CRIMINAL LAW CASE STUDY EXAMS-PART ONE

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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.

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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.

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