Billing for Sexual Assault Forensic
Evidence Collection
General Instructions

State law prohibits health care facilities from billing sexual assault patients, either directly or indirectly, for the cost of gathering sexual assault evidence. (See Appendix A).
Health care facilities are required by law to bill the costs of gathering sexual assault evidence to the CT Judicial Branch, Office of Victim Services. (See Appendix A).
For the purposes of billing requirements, gathering sexual assault evidence means:

The opening of the Kit during the examination of any victim, or
If the victim is age seventeen or younger, the completion of the Forms and the physical examination for evidence and/or signs of sexual assault whenever the completion of the Kit is deemed inappropriate.

The Commission will establish a payment amount to represent the costs of gathering evidence, and shall notify health care facilities of that amount and of any changes in that amount.
Assistance may be available (for other expenses) not covered under CGS § 19a-112a(e). (See Appendix H).
See Appendix C for the Information for Victims of Sexual Assault and Their Families Booklet (Booklet). The Booklet contains information on medical care, compensation, and the billing process.

Development of Internal Procedures

Each health care facility that provides for the collection of sexual assault evidence should develop internal procedures for the processing of bills which are subject to the above billing requirements.
Processing procedures should include:

A method for identifying subject bills.
A method for the documenting on the bill (e.g., UB92) that evidence was gathered during the exam. (See Bill Submission Requirements below).
A method for ensuring that the CT Judicial Branch, Office of Victim Services, is designated as the primary payor on subject bills.
The designation of at least one person in the billing department to be informed […]

By |August 12th, 2013||0 Comments

Sample Forms

Click on the images below to enlarge.



By |August 4th, 2013||0 Comments

Consent for Exam and Police Report

Consent for Medical Exam and Evidence Collection

Consent for medical exam and collection is needed.
Review the “Authorization for the Sexual Assault Medical Exam and Release of Payment Information” form with the patient.
Respect the patient’s right to change her/his mind at any time before or during the examination.
Briefly describe the evidence collection and examination process in order to help the patient understand what s/he is consenting to.
Notify the patient at initial processing that s/he will not be charged for either the cost of the Kit or the completion of the Kit, even if s/he is undecided about whether to report the assault to police. (See page 69 for more information). Explain that s/he may be responsible for other medical expenses associated with her/his medical treatment, but also may be eligible for help with those expenses through the Office of Victim Services Compensation Program. (See page 74).
Follow your facility’s usual procedures for obtaining consent where the patient is a minor, mature minor, or a person with a cognitive disability.
Follow your facility’s usual procedures for obtaining consent in extraordinary cases (e.g., for severely injured or incoherent, including drugged or intoxicated, patients). Any patient who presents with a complaint of sexual assault shall be given the opportunity to provide informed consent to the sexual assault forensic exam prior to discharge.
There is no requirement that police be notified in order for evidence to be collected. If the patient consents, evidence can and should be collected as deemed appropriate, even if police are not notified at that time.
Note that police should not be present in the examining room during evidence collection. (See page 29).
If the patient is undecided about whether to report to police, explain the importance of prompt evidence collection, […]

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Initial Hospital Response

Triage and Intake

A sexual assault patient (hereinafter referred to as patient) should be considered a priority patient–regardless of whether additional physical injuries are evident.
Whenever practicable, provide a private area, such as a private treatment room, in which the patient can await both intake and treatment.
If possible, wait until the sexual assault counselor arrives before beginning the exam.
Avoid exposing the patient to places and situations which may cause her/him to suffer further emotional stress. Keep in mind the fears and disorientation which the patient may be experiencing.
Ask the patient if there is someone that s/he would like to have contacted, or anything that s/he needs at that time.
Exercise discretion and sensitivity when discussing a sexual assault victim or the family with other personnel (e.g., when summoning specialized personnel or when transporting evidence collection materials to an examination room).
Explain to the patient that urinating, rinsing mouth, showering, etc. may destroy evidence prior to collection. If a patient must go to the bathroom, warn her/him that semen or other evidence may be present in pubic, genital, and rectal areas, and not to wash or wipe away those secretions until after the examination.

The State of Connecticut, Office of Victim Services, Gail Burns-Smith Sexual Assault Forensic Examiners Program (SAFE Program)

Hospitals participating in the SAFE Program use the following protocol for triaging patients

Triage should call the on-call SAFE at: (860) 263-0190. If triage is unable to reach the on-call SAFE or if there are any questions, call the Program Coordinator: (860) 748-3706.
The SAFE nurse will then call the local sexual assault crisis services program to activate an advocate.

Counseling and Support

Call the local sexual assault crisis services program as soon as the patient arrives at the emergency department. See page X […]

By |August 2nd, 2013||0 Comments