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 Market/Military Medical Treatment
Facility (MTF). 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 Markets/MTFs
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 The contractor, to include
its claims processors, shall be 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 The contractor, to include
its claims processors, shall not issue Explanations of Benefits
(EOBs) to beneficiaries (parents/guardians of minors or beneficiaries
deemed incompetent) when claims involve services related to sexual
assault or domestic violence. Refer to TRICARE Operations Manual
(TOM),
Chapter 8, Section 8, 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.