Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This proposed amendment sets out additional
definitions and protocols for a medical provider and/or a facility to receive
reimbursement from the Missouri Department of Public Safety, Sexual Assault
Forensic Examination Program for forensic examinations performed on a child in
an emergency or nonemergency sexual assault situation. In addition, it defines
qualifications for providers who perform a non-emergency forensic examination
on a child age thirteen (13) or younger.
(1) For purposes of this section, the
following terms mean:
(A) "Appropriate medical
provider," any licensed nurse, physician, or physician assistant, and any
institution employing licensed nurses, physicians, or physician assistants,
provided that such licensed professionals are the only persons at such
institution to perform tasks under the provisions of this section;
(B) "Child abuse medical resource centers,"
medical institutions affiliated with accredited children's hospitals or
recognized institutions of higher education with accredited medical school
programs that provide training, support, mentoring, and peer review to Sexual
Assault Forensic Examination - Child Abuse Resource and Education (SAFE-CARE)
providers in Missouri;
(C) "Sexual
assault forensic examination child abuse resource education network" or
"SAFE-CARE network," a network of SAFE-CARE providers and child abuse medical
resource centers that collaborate to provide forensic evaluations, medical
training, support, mentoring, and peer review for SAFE-CARE providers for the
medical evaluation of child abuse victims in this state to improve outcomes for
children who are victims of, or at risk for, child maltreatment by enhancing
the skills and role of the medical provider in a multidisciplinary
context;
(D) "SAFE-CARE provider,"
a physician, advanced practice nurse, or physician's assistant licensed in this
state who provides medical diagnosis and treatment to children suspected of
being victims of abuse and who receives-
1.
Missouri-based initial intensive training regarding child maltreatment from the
SAFE-CARE network;
2. Ongoing
update training on child maltreatment from the SAFE-CARE network; and
3. Peer review and new provider mentoring
regarding the forensic evaluation of children suspected of being victims of
abuse from the SAFE-CARE network;
(E) "Evidentiary
collection kit," a kit used during a forensic examination that includes
materials necessary for appropriate medical providers to gather evidence in
accordance with the forms and procedures developed by the attorney general for
forensic examinations;
(F) "Forensic
examination" or "Sexual Assault Forensic Examination (SAFE) exam," an
examination performed by an appropriate medical provider on a victim of an
alleged sexual offense to gather evidence for the evidentiary collection kit or
using other collection procedures developed for victims who are
minors;
(G) "Medical treatment," the treatment of all injuries
and health concerns resulting directly from a patient's sexual assault or
victimization;
(H) "Laboratory fees," those laboratory fees
associated with a forensic examination of a child age thirteen (13) or under or
those laboratory fees associated with lab tests which the appropriate medical
provider deems necessary to determine whether the victim had been
drugged;
(I) "Emergency forensic
examination," an examination of a person under fourteen (14) years of age that
occurs within five (5) days of the alleged sexual offense; and
(J) "Non-emergency forensic examination," an
examination of a person under fourteen (14) years of age that occurs more than
five (5) days after the alleged sexual offense.
(2) The victim or the victim's parent or
guardian shall consent in writing to the examination. If the victim is a minor,
then a representative from the requesting agency which is referring the victim
for the exam, such as law enforcement or Children's Division, may sign for
consent of the forensic exam.
(3)
Claims for payment of forensic examination expenses shall be submitted to, and
received by, the Missouri Department of Public Safety, Sexual Assault Forensic
Examination (SAFE) Program within ninety (90) days from the date of the
forensic examination.
(4) Claims
shall be made on the Sexual Assault Forensic Examination Program Report form
approved by the Missouri attorney general. The appropriate medical provider
must ensure that all lines of the report form are completely and legibly filled
out. The appropriate medical provider shall sign and date the report. If the
report is incomplete, unsigned, or not dated, the claim may be
denied.
(5) To qualify for payment,
all claims shall include the Sexual Assault Forensic Examination Program
Report, the Sexual Assault Forensic Examination Checklist, and an itemized
billing statement.
(6) For billing
purposes, all appropriate charges for the sexual assault forensic examination
shall be itemized with each billable procedure, service, or supply described,
including the accompanying International Classification of Disease (ICD-9) and
Current Procedural Terminology (CPT) code(s). Written explanation and reasoning
may be required to justify certain codes.
(7) To qualify for payment on claims for a
non-emergency forensic exam, physicians, advance practice nurses (APRN), or
physician assistants (PA) must meet at least one (1) of the following criteria:
(A) Child Abuse Pediatrics Sub-board
eligibility or Certificate of Added Qualification; or
(B) A SAFE-CARE provider.
