Provider Notice issued 03/04/08

Sexual Assault Emergency Treatment Program Changes

This notice advises providers of changes to the department’s Sexual Assault Emergency Treatment Program.  These changes are a result of amendments to the Illinois Sexual Assault Survivors Emergency Treatment Act (410 ILCS 70/), effective January 1, 2008. 

The Department of Healthcare and Family Services (HFS) is pleased to announce that beginning January 1, 2008, HFS implemented an improved process that will allow sexual assault survivors in the department’s Sexual Assault Emergency Treatment Program to more easily access follow-up medical services related to the sexual assault.  Prior to January 1, 2008, follow-up services were limited to two visits in the hospital’s emergency room within six weeks from the initial emergency hospital visit.  Effective January 1, 2008, sexual assault survivors have the option to receive their follow-up services from any community provider of their choice for 90 days following the initial hospital visit.

Effective January 1, 2008, hospitals initially treating the patient will be able to register the sexual assault survivor with the department in order to provide the patient with the attached form, HFS 3870, entitled “Illinois HFS Sexual Assault Emergency Treatment Program AUTHORIZATION FOR PAYMENT VOUCHER.”  This voucher will allow the patient to receive follow-up services related to their sexual assault from any community provider of their choice for 90 days following the initial hospital visit.  Patients will use the voucher to obtain any follow-up service related to the sexual assault, with the exception of in-patient hospital services.  The voucher contains a unique number assigned to the survivor and also contains the survivor’s name, the hospital’s name and the date of the initial emergency room visit.  The voucher is valid for a period of 90 days from the date of the initial emergency room visit, and contains an expiration date.  Services provided after the voucher’s expiration date cannot be billed to the Sexual Assault Survivors Program.  A facsimile of the voucher and voucher instruction sheet for patients accompanies this notice.

Providers rendering follow-up services related to a sexual assault do not need to be enrolled as an HFS provider in order to bill the department for reimbursement under the Sexual Assault Emergency Treatment Program.

Illinois law requires that healthcare services rendered to a sexual assault survivor covered by the Illinois Sexual Assault Emergency Treatment Program be provided at no charge to the sexual assault survivor. 

Verification of Eligibility

Because a sexual assault survivor registered in the Sexual Assault Emergency Treatment Program is not Medicaid eligible, providers will not be able to check patient eligibility electronically.  If a patient presents with a voucher, and the provider wishes to verify eligibility, they may do so by contacting the department’s Sexual Assault Emergency Treatment Program at 217-782-3303.  Request to speak to a representative in the Sexual Assault Emergency Treatment Program.

Services Covered Under the Program

The Sexual Assault Emergency Treatment Program covers medical services related to the sexual assault.  The department will allow the provider to use their judgment to determine whether the services being provided are related to the sexual assault.

Billing Process

Claims must be billed on paper and cannot be billed electronically.  Providers should submit their charges on the appropriate paper claim form (e.g., Form HFS 215, Drug Invoice, for pharmacies, Form HFS 2360 for physician services, etc.).  The claim should contain the patient’s name and authorization number, which can be found on the voucher. The claim, along with a copy of the Authorization For Payment Voucher, must be sent to the following address:

ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SEXUAL ASSAULT PROGRAM

P.O. BOX 19129

SPRINGFIELD, ILLINOIS 62794-9129

Copayments

Copayments do not apply to services being reimbursed under the Sexual Assault Emergency Treatment Program.

Reimbursement

The provider should bill their usual and customary charges for services provided to patients covered under the Sexual Assault Emergency Treatment Program.  The department will pay pharmacies for charges up to the HFS allowable amount.  All other providers will be reimbursed for their billed charges.

Other Insurance

If a patient has other insurance coverage the provider must bill that payer first.  The provider may bill the Sexual Assault Emergency Treatment Program for any charges not paid by the primary payer, including copayments and cost sharing.  The department will pay the balance not covered by the primary payer up to the department’s allowable rates for pharmacies and up to billed charges for all other providers.

Questions regarding the Sexual Assault Survivor Program may be directed to:

Attn: Program Coordinator

Sexual Assault Survivor Program

Healthcare and Family services

P.O. Box 19129

Springfield, Illinois 62794-9129

Telephone: 217-782-3303

E-Mail:  hfs.webmaster@illinois.gov

Theresa A. Eagleson, Administrator

Division of Medical Programs

Sexual Assault Survivors Instruction (pdf)

Sexual Assault Survivors Voucher (pdf)