Maryland Payment Resources
Summary of payment program
Maryland Sexual Assault Forensic Exam (SAFE) Hospital Programs are located at various hospitals, and offer free forensic medical exams at no cost, even if the patient chooses not to involve law enforcement.
A provider may not charge the victim or the victim’s family of an alleged rape, sexual offense, or child sexual abuse for a physical examination or an initial assessment for the purpose of establishing and gathering information and evidence as to the alleged crime or for emergency hospital treatment and follow-up medical testing performed up to 90 days after the initial physical examination.
The Sexual Assault Reimbursement Unit, operating under the Code of Maryland Regulations 10.12.02, Rape and Sexual Offenses – Physician and Hospital Charges (select 12 Adult Health, subtitle 12.02 Rape and Sexual Offenses-Physician and Hospital Charges, was created to provide reimbursement for the physical examination, collection of evidence, and emergency treatment of individuals for injuries resulting from alleged rape, sexual assault, or child sexual abuse. The SARU aims to prevent individuals and their families from re-victimization by easing the reimbursement process associated with medical-forensic claims processing.
Reimbursements are made directly to physicians, hospitals, and laboratories on behalf of victims of rape, sexual assault, and child sexual abuse for medical treatment and evidence collection.
Requirements for reimbursement:
The following requirements must be met in order for reimbursement to be provided:
- A police complaint number, for victims who choose to report to police, must be documented. For victims who do not wish to report to police, a property held number, Jane Doe number, CPS/CHESSIE number or similar case identifier for evidence collection
much be documented;
- If you are unable to obtain a case number or case identifier from law enforcement, the exam should still be completed per the victims request and please write ‘not provided but requested’ on the line for the police case identifier.
- All necessary documentation must be submitted, including:
- Signed SARU SAFE Reimbursement Form (Formerly the Maryland Department of Health’s
Form #2923), Medical Examination and Report of Alleged Sexual Assault OR Form #4456, Confidential Report of Alleged Child Sexual Assault;
- Signed by a Physician and Forensic Nurse Examiner;
- Physician Assistants and Nurse Practitioners are able to sign in place of the ED provider, if necessary
- Payment sheet (CMS Form #1450; CMS Form #1500 or self-designed payment form) with vendor name, address, federal tax identification number, patient’s name, patient date of birth, date of service, and amount due; and
- Itemized bill including documentation of laboratory/diagnostic tests and medications ordered.
- Signed SARU SAFE Reimbursement Form (Formerly the Maryland Department of Health’s Form #2923), Medical Examination and Report of Alleged Sexual Assault OR Form #4456, Confidential Report of Alleged Child Sexual Assault;
- Claims must be submitted within 90 days from the date of service.
The Sexual Assault Reimbursement Unit (SARU) shall pay a physician the physician’s usual and customary fee not to exceed $80 for the examination and collection of evidence for victims of alleged rape or sexual offense. The SARU shall pay a physician the physician’s usual and customary fee or the customary fee of those individuals under the physician’s supervision, qualified to participate in the gathering of information and evidence through an initial assessment as defined under Regulation .02B, not to exceed $80 per hour for up to 5 hours for victims of alleged child sexual abuse.
The SARU shall pay the established rate as determined by the Health Services Cost Review Commission for the use of the emergency room or outpatient clinic and the daily in-hospital rate.
The SARU shall pay the established rate as determined by the Health Services Cost Review Commission for laboratory tests necessary to establish and gather information and evidence of the crime, and for screening of the victim for pregnancy and sexually transmitted infections.
- Emergency room treatment, in-hospital treatment, and follow up medical testing obtained within 90 days of the initial examination for injuries sustained as a result of the alleged rape or sexual assault;
- Screening for pregnancy and sexually transmitted infections;
- Diagnostic tests directly associated with the assault;
- Laboratory tests necessary to establish and gather information and evidence of the crime;
- Toxicology screening;
- Postcoital medications;
- Prophylactic medications for sexually transmitted infections and tetanus;
- nPEP therapy and follow-up care (Program for Preventing Human Immunodeficiency Virus (HIV) Infection for Rape Victims);
- Pain and antiemetic medications;
- Any medication directly related to the assault.
Who can file a claim to Maryland Criminal Injury Compensation Board (MD CICB):
- A person who suffers physical injury as a result of any crime;
- A person who suffered psychological or emotional injury as the result of a crime;
- A surviving spouse or child of a homicide victim;
- Any other person dependent for principal support on a homicide victim;
- Any person who assumed responsibility for funeral expenses of a homicide victim.
The CICB legislation requires that you reported the crime to some appropriate authority within 72 hours after the crime occurred. and that you incurred at least $100 in out-of-pocket expenses or two continuous weeks of earnings or support.
Appropriate authorities may include:
- Police department in your local jurisdiction
- District Court Commissioner’s Office
- Sexual Assault Forensic Exam Unit in your jurisdiction
- Educational disciplinary authority
- An application for a peace or protective order in any state
The requirements may be waived for good cause.
- Medical expenses up to $45,000
- Disability up to $25,000
- Psychological Services up to $5,000
- Funeral expenses up to $5,000
- Total dependency up to $25,000
- Partial dependency up to $17,000
The maximum allowable award in any claim may not be more than $45,000
How to file the claim, 4 different way:
- Download one of the applications, complete it, and mail it to the Criminal Injuries Compensation Board at 6776 Reisterstown Road, Ste. 206, Baltimore, MD 21215
- Download and complete one of the applications and fax it to the Criminal Injuries Compensation Board at 410-764-3815
- Present to the CICB offices and sit down with a CICB team member who will help you complete the form
- Complete the form online and submit it to the CICB offices
Coordination with healthcare
The term “forensic medical 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.
Listing of Maryland’s SAFE Programs
All individuals attending the Maryland Board of Nursing Forensic Nurse Examiner Training program who wish to practice as a Forensic Nurse Examiner-Adult/Adolescent (FNE-A) must complete the entire didactic portion (40 hours) of The Maryland Board of Nursing Forensic Examiner Training Program-Adult/Adolescent Curriculum and the entire clinical portion (40 hours) of FNE-A.