Medical Provider Forensic Rape Examination (FRE) Direct Reimbursement Program

Executive Law Section 631(13) provides for direct reimbursement by the Office of Victim Services (OVS) to providers of sexual assault forensic health care examination services.

This measure provides for the personal privacy of sexual assault victims, while reimbursing providers when the victim does not have access to private health insurance or chooses not to use private health care insurance for the forensic examination.

Some frequently asked questions (FAQs) about this program appear below. Important instructions for filing claims under this program can be found here.

If you have a question that does not appear in this section, or you need more information about the direct reimbursement program, please contact OVS at ovs.ny.gov or call at 1-800-247-8035.

View Medical Provider Forensic Rape Examination (FRE) Direct Reimbursement Program Presentation

We hope this FAQ section facilitates the processing of all FRE applications and ensures that sexual assault survivors and the providers that serve them benefit from this important program. As always, the OVS stands poised to do all it can to compassionately and effectively serve innocent victims of crime.

Important Instructions for Completing Application

Download FRE Claim Application

Frequently Asked Questions:

What is a "forensic exam?"

A: The term "forensic exam" means an examination provided to a sexual assault victim by medical personnel trained to gather evidence of a sexual assault in a manner suitable for use in a court of law. A list of the elements of a forensic examination is described in detail in the Department of Health's Protocols for the Acute Care of the Adult Patient Reporting Sexual Assault.

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What is the Medical Provider Forensic Rape Examination (“FRE”) Direct Reimbursement Program?

A: New York State Executive Law (§631.13) provides for direct reimbursement by the Office of Victim Services (OVS) to providers of forensic sexual assault examination services. The law requires the medical provider to explain the victim's billing choices to them. When a victim chooses to have the provider bill OVS directly for the forensic examination and its related charges, the provider shall use the Direct Reimbursement Program. Direct reimbursement from OVS to providers of forensic examination services ensures that a sexual assault survivor will not have to pay for her/his own forensic examination, an added stressor after a highly traumatic event.

The forensic examination reimbursement fee is currently the amount of itemized charges not exceeding $800, and is intended to cover the forensic examiner’s services, facility services related to the forensic examination including the costs of equipment, materials and supplies required for the gathering of forensic evidence, as well as laboratory testing and pharmaceuticals related to a sexual assault forensic examination.

Follow-up HIV post-exposure prophylaxis (PEP) costs beyond the initial 3-day period (effective 11/27/2012, the initial supply to be paid under the FRE will be a 7-day dose pack) and the costs of medical treatment for injuries incurred as a result of the sexual assault, as well as any long-term pharmaceuticals related to the sexual assault other than HIV PEP are NOT intended to be covered by the FRE direct reimbursement program and will continue to be reimbursed through the victim/patient’s insurance, Medicaid, other insurance program, or if the victim chooses to file a full OVS claim application, according to previously-established OVS procedure as a payer of last resort.

If you have questions about any of the above, contact the Office of Victim Services at ovsinfo@ovs.ny.us or at 1-800-247-8035 or TTY: 1-888-289-9749.

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What services are included in the FRE Direct Reimbursement Program’s definition of a "forensic exam?"

A: Facility services such as personnel, overhead, space, necessary supplies and use of equipment which are directly related to the sexual assault forensic examination. This includes an Emergency Room (ER) Physician for a victim seen in the ER if the services provided by the ER Physician are related to the Forensic Exam.

The services of a licensed healthcare provider performing a forensic examination within the scope of the discipline in which the provider is licensed, including a physician, registered physician’s assistant, nurse practitioner or registered nurse or a sexual assault examiner certified by the Department of Health (NYSDOH) to perform a sexual assault forensic examination including those designated and certified by NYSDOH as SAE (Sexual Assault Examiner), SANE (Sexual Assault Nurse Examiner), SANE-A (Sexual Assault Nurse Examiner-Adolescent), SAFE (Sexual Assault Forensic Examiner), SART (Sexual Assault Response Team), FNE (Forensic Nurse Examiner), or NE (Nurse Examiner).

Laboratory tests and pharmaceuticals directly related to the forensic examination.

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What types of healthcare providers are eligible under the FRE Direct Reimbursement Program?

A: Any New York State Hospital or Article 28 facility holding a valid operating certificate issued by the New York State Department of Health.

Any NYS licensed healthcare provider performing a forensic examination within the scope of the discipline in which the provider is licensed, including a physician, registered physician’s assistant, nurse practitioner or registered nurse or a sexual assault examiner certified by the Department of Health to perform a sexual assault forensic examination including those designated and certified by NYSDOH as SAE, SANE, SANE-A, SAFE, SART, FNE, or NE.

The New York State facility in which the exam took place is the Billing Provider eligible to file the FRE Direct Reimbursement Claim.

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How does a healthcare provider apply for Direct Reimbursement?

A: Medical Provider Forensic Rape Examination Direct Reimbursement Claim Forms are available from the OVS website www.ovs.ny.gov and are included in the Sexual Offense Evidence Collection Kit provided free of charge to hospitals and healthcare providers throughout the State.

No later than one year from the date of the forensic examination, the healthcare provider in whose facility the exam took place must submit a completed Medical Provider Forensic Rape Examination Direct Reimbursement Claim Form* AND an itemized bill indicating the relevant current procedural terminology (CPT) codes and the costs associated with each service provided, to the OVS at the address below.

New York State Office of Victim Services
Attn: FRE Processing 
AE Smith Building
80 S. Swan Street, 2nd FL 
Albany, NY 12210

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Does a sexual assault survivor have to file the regular application with the Office of Victim Services to ensure payment for the forensic exam?

