Frequently Asked Questions - SAFE Program

Violence Against Women

1. What is the Statute
2. What is considered a forensic exam?
3. What is considered medical treatment?
4. Who can be billed for the medical treatment expenses?
5. Can a provider bill the patient’s insurance?
6. Is there a cap on the amounts paid for a forensic exam?
7. There is no CPT code for a forensic exam.  How are CPT codes used for billing?
8. May a physician bill for his/her services separately from the hospital's billing?
9. Is the hospital's billing form acceptable as an invoice?
10. Is there a time deadline for billing?
11. How long will processing take at DHSS?
12. If a sexual assault occurs in Missouri, but the forensic exam is done in another state (e.g., Kansas, Illinois, Arkansas) will DHSS pay for the forensic exam?
13. Is urinalysis covered as a part of a forensic examination? 
14. Is STI testing covered a part of a forensic examination? 
15. Is pregnancy testing covered as part of a forensic examination?
16. Is a DNA test considered part of a forensic examination?
17. Are procedures listed on the Sexual Assault Medical Treatment Checklist covered by DHSS?
18. Where can I find the report form and checklists?
19. Whom can I contact for additional information?

1. What is the Statute?
Effective 8/28/07, RSMo 191.225 directs the Department of Health and Senior Services (DHSS) to make payments to cover the charges of the forensic examination of persons who may be a victim of a sexual offense if:

• the victim or the victim’s guardian consents in writing to the exam;
• the report of the examination is made on a form approved by the attorney general with the advice of the DHSS;
• the report of the examination is filed with the prosecuting attorney of the county in which the alleged incident occurs; and
• the appropriate medical provider shall file the report of the examination within three business days of completion of the forensic exam.

The statute can be viewed at http://www.moga.mo.gov/statutes/C100-199/1910000225.HTM

2. What is considered a forensic exam?
RSMo 191.225 defines it as an examination performed by an appropriate medical provider on a victim of an alleged sexual offense to gather evidence for the evidentiary collection kit. The Sexual Assault Forensic Exam Checklist provides a guide for a standardized, quality forensic exam. 

3. What is considered medical treatment?
RSMo 191.225 defines medical treatment as the treatment of all injuries and health concerns resulting directly from a patient’s sexual assault or victimization.  For example, the setting of a broken arm or repair of a laceration that occurred during the assault would be considered medical treatment and not paid by DHSS.

The Sexual Assault Medical Treatment Checklist provides a guide for treatment of the victim’s injuries.

4. Who can be billed for the medical treatment expenses?
The patient’s insurance, Medicaid or Medicare could be billed for medical treatment.
If the victim is eligible for the Crime Victims’ Compensation Program, he/she may have medical expenses paid through that program.  For CVC information, see http://www.dps.mo.gov/CVC/index.htm.

5. Can a provider bill the patient’s insurance?
Not for the forensic examination, but for medical treatment charges.

6. Is there a cap on the amounts paid for a forensic exam?
No.

7. There is no CPT code for a forensic exam.  How are CPT codes used for billing?
There isn't one CPT code for a forensic exam, but some of the procedures within the exam      may have CPT codes that should be itemized on the invoice.

8. May a physician bill for his/her services separately from the hospital's billing?
Yes.  If the physician bills us separately, we can match the victim’s name to the claim and pay the physician’s fee. The physician should bill DHSS on whatever form they normally use for billing.

9. Is the hospital's billing form acceptable as an invoice?
We do receive a variety of billing forms and we are not asking the hospitals to create a new billing form for this procedure. The invoice must be itemized and include the name of each specific service provided. A remit to address also needs to be included on the invoice.

10. Is there a time deadline for billing?
Yes.  Effective January 1, 2008, invoices must be submitted within 120 days of the exam date.

11. How long will processing take at DHSS?
Claims received are processed on a weekly basis. If a claim is complete, the invoice should be paid within approximately 45 business days.  Incomplete claims will be returned to the provider with a request for additional information.

12. If a sexual assault occurs in Missouri, but the forensic exam is done in another state (e.g., Kansas, Illinois, Arkansas) will DHSS pay for the forensic exam?
Yes, if the provider files the SAFE Program Report with the appropriate Missouri Prosecuting Attorney’s office within three business days and submits the itemized billing with the report form to DHSS.  The determining factor is that the assault occurred in Missouri.

13. Is urinalysis covered as a part of a forensic examination?
For children under age 14, urinalysis is covered if testing for STIs.  Urinalysis  is covered for all ages if testing for a specific drug in a drug-facilitated sexual assault.

14. Is STI testing covered a part of a forensic examination? 
STI testing for adults is considered medical treatment and not covered by DHSS.  STI testing for children under age14 is covered as part of a forensic examination.

15. Is pregnancy testing covered as part of a forensic examination?
Pregnancy testing is considered medical treatment, but in the case of a child under age 14 it may be considered part of the forensic examination as evidence of an ongoing victimization.

16. Is a DNA test considered part of a forensic examination? 
The Sexual Assault Forensic Exam Checklist includes collecting an oral swab for a DNA standard.  Collection of DNA evidence is covered by DHSS if itemized on the invoice. The analysis would be conducted by the appropriate crime lab as part of the evidentiary kit and not billed to DHSS.

17. Are procedures listed on the Sexual Assault Medical Treatment Checklist covered by DHSS?
The Sexual Assault Medical Treatment Checklist is intended as a reference tool for treating       the victim’s injuries.  Items on this checklist are generally not covered by DHSS.  Exceptions are urinalysis, STI and pregnancy tests as described in #11, 12 and 13 above.

18. Where can I find the report form and checklists?
They are posted on the DHSS website at http://www.dhss.mo.gov./ApplicationsAndForms/index.html

19. Whom can I contact for additional information?
The SAFE Program staff can be reached at (573) 751-6210