1.0 BACKGROUND
The
National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2007,
Public Law 109-364, directs the Secretary of Defense to establish
a benefit for forensic examinations in Civilian Health Care (CHC)
facilities following a sexual assault or domestic violence for eligible
beneficiaries. All beneficiaries are covered if they are examined
in a Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM).
Prior to passage of this law, forensic examinations were not covered
for beneficiaries in CHC facilities because TRICARE may cost-share
only medically or psychologically necessary services or supplies.
Forensic examinations were not considered medically or psychologically
necessary because the purpose of the examination is primarily for
preservation of evidence for use by the justice system. However,
the forensic examination process serves a dual purpose: one, to
address the medical needs of the victim; and two, to collect and
preserve forensic evidence for use in any future criminal investigation
and/or prosecution. Congress acknowledged this dual purpose by establishing
this benefit to allow CHC facilities to receive reimbursement for
these examinations. This benefit is consistent with the services
that are authorized in medical MTFs/eMSMs for all beneficiaries
who are victims of sexual assault or domestic violence.
2.0 DESCRIPTION
Forensic
examinations are conducted following a sexual assault or domestic
violence to provide medical care to the individual disclosing the
sexual assault or domestic violence and to collect and preserve
forensic evidence for use by the justice system. An evidence collection
kit (also known as a Sexual Assault Forensic Examination (SAFE)
kit or evidence recovery kit) is used during the examination to
collect and preserve the forensic evidence.
3.0 POLICY
Effective October 17, 2006, forensic
examinations, including evidence collection kits, are covered when
provided in CHC facilities following a sexual assault or domestic
violence. TRICARE pays for and will continue to pay for all emergency
room services delivered to a victim.
4.0 POLICY CONSIDERATIONS
4.1 Forensic examinations
include:
4.1.1 Evaluating
and treating injuries;
4.1.2 Conducting prompt examinations to include
collection of forensic evidence;
4.1.3 Providing support, crisis intervention,
and advocacy;
4.1.4 Providing prophylaxis against sexually
transmitted diseases and HIV;
4.1.5 Assessing female patients for pregnancy
risk and discussing treatment options, including reproductive health
services; and
4.1.6 Providing follow-up care for medical and
emotional needs.
4.2 Evidence collection kits for collection
of forensic evidence should/may reflect the requirements of the
jurisdiction in which the examination takes place. Items in the
kit may include but are not limited to:
4.2.1 Forms for documentation of what is observed;
4.2.2 Tubes for blood
samples or DNA blood cards;
4.2.3 Urine sample container (for detecting drugs
that may have been used to facilitate a sexual assault);
4.2.4 Cotton swabs
for biological evidence collection;
4.2.5 Sterile water;
4.2.6 Sterile saline;
4.2.7 Glass slides;
4.2.8 Unwaxed dental floss;
4.2.9 Wooden stick
for fingernail scrapings;
4.2.10 Envelopes or
boxes for individual evidence samples, including the victim’s clothing;
4.2.11 Labels for each
item and paper bags for clothing collection;
4.2.12 Large sheet
of paper for patient to undress over; and
4.2.13 New clothing
to temporarily replace victim’s clothing.
4.3 Privacy and
Confidentiality
4.3.1 Claims
processors and contractors are responsible for ensuring compliance
with the Privacy Act of 1974, Health Insurance and Portability and
Accountability Act (HIPAA), and the Department of Defense (DoD)
Health Information Privacy Regulation (6025.18-R) regarding use
and disclosure of Protected Health Information (PHI) and Personally
Identifiable Information (PII) for victims of sexual assault or
domestic violence.
4.3.2 DoD Directive (DoDD) Number 6495.01
dated November 7, 2008, “Sexual Assault Prevention and Response
(SAPR) Program,” will apply as appropriate in regard to restricted
and unrestricted reporting of sexual assaults.
4.3.3 Claims
processors and contractors shall not issue Explanations of Benefits
(EOBs) to beneficiaries (parents/guardians of minors or incompetents)
when claims involve services related to sexual assault or domestic
violence. Refer to TRICARE Operations Manual (TOM),
Chapter 8, Section 8, paragraphs 5.1 and
6.0 for information regarding EOB issuance
exceptions and beneficiary notification of claim action.
4.3.4 Reimbursement
shall be made according to TRICARE Reimbursement Manual (TRM),
Chapter 1, Section 36.