(8) To qualify for payment on
claims for a non-emergency forensic exam, licensed nurses must meet the
following criteria:
(A) Pediatric Sexual
Assault Nurse Examiners (SANE) certification (if performing exams on children
age thirteen (13) or younger);
(B)
Meet all SAFE-CARE training requirements; and
(C) Review of the exam by a health care
provider who is a SAFE-CARE provider.
(9) Emergency forensic exams performed by an
appropriate medical provider including advance practice nurses (APRN) will be
reimbursed provided that the incident meets the following criteria:
(A) The alleged assault may have resulted in
the transfer of trace biological material; or
(B) The alleged assault may have placed the
child at risk for pregnancy; or
(C)
The child complains of pain in the genital or anal area related to the
disclosure of sexual abuse; or
(D)
There is evidence or complaint of anogenital bleeding or injury.
(10) Payment shall not exceed-
(A) Nine hundred dollars ($900) for forensic
exams performed in an emergency room, including all costs associated with the
facility and the appropriate medical provider fee.
1. When the exam is performed by a physician,
physician assistant, or an advanced practice nurse in an emergency room,
payment shall not exceed-
A. Five hundred forty dollars ($540) for the emergency
room fee; and
B. Three hundred sixty dollars ($360) for the provider
fee if submitted separately;
2. When the exam is performed in an emergency
room by an appropriate medical provider other than a physician, physician
assistant, or an advanced practice nurse, payment shall not exceed-
A. Six hundred forty dollars ($640) for the
emergency room fee if submitted separately; and
B. Two hundred sixty dollars ($260) for the
provider fee if submitted separately;
(I) If a
non-emergency sexual assault forensic examination is performed on a child age
thirteen (13) or younger by a provider under this subsection who is not a
SAFE-CARE provider and the exam is reviewed by a SAFE-CARE provider, then the
provider will receive one hundred and ten dollars ($110) and the SAFE-CARE
provider will receive one hundred and fifty dollars ($150).
(II) If a non-emergency sexual assault
forensic examination is performed on a child age thirteen (13) or younger by a
provider under this subsection who is not a SAFE-CARE provider and the exam is
not reviewed by a SAFE-CARE provider, then payment will not issue;
(B) Six
hundred fifty dollars ($650) for forensic exams performed in a clinic,
including all costs associated with the facility and the appropriate medical
provider.
1. When the exam is performed by a
physician, physician assistant or an advanced practice nurse in a clinic,
payment shall not exceed-
A. Two hundred ninety dollars ($290) for the clinic
fee if submitted separately; and
B. Three hundred sixty
dollars ($360) for the provider fee if submitted separately; and
2. When the exam is performed in a clinic by an
appropriate medical provider other than a physician, physician assistant, or an
advanced practice nurse, payment shall not exceed-
A. Three hundred ninety dollars ($390) for
the clinic fee if submitted separately; and
B. Two hundred sixty dollars ($260) for the
provider fee if submitted separately;
(I) If a
non-emergency sexual assault forensic examination is performed on a child age
thirteen (13) or younger by a provider under this subsection who is not a
SAFE-CARE provider and the exam is reviewed by a SAFE-CARE provider, then the
provider will receive one hundred and ten dollars ($110) and the SAFE-CARE
provider will receive one hundred and fifty dollars ($150).
(II) If a non-emergency sexual assault
forensic examination is performed on a child age thirteen (13) or younger by a
provider under this subsection who is not a SAFE-CARE provider and the exam is
not reviewed by a SAFE-CARE provider, then payment will not issue;
and
(C) Two hundred dollars ($200) for any
laboratory fees associated with the forensic examination, whether the forensic
examination is conducted at an emergency room or clinic.
(11)
The billing statement must include an itemization of the charges incurred while
conducting the forensic examination, including, if applicable, the itemized
laboratory fees.
(12) For the purposes of billing the Sexual Assault
Forensic Examination Program, claims shall not include charges for medical
procedures that are not part of the SAFE exam. The SAFE Program shall not pay
for any portions of the itemized bill that are not part of the SAFE exam. The
SAFE Program shall not pay for any laboratory fees associated with a SAFE exam
except for qualified laboratory fees.
(13) Only one (1)
forensic examination per victim per sexual offense may be reimbursed.
(14)
For a forensic examination to be eligible for reimbursement by the SAFE
Program-
(A) The victim of the alleged sexual
offense must be a Missouri resident; or
(B) The alleged sexual offense must have
occurred in Missouri.
(15) The department,
at its discretion, may require additional information regarding the forensic
examination for auditing purposes.
*Original authority: 595.220, RSMo 2009, amended 2011
.
