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October 16, 2007

Public Act 95-432, which amends the Sexual Assault Survivors Emergency Treatment Act (SASETA), will be effective January 1, 2008.

This memo describes the changes to the SASETA, including an updated section on providing hospital emergency services.

The attachments contain (1) information from the Department of Healthcare and Family Services about accessing their MEDI system in order to generate documentation needed by certain sexual assault survivors to present to providers of their follow-up care and (2) information and registration form for an IHA Webinar.

Please forward this memo and attachments to the Director of the Emergency Department and the Director of Billing Services.

I. BACKGROUND. Many survivors of sexual assault who obtain initial care in the hospital emergency department do not return for follow-up care - a problem for both the survivor who may not receive needed care and for the emergency department professionals who are therefore unable to perform follow-up tests or assess tolerance of medications they may have prescribed at the initial emergency visit. Over the past year, the Illinois Hospital Association participated in a group working to update Sexual Assault Survivors Emergency Treatment Act (SASETA) and provide a method for reimbursing providers of follow-up services for uninsured survivors.

II. HOSPITAL PLANS. Each hospital that provides general medical and surgical hospital services must provide either transfer services or hospital emergency services and forensic services to survivors of sexual assault. Forensic services are the collection of evidence using the Illinois State Police Evidence Collection Kit. Hospitals must: submit a plan to the Department of Public Health that describes how they will provide either transfer or treatment; may develop and participate in areawide plans; and must update and re-submit plans every three years for the Department’s approval.

A. The section of the Act describing the minimum requirements for hospitals has been updated. Hospitals are no longer required to perform an initial blood test to determine the presence of sexually transmitted disease. The update also removes the six-week time period from instructions about follow-up exams and lab tests.

B. Every hospital that provides emergency services and forensic services to a sexual assault survivor, with the survivor’s consent, and as ordered by the attending physician, an advanced practice nurse (APN) who has a written collaborative agreement with a physician that authorizes provision of emergency services, or a physician assistant (P.A.) who has been delegated authority to provide hospital emergency services and forensic services, shall provide the following:

1. appropriate medical examinations and laboratory tests required to ensure the health, safety, and welfare of a sexual assault survivor or which may be used as evidence in a criminal proceeding against a person accused of the sexual assault, or both. The hospital shall maintain records of examination and test results and make these results available to law enforcement upon the request of the sexual assault survivor;
2. appropriate oral and written information concerning the possibility of infection, sexually transmitted disease and pregnancy resulting from sexual assault;
3. appropriate oral and written information concerning accepted medical procedures, medication, and possible contraindications of such medication available for the prevention or treatment of infection or disease resulting from sexual assault;
4. an amount of medication for treatment at the hospital and after discharge as is deemed appropriate by the attending physician, an advanced practice nurse, or a physician assistant and consistent with the hospital’s current approved protocol for sexual assault survivors;
5. an evaluation of the sexual assault survivor’s risk of contracting human immunodeficiency virus (HIV) from the sexual assault;
6. written and oral instructions indicating the need for follow-up examinations and laboratory tests after the sexual assault to determine the presence or absence of sexually transmitted disease;
7. referral by hospital personnel for appropriate counseling; and
8. when HIV prophylaxis is deemed appropriate, an initial dose or doses of HIV prophylaxis, along with written and oral instructions indicating the importance of timely follow-up healthcare.

IV. MEDICATION ISSUE ADDRESSED. P.A. 95-432 addresses concerns about providing medication to a survivor because of concerns about follow-up. Under the amended Act, the physician, APN or P.A. determines the amount of medication that is appropriate for treatment at the hospital and after discharge. Because the amended Act now provides for State payment for follow-up services to survivors not covered by insurance or Medicaid, the hospital provider can be assured that survivors have the opportunity to obtain follow-up care and medication from providers of follow-up services. Furthermore, the law now states that the physician-patient relationship does not extend beyond discharge from the hospital emergency department.

V. FOLLOW-UP HEALTHCARE. Follow-up healthcare means healthcare services related to a sexual assault, including laboratory services and pharmacy services, rendered within 90 days of the initial visit for hospital emergency services. Such services include, but are not limited to, the following: (1) a physical examination; (2) laboratory tests to determine the presence of sexually transmitted disease; and (3) appropriate medications, including HIV prophylaxis.

VI. REIMBURSEMENT. Hospitals, ambulance services, healthcare professionals and laboratories shall furnish services to the survivor without charge and shall be entitled to be reimbursed for their billed charges by the State program; pharmacies shall dispense prescribed medications without charge to the survivor and shall be reimbursed at the HFS Medicaid allowable rates.

A. BILLING FOR TREATMENT. The law explicitly states that hospitals and other providers of services to sexual assault survivors are NOT to charge the survivor. Where the survivor is not covered for the services, the hospital must bill the Illinois Sexual Assault Emergency Treatment Program (State program).

B. SUBMITTING CLAIMS FOR EMERGENCY TREATMENT. Currently, hospitals must collect bills from physicians, ambulance companies, the hospital pharmacy and others who provided services to the survivor at the time of the initial emergency room visit, and submit these bills together to the Illinois Sexual Assault Emergency Treatment Program for payment. This procedure will not change under P.A. 95-432; however where a hospital provides follow-up services, the hospital now will also be eligible to receive payment for those services.

1. DHFS VOUCHER SYSTEM. To implement the new payment system for follow-up care to survivors of sexual assault, HFS is finalizing an online feature that will be added to the Department’s MEDI System. The current MEDI System allows healthcare providers to check online on the Medicaid status of a patient, submit claims and check claim payment status. HFS is adding a feature for the Illinois Sexual Assault Emergency Treatment Program that will generate a voucher for the hospital to print out and give to the survivor. The voucher will contain instructions for providers of follow-up care on how to bill the State program for their services and prescription medications.

2. MEDI SYSTEM ACCESS REQUIRED. Because the only way to generate a sexual assault voucher will be through the online MEDI System, hospitals that have not already done so are encouraged to register to use the MEDI System now, so they are ready by January 1 to access the voucher feature. There is no charge, and instructions are attached to this memo (click here).

VII. PLAN OF CORRECTION PROVISIONS. The fine was raised to $500 per day for a hospital’s failure to submit or implement an acceptable Plan of Correction, after a finding that the hospital is not in compliance with its approved treatment or transfer plan. The Department of Public Health is required to post on its website a list of hospitals whose plans have been found by the Department to be in compliance with the Act; the information is also reported each January 1 to the Illinois General Assembly.

VIII. UNCHANGED PROVISIONS. P.A. 95-432 did not change several important sections of SASETA. Any minor who is a sexual assault survivor who seeks emergency hospital services and forensic services or follow-up healthcare under the Act shall be provided such services without the consent of the parent, guardian or custodian of the minor. Provisions regarding evidence collection and emergency contraception also remain unchanged.

IX. IHA WEBINAR. The Illinois Hospital Association is hosting a Webinar educational program on December 4, 2007 to discuss changes to the SASETA and the new HFS voucher system. Please see the attached form for details about the Webinar, and to register.

We hope this information is helpful. If you have questions, please contact Barb Haller at bhaller@ihastaff.org or 630.276.5474.