SAFE-CARE Network providers should be used whenever possible for sexual abuse, physical abuse or neglect examinations. SAFE-CARE providers have received specialized training in the examination and interviewing of children who may have been sexually assaulted or physically abused. The SAFE-CARE Network provides CD and MO HealthNet Division (MHD) 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, physical abuse or neglect.
Staff may arrange an examination with a Network provider by calling his/her office for an appointment. Providers may also be contacted through the nearest Child Advocacy Center. The provider will conduct an exam which includes a complete medical history, comprehensive physical examination, an interview, complete genital examination, basic office laboratory procedures, and preparation of the SAFE-CARE form.
The Department of Health and Senior Services (DHSS), MO HealthNet Division (MHD), Department of Public Safety (DPS) and Children’s Division (CD) work together on the SAFE-CARE Network. The Department of Public Safety (DPS) is responsible for payment of sexual assault and physical abuse examinations. The first avenue of payment should be through DPS.
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.
If a SAFE-CARE provider notifies Children’s Division staff that they no longer wish to participate in the SAFE-CARE Network, staff should ask the provider to notify Children’s Division, P.O. Box 88, Jefferson City, Missouri 65103, in writing.
If the parent caretaker agrees to take the child to a physician, an appointment time and date must be established before the investigator leaves the home. The investigator must follow up immediately after the scheduled appointment to ensure the child received the necessary examination. If the parent/caretaker failed to keep the appointment, 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 to request assistance in ensuring appropriate measures are taken for the child to receive the examination.
Photographs of children with injuries should be taken by hospital, law enforcement, or juvenile office personnel only. CD workers may take photographs of serious/severe neglect situations where a co-investigator is not present during the investigation.
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 size, 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 SAFE-CARE Examinations
The Department of Public Safety (DPS) is responsible for the payment of the forensic examination charges incurred as a result of gathering evidence for the evidentiary collection kit of persons who may be a victim of sexual assault or physical abuse which occurred in the state of Missouri. For billing purposes, providers would use the Sexual Assault Forensic Examination (SAFE) Program Report. The SAFE Program Report, the checklist, and an itemized billing statement should be mailed to the Department of Public Safety, SAFE Program, PO Box 3001, Jefferson City, MO 65102. All claims for Sexual Assault Forensic Examination and physical abuse examinations must be submitted to DPS within 90 days from the date of the forensic exam. If there are any questions, providers may call 573-526-5779.
In situations where DPS is not able to pay for the SAFE-CARE exams, MO HealthNet Division (MHD) pays for examinations covered by MO HealthNet. CD will pay for examinations not covered by MHD if there is a Child Abuse/Neglect Investigation.
CD, along with MHD 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 MHD rates based on the corresponding MHD Cost Code:
|Procedure Codes||Types of Service||Description||Reimbursement Rate|
|99205 U7||1||SAFE, Sexual Assault||$187.50|
|W1350U7||1||CARE, Child Abuse Resource Education||72.50|
|81025U7||1||Urine pregnancy test||7.20|
|86689U7||1||HIV, Western Blot||24.00|
|87534U7||1||HIV-1, direct probe technique||21.71|
|87535U7||1||HIV-1, amplified probe technique||48.50|
|87537U7||1||HIV-2, direct probe technique||27.71|
|87538U7||1||HIV-2, amplified probe technique||48.50|
|87076U7||1||Culture, Bacterial, any source definitive||7.50|
|87077U7||1||Culture, Bacterial, aerobic isolate||7.50|
|56820U7||1||Exam of Vulva w/Scope||57.12|
|57420U7||1||Exam of Vagina w/Scope||59.98|
When Children’s Division is responsible for SAFE-CARE payments, providers may use a copy of page one of the SAFE-CARE form for billing purposes. This copy is attached to the Payment Request. If SAFE-CARE providers prefer, they may use their own billing statement rather than the copy of page one of the SAFE-CARE forms. Laboratory charges must be itemized on a separate statement. CPT codes must be printed on the invoice. 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 the correct vendor number to enter on the Payment Request.
Payments for a Mental Health Assessment or Evaluation to Determine Evidence of Emotional Maltreatment:
- If the child is MO HealthNet eligible, staff should make every effort to arrange for the mental health assessment or evaluation with a MO HealthNet provider.
- If it is determined the child is not eligible for MO HealthNet and/or no MO HealthNet provider is available, staff should contact a CTS provider to complete the assessment.
- If it is determined no CTS provider contracted for assessment or evaluation is available to provide the services, staff will:
- Select any non-CTS Psychologist, Psychiatrist, Psychiatric Clinical Nurse Specialist (PCNS), Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) to provide the appropriate assessment.
- If a non-CTS provider is willing to provide the service staff must:
- Contact the Contract Management Unit and request a contract be sent to the provider prior to the mental health assessment being conducted.
- Once the provider signs and returns the CTS contract to Contract Management the provider may be used to provide the service.
- Payment for mental health assessments or evaluations may be authorized and paid through a service authorization if entered on a timely basis. If the service authorization is not entered timely, a Payment Request should be completed and sent to the FACES Payment Unit.
- 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.
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 physician(s) to determine if a CA/N report should be made.
- Verify evidence of physical and/or sexual abuse was discovered during a physical examination and resulted in a CA/N report.
- Verify the cost of the examination was not paid/covered by the patient, the Department of Public Safety, MO HealthNet, or private health insurance. If not, request an invoice in triplicate from the physician for purposes of submission to the FACES Payment Unit for 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 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 maximum reimbursement rates for paying providers for medical records were changed effective February 1, 2019. The new amounts are:
- A copying fee of $26.01 and $0.60 cents per page for the cost of supplies and labor for copies provided in paper form
- An additional fee of $24.35 if the records are maintained off-site
- Copies provided electronically (e.g. disc, fax, email) have a maximum copying fee of $26.01 plus $0.60 cents per page, or $114.00 total, whichever is less
- Postage to include packaging and delivery cost
When Children’s Division staff request and receive medical records from providers, all bills for payment for those records are made by completing a Payment Request. To complete the Payment Request, please use Vendor Type- CT, Program Area- CT, Service Code RCRD. If the provider does not have a DVN, staff will follow the instructions located in the FACES Reference Manual (http://dssweb/cs/faces/reference/facesreference/RM/Vendor.pdf). A vendor number will be assigned prior to the Payment Request being entered. Make sure the bill is attached to the Payment Request and send the Payment Request and attachments to the FACES Payment Unit.
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