Crime Victim Compensation: A Critical Hospital Resource

00:00:00:03 - 00:00:19:06
Tom Haederle
Welcome to Advancing Health. For victims of incidents of mass violence, the long road to recovery can be costly in many ways. Every state offers a victim compensation program that can help, and we get some tips on how to access that assistance in this podcast.

00:00:19:08 - 00:00:47:04
Jordan Steiger
Welcome to AHA’s Advancing Health podcast. My name is Jordan Steiger, and I'm the director of behavioral Health and Violence Prevention at the AHA. I'm really, really excited today to have two of my favorite partners with us talking about a topic that I think we really all need to dive a little bit deeper into today, which is mass violence, but specifically victim compensation and the resources that are available to all of our hospitals across the country around this topic.

00:00:47:07 - 00:01:08:28
Jordan Steiger
So a little background before we jump in and introduce our speakers for the day. We have been a partner of the National Mass Violence Center, which is housed at the Medical University of South Carolina since 2017, since they started the National Mass Violence Center. And this work, I will let Anne and Mike go way deeper into this, but is really important to hospitals and health systems.

00:01:08:28 - 00:01:28:21
Jordan Steiger
Just thinking about how we can better be prepared for mass violence, how we can respond as part of the community, and then how we can also support our workforce and our community long after the event happens. Because I think we all think sometimes at this event or these things are not going to happen to us, but we really do need to be prepared.

00:01:28:22 - 00:01:35:06
Jordan Steiger
So before we get started on our topic, I would love to have some introductions. So Anne, why don't you start us off?

00:01:35:08 - 00:01:53:15
Anne Seymour
Thanks, Jordan. I'm so happy to be joining you and Mike today. I'm Anne Seymour. I have been a national advocate for crime victims and survivors for 42 years, and at the National Mass Violence Center, I have been working with them since 2017, since our inception. I am the associate academic program director.

00:01:53:19 - 00:01:55:25
Jordan Steiger
Great. Thank you. And Mike?

00:01:56:02 - 00:02:26:21
Michael Schmidt, Ph.D.
So I'm Michael Schmidt, I'm a professor of microbiology and immunology. And you probably are wondering, how did someone who deals with germs get into mass violence? And that stems from the fact that I've been collaborating with the National Mass Violence Center for many years, starting way back in 2001 with the anthrax attack. And as a microbiologist, I'm well versed in all things icky.

00:02:26:25 - 00:03:01:04
Michael Schmidt, Ph.D.
Consequently, it was a natural flow, and I've been a component of the state's integrated disaster management team as well as our health systems integrated disaster team. And I was part of our pandemic flu planning committee before we had COVID. So I've been worrying about the mental health aspects and all the other things that go into mass violence for many years beyond my role as microbiologist.

00:03:01:07 - 00:03:22:18
Jordan Steiger
Makes total sense how you ended up here once you explain it. But I always think that's a fascinating connection. And I know you bring so much experience and just a wealth of knowledge to this space as well. So thank you again both for being here. Before we jump in, I want to just kind of plug the work that we've been doing together for the last few years and kind of the reason we're here talking about this today.

00:03:22:24 - 00:03:46:07
Jordan Steiger
So earlier this year in January, we co-released a guide that is focused on health care leadership and preparing for, responding to and mitigating mass violence. We'll put a link in the description bio so you can all check that out in our additional resources. But one of the things that we developed in addition to this guide is a tip sheet on crime victim compensation. And Anne,

00:03:46:07 - 00:03:54:24
Jordan Steiger
I would love to just hear a little bit more and tell the audience why we developed this. And really just what is crime victim compensation?

00:03:54:26 - 00:04:21:18
Anne Seymour
Well, we can thank the AHA for jumpstarting this tip sheet, Jordan. As you know, Mike and I presented at your Rural Health Leadership Conference in Arizona a few years ago, and our discussion and our slides were about mass violence, you know, preparation, response and mitigation very much focused on the guide. And when we hit the slide on crime victim compensation, the interest level in the room went through the roof.

00:04:21:19 - 00:04:44:15
Anne Seymour
And it wasn't that they didn't know about crime victim compensation. They asked us for specific information about the role of hospitals and their billing departments in facilitating crime victim compensation, so that mass violence victims physical and mental health needs could not only be addressed, but paid for to the degree possible by crime victim compensation. And so our tip sheet was born.

