Administrative Code Provisions | CMSR 24-000-001 Chapt. 6 | 2018

600. Authority.

The Division of Victim Compensation, Office of the Attorney General is authorized to pay for all medical forensic examinations done for the purpose of sexual assault evidence collection. Mississippi Code Annotated § 99-37-25 provides that the bill for the medical forensic examination and the preparation of the sexual assault evidence collection kit will be sent to the Division of Victim Compensation, Office of the Attorney General. No bill for the examination will be submitted to the victim, nor shall the medical facility hold the victim responsible for payment. No payments shall be made that exceed the amount of money in the Crime Victims' Compensation Fund. M.C.A. § 99-41-29.

601. Application.

1. All bills submitted for payment should be accompanied by a copy of the State of Mississippi Crime Laboratory Sexual Assault Examination Form, and include a standard UB-04 form or other official itemized billing form. NOTE: For minor victims receiving a sexual assault medical forensic examination seventy-two hours or longer after the sexual assault, the authorized non-acute sexual assault exam form for minors >72 hours should be submitted.

2. Payment may be made whether or not the victim pursues prosecution. Though it is strongly encouraged that the victim reports the sexual assault to law enforcement, reporting the assault is the victim's decision. This does not apply to state mandated reporting requirements for minors, vulnerable adults, and certain violent crimes.

3. A request for payment for the sexual assault medical forensic examination must include the International Classification of Diseases (ICD-9) code V71.5 for examination of the victim of sexual assault, code E960.1 for a victim of rape, code V71.81 when there are no forensic findings for a sexual assault exam, code 995.53 when there are forensic findings for a sexual assault exam of a child, or code 995.83 when there are forensic findings for a sexual assault exam of an adult.

4. A request for payment for the sexual assault medical forensic examination must include the following information as applicable:

a. Physician/ARNP, Office or other outpatient services (CPT codes 99201-99205 for New Patient, CPT codes 99211-99215 for Established Patient, CPT codes 99241-99245 for office consultations); Emergency Department Services (CPT codes 99281-99285 for New or Established Patient) which include the collection of evidence as needed in the sexual assault kit.

b. Venipuncture for the collection of whole blood samples (CPT codes 36400, 36405, 36406, 36410, 36415).

c. Laboratory test for pregnancy (CPT codes 84702, 84703, 81025).

d. HIV Testing (CPT codes 86701-86703, 86687-86689) if medically necessary.

e. Hepatitis Panel (CPT codes 80074, 86705, 86709, 87340, 86803) if medically necessary.

f. RPR (CPT codes 86592, 86593) if medically necessary.

g. Herpes Simplex (CPT codes 86694, 86696) if medically necessary.

h. Gonorrhea culture (CPT codes 87040, 87070, 87081, 87590, 87591, 87592) if medically necessary.

i. Chlamydia culture (CPT codes 87320, 86631, 86632, 87110) if medically necessary.

j. Urinalysis (CPT codes 81000-81003, 81005, 81007, 81015) if medically necessary.

k. Urine culture (CPT codes 87086, 87088) if medically necessary.

l. Trichomonas vaginalis (CPT codes 87660, 87205, 87210) if medically necessary.

m. Other laboratory tests if medically necessary.

n. Colposcopy (CPT codes 57420, 57452, 99170).

o. Camera/Other photography (CPT code 99199). Use of this code requires additional reporting information to verify that a camera/photography was used.

p. Medication for prevention of STDs, Hepatitis B, pregnancy, and a three-day supply of HIV prophylaxis.

5. If the victim refuses to have all or portions of the sexual assault exam completed, notes to verify this should be included in the exam form. Payment will be considered for a "partial exam" when allowable exam expenses are incurred, such as medication treatment for prevention of STDs, Hepatitis B, pregnancy, and a three-day supply of HIV prophylaxis.

6. Follow-up sexual assault medical forensic exams/related labs will be considered for payment when the victim is a minor; however, this expense will only be reimbursed the difference between the amount already paid out for the exam (and any other allowable expense) and the maximum payment amount ($ 1,000) allowed. If the prior payment(s) totals $ 1,000 then these additional expenses will not be eligible for payment.

7. Expenses for procedures other than those listed above must be justified and submitted, in writing, as being necessary and directly related to the medical forensic examination.

8. Payments for admissions, treatment of injuries, medications such as anti-depressants, sedatives or tranquilizers are NOT ELIGIBLE under this policy. See § 602 (6).

602. Eligibility Guidelines.

1. In order to be considered for payment, the following criteria must be met:

a. The crime must have occurred in Mississippi.

b. The initial sexual assault medical forensic examination and collection of evidence must have occurred after June 30, 2005.

c. All requests for payment must be post-marked and received by the Office of the Attorney General, Division of Victim Compensation, within ninety (90) days of the forensic medical examination. The ninety (90) days may be waived if the medical provider can show good cause for failure to submit the payment request within such time. Good cause will be determined on a case by case basis.

d. Only costs associated with sexual assault medical forensic exams are considered for payment through this program.

