VIEWS: 2 PAGES: 27 POSTED ON: 5/18/2012
HOW DO WE PROCESS APPLICATIONS ? Valerie Martinez, Reparation Officer Supervisor APPLICATION RECEIVED AND DATE STAMPED Clock starts now Not based on the date of incident, but when application is received in our office Completion may take up to six months due to lack of requested information ROBERTA MARQUEZ, COMPENSATION MANAGEMENT ANALYST, RECEIVES AND REVIEWS APPLICATION TO INCLUDE ANY AND/OR ALL ADDITIONAL DOCUMENTS RECEIVED WITH APPLICATION The more info provided with the application the faster the application can potentially be completed Medical bills Medical records Funeral contract/bill Police reports (if in Albuquerque, at least a case #) Employer pay stubs (for loss of wages) Receipts (if food receipts, they must be itemized) ROBERTA THEN: Assigns the application a claim number Enters all information into the agency database And, based on where crime occurred, a Reparation Officer is assigned to process the application IF THERE IS ENOUGH BASIC INFORMATION COMPLETED ON THE APPLICATION, SUCH AS Victims name Victims date of birth Date of incident Police agency reported to List of incurred expenses Completed ORIGINAL authorization (initialed, signed, dated) AGAIN, THE MORE INFORMATION THAT IS PROVIDED ON/WITH THE APPLICATION, THE FASTER IT CAN POTENTIALLY BE PROCESSED IF SO, ROBERTA ORDERS AND MAILS ALL NECESSARY LETTERS Police records request Medical bills/records request Counseling treatment plan/bills request LETTERS ORDERED, BUT NOT MAILED UNTIL ASSIGNED REPARATION OFFICER REVIEWS Initial contact letter to victim/claimant Letter to appropriate District Attorney’s Office Loss of wages letter (victim/claimant must confirm it is okay to mail to employer) POLICE RECORDS LETTER Date Reported: (To law enforcement) Re Victim: Date of Incident: SSN: (Victim’s) Date of Birth: (Victim’s) Suspect: Place of Incident: (Exact address if known) Police Case #: Dear Sir/Madam: An application has been submitted to this agency for reparation under the Crime Victims Reparation Act. In order for the Commission to make a determination on payment of bills in this case, we must have copies of all police reports, statements, supplementals and any other information available that would assist the Commission in making a determination in this matter. Please forward these documents to our office as soon as possible. Your cooperation and assistance is appreciated. If you have any questions or wish to speak to the person processing this application, please call: (Assigned Reparation Officers Name) at 505-841-9432 MEDICAL BILLS/RECORDS REQUEST RE: (Victim’s name) SSN: (Victim’s SSN) Date Submitted: Date of Incident: Date of Birth: Dear Sir/Madam: The above victim/claimant has applied to the State of New Mexico for reparation under the New Mexico Crime Victims Reparation Act. We have been advised that you provided treatment to this victim. In order for us to determine if you are eligible for payment under this program, we must have a copy of the MEDICAL REPORT AND ITEMIZED STATEMENT for the treatment of the victim FROM THE ABOVE DATE OF INCIDENT TO THE PRESENT. Please include in the statement the charges, payments made, and the balance. If no outstanding balances remain, please furnish the names of persons who have paid and amounts paid so that reimbursement to these individuals can be considered. Your cooperation and assistance is appreciated. If you have any questions or wish to speak to the person processing this application, please call: (Assigned Reparation Officer’s Name) at 505-841-9432 COUNSELING TREATMENT PLAN/BILL Date of Incident: Re Victim: Date of Birth: (Victim’s) SSN: (Victim’s) Date Submitted: Dear Sir/Madam: An application has been filed as a result of a crime committed against the above named individual. Section 31-22-5 (B) of the New Mexico Crime Victims Reparation Act requires verification of information in order to make a determination on the application. In accordance with the Crime Victims Reparation Commission (CVRC) Regulations, evaluation and counseling shall be performed by a provider licensed in accordance with the New Mexico Counseling and Therapy Act. Those providers awaiting licensure approval must be under the direct supervision of a licensed professional. Treatment is to be directed towards specific objectives in healing crime-related problems. Counseling dealing with unrelated conditions is not eligible for compensation. At any time during treatment, the Commission may require a follow-up report or prognosis notes from the provider detailing the results of the treatment and setting forth the need for continuing treatment. The provider shall furnish the commission with a detailed report explaining why continuing treatment is necessary. In-patient hospitalization may only be considered in life-threatening situations when the treatment has been recommended, in writing, by the victim’s physician or mental health provider. The Commission will not consider payment for the following: missed appointments, report writing, telephone counseling, court appearances, therapist