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Nurses Say The State Hasn't Been Reimbursing Them For Rape Kits

Sexual Assault Kits
Nick de la Canal / WFAE
A staff member at Charlotte's Safe Alliance holds an sample sexual assault kit.

WFAE’s She Says podcast found that all sexual assault survivors don’t have equal access to evidence kits. A little more than half of the 121 hospitals registered to the state have programs and kits. But now, Sexual Assault Nurse Examiners at some of those hospitals say the state hasn’t been reimbursing them for the services they provide victims for more than a year.  

Rape victims are not allowed to be billed for the sexual assault evidence collection kits, according to state law. There’s a fund with more than $1.5 million to pay hospitals for providing this treatment. That funding source helped nurse Catherine Rossi start a Sexual Assault Nurse Examiner, or SANE, program at Cone Health in Greensboro in 1997.

“I was able to show while there isn’t a lot of money to be made per se and you are still going to lose money, the cost-effectiveness of what we do — and ability to do the right thing for the patients in our community — is a huge selling point,” Rossi said.

And for two decades, she said, the state reimbursed Cone Health a limited amount of money for this care. Her program now covers six hospitals in three counties.

But Rossi said she serves people far beyond those geographical boundaries.

“We already have counties in our state that have no services," she said. "I have patients that are put in ambulances that travel two to three hours to me — to come see a specialized professional to care for them.”

According to Rossi, the program at Cone Health does about 150 kits a year. It’s unclear exactly how much it costs the hospital. State law spells out that it can reimburse programs up to $800 per patient, with $350 for evidence collection – which can take several hours. The rest is for costs of materials and equipment as well as other things like ambulance rides or medicines for sexually transmitted infections. Rossi said Cone Health hasn’t been paid for about 100 patients. If the state had fully reimbursed the hospital, it could mean as much as $80,000.

She noticed last year that the Department of Public Safety stopped sending checks from the Rape Victim Assistance Program, or RVAP.

Rossi said DPS wouldn’t return calls, they would just send mail.

“It was decline after decline after decline,” she said.

She also said some reimbursements trickled in over the last year and a half, but they often weren’t for the full amount.

Rossi wasn’t the only one dealing with these problems. Heather Waleski runs the SANE program in Union, Stanly and Anson counties for Atrium Health. She is also the president of the North Carolina chapter of the International Association of Forensic Nurses. In that role, she said she heard from other nurses around the state that they were also having trouble with reimbursements.    

“It seemed to have switched with a personnel switch — not that there was a change to law, a change to the statute or anything like that,” Waleski said.

Credit Alex Olgin/ WFAE / WFAE
The hospitals in North Carolina that reported having SANE programs as of July 2018.

Before, Waleski and others in her position faxed a form to DPS with basic patient information — which counted as proof — a kit was collected. But recently, Waleski said DPS has been wanting confirmation from local law enforcement agencies that they have the kits.

“The aspect of law enforcement somewhere verifying that that kit has been collected when it’s a medical exam and a kit that was provided at a medical hospital,” she said. “The verification of that being done by law enforcement can be tricky sometimes.”  

According to the Violence Against Women’s Act, a victim is not required to participate in a criminal investigation for the hospital to be reimbursed for providing these services. Waleski thinks the statewide tracking system for kits that lawmakers established with a new law this year could help with that verification. The law passed after a report in February found there were about 15,000 untested kits at local law enforcement agencies across the state. That tracking system is supposed to go into effect in October.

Rossi, the nurse at Cone Health, said she used to indicate kits were anonymous on the reimbursement form.

But recently, DPS has been asking for more, she said. 

“On top of that, to add the additional layer of seeing the private medical information detailing some of the most explicit unspeakable acts that can be done on one human being to another — it’s just unacceptable," Rossi said.

Rape Kit
Credit Sarah Delia / WFAE
The inside of a sexual assault kit. Each envelope will contain evidence taken the night of the assault.

Anonymous kits are stored at a warehouse in Raleigh while the victim decides whether or not to press forward with a criminal investigation. Rossi and Waleski said they met with representatives at the Department of Public Safety in the spring to try and resolve the reimbursement problems.

But little changed after that meeting, until two weeks ago. That's also when WFAE requested records about how much of the money in the RVAP was paid out and how many applications for reimbursement hospitals sent. A department spokeswoman said the legal department is reviewing the documents and will be releasing them, but didn’t specify when.

Waleksi said her program got 15 checks in the last two weeks. And Rossi said this week her program started hearing back from people at DPS.

“An unusual amount of activity in that they’ve reached out to resolve some longstanding, outstanding bills that we’ve had with them,” she said. “They called us about statements from a year ago for payment, and for rape services or evidence collection.” 

Rossi and Waleksi’s biggest concern is that SANE Programs could fold without the money. A large system like Cone Health is in a better position to absorb the cost than some hospitals in rural areas. They are also concerned that if the lawmakers see that the money from the Rape Victims Assistance Fund isn’t being paid to hospitals, they could decide not to fund it in the future.  

DPS responded to requests for comment with this statement Thursday: 

"A transition in personnel earlier this year led to a brief period where a backlog in reimbursements did take place. Victim Services met with a representative group of SANE nurses in May 2018 to assure its commitment to erasing this backlog, and ways to expedite clearing of payments. Victims Services reports that at this time, according to reimbursement claims received, claims processing for payment is current."