Applicant and Payment Procedures

 

DEPARTMENT OF LEGAL AFFAIRS

Division of Victim Services and Criminal Justice Programs

RULE NO.:RULE TITLE:

2A-3.002Applicant and Payment Procedures

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 45 No. 204, October 18, 2019 issue of the Florida Administrative Register.

2A-3.002 Applicant and Payment Procedures.

(1) The Bureau of Victim Compensation pays for medical expenses connected with the initial forensic physical examination of a victim of sexual battery as defined by section 794.011(1)(h), F.S., or a lewd or lascivious battery or molestation as defined by section 800.04(4) or (5), F.S.

(2) through (3) No change.

(4) The claim form and invoice must be filed and received by the department within 120 days of the forensic examination. Corrections or technical defects on the in claim form or invoice shall not result in a change to the original filing date for purposes of complying with the filing deadline. Failure to submit a properly completed claim form and invoice will result in denial of benefits.

(5) The claim form and invoice shall be mailed to the Office of the Attorney General, Bureau of Victim Compensation, PL-01, The Capitol, Tallahassee, FL 32399-1050; faxed to [phone] or [phone]; or emailed to [e-mail], or submitted via the department’s web portal. The form BVC100SB, Sexual Battery Forensic Examination Claim Form revised 11/1910/15, is adopted and incorporated by reference at the following address: http://www.flrules.org/Gateway/reference.asp?No=Ref-11403. A copy of said form can be obtained at www.myfloridalegal.com or by contacting the Office of the Attorney General, Bureau of Victim Compensation. Failure to submit a properly completed claim form and invoice will result in denial of benefits.

(6) through (7) No change.

(8) The claim form shall include the following:

(a) through (g) No change.

(h) Forensic facility information which includes the name of the facility where the examination was performed, the facility’s federal tax identification number, mailing address, email address (if applicable), and telephone number including the area code;

(i) Forensic examiner information which includes their name, title, and license number; The name of another employee of the facility who was present at the time the examination was performed and shall henceforth be identified as the witness;

(j) Certification by the forensic examiner to affirm that the initial forensic physical examination for which the claim is based was performed for the purpose of collecting forensic evidence from the victim on the date identified using practices consistent with the established Adult and Child Sexual Assault Protocols; and, The witness must attest to the fact that the examination was performed on the victim at the location identified;

(k) The signature of the forensic examiner and date of signature. The signature of the witness and date of signature;

(l) Name, federal tax identification number, payment remittance address, email address, and telephone number of the medical provider seeking reimbursement; Forensic examiner information which includes their name, title, and license number;

(m) Medical provider billing representative’s name, title, acknowledgement from the representative that they have reviewed the medical records proving the examination occurred; Certification by the forensic examiner to affirm that the initial forensic physical examination for which the claim is based was performed for the purpose of collecting forensic evidence from the victim on the date identified using practices consistent with the establish Adult and Child Sexual Assault Protocols; and,

(n) Affirmation from the medical provider’s billing representative that the information presented is correct and payment for services is outstanding. The signature of the forensic examiner and date of signature.

(9) The itemized invoice shall be prepared using industry standard forms or on the provider’s letterhead. It must include the following:

(a) through (c) No change.

(d) Examination Ddiagnostic codes for the encounter for examination and observation following alleged adult or child rape; child sexual abuse suspected/confirmed; adult sexual abuse suspected/confirmed; or seduction (V71.5), encounter for examination and observation following alleged rape (Z044), encounter for examination and observation following alleged adult rape (Z0441), encounter for examination and observation following alleged child rape (Z0442); and,

(e) No change.

(10) No change.

Rulemaking Authority 960.045(1) FS. Law Implemented 960.28 FS. History–New 11-1-92, Amended 9-13-94, 9-26-95, 6-19-96, 9-24-97, 2-3-00, 3-17-03, 1-16-08, 8-1-10, 12-24-15, ___________.