Forensic Rape Exam Direct Reimbursement Program

The Office of Victim Services directly reimburses medical providers for forensic rape examinations (FREs) if victims of sexual assault do not have access to private health insurance or chose not to use their private health care insurance for the examination. This measure is an exception to the agency’s payer of last resort rule and provides for the personal privacy of victims. 

An exam may also include collection and preservation of evidence in a Sexual Offense Evidence Collection Kit, which can assist law enforcement if an individual decides to report the crime. Reporting to police is not mandatory, however, and should never prevent someone from seeking medical care. Providers are required to retain sexual offense evidence collection kits for 20 years.

OVS Forensic Rape Examination (FRE) Direct Reimbursement Program - TRAINING VIDEO

June 2020: Updated Guidance to Laws and Regulations related to FREs from OVS and the state Department of Health

Memo to Hospital CEOs

Memo to Hospital Emergency Departments

Medical Provider Forensic Rape Examination (FRE) Direct Reimbursement Program Training

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For additional information or clarification, please refer to the Frequently Asked Questions or contact OVS for more information: 1-800-247-8035.

OVS aims to ensure that survivors of sexual assault and the providers that assist them benefit from this important program. The agency remains ready to do all it can to compassionately and effectively serve innocent victims of crime.

FRE Claim Application for Medical Providers

FRE Claim Supplemental Information

Forensic Rape Exam (FRE) Frequently Asked Questions

What is a "forensic exam?"

The term "forensic exam" means an examination provided to a sexual assault survivor by medical personnel trained to gather evidence of a sexual assault in a manner suitable for use in a court of law. The Department of Health refers to the U.S. Department of Justice Office on Violence Against Women "A National Protocol for Sexual Assault Medical Forensic Examinations" for a detailed list of the elements of a forensic examination.

What is the Medical Provider Forensic Rape Examination (“FRE”) Direct Reimbursement Program?

New York State Executive Law [(§631(13)] provides for direct reimbursement by OVS to providers of forensic sexual assault examination services. The law requires the medical provider to explain the survivor's billing choices to them. When a survivor chooses to have the provider bill OVS directly for the forensic examination and its related charges, the provider shall use the Direct Reimbursement Program. Direct reimbursement from OVS to providers of forensic examination services ensures that a sexual assault survivor will not have to pay for their own forensic examination, an added stressor after a highly traumatic event.

The forensic examination reimbursement fee is currently the amount of itemized charges not exceeding $800, and is intended to cover the forensic examiner’s services, facility services related to the forensic examination including the costs of equipment, materials and supplies required for the gathering of forensic evidence, as well as laboratory testing and pharmaceuticals related to a sexual assault forensic examination.

Effective June 15, 2020, the forensic examination reimbursement fee will be the amount of itemized charges, to be reimbursed at the Medicaid rate and which cumulatively shall not exceed the following, tiered reimbursements:

• Tier 1 - $800 for an exam of a sexual assault survivor where no Sexual Offense Evidence Collection Kit is used;
• Tier 2 - $1,200 for an exam of a sexual assault survivor where a Sexual Offense Evidence Collection Kit is used;
• Tier 3 - $1,500 for an exam of a sexual assault survivor who is 18 or older, with or without the use of a Sexual Offense Evidence Collection Kit, and with the provision of an initial 7-day supply (“starter pack”) of HIV post-exposure prophylaxis (PEP); and
• Tier 4 - $2,500 for an exam of a sexual assault survivor who is younger than 18, with or without the use of a Sexual Offense Evidence Collection Kit, and with the provision of the full regimen of HIV PEP.

Follow-up HIV PEP costs beyond the initial 7-day supply (for all survivors seen prior to June 15, 2020, and for survivors who are 18 and older thereafter), as well as any long-term pharmaceuticals related to the sexual assault other than HIV PEP are not intended to be covered by the FRE direct reimbursement program and will continue to be reimbursed through the survivor/patient’s insurance, Medicaid, other insurance program, or if the survivor chooses to file a full OVS claim application, according to previously established OVS procedure as a payer of last resort.

Questions about these requirements should be directed to [email protected] or 800-247-8035.

Changes to the FRE Direct Reimbursement Program take effect on June 15, 2020.  How will my claim be processed?

The changes to the FRE Direct Reimbursement Program will apply to claims received by OVS on, or after, June 15, 2020.  Claims received prior to June 15, 2020 will be processed under the Program rules in effect up to that date.  Claims received after that date on the older or “legacy” claim forms will be returned to the provider to obtain the new information necessary after June 15, 2020.