travel time/costs, interest, telephone calls to the Commission office, and sessions which include the offender. If the victim has health insurance that provides payment for mental health therapy, but requires a co-pay from the victim, the Commission is willing to accept a copy of the treatment plan that you provide to the victim’s insurance company in lieu of our enclosed form. Please submit additional bills and requested documentation on a timely basis. When the victim is a minor, a therapist shall be prohibited from receiving reparation if they are providing treatment to the minor victim as well as to the offender. In all cases of mental health are, the Commission shall approve for payment no more than 30 total visits per application submitted unless prior approval for additional treatment has been granted. This prior approval must be requested by the provider and must clearly document the need. COUNSELING TREATMENT PLAN, CONT The responsibility for any charges for your services remains with the patient. The Crime Victims Reparation Commission assumes no responsibility until the Board has approved the application. The Crime Victims Reparation Commission is neither an insurance company nor a program of entitlement. All attempts to have insurance, Medicaid, Medicare, or indigent funds pay for the treatment must be made prior to our consideration. Per federal law, CVRC is the payer of last resort. Please complete the following form, as this documentation is required for this application to be considered for payment. Additional information should be attached to this document. Also enclose an itemized statement. Victim/Client Name:____________________________________________________________________ Detailed patient evaluation describing the effect of the victimization: Presenting complaints: Pre-existing conditions: Treatment Goal/Plan: Method for accomplishing treatment goals: Medication prescribed and reason: Estimated lenth of treatment: Explain what percentage of treatment is related to the victimization: State license number:_______________________ _____________________________ _______________________________ Print Name Signature INITIAL CONTACT LETTER Date Submitted: Date of Incident: Re Victim: Dear Sir/Madam: Your application has been received at this office, and is currently being worked on by our staff. Due to the time required to verify the facts of the case, it is possible that it may take up to six months before your application will be presented to the Commission Board for review and decision. At this time, the Commission cannot guarantee, or pre-approve payment of any expenses. All applications undergo a thorough review by the Crime Victims Reparation Commission Board. Commission staff contact police, courts, employers, hospitals, physicians, etc., to confirm the information you have provided on your application. Commission staff verify the facts of the case, determine whether or not eligibility criteria are met, and verify that all expenses submitted are for services directly related to the victimization. Once the Board has reviewed your application, you will be notified of their decision in writing. Only those expenses that are a direct result of the crime can be considered. Expenses incurred as a result of the incident must first be submitted to all readily available collateral sources, such as your insurance company, local indigent program, Medicare, and Medicaid for payment. Those expenses not fully covered by collateral sources will be considered for reparation. You have the responsibility to file with these collateral sources. If you have any questions concerning these sources, contact our office. Additionally, proceeds from a civil suit and restitution payments from the suspect are considered collateral sources. No award of reparation can be made for property loss, legal fees, or pain and suffering. Please note that any person applying for assistance with the New Mexico Crime Victims Reparation Commission must cooperate with Law Enforcement and this agency. This includes a willingness to assist in the prosecution of the suspect(s). YOU MUST CONTACT THIS AGENCY WITHIN FIFTEEN (15) DAYS FROM THE DATE OF THIS LETTER. FAILURE TO COOPERATE WITH THIS AGENCY AND PROVIDE YOUR CURRENT CONTACT INFORMATION WILL RESULT IN DENIAL OF YOUR APPLICATION. If you have any questions or wish to speak to the person processing this application, please call: (Assigned Reparation Officer’s Name) at 505-841-9432 DISTRICT ATTORNEY’S OFFICE LETTER Date Submitted: Re Victim: Date of Incident: SSN: (Victim’s) Date of Birth: (Victim’s) Suspect: (Name, DOB, SSN) Place of Incident: (Exact address if known) Police Case #: Dear Sir/Madam: An application has been submitted to this agency for reparation under the Crime Victims Reparation Act. In order for the Commission to make a determination on payment of this application, we must have copies of the following items: _____ Criminal Complaint _____All documents pertaining to this case _____ Indictment _____ Court Documents _____ Judgment/Verdict _____ Protection