Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.10.01 - ADMINISTRATIVE RULES UNDER THE CRIME VICTIMS COMPENSATION ACT › Section 17.10.01.011 - APPLICATIONS FOR COMPENSATION

Current through August 31, 2023
01.
Claim for
			 Benefits
. To claim benefits under the Crime Victims Compensation Act,
			 the claimant shall file an Application for Compensation with the Crime Victim's
			 Compensation Bureau of the Commission. Applications for Compensation shall be
			 made using the form approved by the Commission. An Application for Compensation
			 is deemed filed when it is received at the Commission's office in Boise.
			 (3-31-22)
02.
Providing
			 Information
. Before paying benefits to any claimant, the Commission
			 shall gather sufficient information to establish that the claimant is eligible
			 for benefits. The Commission may require the claimant to assist the Commission
			 in obtaining that information. (3-31-22)
03.
Employment Verification
. To
			 verify information concerning a victim's employment, the Commission may require
			 the victim's Employer or Employers to complete an Employment Verification form
			 or the Commission may obtain such information from an Employer by telephone.
			 (3-31-22)
04.
Order
.
			 After sufficient information has been gathered pursuant to Subsection
			 011.02 of this rule, the
			 Commission may enter an award granting or partially granting benefits or an
			 order denying benefits. The Commission may also enter orders necessary to
			 further the purposes of the Act. (3-31-22)
05.
Finality of Order
. An award
			 or order issued by the Commission shall be final and conclusive as to all
			 matters considered in the award or order; provided that within twenty (20) days
			 from the date that such an award or order is issued, the claimant may file a
			 request that the Crime Victim's Compensation Program reconsider the order, or
			 the Crime Victim's Compensation Program may reconsider the matter on its own
			 motion, and the order of the Crime Victim's Compensation Program shall be final
			 upon issuance of the order on reconsideration; and provided further that,
			 within forty five (45) days from the date that any order is issued by the Crime
			 Victim's Compensation Program, a claimant may file a Request for Hearing before
			 the Commission. The Hearing shall be held in accordance with the procedures set
			 out in Section 012 of these
			 rules. Requests for Hearing before the Commission and requests that the Crime
			 Victim's Compensation Program reconsider an order is deemed filed when received
			 at the Commission's office in Boise. (3-31-22)
06.
Recipients of Payments for Medical
			 Services
. If, pursuant to any order of the Commission or the Crime
			 Victims Bureau, it is determined that a claimant is entitled to payment of
			 medical expenses as provided in Section
			 72-1019(2), Idaho
			 Code, or funeral or burial expenses as provided in Section
			 72-1019(4), Idaho
			 Code, payment shall be made directly to the medical provider or the provider of
			 funeral or burial services unless the claimant has already paid the provider;
			 if the claimant has already paid the provider, payment shall be made to the
			 claimant. (3-31-22)
07.
Allowable Payments for Medical Services
. The Commission shall pay
			 providers the allowable payment for medical services under these rules adopted
			 in accordance with Section
			 72-1026, Idaho Code. (3-31-22)
a. Adoption of Standard. The Commission
			 hereby adopts the Resource-Based Relative Value Scale (RBRVS), published by the
			 Centers for Medicare and Medicaid Services of the U.S. Department of Health and
			 Human Services, as amended, as the standard to be used for determining the
			 allowable payment under the Crime Victims Compensation Act for medical services
			 provided by providers other than hospitals and ASCs. The standard for
			 determining the allowable payment for hospitals and ASCs shall be: (3-31-22)
i. For large hospitals: Eighty-five percent
			 (85%) of the reasonable inpatient charge. (3-31-22)
ii. For small hospitals: Ninety percent (90%)
			 of the reasonable inpatient charge. (3-31-22)
iii. For ambulatory surgery centers (ASCs)
			 and hospital outpatient charges: Eighty percent (80%) of the reasonable charge.
			 (3-31-22)
iv. Surgically implanted
			 hardware shall be reimbursed at the rate of actual cost plus fifty percent
			 (50%). (3-31-22)
v. Paragraph
			 011.07.e. of this rule, does not apply to hospitals or ASCs. The Commission
			 shall determine the allowable payment for hospital and ASC services based on
			 all relevant evidence. (3-31-22)