CVB-39-09-00005-P Reimbursement for Sexual Assault Forensic Examination

9/30/09 N.Y. St. Reg. CVB-39-09-00005-P

NEW YORK STATE REGISTER

VOLUME XXXI, ISSUE 39

September 30, 2009

RULE MAKING ACTIVITIES

CRIME VICTIMS BOARD

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. CVB-39-09-00005-P

Reimbursement for Sexual Assault Forensic Examination

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed Action:

This is a consensus rule making to amend section 525.12(h) of Title 9 NYCRR.

Statutory authority:

Executive Law, section 631(13)

Subject:

Reimbursement for sexual assault forensic examination.

Purpose:

To comply regulations with recent statutory amendments (L. 2009, c. 56) as they relate to certain reimbursements by the Board.

Text of proposed rule:

Subdivision (h) of section 525.12 is amended to read as follows:

(h) Direct reimbursement of forensic sexual assault examinations.

(1) Definitions:

(i) Licensed provider shall mean any New York State accredited hospital or licensed physician, nurse practitioner, registered nurse or physician assistant practicing within the State of New York whose performance of a sexual assault forensic examination is within the scope of practice of the discipline in which s/he holds a license or any other sexual assault examiner certified by the Department of Health to conduct a sexual assault forensic examination.

(ii) Sexual Assault shall mean any sexual offense defined in Article 130 of the New York State Penal Law.

(iii) Forensic Examination shall mean an examination conducted by a licensed provider as defined in Section 525.12(h)(1)(i) hereof for the purpose of collecting and preserving evidence to document a sexual assault, conducted in accordance with the New York State Department of Health's Protocol for the Acute Care of the Adult Patient Reporting Sexual Assault or the Child and Adolescent Sexual Offense Protocol. Copies of these protocols may be obtained from the Department of Health at the following address:

The Bureau of Women's Health

NYS Department of Health

Room 1882, Tower Building

Empire State Plaza

Albany, New York 12237-0621

Phone: [phone]

(iv) Claim Form shall mean the New York State Crime Victims Board Medical Provider Forensic Rape Examination Claim Form. In addition to being included in the Sexual Offense Evidence Collection Kit, this form is available from [any office of] the Crime Victims Board [and is available] online at http://www.cvb.state.ny.us.

(v) Child victim shall mean a person less than eighteen years of age as defined in New York State Executive Law Article 22, Section 621(11).

(2) Notwithstanding any contrary provisions, whenever a licensed provider administers a forensic examination to a survivor of a sexual assault in accordance with the established protocol as defined in section 525.12(h)(1)(iii) hereof, such provider shall render such services without charge and shall bill the Board directly for such services, unless the sexual assault survivor assigns his or her private insurance benefits for the forensic examination, in which case the Board shall not be billed for such services by the provider pursuant to this subdivision. [Nothing] Except as provided in section 525.12(h)(6) hereof, nothing in this section shall preclude a licensed provider from billing a sexual assault survivor for medical services unrelated to the forensic exam as set forth in Section 525.12(h)(5)(i), (ii), (iii) and (iv).

(3) At the time of the initial visit, the provider shall:

(i) request assignment of any private health insurance benefits on a form prescribed by the Board,

(ii) advise a sexual assault survivor orally and in writing that he or she may decline to provide private health insurance information if he or she believes it would substantially interfere with his or her personal privacy or safety,

(iii) advise a sexual assault survivor that providing such information may provide additional resources to pay for services to other sexual assault victims, and

(iv) require that if he or she declines to provide such health insurance information, he or she shall indicate such decision on the form prescribed by the Board.

(4) Eligibility criteria:

(i) To establish eligibility, a licensed provider shall submit a completed Claim Form as defined in section 525.12(h)(1)(iv) and attach an itemized bill indicating the relevant forensic examination related current procedural terminology (CPT) codes associated with each service provided to the Board at the address below.

New York State Crime Victims Board

[845 Central Avenue - South 3] 1 Columbia Circle, Suite 200

Albany, NY [12206] 12203

(ii) Upon receipt of a completed Claim form with an itemized bill including CPT codes and acceptance by the Crime Victims Board, payment will be authorized directly to the licensed provider through the appropriate billing facility as set forth in Section 525.12(h)(8).

(5) The provider shall be reimbursed at the rate of itemized charges not exceeding $800 for forensic examiner services, hospital or healthcare facility services directly related to the forensic exam, and related laboratory tests and pharmaceuticals directly related to the exam. The Board has determined that reimbursable expenses shall include at a minimum:

(i) Forensic examiner and hospital or healthcare facility services directly related to the exam, including integral forensic supplies.

(ii) Scope procedures directly related to the forensic exam including but not limited to anoscopy and colposcopy.

(iii) Laboratory testing directly related to the forensic examination, including drug screening, urinalysis, pregnancy screen, syphilis screening, chlamydia culture, gonorrhea coverage culture, blood test for HIV screening, hepatitis B and C, herpes culture and any other STD testing directly related to the forensic examination.