What services are included in the FRE Direct Reimbursement Program’s definition of a "forensic exam?"

Facility services such as personnel, overhead, space, necessary supplies and use of equipment which are directly related to the sexual assault forensic examination. This includes an Emergency Room (ER) Physician for a survivor seen in the ER if the services provided by the ER Physician are related to the Forensic Exam.

The services of a licensed healthcare provider performing a forensic examination within the scope of the discipline in which the provider is licensed, including a physician, registered physician’s assistant, nurse practitioner or registered nurse or a sexual assault examiner certified by the state Department of Health to perform a sexual assault forensic examination, including those designated and certified by the Health Department as Sexual Assault Examiner (SAE), Sexual Assault Nurse Examiner (SANE), Sexual Assault Nurse Examiner-Adolescent (SANE-A), Sexual Assault Forensic Examiner (SAFE), Sexual Assault Response Team (SART), Forensic Nurse Examiner (FNE) or Nurse Examiner (NE).

Laboratory tests and pharmaceuticals directly related to the forensic examination.

What types of healthcare providers are eligible under the FRE Direct Reimbursement Program?

Any New York State Hospital or Article 28 facility holding a valid operating certificate issued by the New York State Department of Health.

Any New York State licensed healthcare provider performing a forensic examination within the scope of the discipline in which the provider is licensed, including a physician, registered physician’s assistant, nurse practitioner or registered nurse or a sexual assault examiner certified by the Department of Health to perform a sexual assault forensic examination including those designated and certified by the state Department of Health as SAE, SANE, SANE-A, SAFE, SART, FNE, or NE.

The New York State facility in which the exam took place is the Billing Provider eligible to file the FRE Direct Reimbursement Claim.

How does a healthcare provider apply for Direct Reimbursement?

Medical Provider Forensic Rape Examination Direct Reimbursement Claim Forms are available on the OVS website and are included in the Sexual Offense Evidence Collection Kit provided free of charge to hospitals and healthcare providers throughout the State.

No later than one year from the date of the forensic examination, the healthcare provider in whose facility the exam took place must submit a completed Medical Provider Forensic Rape Examination Direct Reimbursement Claim Form, an itemized bill and any necessary supporting documentation to OVS at the address below.

New York State Office of Victim Services
Attn: FRE Processing 
AE Smith Building
80 S. Swan Street, Second Floor 
Albany, NY 12210

What is an itemized bill?

The itemized bill should be in the same form and substance as that billed to NYS Medicaid.  It must include a billable code and charge for each line item (e.g., it is not acceptable for “pharmaceuticals” to be listed as one item), the sum total of all charges, and a valid sexual assault or sexual abuse diagnosis code.

Is a Sexual Offence Evidence Collection Kit required for Direct Reimbursement?

No.  There is no requirement that a survivor consent to any portion of an evidence collection kit for a provider to be eligible for reimbursement under the FRE Direct Reimbursement Program.

Does a sexual assault survivor have to file the regular application with the Office of Victim Services to ensure payment for the forensic exam?

No. Medical providers should advise sexual assault survivors that consenting to bill OVS for the FRE does not automatically make them eligible for any other compensation benefits available from OVS and should encourage survivors to file an application with the agency. OVS can assist with reimbursement for loss of personal property, loss of earnings or support, and expenses associated with counseling, in addition to medical care, if a regular application is filed. 

Does a sexual assault survivor have to use Medicaid or apply for Medicaid to pay for the forensic exam?

No. Sexual assault survivors do not have to use their private insurance benefits, Medicaid, Medicare, HMO (Health Maintenance Organization) or any other insurance program for payment of the forensic exam especially if it would interfere with personal privacy or safety. A sexual assault survivor may be asked to provide such information for medical care or services that are not related to the sexual assault forensic examination and not billed by the provider as part of the direct reimbursement claim.

Is it necessary to file a police report to qualify for coverage through the FRE Direct Reimbursement Program?

No. OVS will accept the Medical Provider Forensic Rape Examination Direct Reimbursement Claim Form, along with the itemized bill, as documentation of the sexual assault forensic examination in lieu of a police or criminal justice agency report and will provide direct reimbursement for the forensic examination to the healthcare provider.

Can a minor child (under 18) sign a Direct Reimbursement claim form?

