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Attachment A: SAFE-CARE (Sexual Assault Forensic Examination) Network

Staff are strongly encouraged to use a SAFE-CARE Network provider, whenever possible, for sexual abuse or physical abuse / neglect examinations.  SAFE-CARE providers (physicians and nurse practitioners) have received special training in the examination and interview of children who may have been sexually assaulted or physically abused or neglected.  The SAFE-CARE Network provides CD and Medicare providers with the unique opportunity to work closely and learn from each other.  Most importantly, the SAFE-CARE Network will help reduce the trauma experienced by children who are subjected to sexual abuse or physical abuse / neglect.

Staff may arrange an examination with a Network provider simply by calling his/her office for an appointment.  The provider will conduct an exam which includes a complete medical history; comprehensive physical examination; an interview; complete genitalia examination, basic office laboratory procedures, and preparation of the SAFE-CARE form, “SAFE-CARE Network Medical Examination.”  Providers may use the yellow copy of page one of the SAFE-CARE form for billing purposes.  This copy is attached to the CS-65 for payment.  If SAFE-CARE providers prefer, they may use their own billing statement rather than the yellow copy of page one of the SAFE-CARE form.  Laboratory charges must be itemized on a separate statement.  In addition, some providers use a colposcope to photograph a child’s genitalia, although one is not necessary.  A colposcope is valuable because it provides magnification, allowing the health care provider to see if there are injuries that may have otherwise gone undetected.

The Department of Health, the Division of Medical Services (DMS), and CD work together on the SAFE-CARE Network.  DMS pays those costs for examinations covered by Medicaid, while CD pays for examinations not covered by Medicaid when there is a child abuse / neglect investigation.  The Department of Health and Senior Services (DHSS) has funds to pay for examinations if there is sexual assault and the child is not covered by any other form of payment, i.e., children who are sexually assaulted by someone who does not have care, custody, and control.  DHSS will not pay for any physical abuse/neglect examinations.

Providers use their discretion in the number of SAFE-CARE examinations they conduct and the distance of families traveling for the examinations.  Some providers may restrict examinations for children within their county boundaries, while others may agree to examine children from surrounding counties.  Both factors are concerns for providers in order to allow them sufficient time for a quality examination and if necessary, time to testify in court.

In most situations, CD Children’s Service Workers will make the referral to a provider for a SAFE-CARE examination; in other situations, providers may suspect abuse or neglect, proceed with a SAFE-CARE examination, and then call the Hotline.  In both instances, CD will pay for the examination unless the child has private insurance or is covered by Medicaid.

If a provider notifies county staff they no longer wish to participate in the SAFE-CARE Network, county staff should ask the provider to notify Children’s Services, P.O. Box 88, Jefferson City, Missouri 65103, in writing.

Scheduling Examinations

If the parent / caretaker agrees to take the child to a physician, a time and day must be established before the investigator leaves the home.  The investigator must follow up immediately after the scheduled visit to ensure that the parent / caretaker complied with the agreement.  If the parent / caretaker did not, the investigator must immediately contact the family to locate the child and determine the reason the child was not taken.  If the parent / caretaker refuses to cooperate, the worker shall immediately contact the Juvenile Office or local law enforcement agency to request protective custody for the purpose of obtaining a physical examination.

Photographs

Photographs of children with injuries should be taken only by hospital, law enforcement, or juvenile office personnel.  CD workers may take photographs of serious / severe neglect situations where a co-investigator is not present during the investigation. 

Related Subject:  Section 2, Chapter 4, Attachment B, Videotaping of CA/N Victims

Diagrams

Diagrams may be used by the worker to complete a silhouette of the child and mark the location of injuries on the silhouette.  Try to approximate the shape and relative site, and write a brief description of the injury next to the silhouette.  In describing injuries, avoid words that are open to interpretation such as “old bruises: or “severe cut.”  Instead, the coloring, measurements, and precise adjectives should be used to describe the condition.

Payments For Medical Examinations For Alleged Child Subjects of Child Abuse/Neglect Where It Is Necessary To Determine Evidence Of Physical and Sexual Abuse

  1. If the child is Medicaid eligible, staff should make every effort to arrange for the physical examination with a Medicaid physician.
  2. If it is determined that the child is not eligible for Medicaid or no Medicaid physician is available, staff should contact a CTS provider to complete the exam.
  3. If it is determined that no CTS provider in the County is contracted for Evaluation and Diagnosis Type EVCG, or all providers who are contracted for this service are unavailable to provide the service within the time frame required, select any physician in the County to provide an examination to determine evidence of physical and/or sexual abuse.
  4. Payment for physical examinations may be paid through SEAS if the provider has a contract and the CS-67A is entered in SEAS on a timely basis.  If the CS-67A is not entered in SEAS on a timely basis, a CS-65 should be completed and sent to the Children’s Services Payment Unit for data entry, using the provider’s contracted service code and rate.

    5. When a provider has a contract, only the contracted rate or less can be paid.  Staff should check the Contract System to obtain each contracted provider’s rates.

    If the provider does not have a contract, a CS-65 should be completed and sent to the Children’s Services Payment Unit for entry, using service codes MHSP, MDTR, or COUN as appropriate.

  5. The original invoice should be attached to a completed CS-65 which must contain the following information on the form.

    6. NOTE:  Circuit Mangers should provide the name of physicians who may be interested in contracting for this service to their Regional Director for inclusion on the Request for Proposal (RFP) mailing list when the next contracting period occurs.

