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.