Yes, as long as it is reasonable for the provider to conclude that the survivor understands the contents of the form he or she is signing, a minor child may sign their own claim form.

Is follow-up or post-exposure HIV prophylaxis covered under this program?

No. Only costs for the initial 7-day supply of HIV PEP are intended to be reimbursed by the Direct Reimbursement Program. For reimbursement of the expenses associated with HIV PEP beyond the initial 7-day supply, an eligible survivor must file a claim with OVS. 

Effective June 15, 2020, HIV PEP will be covered as follows:

Survivors younger than 18 should be provided the full regimen of HIV PEP.  The costs for the full regimen are intended to be reimbursed by the Direct Reimbursement Program under Tier 4 indicated above.

Survivors who are 18 or older should be provided the initial 7-day supply of HIV PEP.  The costs for the initial 7-day supply are intended to be reimbursed by the Direct Reimbursement Program under Tier 3 indicated above.  For reimbursement of the expenses associated with HIV PEP beyond the initial 7-day supply, an eligible survivor must file a claim with OVS. 

Can a hospital or other forensic examiner bill the victim for the remaining balance after direct reimbursement by the OVS?

No. Once the survivor chooses that a provider bill OVS through this program, the provider and any other services providers that provided forensic exam related services, cannot bill the survivor or their insurance. Additionally, if the provider receives reimbursement through the program, the healthcare provider must accept the OVS reimbursement rate as payment in full for covered and submitted services. The purpose of this Direct Reimbursement Program is to ensure that the sexual assault survivor not be held responsible for the payment of the cost of the forensic examination. The healthcare provider shall not submit any remaining balance after reimbursement by OVS to the survivor or commence civil actions against the survivor to recover any balance due for services related to the sexual assault forensic examination. The billing provider should work with all the other service providers, including the ER Physician, to ensure no further billing of the survivor for services occurs.

Any services billed by a provider as part of the Forensic Examination Direct Reimbursement Claim are covered by the direct reimbursement payment at the statutory rate of reimbursement indicated above.

Can the FRE program pay for the cost of a forensic examination of a minor child?

Yes. The Direct Reimbursement Program will pay for the cost of a forensic sexual assault examination regardless of age.

Will a sexual assault survivor be required to follow through with prosecution in order to secure payment for the forensic examination?

No. A sexual assault survivor will not be required by the Office of Victim Services to pursue prosecution in order to have the sexual assault forensic examination and related services paid for under the direct reimbursement program.

If the sexual assault survivor seeks additional assistance from OVS, including reimbursement for medical services that were not directly related to or billed as part of the sexual assault forensic examination, and has reported the crime to the police, OVS will need the police report and the survivor will be required to comply with the reasonable requests of law enforcement authorities in the investigation and prosecution of crime.

Does a sexual assault survivor have to have a forensic examination performed right away? What is the timeframe?

Generally, a forensic exam must be performed within 96 hours of the assault in order to obtain essential evidence. However, the Office of Victim Services will cover the cost of a forensic exam conducted beyond 96 hours for a child survivor, or for any survivor where good cause is shown for the delay.

I am a private physician who conducted an FRE exam in my office. I did not use a Sexual Offense Evidence Collection Kit. Can I still be reimbursed?

Yes, as long as the examination was conducted in accordance with Public Health Law §2805(i) and A National Protocol for Sexual Assault Medical Forensic Examinations and a diagnosis of sexual assault is indicated on the itemized bill.

I am a medical provider who performed a forensic exam in a hospital where I have privileges, how do I get paid for my services?

You must request payment from the hospital. OVS will reimburse the hospital or facility in which the forensic examination was conducted. The hospital or facility in which the examination was conducted shall be responsible for proportionately allocating reimbursable expenses among service providers.

If a sexual assault survivor used their insurance to pay for the cost of the exam, but insurance did not cover 100% of the bill, can the hospital or provider charge OVS for the balance?

No. Once private health care insurance is assigned, the hospital or healthcare provider may not bill the Direct Reimbursement Program for any balance due. A sexual assault survivor may file a regular claim application with OVS and if eligible, be reimbursed for any non-covered medical expenses related to the sexual assault.

Who do I contact for more information about the program?

Contact OVS, call 800-247-8035, or write: New York State Office of Victim Services Attn: FRE Processing AE Smith Building 80 S. Swan Street, Second Floor Albany, NY 12210