Financing Your Program

All programs should have income that results from the services they provide. In addition to revenue generated from services provided, SANE programs may need to look to other sources for funding. 

Billing for Care of Sexual Assault Patients 

SANE programs typically have three options for billing directly for services, but different options for reimbursement may exist in your state. SANE programs can bill a patient's health insurance company. All billing of insurance companies must be in compliance with VAWA regulations. As discussed in Chapter 4,  under the Violence Against Women Act (VAWA), states must certify, as a condition for certain grant funds, that the state or another governmental entity bear the “full out-of-pocket costs” for medical forensic examinations. Although it is allowable for states to help fund the examinations through billing of a victim's personal insurance, the Office on Violence Against Women (OVW) strongly discourages states from requiring victims to use their insurance. In some cases, insurance billing can present a hardship for victims. For example, a victim of spousal rape may not want her husband to find out that she got a forensic exam. If the victim is forced to submit the claim to her insurance company, and she is on her husband’s insurance policy, he may receive a statement from the insurance indicating that she got the exam. In addition, billing departments need to ensure that victims do not receive bills for any out-of-pocket costs, such as copayments or deductibles.

In some states, programs may be able to bill the state Crime Victims Compensation program directly. State and federal monies derived from fines paid by convicted criminals fund these programs. The funds are used for victim services and to compensate victims for some losses that occur as a result of a crime. 

In some jurisdictions, law enforcement or prosecution may pay for the evidence collection because they view it as a law enforcement function. 

Billing and Coding Practices

In order to bill both insurance companies and victim compensation funds, the SANE program may need to provide itemized bills using standard health care billing practices. This means proper International Statistical Classification of Diseases and Related Health Problems (ICD-10), coding of charges. A list of ICD-10 Codes can be found at the end of this chapter. 

Other Sources of Earned Income 

SANE programs may provide other services that can be billed. Two common services are suspect examinations and expert witness fees. 

Suspect Examinations

These types of examinations fall outside the SANE's scope of victim sexual assault examinations. Existing laws and statutes may not cover suspect examinations in the same manner as examinations for victims. If the SANE program is involved in suspect collections, a fee schedule and a payment process should be discussed with the law enforcement or prosecuting agency requesting the examinations.

Expert Witness Fees

Because of their unique skills in administering forensic exams, SANEs are sometimes asked to provide court expert witness testimony and case consultation. This assistance may be requested by either a prosecuting agency or defense counsel, and could be outside the scope of their existing employer. When considering this type of potential work, it is important to remain within the individual's field of expertise. If employed by a medical facility, the SANE should take steps to advise their present employer of any involvement in court testimony or consultation. Depending on how this service is provided, the team may be paid for the nurse’s services or the nurse may be reimbursed directly. It is important to make sure that providing testimony is not a conflict of interest for a nurse who is a member of a SANE team. 

Providing this testimony and consultation usually entails a fee schedule. There is a minimal amount of information in the public forum pertaining to fee schedules. These fees may vary from within jurisdictions as well as by the scope of the testimony and consultation requested. Any compensation should ultimately be determined by the nurse's work, education, certification, and experience.

Fundraising 

If you are part of a hospital-funded program, then fundraising may not be a significant part of your program development. For community-based programs, fundraising is a critical component as the program identifies how to purchase equipment, provide nursing education, and fund basic administrative costs. Once a program is established, fundraising fills the gap between what the program earns by billing for the examination and the actual program costs. It is important to know if there are people who need to grant you permission if you want to do fundraising. For example, in a tribal community, tribal leaders may need to grant permission to raise money. SANE programs need to understand that they are part of a larger community, and should be aware when there are limited dollars for social programs, so their fundraising may impact the ability of other organizations to provide services. For example, a community fund might be willing to contribute to the SANE program, but only if they cut existing funding to rape crisis services and the Children's Advocacy Center. It is important to work with community partners to avoid creating an atmosphere of competition for limited funds. 

Getting Started – How Will You Ask for Money?

Before you can ask for money, you need to have some sort of corporate entity established that can accept the money. Most corporations or foundations will not give to an organization unless they are recognized as a not-for-profit, tax-exempt organization by the Internal Revenue Service (IRS). It can take 3 to 6 months or longer to receive approval from the IRS after an application is submitted. If you are part of an existing nonprofit, such as a rape crisis center, you will need to work closely with them to see if they will allow donations for your program to be designated for your use. 

It is possible to use another organization's tax-exempt status to raise funds for your SANE program initially. This concept is called a fiscal sponsorship. It is both helpful and recommended to have legal counsel during the process of creating your nonprofit and if you decide to create a formal relationship with an existing nonprofit. There are also many web-based organizations with free information about starting nonprofits and fundraising in your community. 

In addition to obtaining tax-exempt status, 40 states require charitable organizations to register with the state before they can solicit individuals for funds. A SANE program that serves more than one state will need to register in all states where they plan to solicit donations. If a program solicits donations on a website, they may be required to register in all 40 states. 

