Or. Admin. Code § 137-076-0019

Current through Register Vol. 63, No. 11, November 1, 2024

Section 137-076-0019 - Fee Schedules

The Department shall calculate payment of eligible crime-related medical and counseling expenses under ORS 147.005 to 147.367 as follows:

(1) When the victim of a compensable crime has been awarded compensation and does not have insurance benefits or any other prior resource to pay for crime-related medical or counseling expenses, the Department shall pay crime-related medical and counseling expenses at the rates set forth in the Oregon Workers' Compensation medical fee schedule in OAR 436-009-0040, except in the following circumstances:

(a) When crime-related medical expenses are incurred in another state, expenses shall be paid at 75% of the billed amount;

(b) Medical expenses involving dental work shall be calculated based on the Oregon Workers' Compensation dental fee schedule rate of 90% of the billed amount;

(c) Ambulance and emergency transportation expenses shall be paid at 75% of the billed amount;

(d) Residential treatment expenses shall be paid at 75% of the billed amount;

(e) Transportation under ORS 147.035 (1)(g) shall be paid at the rate of .50 cents per mile and will include personal vehicle, taxi, or bus;

(f) Counseling services must be provided by one of the following counseling providers in order to be eligible for payment by the Department. Providers shall be paid at the following hourly rates:

(A) Qualified Mental Health Professionals as defined in OAR 309-039-0510(10) or equivalent in another state shall be paid at the hourly rate of $75.00 if they are licensed or being supervised by a licensed mental health provider;

(B) Counselors, therapists, and social workers licensed by the Oregon Board of Licensed Professional Counselors and Therapists under ORS 675.705 through 675.835 or equivalent in another state shall be paid at the hourly rate of $105.00;

(C) Psychologists licensed under ORS Chapter 675 or equivalent licensure in another state shall be paid at the hourly rate of $130.00;

(D) Psychiatric nurses licensed under ORS Chapter 678 or equivalent in another state shall be paid at the hourly rate of $130.00;

(E) Doctor of Medicine or Doctor of Osteopathy licensed under ORS Chapter 677 or equivalent licensure in another state shall be paid at the hourly rate of $160.00;

(F) The Department may pay for other counseling services based on the nature of the victimization and the education, training, and experience of the provider when sufficient documentation establishing the provider's education, training, and experience is provided to the Department. The Department will determine the hourly payment amount based on the supporting documentation.

(2) For the purposes of ORS 147.035(7), "other expenses" related to the proceeding or involvement in the proceeding shall be paid as follows, up to the maximum amount of the award or $3,000, whichever is less:

(a) Lodging expenses shall be reimbursed at actual expense, not to exceed the current federal per diem lodging rates for Oregon found at http://www.gsa.gov/portal/content/104877, if the location of the proceeding is more than 70 miles one-way from the residence of the victim, survivor, dependent, or personal representative, and upon submission of a valid receipt. Reimbursement will only be provided for the number of nights necessary for the victim, survivor, or dependent to attend or be involved in the proceeding, as determined by the Department;

(b) Other reasonable and necessary incidental expenses generally associated with travel and necessary for the victim, survivor, dependent, or personal representative to travel to the proceeding shall be paid at actual expense, at the discretion of the Department, up to a total amount not to exceed the current federal per diem incidental rates for Oregon found at http://www.gsa.gov/portal/content/104877 and upon submission of a valid receipt;

(c) Mileage reimbursement shall be paid at $0.50 per mile for actual round-trip travel from the residence of the victim, survivor, dependent, or personal representative to the location of the proceeding or when the victim's provider is more than 60 miles roundtrip from victims' residence. In lieu of mileage reimbursement, the Department may, at its discretion, reimburse reasonable and necessary round-trip car rental or bus, train, or air fare, upon submission of a valid receipt.

(3) For the purposes of ORS 147.035(2)(e), medical assessments related to strangulation (SKIT exams) will be submitted and paid as follows:

(a) Application and bill will be submitted to the SAVE Fund using a SKIT application;

(b) The SKIT exam will be billed to insurance (unless it poses a risk to the victim) or paid under the Workers' Compensation Fee Schedule if there is no insurance;

(c) The maximum award is $5,000.00.

Or. Admin. Code § 137-076-0019

DOJ 3-2017, f. 4-25-17, cert. ef. 4/27/2017; DOJ 6-2021, amend filed 03/09/2021, effective 3/15/2021; DOJ 7-2024, amend filed 04/29/2024, effective 4/29/2024; DOJ 14-2024, amend filed 08/16/2024, effective 8/16/2024

Statutory/Other Authority: ORS 147.205(1)(c)

Statutes/Other Implemented: ORS 147.035