SECTION 61.508. Other Limits on Medical Expenses

(a) The OAG considers the following medical services to be reasonable and necessary as a result of the personal injury caused by the criminally injurious conduct:

(1) the one time only repair or replacement of medical or dental devices in use by the victim prior to the criminally injurious conduct, if the device is damaged, lost or rendered unusable as a result of the criminally injurious conduct; and

(2) the one time only purchase, or the reasonable and necessary rental, for medically prescribed assistive or adaptive items.

(b) The OAG does not consider the following medical services to be reasonable and necessary as a result of the personal injury due to the criminally injurious conduct:

(1) treatment for wellness or the prevention of disease;

(2) membership in a health club or gym facility;

(3) the rental or purchase of fitness, exercise, or gym equipment; or

(4) any other items or services which are not regularly used in the course of treating a medical condition in a health care facility or setting.

(c) Unless the OAG has made a determination that good cause exists, the OAG will not process bills and requests for reimbursements for health care services that are received three years after the date of service.

(d) For victims under the age of 18 at the time of the criminally injurious conduct, bills and requests for reimbursements for health care services may be submitted up to the victim's 22nd birthday for consideration of payment.

(e) Physical therapy expenses will be reviewed as health care services under this subchapter. Physical therapy includes the testing and measurement of the function of the musculoskeletal, neurological, pulmonary, and cardiovascular systems and rehabilitative treatment concerned with the restoration of function and prevention of disability. It also includes treatment, consultive, educational, and advisory services for the purpose of reducing the incidence and severity of disability and pain to enable, train, or retrain an individual to perform the independent skills and activities of the victim's daily living at the same level as immediately before the criminally injurious conduct.

Source Note: The provisions of this §61.508 adopted to be effective May 8, 2005, 30 TexReg 2491; amended to be effective October 30, 2014, 39 TexReg 8373