1 Tex. Admin. Code § 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.
Notes
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