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.