RD558 - Report of the Virginia Sexual Assault and Forensic Exam (SAFE) Program Work Group – October 28, 2020

Executive Summary:

House Bill 806 (Chapter 1072, 2020 Acts of Assembly)(*1) directed the Secretary of Health and Human Resources to convene a workgroup to evaluate the feasibility and cost of expanding the type of services that are covered by the Criminal Injuries Compensation Fund created pursuant to § 19.2-368.18 of the Code of Virginia, particularly the unreimbursed costs resulting from sexual abuse; evaluate the feasibility of transferring from the Virginia Workers' Compensation Commission to the Department of Medical Assistance Services for the Sexual Assault Forensic Examination program (the SAFE program); to develop recommendations for an efficient, seamless electronic medical claim processing system for hospitals and health care providers if transfer of the SAFE program from the Virginia Workers’ Compensation Commission to DMAS is not feasible; and to provide recommendations related to increasing reimbursement rates for sexual assault forensic examinations to cover the cost of examinations, including the costs associated with preparing for and participating in criminal trials.

The SAFE Program workgroup assessed opportunities to increase efficiency and effectiveness of the SAFE Program and the Criminal Injuries Compensation Fund (CICF) with the ultimate goal of maintaining a survivor-centered approach to service delivery. Review of existing procedures revealed that the SAFE Program and CICF are administratively sound programs and the greatest opportunities for systems change lie in the “front end" hospital billing process through training and education on braiding funding alongside enhanced reimbursement rates. Work Group recommendations reflect these assessments. The workgroup met with key stakeholders between August and September of 2020 and developed the following recommendations:

• Maintain administration of the Sexual Assault Forensic Examination (SAFE) Program at the Virginia Workers’ Compensation Commission.

• Expand upon standardized billing training to hospitals/health systems, MCOs and community providers.

• Examine opportunities to create statewide electronic claims systems once new CPT Codes for forensic exams are established.

• Reduce barriers to accessing payment from the Criminal Injuries Compensation Fund.

• Expand services covered by the Criminal Injuries Compensation Fund

• Increase reimbursement rates for the SAFE Program.

• Examine opportunities for a specialized Medicaid rate for forensic-level fee and/or increase the medically necessary rate.

• Facilitate access to reimbursement through CICF by reviewing Code section 19.2-368.10, and any related Code sections, for any changes that may be beneficial.

• Increase funding to the Criminal Injuries Compensation Fund.

Over the past few years, Virginia has experienced significant advancements in its understanding of the landscape of forensic nursing, supported by the 2019 Forensic Nurse Study by the Joint Commission on Healthcare, and looks forward to meaningful change in how services will be delivered in the coming years. Expected systems transformation includes requiring hospitals implement referral protocols which will increase access to a forensic nurse examiner across the Commonwealth. This is occurring in conjunction with establishing a forensic nurse examiner coordinator at the Department of Criminal Justice Services that will serve to further coordinate statewide efforts in providing high quality, victim centered services. The changes to the SAFE Program and Criminal Injuries Compensation Fund considered by HB8062 (Appendix A) support continued progress toward a vision for the Commonwealth’s delivery of person centered services for victims of sexual assault – that an individual will receive high quality, trauma-informed care and assistance to navigate the systems involved in receiving payment for costs related to injuries suffered as a result of sexual assault.
(*1) Full text of the legislation can be found here, https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+CHAP1072