OAR 137-084-0020: Maximum Amounts Paid for Medical Services

(1) For dates of service beginning July 1, 2019, the Fund will pay eligible medical services providers the costs incurred for providing sexual assault medical services to victims of sexual assault up to the following maximum amounts: (a) $475.00 for a medical examination plus collection of forensic evidence using the Oregon State Police SAFE Kit; (b) $215.00 for a medical examination without collection of forensic evidence using the Oregon State Police SAFE Kit; (c) $70.00 for emergency contraception (including pregnancy test); (d) $125.00 for sexually transmitted disease prophylaxis; (e) Up to five (5) days of HIV prophylaxis will be paid at 50% of the amount charged, up to a maximum amount listed in 137-084-0020(h); (f) $95.00 for services provided by a Doctor of Medicine or a Doctor of Osteopathy; (g) Payment for all other services provided in conjunction with the sexual assault exam will be calculated using the Oregon Workers Compensation Fee Schedule, up to a maximum amount listed in 137-084-0020(h); see section 137-084-0030 for examples of non-covered services; (h) The combined maximum payment amount for services listed in 137-084-0020 (e) and (g) will not exceed $2,000.00; (i) Payment for laboratory and radiology services provided in conjunction with the sexual assault exam will be calculated using the Oregon Workers Compensation Fee Schedule up to a combined maximum amount of $500.00; (j) Any services provided after the date of the sexual assault exam will not be paid by the SAVE Fund with the exception of 137-084-0020(k). Services after this date may be covered by the Crime Victims' Compensation Program. (k) Five (5) counseling sessions; counseling sessions expire 18 months from the date of the sexual assault exam. Hourly rates as of March 1, 2021: (A) $160.00 per hour for a Doctor of Medicine; (B) $130.00 per hour for a PhD, PsyD, or PMHNP; (C) $105.00 per hour for an LCSW, LPC, or LMFT; (D) $75.00 per hour for a QMHP. (l) The Department may pay for other counseling services based on the nature of the victimization and the education, training and experience of the provider when sufficient documentation establishing the provider's education, training and experience is provided to the Department. The Department will determine the hourly payment amount based on the supporting documentation. (2) An additional payment of $95.00 will be made to eligible medical services providers who document that the medical examination, as part of either a partial or complete medical assessment, was conducted by a SANE/SAE as described in section 137-084-0001 of these rules. (3) The payment amounts set out in this rule will be reviewed at least every four years by the Attorney General or the Attorney General's designee to determine whether they should be adjusted to meet current circumstances. (4) An eligible medical services provider (including subcontractor or other designee) who submits a bill to the Fund under these rules may not bill the victim or the victim's insurance carrier for a medical examination, collection of forensic evidence using the Oregon State Police SAFE Kit, or other services provided in conjunction with the sexual assault exam, except to the extent the Department is unable to pay the bill due to lack of funds or declines to pay the bill for reasons other than untimely or incomplete submission of the bill to the Fund under OAR 137-084-0030(2)(e).