Different travel rates apply for different years and are based on the state rate at the time. Travel reimbursements are for crimes on or after September 1, 1997

A completed/signed CVC Travel/Appointment Verification Form Receipts for lodging/airfare (if 60 miles or more one way) Travel Requirements

Applications with medical bills greater than $50,000 Identified in system as “Med Max”60 days to submit bills from initial request (checklist)30-day letter requesting all bills Long timeline to process these payments as CVC awaits receipt of all bills from all service providers Medical Max Applications (Slide 1 of 2)

Medical Max Applications(Slide 2 of 2) Bills are or pro-rated based on their share of the total CVC money available in the claim. Since bills have not been paid at full fee guideline amount, victim does owe balance up to the medical fee guideline (MFG).

Extraordinary Pecuniary Loss Injury is a total and permanent disability. Above the base award, Extraordinary Pecuniary Loss benefits are: Additional $25,000 (for crimes occurring September 1995-97) Additional $50,000 (for crimes on or after September 1, 1997 to August 31, 2001) Additional $75,000 (for crimes occurring on or after September 1, 2001)

Extraordinary Pecuniary Loss Total and Permanent Disability Durable medical equipment (September 1, 2001)Rehabilitation technology (September 1, 2001)Long-term medical expenses (September 1, 2001) Home and vehicle wheelchair accessible Rehabilitation Loss of earnings Job training Home health care Training in the use of special appliances

$1,500 maximum Must be paid from an existing or anticipated benefit, it is not a “free award”May be considered for situations that pose an undue hardshipDecision made by CVC staff based on “best interest of the victim” Emergency Award

All funds distributed by the State of Texas flow from the Comptroller’s Office. The Comptroller maintains a database of payees and payee information. Necessary to gather and collect an audit trail for payments Also the method for determining 1099 / tax situation for payees It takes two business days to set up a new payee or a new mailing address for an old payee. Vendor / Payment Setup (Slide 1 of 3)

The Comptroller can issue a temporary tax ID. Businesses must have a federal tax ID. Sole proprietors and limited partnerships must supply each owner’s SSN. Corporations must provide their charter number. Vendor / Payment Setup (Slide 2 of 3)

Once a payee account is set up, a warrant (check) request is made. It takes two business days to receive a warrant (check) once a request is made if no holds are present. After that, it takes two to three business days to be mailed. Vendor / Payment Setup (Slide 3 of 3)

The Comptroller’s warrant (check) hold program is a tool that allows all state agencies to collect outstanding debts. 52 agencies currently participate. An agency sends the Comptroller’s office a request to participate in the program. The Comptroller’s Claim Division requests the agency to identify the source of debt owed to the State and sets the hold. As the Comptroller’s office prepares warrants (checks), the debtors’ identification numbers are electronically checked against the prepared warrants (checks). Holds (Slide 1 of 3)

The OAG has no control over the hold process – it is completely managed by the Comptroller and the agency to which the state debt is owed. Frequent reasons for hold: Delinquent child supportDelinquent student loansOverpayment of unemployment compensation benefits Sales tax due from a business owner Unemployment insurance taxes due Holds (Slide 2 of 3)

Victims and claimants can contact the agency that requested the hold to make arrangements. Usually a resolution can be reached that will allow the warrant (check) to go through, but it must be worked out by the victim or claimant. CVC will provide the payee with appropriate phone numbers to contact the debt-holding agency. Holds (Slide 3 of 3)

Appeals Process(Slide 1 of 4) The victim or claimant has the right to appeal a decision (eligibility or awards)Reconsideration Final ruling hearing District court

Appeals Process(Slide 2 of 4) ReconsiderationFirst step in appeals process30 days to appeal a denial of benefits Victim or claimant is asked to send CVC all documentation to prove claim

Appeals Process(Slide 3 of 4) Final ruling30 days to appeal Reconsideration denial Last opportunity to prove compensable claim Victim or claimant requested to send CVC all documentation to prove claim Victim or claimant speaks personally with a CVS attorney (hearings officer) about their application

Appeals Process(Slide 4 of 4) District courtVictim or claimant has 40 days to send CVC letter of dissatisfaction with Final Ruling Decision. Victim or claimant has 40 days after letter of dissatisfaction to file suit against CVC in district court.

Claim Closure Due to Fraud (Slide 1 of 3) Texas Code of Criminal Procedure, Article 56.41 (b)(7)(b) The Attorney General shall deny an application for compensation under this subchapter if: (7) the claimant or victim knowingly or intentionally submits false or forged information to the Attorney General. Texas Code of Criminal Procedure, Article 56.38 (b) The Attorney General may investigate an application. Texas Code of Criminal Procedure, Article 56.47 (a) The Attorney General, on the Attorney General’s own motion, or on request of a claimant or victim, may reconsider; (1) a decision to make or deny an award; or (2) the amount of the award

Claim Closure Due to Fraud(Slide 2 of 3) Loss of earnings:Victim was awarded loss of earnings.CVC received information that victim submitted two false employment verification documents and also forged HR Director’s signature to falsely show they were employed. Victim was charged and arrested with Tampering with a Governmental Record. Victim submitted false medical documentation in order to continuing receiving loss of earnings. Victim, a nurse, had been terminated from their job due to felony forgery convictions but falsely indicated that it was due to a crime related injury.

Claim Closure Due to Fraud(Slide 3 of 3) Relocation:Victim awarded relocation but claimed she never received the check.CVC processed a stop payment and issued a second check. Comptroller’s records revealed both checks had been cashed. Victim was charged with Theft. Victim submitted a falsified lease. CVC called apartment complex and was advised victim was not approved. Victim was charged with Tampering with a Governmental Record.

Office of the Attorney General Crime Victim Services DivisionCVC ProgramP.O. Box 12198 Austin, TX 78711-2198 Main Number: (512) 936-1200 or (800) 983-9933 Priority Application Fax: (512) 370-9837 Presumptive Eligibility Fax: (512) 370-9995 www.texasattorneygeneral.gov ITServices@oag.texas.gov Voice: (512) 936-1768 Fax: (512) 370-3959 Contact Information