(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) Payments are awarded regardless of whether the victim is covered by health or disability insurance. The victim must not be billed directly or indirectly for expenses associated with the examination.
    (3) Payments are not contingent on the victim’s participation in the criminal justice system or cooperation with law enforcement.
    (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 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 (850)414-6197 or (850)414-5779; emailed to VCIntake@MyFloridaLegal.com, or submitted via the department’s web portal. The form BVC100SB, Sexual Battery Forensic Examination Claim Form revised 11/19, is adopted and incorporated by reference at the following address: http://www.flrules.org/Gateway/reference.asp?No=Ref-12144. 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.
    (6) For a faxed claim form and invoice to be timely received, the transmittal cover page must provide sufficient information to identify the claim for which payment is sought, and bear a faxed date stamp that is within 120 days immediately following the examination.
    (7) Payment shall not exceed $500 with respect to any violation. Separate invoices submitted for payment consideration of a single examination shall be divided in accordance with the direction and discretion of the department.
    (8) The claim form shall include the following:
    (a) The victim’s name;
    (b) Optional demographic data for statistical purposes, including date of birth, race/ethnicity, gender, and national origin;
    (c) The date the sexual battery or lewd or lascivious battery or molestation as reported by the victim;
    (d) Indication whether or not the victim has reported the incident to law enforcement, and if so, what law enforcement agency took the report, and the case/report number, if applicable;
    (e) City, county, and state where the crime was committed according to the victim’s statement;
    (f) Whether or not the crime occurred while the victim was incarcerated or in custody;
    (g) The date the examination was completed;
    (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 and telephone number including the area code;
    (i) Forensic examiner information which includes their name, title, and license number;
    (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,
    (k) The signature of the forensic examiner and date of signature;
    (l) Name, federal tax identification number, payment remittance address, email address, and telephone number of the medical provider seeking reimbursement;
    (m) Medical provider billing representative’s name, title, acknowledgement from the representative that they have reviewed the medical records proving the examination occurred; and,
    (n) Affirmation from the medical provider’s billing representative that the information presented is correct and payment for services is outstanding.
    (9) The itemized invoice shall be prepared using industry standard forms or on the provider’s letterhead. It must include the following:
    (a) Facility name, address, and tax identification number;
    (b) Date of the examination;
    (c) Victim’s name;
    (d) Diagnostic codes for the encounter for examination and observation following alleged adult or child rape; child sexual abuse suspected/confirmed; adult sexual abuse suspected/confirmed; and,
    (e) One or more of the following procedures:
    1. Certified or board-eligible healthcare examiner’s office or other outpatient services;
    2. Emergency department services;
    3. Use of medical facility for the collection of forensic physical evidence;
    4. Venipuncture for the collection of blood samples;
    5. Laboratory tests for baseline sexually transmitted disease and pregnancy; or
    6. Forensic evidence collection kit.
    (10) Only medical expenses connected with the initial forensic physical examination shall be considered.
Rulemaking Authority Florida Statutes § 960.045(1). Law Implemented Florida Statutes § 960.28. 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, 9-13-20.