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We took a closer look by learning what is happening in six states across 19 jurisdictions that represent various models of funding sources and payers.


We conducted case studies in each jurisdiction by interviewing local stakeholders, including law enforcement personnel, prosecutors, community-based victim service agency staff, SANEs, and other hospital billing personnel, as well as conducting focus groups with sexual assault victims. All six case-study states cover forensic evidence collection procedures, which often includes facilities' fees, emergency room triage, emergency room doctor fees, SANEs' fees, colposcopy and endoscopy, and other photographic imaging.

In addition, all six states cover testing for pregnancy and sexually transmitted infections, and five cover treatment and prophylaxis for pregnancy and sexually transmitted infections. Two states cover prophylaxis for HIV: one covers the first three days of the treatment, and the other covers the treatment only under certain circumstances. States cover ambulance fees and alcohol and drug testing under certain circumstances.

In one state, testing for drug-facilitated rape requires approval from a prosecutor to be covered by the designated payer. Beyond the services stated above, states cover other services in varied ways or not at all. Only one case-study state routinely covers testing or treatment for injuries e. Another state covers treatment of injuries only under certain circumstances.

In this state and others, the remaining costs for these services are paid in several ways. The victim's insurance, if she has any, might be billed for those additional treatments. Victims can also access compensation funds to cover other medical interventions if they have reported the assault to the police though the victim's insurance still might be billed because victim compensation is the payer of last resort.

In some states, having had an exam, regardless of whether the assault is reported to the police, satisfies the condition to qualify for compensation. Similarly, as is the situation in one case-study state, health care providers that perform exams are considered adjunct criminal justice agencies; therefore, having an exam meets the condition of cooperation with the criminal justice system to qualify for compensation.

In addition, many respondents across case-study states indicated that some hospitals typically absorb any remaining cost of the exams and medical treatments as part of their community service efforts. Four case-study states had specified maximum amounts payment caps the designated payer would provide for allowable exams services. These caps were either overall total amounts for all allowable services e.

According to site-level respondents, exams often cost more than the payment caps. With prohibitions in some states against billing the victim's insurance either at all or for the balance of the bill , the exam provider is faced with the choice of covering the remaining costs or billing victims for services specified in state legislation as part of an exam. Based on feedback from respondents in the casestudy states, victims are typically not being billed for the uncovered costs of the services specified as part of the exams or covered by the public payer under state statutes.

However, they might be billed for other services that are not covered by the public payer as specified in state statutes. This distinction may be lost on victims—a bill is a bill.

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In addition, in the case-study state employing a county-administered payment program, individual counties negotiated designated funding sources and payers, as well as the particular services that are covered for an exam payment. Thus, victims in some portions of the state have many more services paid for via designated exam payers than do victims in other portions of the state.

One county in the county-administered case-study state appears to have an approach to medical forensic exam payment that focuses primarily on the victims' needs. The designated payer a government-based victim agency negotiated a payment process with the local hospital that conducts all the MFEs in that region through a hospital-based SANE program.

The contract between the county and the hospital is that the county will pay for all reasonable services conducted during an MFE, some of which are not legally required to be paid, and the hospital will give the county a 50 percent discount on all such services. Thus, the county pays for 50 percent of the initial exam, testing, and services provided during the first visit to the program.

The county will not pay for victim injuries and the cost of a hospital stay. When this occurs, either the victim's insurance is billed or the hospital writes off the additional treatment costs. A common theme that we heard in our case studies was that funds available for exams are frequently insufficient. Whether federal, state, local, or a combination of these monies are used, funds allocated for exam payment may be exhausted, so funds must be obtained from other sources to cover obligations.

For example, one state's annual allocation for exam payment covered only 75 percent of the funds needed, so additional funds had to be reallocated. That was such a big burden. They mentioned that there was no cost, like I don't have to pay for it. To spread funds as far as possible, states have set caps on provider payments. The caps may be a flat fee per exam, regardless of services provided, or they may be set fees for each service, requiring itemized bills.