00:04:44:21 - 00:05:29:24
Michael Schmidt, Ph.D.
And one of the reasons this topic matters so much is that the mass violence response doesn't end when the last patient leaves the emergency department. In many ways, that is when this next phase begins. Helping victims, helping survivors, helping families and communities navigate that long road of recovery. So our guide was built around the idea that hospitals must be prepared before, during, and after an incident because the consequences can affect patients, families, even your staff in the broader community long after the immediate threat has passed.

00:05:29:26 - 00:05:51:04
Jordan Steiger
You know, I just want to reiterate for the audience that this is a huge resource that I think is underutilized by probably many hospitals and health systems across the country. I mean, we're saying now that this can help cover the costs of some of that care. So, Anne, can you tell us a little bit more about what crime victim compensation is and what it covers and why this matters?

00:05:51:07 - 00:06:30:21
Anne Seymour
Yeah, I'm happy to. Crime victim compensation is actually considered the original crime victims rights beginning in California in 1965. So it's been around a long time. CVC programs reimburse victims, including victims and survivors of mass violence and terrorist crimes, for crime related expenses, which, as you both know, can be absolutely overwhelming. Every state, the District of Columbia, US Virgin Islands, Puerto Rico and Guam have a crime victim compensation program that can provide substantial financial assistance to eligible mass violence crime victims and their families.

00:06:30:24 - 00:06:36:16
Jordan Steiger
That makes sense. And what kind of like services does crime victim compensation cover?

00:06:36:24 - 00:07:15:01
Anne Seymour
Well, crime victim compensation programs can pay for a wide variety of expenses and losses. Each state is different. It's really important to state that up front. Each state has a cap for remuneration to survivors, which generally ranges from $10,000 to $50,000. In some states it can be a bit higher, but in general, comp benefits can help cover the cost of things like funerals, hospitals, physicians, mental health counseling, dentists, ambulances, physical therapy, prescriptions and medication, medical supplies and equipment that are needed or that were damaged as a result of the crime.

00:07:15:02 - 00:07:45:13
Anne Seymour
Things like prosthetic devices, dental devices, walkers, canes, eyeglasses, and things like that. Also covers medical co-pays and deductibles and home health care and things like transportation to medical treatment and appointments. And Jordan, it's really important for hospitals to know that crime victim compensation is a payer of last resort, which means that victim comp can be provided only after payment, such as insurance or victim restitution have been paid.

00:07:45:13 - 00:08:13:06
Anne Seymour
In some states, medical expenses for treatment received will be paid to hospitals or other health care providers on behalf of the victim at prorated reimbursement, for example, 70% and considered a payment in full. And that's again in accordance with every state's law. Every state is different. So in the process of applying for victim comp, survivors will be asked to document other reimbursements, such as insurance that they have received.

00:08:13:08 - 00:08:49:19
Michael Schmidt, Ph.D.
I'd like to encourage hospital executives to think about crime victims compensation as part of their patient centered financial navigation. These programs can help victims and families with costs that may otherwise be overwhelming to them. Hospital care, physician services, counseling, prescription, transportation to treatment, medical equipment, and, in the case of the fatality, as Anne mentioned, funeral expenses. But survivors should not have to discover that support on their own.

00:08:49:19 - 00:09:09:10
Michael Schmidt, Ph.D.
In the middle of a trauma, hospitals can take that pathway visible, understandable and accessible. It's all about access to help that patient navigate the complexities that candidly, every hospital will say, yeah, our billing system could be better.

00:09:09:16 - 00:09:30:03
Jordan Steiger
I mean, absolutely. And I think this is just so important to kind of underscore the patient centeredness of this. I'm so glad you brought that up, that this is really trying to make it easier for people that have already gone through the unthinkable and just giving them one more resource that we can help them kind of navigate through these really, really tough situations.

00:09:30:04 - 00:10:12:12
Michael Schmidt, Ph.D.
From the perspective of a hospital leader, crime victims compensation should be viewed as something separate from emergency preparedness. It belongs in your response plan. A mass violence incident is not simply a high volume clinical event. It's also a criminal event, a community trauma event, and often, unfortunately, a long term recovery event. This means clinical care, documentation, victim services, billing, legal considerations, and most importantly, community partnerships all have to be aligned.