Sources of Fundraising Money 

1. Events 
   Depending on how much money you need to raise, fundraising events can serve a dual purpose. They can bring in donations while raising awareness about the issues surrounding sexual assault and the need for a SANE program at the same time. Events typically do not raise a lot of money for the amount of time and expense required to organize and hold the event. 
    
2. Community Clubs and Organizations
   Sponsorship from a community organization can raise money without a lot of time or expense on the part of the SANE program. Many community organizations, including fraternal, service, and religious groups, may provide funds for a specific piece of equipment or other needed items, such as teddy bears to give to children during an examination or clothing for a patient to wear home after evidence collection. Service clubs will often hold events in the community and donate the proceeds to other organizations. Volunteering to talk to a monthly meeting of a club or organization is a good way to develop a relationship that can be a source of funding and increase community awareness. 
    
3. Private Grants 
   Grant writing to private foundations is another source of funding. It is important to make sure the foundation provides funds for your type of program. For example, there are some foundations that only provide money to the performing arts or scholarships for college students. Make sure you complete any requested forms and meet all application deadlines. All foundations are required to file IRS 990 forms, which can be searched online. Looking at a foundation's 990 forms will let you know what types of causes they give money to and what is a typical amount donated to any one cause. 
    
4. Federal Grants
   In addition to private grants, there are federal sources of money for SANE program development. OVW currently administers 24 grant programs authorized by VAWA of 1994 and subsequent legislation. Four programs are "formula," meaning the enacting legislation specifies how the funds are to be distributed. The remaining 20 programs, including 6 formerly authorized programs that still have open and/or active grants, are "discretionary," meaning OVW is responsible for creating program parameters, qualifications, eligibility, and deliverables in accordance with authorizing legislation.
   
   Each program has a specific focus, such as rural areas or culturally specific services. Please see the OVW website for more details on each program. You can also review past years' solicitations for an idea of what you will need to prepare in order to apply. For formula grants, you can apply for subgrant funding through the state administering agency. It is important to note that VAWA includes a nondiscrimination grant condition that prohibits recipients of funds made available under VAWA from discriminating on the basis of actual or perceived race, color, national origin, religion, sex, disability, sexual orientation, or gender identity in their services and employment practices.  
   
   The Office for Victims of Crime also provides federal funding to the states in the form of Victim Assistance Formula Grants. It is important to note that VOCA program guidelines include a nondiscrimination condition that prohibits all recipients of federal funds made available under VOCA from discriminating on the grounds of race, color, religion, national origin, sex, age, or disability, or excluding from participation in, denying the benefits of, subjecting to discrimination under, or denying employment in connection with any program or activity receiving federal financial assistance. Check with your state VOCA funds administrator to learn how to apply.
   
   The National Sexual Assault Medical Forensic Exam Response Protocols and Federal Funding
    
5. Nonprofit Hospital Community Benefit 
   If your program is either nonprofit hospital-based or in a community with a nonprofit hospital, funds may be available as part of the hospital's community benefit program. Under the Affordable Care Act, nonprofit hospitals are required to perform a community needs assessment every 3 years. Find out how this is done in your community and if sexual violence programs and services are part of the assessment. Once an assessment is completed, the nonprofit hospital must use a certain percentage of its funds to meet these community needs. Many nonprofit hospitals also have a foundation where SANE programs may be able to apply for money. 
    
6. In-Kind Donations
   Many community businesses may not be in a position to donate money, but may be willing to donate their products or services. Everything from carpet cleaning to office supplies are one less expense for a SANE program budget if donated. It is also a way to educate and engage the community about your program and other sexual violence issues.
    
7. Funding Programs in Tribal Communities 
   The United States Government has a legally defined responsibility to provide health care to American Indians and Alaska Natives. Health care services are provided through facilities managed by the federal Indian Health Service (IHS), through facilities managed by tribes under contract with IHS and urban Indian health programs.
   
   The IHS Domestic Violence Prevention Initiative (DVPI) has funding available to develop and implement a SANE program and a Sexual Assault Response Team. Receiving funding through a DVPI grant involves a competitive application process. Federal IHS facilities, tribes, tribal organizations, and urban Indian health programs are eligible to apply.
   
   Additional funding opportunities may also be available, and creative funding options such as fundraising should be considered. Federal IHS programs must have all sources of funding approved through the regional IHS area office, as well as IHS headquarters. Federal IHS programs should also ensure that sources of funding are acceptable and approved by tribal leadership. Tribal organizations may have more flexibility with funding sources but, similar to federal IHS programs, all sources of funding would need approval by tribal leadership.

ICD-10 Codes:

• Confirmed abuse, neglect and other maltreatment, confirmed (adult and child)
• Confirmed abuse, neglect and other maltreatment, suspected (adult and child)