When a hospital or ambulance provider furnishes emergency
services, a hospital or health care professional or laboratory provides
follow-up healthcare, or a pharmacy dispenses prescribed medications to any
sexual assault survivor who is neither eligible to receive those services under
the Illinois Public Aid Code [305 ILCS 5/5 ] nor covered for those services by
a policy of insurance, the hospital, ambulance provider, health care
professional, laboratory or pharmacy shall furnish the services without charge
to that person, and shall be entitled to be reimbursed in providing the
services, under the following conditions:
a) An Illinois hospital shall be eligible for
reimbursement only after receiving Department of Public Health approval for
participation as a Sexual Assault Treatment Facility or as a Sexual Assault
Transfer Facility.
b) Charges for
outpatient emergency care, physician, and ambulance transportation, and other
related charges, shall be reimbursed as described in this subsection (b):
1) Physicians, ambulance providers, and other
miscellaneous medical providers rendering services in the hospital emergency
department shall be directly reimbursed by the Department of Healthcare and
Family Services.
2) Charges for
inpatient care shall not be reimbursed.
3) Charges must be directly related to care
rendered for examinations, injuries, or trauma resulting from a sexual assault
and/or the completion of sexual assault evidence collection through the use and
application of the Illinois State Police Sexual Assault Evidence Collection
Kit.
4) Emergency services must
have been provided within the hospital emergency department or under the
direction of an attending emergency room physician at the facility who
supervised or provided the hospital emergency care of the sexual assault
survivor, or during the ambulance transport of the sexual assault
survivor.
5) Charges may include,
but are not limited to, outpatient emergency care, physician, laboratory,
x-ray, pharmacy and ambulance services, including charges for follow-up visits
to the emergency department that are related to the sexual assault and occur
within 90 days after the initial visit.
6) Services provided to sexual assault
survivors shall be reimbursed at the Department's reimbursement
rates.
7) Claims must be received
by the Department within 180 days from the date of service to be eligible for
payment pursuant to 89 Ill. Adm. Code
140.20.
c) The hospital shall maintain
sufficient records to document its charges for services to each sexual assault
survivor. The records shall be available for the Department's review upon its
request and shall contain at least the following:
1) Sexual assault survivor's name, address,
date of birth, Social Security Number, marital status, sex, employer and name
of parent or guardian (if minor patient);
2) Date of service;
3) Hospital patient number and name of
attending physician;
4) List of
services provided;
5) Charges for
each service;
6) Any documentation
concerning the sexual assault survivor's insurance coverage; and
7) A report outlining each service provided
and paid for by the Department and the services available to sexual assault
survivors.
d) The
hospital outpatient-billing department shall submit the following documentation
in order to be considered for reimbursement:
1) Documentation of any insurance payment
that has been received, or a copy of the denial from the insurance carrier;
and
2) A properly completed
Universal Billing (UB) Form.
e) The health care professional who provides
follow-up healthcare, the laboratory that furnishes follow-up services, and the
pharmacy that dispenses related prescribed medications to a sexual assault
survivor are responsible for submitting the request for reimbursement for
follow-up healthcare, laboratory services or pharmacy services to the Illinois
Sexual Assault Emergency Treatment Program under the Department of Healthcare
and Family Services. Health care professionals, laboratories and pharmacies are
to be reimbursed at the Department's reimbursement rates.
f) Under no circumstances shall a sexual
assault survivor be billed for outpatient hospital care, emergency room care,
follow-up health care or transportation services when the services are directly
related to the sexual assault.
g) A
request for reimbursement that is rejected by the Department shall be returned
to the requestor and accompanied by an explanation that specifies the basis for
rejection. Corrected or amended requests may be resubmitted to the Department
within 180 days from the date of service pursuant to 89 Ill. Adm. Code
140.20.