Order Filed _____ Other_____________________________________________________________ _____________________________________________________________ Police Reports: Initial Report______ Supplementals_____ Statements_____ Other______________________________________________________ Please let us know if there are other facts concerning this case that we should know. If there is no suspect listed above, we do not know of any suspect. Thank you very much for your assistance. If you have any questions or wish to speak to the person processing this application, please call: (Assigned Reparation Officers Name) at 505-841-9432. LOSS OF WAGES LETTER Date of Birth: (Victim’s DOB) Re: Victim: Date of Incident: SSN: (Victim’s SSN) An application has been submitted to this agency for financial assistance. If eligibility is determined, we may reimburse the above employee for applicable loss of earnings. Please complete the following form and return to me soon so that I can complete the processing of this application. Please call if you are unsure how to complete this form. Date Employment Began___/___/___ Hours Worked per Day________Hours Worked per Week_______ Exact work Dates Missed After above Date of Incident to present______________________________ Hourly Rate__________ Gross Salary__________ Form of payment: __Cash __Check Number of Days worked per week_____ Regular Days Off: Su,M,T,W,Th,F,Sa Job Title:_______________________ Was employee eligible for any leave:Yes___No___If so, dates taken as leave and specify type of leave: _______________________________________________________________________ Date of Termination, if applicable_________________ Reason for Termination___________________________________ Is the employee eligible for health and/or disability insurance? If so, please furnish the name, address, telephone, and policy number for this company: _______________________________________________________________________ ____________________________________________ Telephone:_____________________________ Signature ____________________________________________ Print Name/Title If you have any questions or wish to speak to the person processing this applications, please call: (Assigned Reparation Officer’s Name) at 505-841-9432 IF THERE IS NOT ENOUGH INFORMATION AVAILABLE OR THE AUTHORIZATION IS NOT COMPLETE An Incomplete letter will be generated and mailed to the victim/claimant to request the missing information be submitted as soon as possible INCOMPLETE LETTER Dear Sir/Madam: I am sorry for the tragedy that you have experienced. It is always sad to learn that crime has touched another family. The New Mexico Crime Victims Reparation Commission wants to do whatever we can to help. However, this application is incomplete. We require the following information to be completed and returned to this agency within thirty (30) days. Please fill out the information required on the enclosed document(s). The information required is highlighted. Please return the enclosed form(s). Enclosed is a new authorization form, which you must initial, sign, and date. Please return the enclosed form. Enclosed is a new authorization form to be signed by the parent or legal guardian of the victim. Please return the enclosed form. You must submit the original Authorization for Release of Information. Please return the enclosed form. Enclosed are additional page(s) of the application form which were missing and must be filled out and returned. Please return the enclosed forms. Enclosed is a new page requiring that the claimant fill out he claimant data since a minor cannot be the claimant. Please return the enclosed form. For your convenience, I have enclosed a self-addressed stamped envelope for you to return this/these document(s). If we do not receive the completed information within thirty (30) days, we will assume that you do not wish to pursue your application with this agency. Your application will be enclosed and placed in an inactive status until we receive the completed information. If you have any questions, please call me at 505-841-9432. THE NEW CLAIM IS GIVEN TO KATIE SILVA, VICTIM ADVOCATE, TO REVIEW AND ATTEMPT CONTACT WITH THE VICTIM/CLAIMANT. If contact is made, Katie verifies Address/phone numbers written on application are correct Asks for additional information that may be needed Verifies known expenses Asks if the victim/claimant need any additional referrals (Katie has a 5 day window to hold file) KATIE HAS A FIVE DAY WINDOW TO HOLD THE FILE IF NEEDED, SO THAT SHE CAN TRY TO SPEAK WITH THE VICTIM/CLAIMANT THE ASSIGNED REPARATION OFFICER IS GIVEN THE NEWLY ASSIGNED CLAIM The initial contact letter is signed by the Reparation Officer, who also provides CVRC’s toll free phone number Reminder: this letter requests that the victim/claimant call and speak with the assigned Reparation Officer within 15 calendar days from the date of the letter Why is this needed: The Reparation Officer will have reviewed all available information in depth. Speaking with the victim/claimant will provide the opportunity to give policy/procedure