Alabama Payment Resources
Summary of payment program
Code of Alabama § 15-23-5 (24) (1995), which provides: The commission shall have all the powers and privileges of a corporation and all of its business shall be transacted in the name of the commission. In addition to any other powers and duties specified elsewhere in this article, the commission shall have the power to: Provide for the cost of medical examinations for the purpose of gathering evidence and treatment for preventing venereal disease in sexual abuse crimes and offenses.
Exams Performed by a Sexual Assault Nurse Examiner (SANE)
- Each itemized bill or statement for a sexual assault examination will be considered for payment in the order that it is received.
- Each itemized bill or statement will be reviewed for accuracy and to determine the appropriate payment category. The itemized bill or statement will be paid based upon the payment category the Commission determines is appropriate.
- The Commission will provide reimbursement for “Jane Doe” sexual assault examinations performed on adult victims.
- The Commission will not reimburse for “Jane Doe” sexual assault examinations for children.
- Each itemized bill or statement must identify the International Classification of Diseases (ICD9) code.
- Each billed procedure, service or supply/medication must be itemized.
- Each billed procedure, service or supply/medication must include the appropriate Physicians’ Current Procedural Terminology (CPT) code.
- The initial forensic examination will be considered for payment. Only services rendered, and medications provided “for the purpose of gathering evidence and treatment for preventing venereal disease in sexual abuse crimes and offenses” will be considered pursuant to the Commission’s Sexual Assault Examination Payment Policy.
- Each itemized bill or statement must include a copy of the completed Sexual Assault Information Form (AL102) that is included in the State of Alabama Collection Kit provided by the Alabama Department of Forensic Sciences or equivalent documentation. Alabama Department of Forensic Sciences provides collection kits free of charge and payment will not be provided for the kits.
- Signed, written confirmation from an employee of the SANE facility that the sexual assault was reported to the Department of Human Resources (DHR) or law enforcement must be provided in cases in which the victim is a minor. If confirmation is not received, the sexual assault examination will not be considered for payment.
Adult Sexual Assault Examination Without Medication – $400
- This fee includes exam, nurse examiner fee, pregnancy test, microscopic sperm screening, 14 Fr Foley Hymenal Exam, and drug screen.
- If the itemized bill is less than $400, the lesser amount of the itemized bill will be paid.
Adult Sexual Assault Examination with Medication – $550
- This fee includes exam, nurse examiner fee, pregnancy test, microscopic sperm screening, 14 Fr Foley Hymenal Exam, drug screen, and all medications except HIV prophylaxis.
- If the itemized bill is less than $550, the lesser amount of the itemized bill will be paid.
The following expenses are not eligible pursuant to the Commission’s Sexual Assault Examination Payment Program –
- treatment for injuries
- medication for any purpose other than the treatment and prevention of venereal disease
- hospital admissions.
All sexual assault victims should be provided a crime victims’ compensation application. Expenses that are ineligible pursuant to the Commission’s Sexual Assault Examination Payment Program may be eligible for crime victims’ compensation benefits.
Referrals from Hospitals and Medical Clinics
- When a hospital or medical clinic refers a victim of sexual violence to a SANE facility, the SANE facility will be paid for the cost of the sexual assault examination.
- When a hospital or medical clinic and a SANE facility perform a sexual assault examination for the same incident, the SANE facility will be paid for the cost of the sexual assault examination. If the hospital or medical clinic administered medication and the SANE facility did not administer medication, the hospital or medical clinic may be paid the difference between the cost of an exam with medication and the cost of an exam without medication for the appropriate payment category.
- The Commission will not pay a hospital or medical clinic and a SANE facility a duplicate fee for the same incident through the Sexual Assault Examination Payment Program (information materials for providers).
- The claim must be filed within one (1) year of the incident, or good cause shown. Good cause must be submitted in writing.
- The crime must be reported to the proper law enforcement agency within 72 hours of the incident, or good cause shown. Good cause must be submitted in writing.
- The victim or claimant must cooperate fully with law enforcement.
- The victim or claimant must not be the offender or an accomplice of the offender.
- No portion of the compensation shall unjustly benefit the offender.
- The victim must not have contributed to the offense.
- The victim will not be compensated if he/she has committed a criminal injury to another or he/she shall be convicted of a felony after applying for compensation.
- Must be a U.S. citizen or alien eligible for public benefits.
Coordination with healthcare
Sexual Assault Nurse Examiners (SANE) are available 24 hours a day at USA Children’s and Women’s Hospital in Mobile, AL. If you have been assaulted, a forensic exam can be performed and evidence collected up to 120 hours after the assault. Victim participation is at the discretion of the victim while at the hospital. A victim may decline any and all parts of the exam. and choose whether to report to law enforcement. Trained volunteer advocates will meet you at the hospital.
The Standing Together Against Rape (S.T.A.R.) program, a division of the One Place Family Justice Center, provides Sexual Assault Nurse Examiners 24 hours a day, 7 days a week to compassionately conduct sexual assault forensic exams for all ages, in Montgomery, AL. Call the S.T.A.R Crisis Line 334.213.1227 for immediate assistance.
- The Commission may consider payment for the cost of providing HIV prophylaxis for victims of sexual violence through its Sexual Assault Examination Payment Program. Payment for HIV prophylaxis may be reduced when payment is made by insurance or other collateral sources.
- If it is determined that a victim of sexual violence is at risk for exposure to HIV, the Commission may provide payment for a 28-day drug regimen of HIV prophylaxis to a SANE facility, hospital, medical clinic, pharmacy, or victim of sexual violence.
- The Commission may provide payment for one follow-up medical visit to monitor tolerance of the HIV prophylaxis by a victim of sexual violence. The amount of payment for this expense will be decided on a case-by-case basis and it will be determined based on the reasonableness of the charges. (Additional medical care may be considered for payment if the victim of sexual violence files a regular crime victims’ compensation application.)
- If a victim of sexual violence has health insurance, the pharmacy, hospital, or medical clinic filling the prescription for HIV prophylaxis must first seek payment of the expense from the health insurance provider.
- The Commission will not reimburse for HIV prophylaxis if the nature of the assault does not support this treatment protocol.
- The Commission recognizes that HIV prophylaxis is costly. Sexual assault examinations that exceed $2,000 must be presented to the three-member Commission for approval pursuant to section 15-23-5 (13) of the Code of Alabama. Sexual assault examinations that exceed $2,000 may take longer to process for payment.
HIV Prophylaxis Payment Limitations
- Truvada (28-day supply): $1,546.52
- Isentress 400 mg (28-day supply): $1,473.72
- Retrovir (28-day supply): $554.60
- Epivir (28-day supply): $498
- Tivicay (28-day supply): $1825.99
COLLECTION OF EVIDENCE WITHIN 72 HOURS
- If it is determined that the sexual assault took place more than 72 hours prior to the sexual assault examination, the use of an evidence collection kit may not be necessary. Alabama Attorney General’ Alabama Protocol for the Examination and Treatment of Victims of Sexual Assault.
- The reasonableness of the charges for sexual assault examinations performed after 72 hours will be determined on a case-by-case basis.
- The age, mental capacity, and the victim’s ability to seek a sexual assault examination within 72 hours of the assault will be considered when making a determination regarding the reasonableness of a sexual assault exam performed more than 72 hours after the sexual assault.