26- 550 C.M.R. ch. 8, § 3

Current through 2024-51, December 18, 2024

Section 550-8-3 - Payment for Forensic Examinations for alleged victims of gross sexual assault

1. A victim seeking examination and treatment following a gross sexual assault shall be exempted from the payment of expenses incurred as a result of sexual assault forensic examination services. The licensed hospital or licensed health care practitioner may bill the patient or patient's insurer for services outside the scope of the forensic examination. A victim may apply to the Victims' Compensation Board for reimbursement for losses outside the scope of the gross sexual assault forensic examination.

2. The Victims' Compensation Board shall pay the costs of forensic examinations for alleged victims of gross sexual assault from the Victims' Compensation Fund. To be reimbursable an examination must incorporate the use of a uniform standardized forensic examination kit distributed by the Department of Public Safety, and that use must have a forensic basis. If at any time a uniform kit is not available for distribution, the licensed hospital or licensed health care practitioner must use a standardized evidence collection kit that has met the requirements established by rule of the Department of Public Safety. The maximum payment by the fund for a forensic examination shall not exceed the statutory maximum of $500.00. The Board may delegate to the director of the Victims' Compensation Board the review of claims and approval of reimbursement for services included in forensic examinations in accord with rules and guidelines established by the Victims' Compensation Board. Payments from the Compensation Fund shall be made directly to the licensed hospital or licensed health care practitioner and shall be considered payment in full and shall bar balance billing or other actions for collection.

A. Upon completion of a gross sexual assault forensic examination the licensed hospital or licensed health care practitioner shall submit an itemized bill detailing the treatment costs and examination costs for collection of evidence required by the Department of Public Safety. Claims will be paid only where the sexual assault procedures as required by 24 MRSA §2986, 25 MRSA § 291525 M RSA § 3821, and 5 MRSA §3360-M for forensic examinations and treatment are followed.

B. In the event that there are multiple fees from separate service providers, the statutory maximum shall be allocated among the service providers.

C. The licensed hospital or licensed health care practitioner to receive reimbursement is responsible for submitting to the Victims' Compensation Board (on forms approved by the Board) the following information:

(1) Victim tracking number

(2) Examination kit number

(3) Victim's date of birth

(4) Victim's gender

(5) Date and time of incident

(6) Location of incident (Town)

(7) Date and time of treatment by medical provider

(8) Whether a report to law enforcement was filed

(9) Name of law enforcement agency notified

(10) Name and address of medical provider

(11) Hospital / Practitioner Federal Tax Identification Number

(12) Provider billing office contact person and phone number

(13) Signed verification from the licensed health care practitioner

(14) All itemized copies of medical bills complete with current procedural terminology (CPT) codes. This billing statement must show individual charges for lab work as listed in 1A of this rule.

D. The licensed medical facility or licensed practitioner must send the reimbursement form with the attached itemized bills to the Victims' Compensation Board.

E. All claims must be submitted to the Board within 60 days of examination.

26- 550 C.M.R. ch. 8, § 3