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.