(iv) Pharmaceuticals directly related to the forensic examination including STD, pregnancy, initial HIV prophylaxis up to a three day supply and hepatitis prophylaxis.

(v) [Follow-up]Except as provided in section 525.12(h)(6) hereof, follow-up post exposure HIV prophylaxis and follow-up HIV counseling, charges for inpatient services, and for services other than those included in Section 525.12(h)(5)(i), (ii), (iii) and (iv) are not included in this rate and shall not be reimbursable under this part, but shall continue to be reimbursable under established Board procedure.

(6) The victim shall not be responsible for the payment of the cost of the forensic examination or any other services specified by the provider in its submission to the Board pursuant to Section 525.12(h)(4) hereof. The licensed provider must accept the reimbursement rate as payment in full for those services submitted to the Board pursuant to Section 525.12(h)(4) hereof and included in Section 525.12(h)(5)(i), (ii), (iii) and (iv). The licensed provider shall not submit any remaining balance due for such services after [reimbursement by] submission to the Board to the victim or commence civil actions against the victim to recover any balance due for such services.

(7) The costs for multiple forensic examinations of the same victim will not be reimbursed. The cost of only one forensic sexual assault examination per victim per alleged sexual assault will be considered a reimbursable cost.

(8) For the forensic examination and services directly related to the forensic examination, the Board will reimburse the facility in which the forensic examination was conducted and whose operator's certificate number or facility identification, if applicable, appears on the Claim Form, the amount of itemized charges not exceeding $800. The [$800] amount reimbursed shall be proportionately allocated among the service providers by the billing facility.

(9) Expenses must be related to a forensic examination performed within 96 hours following the incident. This reporting time shall be waived for a child victim or for any victim if good cause has been shown.

(10) A claim for reimbursement of expenses associated with a forensic examination made pursuant to this section must be submitted within one year of the date of the examination to the Albany Office of the Crime Victims Board.

Text of proposed rule and any required statements and analyses may be obtained from:

John Watson, General Counsel, New York State Crime Victims Board, One Columbia Circle, Suite 200, Albany, New York 12203, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

Consensus Rule Making Determination

This rule is being proposed as a consensus rule because, in accordance with State Administrative Procedure Act § 102 (11) (b), it implements or confirms to non-discretionary statutory provisions. Section 68 of Chapter 264 of the Laws of 2003 added a new subdivision 13 to Executive Law section 631 to authorize the New York State Crime Victims Board direct reimbursement for the costs of certain services related to a sexual assault forensic exam performed by any New York State accredited hospital, accredited sexual assault examiner program or licensed health care provider.

Section 68 of Chapter 264 of the Laws of 2003 established the flat rate for reimbursement to be eight hundred dollars. The hospital, sexual assault examiner program or licensed health care provider must accept this fee as payment in full for the specified services. No additional billing of the survivor for said services is permissible. A sexual assault survivor may voluntarily assign any private insurance benefits to which she or he is entitled for the healthcare forensic examination, in which case the hospital or healthcare provider may not charge the board.

More recently, Chapter 56 of the Laws of 2009 became effective April 7, 2009. These new amendments changed the flat rate of eight hundred dollars to a reimbursement for the actual cost of itemized charges not to exceed eight hundred dollars for such exams under Executive Law, section 631(13).

Section 525.12(h) of Title 9 NYCRR governing the practice and procedures before the Board provides for "Direct reimbursement of forensic sexual assault examinations." As New York State's primary crime victim compensation agency, it is important that the Board's regulations be updated to conform to the amendments introduced by Chapter 56 of the Laws of 2009. The proposed consensus rule would amend section 525.12(h) of Title 9 NYCRR as it relates to the rate the hospital, sexual assault examiner program or licensed health care provider is reimbursed. The proposed rule does not increase or decrease the statutory amount of eight hundred dollars established by Section 68 of Chapter 264 of the Laws of 2003; rather it would allow the New York State Crime Victims Board to reimburse the actual amount of itemized charges up to that eight hundred dollar amount. This proposed consensus rule also makes other amendments to reflect the fact that such reimbursement has been changed from a flat rate to a rate reflecting the actual costs up to an eight hundred dollar cap.

The proposed consensus rule is submitted by the New York State Crime Victims Board in order to conform to its statutory obligations.

Job Impact Statement

The Crime Victims Board projects no substantial adverse impact on jobs or employment opportunities in the State of New York as a result of this rule. The rule simply mirrors the statutory requirements and requires itemization of charges by licensed providers up to $800, in accordance with Executive Law § 631. There will be no change in the number of agency employees as a result of these regulations. Nothing in the proposed regulations will increase or decrease the number of jobs in New York State, have an adverse impact on specific regions in New York State or negatively impact jobs in New York State.