A: No. However, sexual assault survivors are encouraged to file an application if other medical services (outside of the forensic exam) are needed. Also, sexual assault survivors should be advised that they may be eligible to recover reimbursement for loss of personal property, loss of earnings or support and expenses associated with counseling, in addition to medical care, if a regular application is filed.

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Does a sexual assault survivor have to use Medicaid or apply for Medicaid to pay for the forensic exam?

A: No. Sexual assault survivors do not have to use their private insurance benefits, Medicaid, Medicare, HMO (Health Maintenance Organization) or any other insurance program for payment of the forensic exam especially if it would interfere with personal privacy or safety. A sexual assault survivor may be asked to provide such information for medical care or services that are NOT related to the sexual assault forensic examination and not billed by the provider as part of the direct reimbursement claim.

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Is it necessary to file a police report to qualify for coverage through the FRE Direct Reimbursement Program?

A: No. OVS will accept the Medical Provider Forensic Rape Examination Direct Reimbursement Claim Form, along with the itemized bill, as documentation of the sexual assault forensic examination in lieu of a police or criminal justice agency report and will provide direct reimbursement for the forensic examination to the healthcare provider.

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Can a minor child sign a Direct Reimbursement Claim Form?

A: Yes. So long as it is reasonable for the facility to conclude that the victim understands the contents of the form he or she is signing, a minor may sign his or her own claim form.

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Is follow-up or post-exposure HIV prophylaxis covered under this program?

A: No. Only costs for the initial 3-day supply of HIV prophylaxis (effective 11/27/2012, the initial supply to be paid under the FRE will be a 7-day dose pack) are intended to be reimbursed by the Direct Reimbursement Program.

For reimbursement of the expenses associated with follow-up or post-exposure HIV prophylaxis beyond the initial 3-day supply (effective 11/27/2012, 7-day supply), an eligible victim must file a regular claim application form with the OVS. Claim applications are available from the OVS website www.ovs.ny.gov .

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Can a hospital or other forensic examiner bill the victim for the remaining balance after direct reimbursement by the OVS?

A: No. Once the victim chooses that a provider bill the OVS through this program, the provider and any other services providers that provided forensic exam related services, can not bill the victim or the victim's insurance. Additionally, if the provider receives reimbursement through the program, the healthcare provider must accept the OVS reimbursement rate as payment in full for covered and submitted services. The purpose of this Direct Reimbursement Program is to ensure that the sexual assault survivor not be held responsible for the payment of the cost of the forensic examination. The healthcare provider shall not submit any remaining balance after reimbursement by the OVS to the victim or commence civil actions against the victim to recover any balance due for services related to the sexual assault forensic examination. The billing provider should work with all the other service providers, including the ER Physician, to ensure no further billing of the victim for services occurs.

Any services billed by a provider as part of the Forensic Examination Direct Reimbursement Claim are covered by the direct reimbursement payment at the statutory rate of reimbursement.

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Can the FRE program pay for the cost of a forensic examination of a minor child?

A: Yes. The Direct Reimbursement Program will pay for the cost of a forensic sexual assault examination regardless of age.

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Will a sexual assault survivor be required to follow through with prosecution in order to secure payment for the forensic examination?

A: No. A sexual assault survivor will not be required by the Office of Victim Services to pursue prosecution in order to have the sexual assault forensic examination and related services paid for under the direct reimbursement program.

However, if the sexual assault survivor seeks additional benefits from the OVS, including reimbursement for medical services that were not directly related to or billed as part of the sexual assault forensic examination, and has reported the crime to the police, the OVS will need the police report and the victim will be required to comply with the reasonable requests of law enforcement authorities in the investigation and prosecution of crime.

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Does a sexual assault survivor have to have a forensic examination performed right away? What is the timeframe?

A: Generally, a forensic exam must be performed within 96 hours of the assault in order to obtain essential evidence. However, the Office of Victim Services will cover the cost of a forensic exam conducted beyond 96 hours for a child victim, or for any victim where good cause is shown for the delay.

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I am a private physician who conducted an FRE exam in my office. I did not use a Sexual Offense Evidence Collection Kit. Can I still be reimbursed?

A: Yes, so long as the examination was conducted in accordance with Public Health Law §2805(i) and the Department of Health’s Protocols for the Acute Care of the Adult Patient Reporting Sexual Assault, and a diagnosis of sexual assault is indicated on the itemized bill.

Protocols for the Acute Care of the Adult Patient Reporting Sexual Assault, is currently available on the web: Click Here

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I am a medical provider who performed a forensic exam in a hospital where I have privileges, how do I get paid for my services?

A: You must request payment from the hospital. The OVS will reimburse the hospital or facility in which the forensic examination was conducted. The hospital or facility in which the examination was conducted shall be responsible for proportionately allocating reimbursable expenses among service providers.

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If a sexual assault survivor used her insurance to pay for the cost of the exam, but insurance did not cover 100% of the bill, can the hospital or provider charge OVS for the balance?

A: No. Once private health care insurance is assigned, the hospital or healthcare provider may not bill the OVS for any balance due. Most healthcare providers that accept private insurance will accept the insurance payment as “payment in full.” Additionally, a sexual assault survivor may file a full claim application with the OVS and if eligible, be reimbursed for any non-covered medical expenses related to the sexual assault.

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Who do I contact for more information about the program?

A: You may contact the Office of Victim Services from the website. www.ovs.ny.gov . You may also call the OVS at 1-800-247-8035 (TTY: 1-888-289-9749), or contact us by mail to: New York State Office of Victim Services, Attn: FRE Processing, AE Smith Building, 80 S. Swan Street, Albany, NY 12210.

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