2. A payment request from the medical provider should only be submitted for a victim who is not covered by a federal or federally financed program, such as Medicaid, Medicare, Tricare, or the Veterans' Administration. This stipulation has been made pursuant to the federal Victims of Crime Act (VOCA). In addition, a payment request from the medical provider should not be submitted for a victim covered by the Mississippi Children's Health Insurance Plan (CHIPS).

3. The victim's private insurance should not be billed for the cost of the sexual assault medical forensic examination.

4. A reimbursement request from the medical provider should not be submitted for a victim who was confined in a federal, state, county or city jail or correctional facility at the time of the sexual assault. The medical provider should contact the appropriate jail or correctional facility for payment information.

5. A reimbursement request from the medical provider should not be submitted for a medical forensic examination of the person arrested, charged or convicted of the sexual assault. Such payment shall be made by the county directly to the medical provider.

6. Other expenses incurred by the victim not payable under these criteria may be eligible for payment through the Victim Compensation Program. See § 601 (8). The medical provider may not apply for these program benefits.

603. Payment Procedures.

1. The bill for the sexual assault medical forensic examination must not be submitted to the victim.

2. A completed copy of the State of Mississippi Crime Laboratory Sexual Assault Examination Form (or authorized sexual assault exam form for minors >72 hours), and a UB-04 form or other appropriate itemized billing form should be submitted to the Office of the Attorney General, Division of Victim Compensation, Post Office Box 220, Jackson, MS 39205-0220.

604. Payment Amount.

1. The Office of the Attorney General will pay up to $ 1,000 per case. This fee includes the following limits:

a. Medical personnel time to include physician, nurse practitioner, or Sexual Assault Nurse Examiner's (S.A.N.E.) fee - $ 350

b. Facility fee to include supplies, equipment and medications for the prevention of STDs, Hepatitis B, pregnancy (ECP), and a three-day supply of HIV prophylaxis - $ 450

c. Fees for lab tests - $ 200

2. Expenses for procedures other than those listed in § 601(4) must be justified and submitted in writing, as being necessary and directly related to the medical forensic examination.

3. Payments for admissions, treatment of injuries, medications such as anti-depressants, sedatives or tranquilizers are NOT ELIGIBLE under this policy. See § 602 (6).

4. No payment shall be made which exceeds the amount of money in the Crime Victims' Compensation Fund. M.C.A. § 99-41-29.

5. Payment made to the provider by the Office of the Attorney General Victim Compensation Division for the sexual assault medical forensic examination shall be considered by the provider as payment in full.

6. The medical provider may not submit any remaining balance to the victim/claimant or to the Victim Compensation Division after reimbursement for the sexual assault medical forensic examination by a federal or federally financed program, such as Medicaid, Medicare, Tricare, or the Veterans' Administration or by a state financed program such as Mississippi Children's Health Insurance Plan (CHIPS). EXCEPTION: If, for example, the victim has a co-pay or has used all of their allowed paid medical visits with Medicaid, the medical provider may submit those expenses to the Victim Compensation Division.

605. Appeal Process.

1. The Division Director, on his/her own motion or on request of the medical provider, may reconsider a decision granting or denying a payment.

2. Reconsideration: If the Victim Compensation Division denies a payment request the medical provider may appeal the decision by notifying the Division in writing. The written request for a reconsideration should be provided within thirty (30) days from the date the medical provider received the decision notification from the Victim Compensation Division. The request should include the following and clearly state: (1) that the medical provider is requesting a reconsideration; (2) in a brief statement, the reason the provider is requesting a reconsideration; and (3) any information omitted from the original payment request that would have resulted in a different decision had the information been provided to the Division.

3. Contested Hearing: If the Victim Compensation Division upholds the original decision the medical provider may appeal the decision by notifying the Division in writing. The written request for a contested hearing should be provided within thirty (30) days from the date the medical provider receives the decision notification from the Victim Compensation Division. The request should include the following and clearly state: (1) that the medical provider is requesting a contested hearing; (2) in a brief statement, the reason the provider is requesting a contested hearing; and (3) any information omitted from the original payment request that would have resulted in a different decision had the information been provided to the Division.

4. Failure to appear at the hearing, without good cause, will be considered as a withdrawal, waiving the right to appeal and will result in dismissal of the claim.

5. The medical provider will be notified of all appeal request decisions in writing.

6. Circuit Court: A medical provider who disagrees with the contested hearing decision may appeal to the circuit court where the medical provider is located or the Circuit Court of the First Judicial District of Hinds County by filing a petition with the clerk of the court and executing and filing bond payable to the State of Mississippi with sufficient sureties to be approved by the clerk of the court, conditioned upon the payment of all costs of appeal, including the cost of preparing the transcript of the contested hearing. The petition and bond shall be filed within thirty (30) days of receipt of the contested hearing decision.

7. The decision of the contested hearing becomes the final ruling of the Director within thirty (30) days of notification of the decision if no appeal before the circuit court is made.