00:10:12:12 - 00:10:18:20
Michael Schmidt, Ph.D.
And that's really what a hospital leader is all about, aligning those priorities.

00:10:18:22 - 00:10:40:07
Jordan Steiger
I would like to shift this now a little bit more to kind of operationalizing this and making this more tactical. So, we know what crime victim compensation is now. But what actually happens when a mass violence victim applies for crime victim compensation? What kind of documentation do they need? What is required of hospitals and health systems? Tell us a little more.

00:10:40:14 - 00:11:14:22
Anne Seymour
Well that's the most important point of this podcast, Jordan. There's a lot of paperwork involved in victim compensation, but I understand that hospitals have some experience here. So generally crime victim compensation require victims and survivors to submit a lot of detailed documentation, things like itemized bill in their name with each service listed, including the name and address and telephone number of the hospital that's providing the service, the date of the service, type of services provide, and the amount that's charged for each service.

00:11:14:22 - 00:11:46:09
Anne Seymour
This is pretty standard, I think, for hospitals. For prescription and medication reimbursements, they need a copy of the actual prescription or a printout from the pharmacy that includes a victim's name, type of medication, date prescribed, and the doctor's name. And CDC program staff in different states may also request doctor's verification for any medication for which the victim is seeking reimbursement, to make sure that the expenses are crime related. And if the victim or claimant is covered by medical insurance,

00:11:46:12 - 00:12:13:09
Anne Seymour
an insurance explanation of benefit statement for each bill has to be included again, including all the details we talked about above, such as co-pays and deductibles and the amount that was paid by insurance. Sometimes justification is required from the victim if they are covered by an insurance plan or medical assistance, but did not utilize that coverage, for example, if they did not obtain the required care, or there may be travel considerations or other things related to that.

00:12:13:09 - 00:12:48:20
Anne Seymour
And sometimes victims who have health insurance and go to an out of network provider also need to submit those bills to their insurance company before CVC can consider reimbursement for such bills, and this includes documentation of the insurance companies partial payment or indication that they have denied the payment. So lot, lot of information, a lot of paperwork. And I think for hospitals, it's important for them to think how they can ease the process by making this documentation readily accessible to survivors who have been through a terribly traumatic event.

00:12:48:22 - 00:13:31:27
Michael Schmidt, Ph.D.
Bottom lining all of these points Anne offered: while the phrase payer of last resort sounds intimidating, operationally it matters a lot. It challenges hospitals to help their victims document what has already been paid by their insurance, restitution, or other sources before the Crime Victims Compensation Fund can determine what remains eligible. If you can, as a hospital, offer a template or better yet, as part of your plan, develop a crime victims compensation dashboard for both the patient and as well as the hospital.

00:13:31:28 - 00:13:48:15
Michael Schmidt, Ph.D.
If we be build these things into our billing workflows, the process can hopefully transition from being confusing and frustrating to survivors and even the billing people to something manageable for both parties.

00:13:48:18 - 00:14:09:12
Jordan Steiger
That's a really, really good idea. Let's definitely talk about it. Anne, I want to bring in a story that you recently told me about being in a hospital recently, and you said that you saw some, you know, advertisement kind of patient focused information around crime victim compensation in the waiting room, is that right?

00:14:09:14 - 00:14:38:12
Anne Seymour
Yeah. And, you know, that's where it needs to be. And thank you for letting me give a shout out to Howard University, one of the great, great hospitals here in Washington, DC. And, you know, every single state, Jordan, has informational brochures for crime victims and survivors about crime victim compensation, often available in multiple languages. Hospitals should have a ready supply of these brochures, like Howard University Hospital, and it's likely they already have them in their emergency rooms

00:14:38:12 - 00:15:07:19
Anne Seymour
for all victims of a violent crime. Folks can also visit the website of the National Association of Crime Victim Compensation Boards. And that's NACVCB.org. I'm going to say it again, NACVCB.org. And they give you a direct link to your state's crime victim compensation program. As we've clearly discussed, every single state has different benefits, different requirements for applications.

