Section 203 IAC 1-2-2 - Application for reimbursement; information requiredAuthority: IC 5-2-6.1-46
Affected: IC 5-2-6.1; IC 16-21-8
Sec. 2.
(a) To receive payment, the hospital or licensed medical service provider, sex crime victim, and, if present, a law enforcement agent must supply information regarding the alleged sex crime on a claim form prescribed by the division completed and filed not later than ninety (90) days from the date of the first emergency room medical services provided. The hospital or licensed medical service provider shall attach to the application the patient's emergency department report of the date of treatment including the following: (1) A copy of the medical examination report by the attending physician.(2) A narrative statement describing the alleged sex crime, including the time and place thereof, and a brief description of the injuries sustained.(3) An itemized statement showing all services provided to the alleged sex crime victim that were a direct and proximate result of the alleged sex crime.(b) The division may also require additional information as needed to determine eligibility. The hospital or licensed medical service provider shall provide to the patient, at the time of the sex crime victim's release from the hospital or licensed medical service provider, the fund information sheet. Applications for payment for the following subsequent medical procedures shall be filed within thirty (30) days of the services rendered:(1) Sexually transmitted disease testing.(3) Mental health counseling for problems directly related to the sexual assault.(c) If an application is denied or additional information from the hospital or licensed medical service provider is required, the division shall so notify the hospital or licensed medical service provider in writing. A hospital or licensed medical service provider has thirty (30) days from the date of the division's notification to present the information required to the division. The additional information will then be evaluated.(d) All applications should be mailed to or filed in person at the division's office located in Indianapolis, Indiana.Victim Services Division; 203 IAC 1-2-2; filed Aug 26, 2004, 1:30 p.m.: 28 IR 10; readopted filed Dec 2, 2010, 2:29 p.m.: 20101229-IR-203100660RFAReadopted filed 11/30/2017, 1:38 p.m.: 20171227-IR-203170441RFAReadopted filed 6/22/2023, 11:34 a.m.: 20230719-IR-203230221RFA