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Clarification regarding the applicability of the payer of last resort provision in the Patient Protection and Affordable Care Act to state VOCA victim compensation programs

June 3, 2016

TO:         VOCA Victim Compensation Administrators

FROM:   Joye E. Frost
              OVC Principal Deputy Director
              Office for Victims of Crime

The purpose of this message is to clarify how the payer of last resort provision in the recently enacted Patient Protection and Affordable Care Act (ACA) applies to your state’s Victims of Crime Act of 1984 (VOCA) victim compensation program.

A state victim compensation program asked the Office for Victims of Crime (OVC) and the Department of Health and Human Services’ Indian Health Service (IHS) to opine on how the VOCA payer of last resort provision (42 U.S.C. § 10602(e), for state victim compensation programs) applies in light of ACA’s similar and more recently enacted provision (25 U.S.C. § 1623, for certain Indian health programs). In particular, OVC and IHS were asked to provide policy guidance in determining the appropriate funding source to cover the costs of sexual assault examinations for victims who are eligible to receive such examinations from the Indian health organizations covered by the ACA provision. ACA identifies such organizations as IHS, Indian Tribes, tribal organizations, and urban Indian organizations, and provides specific definitions (25 U.S.C. § 1603).

After a thorough evaluation of the prevailing statutes, OVC determined that the more recently enacted ACA payer of last resort provision supersedes the VOCA provision in situations where both apply. Consequently, state compensation programs should use VOCA funds to pay for eligible victim compensation costs (including sexual assault examinations) that otherwise would be covered by the Indian health programs listed in the ACA provision; and the Indian health programs covered by the ACA provision would be the payer of last resort for such costs.

OVC encourages state victim compensation programs to coordinate proactively with the relevant Indian health organizations in the state to ensure that any potential gaps in services are addressed, and that victims’ needs are met, in instances where both VOCA funds and IHS resources for sexual assault examinations are possible options.

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