info, explain process time, verify all expenses, request if loss of wage letter can be mailed. If needed, additional letters to providers will be generated and mailed LETTERS MAILED TO PROVIDERS To allow providers time to gather and return requested information, the Reparation Officer waits 30 calendar days from the date of the letter for a response from providers After 30 calendar days have passed, if the requested information has not been received, a Second Request letter is mailed to those specific providers The Reparation Officer, at their discretion, may also attempt to call the provider and do a verbal request of the needed information or they may call the victim/claimant, explain the situation, and ask the victim/claimant to explain to the provider why the request is needed LETTERS MAILED TO PROVIDERS After the 60 calendar days have passed If the requested information is necessary to have before processing the claim, the Reparation Officer can attempt additional verbal and/or written requests If the requested information is not necessary to have before processing the claim, the Reparation Officer can decide to process the claim with the expenses that are available and any unavailable expenses can be considered at a later date if received WHAT’S THE ABSOLUTE MINIMUM NEEDED TO PROCESS THE APPLICATION? Police report with enough information to determine what occurred If report is unavailable (mostly for homicide cases), a law enforcement questioner may be completed Initial medical records (first place victim was treated) Including toxicology results if performed Ambulance run report if transported or treated at the scene An OMI (autopsy/cause of death/toxicology) report, if victim is deceased WHAT’S THE ABSOLUTE MINIMUM NEEDED TO PROCESS THE APPLICATION? Verbal contact with the victim/claimant to discuss final process expenses to be considered (if any) explanation of pro-rated expenses if needed process of submitting future expenses any contributory issues the Board will review IF A POLICE REPORT CANNOT BE RELEASED Reparation Officer can attempt a verbal contact with the records department with the reporting police officer or detective assigned to the case with a Victim Advocate in the District Attorney’s Office if an offender is known FBI or homicide cases, the detective can complete a questioner regarding the case that may substitute for an actual police report **LAST RESORT** WHEN THE REPARATION OFFICER HAS ALL THE NECESSARY INFORMATION AND HAS MADE VERBAL CONTACT WITH THE VICTIM/CLAIMANT Police reports and medical records are thoroughly reviewed for any contributory issues (alcohol, drugs, gang activity, etc.) If there are contributory or other issues (crime enumerated, unjust enrichment, etc.) then the Reparation Officer will write a summary to the Board for review to determine eligibility If there are no contributory or other issues, the Reparation Officer may process the application for approval by the Director REMINDER: DUE TO FINANCIAL CUTBACKS, ALL PROVIDERS (EXCEPT FUNERAL HOMES) WILL ONLY BE CONSIDERED AT 50% OF THE PATIENTS RESPONSIBLE PORTION OF THE BILL IF AN APPLICATION IS BEING REVIEWED BY THE BOARD, ADDITIONAL REDUCTIONS MAY BE MADE FOR CONTRIBUTORY ISSUES IN INCREMENTS OF 25% Example: A bill for $100 to be paid to a medical provider will be submitted to the Board at a 50% reduction due to cutbacks. That $50, due to contributory issues related to the incident, is then reduced by another 50%. So the provider will only be paid $25 If the victim/claimant is able to pay the remaining $75 to the provider and submits a receipt of payment to our office, we can reimburse the victim/claimant up to 50% (contributory issue reduction) of the original bill. So, we would pay the victim/claimant $25 APPROVAL LETTER (REDUCTION) RE: Application submitted for (Victim’s name) The New Mexico Crime Victims Reparation Commission Board has approved your application for payment of some of your expenses resulting from the victimization. The Crime Victims Reparation Commission is aware that the trauma of the criminal victimization cannot be corrected by this monetary award, but we sincerely hope that this will illustrate to you that the State of New Mexico is concerned for its citizens and/or their families who became the innocent victims of violent crime. The laws that have been set up to govern the Crime Victims Compensation Fund in this state are very specific as to what can and cannot be paid. After comparing the circumstances of your case with the laws that govern the fund, the Board has approved the following payments. If you wish to appeal this decision, please write the Director requesting an appeal. All awards and orders for reparation are subject to the making of an appropriation by the Legislature. The Commission Board has approved 75% / 50% / 25% of eligible expenses. (Provider’s name) (Type of service, Date of service) $ Amount Total $ Amount If you have any questions or concerns, do not hesitate to contact me. Kristy Ring (Director) QUESTIONS?
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