00:15:07:19 - 00:15:31:26
Anne Seymour
So it's really helpful for hospitals to be able to be specific to their state and to their community. And the thing that makes me very proud is that we have over 6000 organizations that are funded by the federal Victims of Crime Act, or VOCA, and a requirement of all VOCA funded programs is that they assist all victims with their crime victim compensation application.

00:15:31:26 - 00:16:03:27
Anne Seymour
So, Jordan, there are literally thousands of victim service professionals available nationwide to help mass violence victims and survivors with their applications, and also to help them coordinate their applications with hospitals and health care systems. And I think the most important message I have for hospitals in health care is that state crime victim compensation programs offer many opportunities for free training about comp. State hospital associations, or individual hospitals and health systems -

00:16:03:27 - 00:16:20:21
Anne Seymour
they can pull together different hospitals in a community. They can contact their state crime compensation program and request either on site or virtual training programs, and also a ready supply of those all important victim compensation informational brochures and applications.

00:16:20:21 - 00:16:28:08
Jordan Steiger
I didn't know that, and that is an awesome thing to share with our audience today. And you said that's free and available at the state level.

00:16:28:10 - 00:16:56:15
Anne Seymour
Yeah. You know, some states like Florida, they actually have regional folks that are available to do training for folks who need it. And, you know, it's not just hospitals, it's law enforcement. It's emergency management, mental health professionals. There are so many people who are part of the compensation complex. I mean, I say that and it is very complex, and they need to know about the specific things related to their state, and they also need to know their role in helping victims

00:16:56:15 - 00:17:01:28
Anne Seymour
as we discussed earlier, Jordan, document everything that's needed for a comp claim.

00:17:02:01 - 00:17:25:15
Michael Schmidt, Ph.D.
And if I were speaking directly to the chief financial officer of a health system, the revenue cycle leader, or even the billing director, I would say this is not something to figure out for the first time during the event, during the mass violence incident. Build the process now. Know your state program. Take advantage of that training. Know what documentation is required.

00:17:25:16 - 00:17:51:26
Michael Schmidt, Ph.D.
Make sure your billing team understands the need for itemized statements, especially when it comes to prescriptions, explanations of benefits, the out of network denials, and the kinds of records that survivors may need for a successful claim. And part of that successful claim - it not only goes to the victim, but also to you, the health care team. And again, I'm going to end,

00:17:51:27 - 00:17:59:17
Michael Schmidt, Ph.D.
the most compassionate response is often one that has been operationalized in advance.

00:17:59:21 - 00:18:20:21
Jordan Steiger
I think that's a really strong and impactful message to kind of end this on. We really thinking about how to do this in advance, how to make sure that you are prepared to support these victims once they walk through your door and need support. Before we end today, how can people access all of the work that we've done together on crime victim compensation?

00:18:20:21 - 00:18:23:04
Jordan Steiger
The tip sheet that we've put together?

00:18:23:07 - 00:18:47:27
Anne Seymour
Well, Jordan, in addition to being available on the AHA website, it's also available on our website. And that's nmvvrc.org. And folks who are tuning in to our discussion, I think, could also benefit from the wide range of resources that we have about mass violence preparedness, response, recovery and resilience, with many of them focused on physical and mental health care.

00:18:47:27 - 00:19:04:02
Anne Seymour
And also, you know, we're so proud of our partnership with y'all. There are so many other important partnerships that are needed to provide effective services and support related to mass violence incidents and including, of course, at all times, hospitals and health care systems.

00:19:04:04 - 00:19:28:07
Jordan Steiger
Absolutely. Well, we're very proud to be part of this work as well. With that, please check out our resources. Please take advantage of some of the resources that Mike and Anne shared today. I think this is really important work that is happening. And there's a lot of, I think, underutilized support that's out there for members of the American Hospital Association and other health care providers that we could be taking advantage of.

00:19:28:07 - 00:19:37:03
Jordan Steiger
Anne and Mike, thank you again so much for being here. We're so happy to have you as a partner and for you sharing this information with us today.

00:19:37:10 - 00:19:39:22
Jordan Steiger
Thank you. It's been really nice to be with you.

00:19:39:22 - 00:19:43:03
Michael Schmidt, Ph.D.
And the partnership couldn't be better.

00:19:43:06 - 00:19:51:28
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.