Public law and criminal law

Whichever cap system was used, we frequently heard that these caps often fall far short of covering providers' actual expenses. Exam providers said shortfalls range from several hundred to several thousand dollars per exam, depending on the services provided and the area of the state providers in rural areas with lower pay scales and other operating expenses may have more of their expenses covered, even within payment caps.

Some providers bill the victim's insurance when she or he has insurance to make up the shortfalls, but many simply write off these costs and absorb the losses. In the short term, this practice spreads state or local funds to provide at least partial coverage for a larger number of exams than could be paid at full coverage levels; however, the potential long-term consequences may be dire. It is difficult for a health care agency, even a nonprofit, to continue providing services on which they take a financial loss. In addition, other providers may be discouraged from offering this service when they stand to lose money each time they provide it.

During our discussions with case study respondents, we found that there are distinct advantages to having victim compensation programs pay for exams. You'll analyse whether and how the parliamentary process maintains constitutional values, the community is safeguarded through the oversight of the police and the individual is protected through the incorporation of human rights and civil liberties. You'll begin studying criminal law by placing the law itself in context by looking at how and why certain actions are criminalised by the state.

You'll explore the elements of a criminal offence and some of the general principles underpinning the criminal law, including the standards of conduct and mental states required to commit criminal offences. You'll then look in more detail at a series of violent offences and some of the defences that may be used to deny that the actions that would otherwise constitute a crime are unlawful. You'll analyse the common law offence of murder and its impact on the law relating to intention.

You'll consider different forms of manslaughter and how and why they are differentiated from murder, using the partial defences of loss of control and diminished responsibility. You'll look at the areas of corporate criminal responsibility - how corporations are made liable under the criminal law, particularly for homicide - and criminal law reform, the process by which reforms to criminal law are proposed and accepted or rejected.

You'll be introduced to selected offences against the person including assault and aggravated assault, and will evaluate the law relating to sexual offences, particularly rape. As part of this you'll consider some of the wider political and social factors that impact on this complex area.

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  • In the closing units of the module you'll critically analyse aspects of the criminal law. You'll explore property offences, such as theft and burglary, through an evaluation of the concept of property as a fundamental part of the law. You'll conclude the module by bringing together aspects of public and criminal law to explore the social, political and legal contexts of human trafficking and modern slavery. This module emphasises the critical and comparative analysis of public and criminal law so you'll understand not only the provisions of the law but also how they may be critiqued and reconceptualised and how similar concerns are tackled in other jurisdictions.

    It provides a broad context for your understanding of rules and principles that form the law in these areas.

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    Alongside this you'll develop transferable legal and general study and employability skills. The activities and assessments you undertake will support the growth of personal and academic skills in areas such as communication, research, information technology, problem solving skills and self-reflection and appraisal. If you are intending to use this module as part of the LLB, and you hope to enter the Legal Professions, you should read carefully the careers information on The Open University Law School website.

    There are different entry regulations into the legal professions in England and Wales, Scotland, Northern Ireland and the Republic of Ireland. You should read the information on the website as it is your responsibility to ensure that you meet these requirements. You will have a tutor with whom you can communicate by email, online forum, online conferencing OU Live , telephone and if required post. They will help you with the study material and mark and comment on your written work, and whom you can ask for advice and guidance. Your tutor will also run face-to-face and online tutorials that you are encouraged to attend.

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    • In these circumstances, you must negotiate with your tutor to get their agreement to submit your assignment on paper. Public law and criminal law starts once a year — in October. This page describes the module that will start in October This is an OU level 2 module and you will need the study skills required for this level of study, which may have been obtained either from OU level 1 study or from another university. There may be extra costs on top of the tuition fee, such as a computer, travel to tutorials, set books and internet access. If you're on a low income you might be eligible for help with some of these costs after your module has started.

      All credit is subject to status and proof that you can afford the repayments. If you feel you would be unable to obtain an OUSBA loan on your own due to credit history or affordability issues, OUSBA offers the option to apply for a joint loan application with a third party. For example, your husband, wife, partner, parent, sibling or friend. As additional affordability checks are required when processing joint loan applications, unfortunately, an instant decision cannot be given. On average the processing time for a joint loan application is five working days from receipt of the required documentation.

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