Payments for SAFE-CARE Examinations

CD, along with the Department of Health and the Division of Medical Services (Medicaid), will pay a special rate of $187.50 for sexual assault examinations (excluding laboratory tests) and $72.50 for physical abuse/neglect examinations.  The following laboratory fees and examinations will be paid at Medicaid rates based on the corresponding Medicaid Cost Code:

 

Procedure Codes Types of Service Description Reimbursement Rate

W1350

1

SAFE, Sexual Assault

$187.50

W1350WO

1

CARE, Child Abuse Resource Education

    72.50

57452WO

2

Colposcopy

    28.00

81025WO

1

Urine pregnancy test

      7.20

86317WO

1

Chlamydia

    20.72

86631WO

1

Chlamydia

    12.67

86632WO

1

Chlamydia, IgM

    12.67

87110WO

1

Chlamydia culture

    21.77

86592WO

1

RPR

      5.00

87163WO

1

Gonorrhea Culture

      7.50

87210WO

1

Wet mount

      4.00

86687WO

1

HIV

     11.60

86688WO

1

HIV

     14.84

86689WO

1

HIV, Western Blot

     24.00

87390WO

1

HIV-1

     24.38

87391WO

1

HIV-2

     24.30

87534WO

1

HIV-1, direct probe technique

     27.71

87535WO

1

HIV-1, amplified probe technique

     48.50

87536WO

1

HIV-1, quantification

Manually priced

87537WO

1

HIV-2, direct probe technique

     27.71

87538WO

1

HIV-2, amplified probe technique

     48.50

87539WO

1

HIV-2, quantification

Manually priced

It is appropriate to pay for lab fees in duplicate if for different sites, i.e. Chlamydia - Vaginal, Chlamydia - Rectal, Chlamydia - Oral.

Staff will receive one complete copy of “SAFE-CARE Network Medical Examination.”  The first page should be used for billing purposes by attaching it to a CS-65 and sending both to the Children’s Services Payment Unit.  The service codes of MHSP or MDTR should be used.   Because providers do not receive reimbursement directly to their facility, in the metropolitan areas, workers are encouraged to ask the provider to provide specific mailing address for reimbursement purposes. This address will aid in verifying correct vendor number to enter on the CS-65.  The State Office Payment Unit requests the worker, if uncertain of correct Vendor Number, to include provider payment address and leave Field 1 (DVN) blank.
SAFE/CARE providers are required to send a complete copy of the form to Brenda Record, SAFE/CARE Network Program Administrator, at 108 E. Green Meadows, Suite 9, Columbia, MO 65203, for statistical purposes.  All identifying information is confidential.

Payments for a Mental Health Assessment or Evaluation to Determine Evidence of Emotional Maltreatment:

  1. If the child is Medicaid eligible, staff should make every effort to arrange for the mental health assessment or evaluation with a Medicaid provider.
  2. If it is determined that the child is not eligible for Medicaid and/or no Medicaid provider is available, staff should contact a CTS provider to complete the assessment.
  3. If it is determined that no CTS provider contracted for assessment or evaluation is available to provide the services, staff will:
  4. If a non-CTS provider is willing to provide the service staff must:
  5. Payment for mental health assessments or evaluations may be authorized and paid through SEAS if the CS-67A is entered in SEAS on a timely basis. If the CS-67A is not entered in the SEAS on a timely basis, a CS-65 should be completed and sent to the CD Payment Unit.
  6. When a provider has a contract, only the contracted rate, or less, can be paid. Staff should check the Contract System to obtain each contracted provider’s rates.

Related Subject: Section 7, Chapter 33   Emotional Maltreatment

Payments for Medical Examinations When A Child Abuse/Neglect Report is Made or Caused to be Made by a Medical Provider

The Division will pay for a medical examination which was done to assist the physicians to determine if a CA/N report should be made.

  1. Verify that evidence of physical and/or sexual abuse was discovered during a physical examination and resulted in a CA/N report.
  2. Verify that the cost of the examination was not paid/covered by the patient, Medicaid, or private health insurance.  If not, request an invoice in triplicate from the physician for purposes of submission to Children’s Services Payment Unit or reimbursement. 

Payment for Copies of Medical Records

The Division may pay for copies of medical records. Section 191.227, RSMo sets the handling and per page fees for medical records. Section 191.227, RSMo was amended in 2002 to provide that effective February 1st of each year, the handling fee and per page fee would be increased or decreased based on the annual percentage change in the unadjusted, U.S. city average, annual average inflation rate of the medical care component of the Consumer Price Index for all urban consumers (CPI-U). The current reference base of the index, as published by the Bureau of Labor Statistics of the U.S. Department of Labor, shall be used as the reference base.

The following table shows the changes for the handling and copy charges:
 

Effective Date Handling/Retrieval Copies

2/1/08

$19.31

$0.46

When Children’s Division staff request and receive medical records from providers, all bills for payment for those records are made by completing a CS-65. To complete the CS-65, please use Vendor Type- CT, Program Area- CT, Fund Category- 30, Services Code RCRD, and please list the retrieval fee and the number of photocopy pages on separate lines. If the provider does not have a DVN, please attach a completed SS-60 and IRS Form W-9 (with Federal Tax ID or SSN) with the CS-65, and Central Office will assign the DVN. Make sure the bill is attached to the CS-65 and send the CS-65 and attachments to the Children’s Division Payment Unit, Central Office.

Safe-Care Provider List pdf format 3 pages (Employee Access Only)

Chapter Memoranda History: (prior to 1/31/07)

CD04-66, CD05-34, CD05-35, CD06-84, CD06-101,

Memoranda History:

CD07-24, CD08-39