reglab/statecodes huggingface dataset:
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.37 - CHILDREN'S MENTAL HEALTH SERVICES › ALTERNATE CARE PLACEMENT › Section 16.07.37.283 - PAYMENT TO FAMILY ALTERNATE CARE PROVIDERS

Current through August 31, 2023
Monthly payments for care provided by family alternate care
				  providers are paid according to IDAPA 16.06.01, "Child and Family Services."
				  (3-17-22)
01.
Gifts
.
				Additional payments for Christmas gifts and birthday gifts will be paid in the
				appropriate months. (3-17-22)
02.
Clothing
. Costs for clothing will be paid, based upon the
				Department's determination of each child's needs. All clothing purchased for a
				child in alternate care becomes the property of the child. (3-17-22)
03.
School Fees
. School fees due
				upon enrollment will be paid directly to the school or to the foster parents,
				based upon the Department's determination of the child's needs.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.37 - CHILDREN'S MENTAL HEALTH SERVICES › ALTERNATE CARE PLACEMENT › Section 16.07.37.284 - ADDITIONAL PAYMENTS TO FAMILY ALTERNATE CARE PROVIDERS

Current through August 31, 2023
For those children who, as determined by the Department,
				  require additional care above room, board, shelter, daily supervision, school
				  supplies, and personal incidentals, the Department may pay the family alternate
				  care provider an additional amount to that paid according to IDAPA 16.06.01,
				  "Child and Family Services." The family alternate care rate is based upon a
				  continuous ongoing assessment of the child's circumstances that necessitate
				  special rates as well as the care provider's ability, activities, and
				  involvement in addressing those special needs. (3-17-22)
01.
Lowest Level of Need
. A
				child requiring a mild degree of care for documented conditions receives the
				lowest level of additional payments for the following: (3-17-22)
a. Chronic medical problems;
				(3-17-22)
b. Frequent,
				time-consuming transportation needs; (3-17-22)
c. Behaviors requiring extra supervision and
				control; and (3-17-22)
d. Need for
				preparation for independent living. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.37 - CHILDREN'S MENTAL HEALTH SERVICES › ALTERNATE CARE PLACEMENT › Section 16.07.37.600 - TREATMENT FOSTER CARE

Current through August 31, 2023
A family home setting in which treatment foster parents
				  provide twenty-four (24) hour room and board as well as therapeutic services
				  and a high level of supervision. Services provided in treatment foster care are
				  at a more intense level than provided in foster care and at a lower level than
				  provided in residential care. Services may include the following: participation
				  in the development and implementation of the child's treatment plan, behavior
				  modification, community supports, crisis intervention, documentation of
				  services and the child's behavior, participation as a member of a
				  multi-disciplinary team, and transportation. Placement into a treatment foster
				  home for children eligible for services under Section
				  107 of these rules is based on the
				  documented needs of the child, the inability of less restrictive settings to
				  meet the child's needs, and the clinical judgment of the Department.
				  (3-17-22)
01.
Qualifications
. Prior to being considered for designation and
				reimbursement as a treatment foster parent, each prospective treatment foster
				parent must accomplish the following: (3-17-22)
a. Meet all foster family licensure
				requirements as set forth in IDAPA 16.06.02, "Child Care Licensing";
				(3-17-22)
b. Complete
				Department-approved treatment foster care initial training; and
				(3-17-22)
c. Provide a minimum of
				two (2) references in addition to those provided to be licensed to provide
				foster care. The additional references must be from individuals who have worked
				with the prospective treatment foster parent. The additional references must
				verify that the prospective treatment foster parent has: (3-17-22)
i. Training related to, or experience working
				with, children or youth with mental illness or behavior disorders; and
				(3-17-22)
ii. Demonstrated
				cooperation and a positive working relationship with families and providers of
				mental health services. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.37 - CHILDREN'S MENTAL HEALTH SERVICES › ALTERNATE CARE PLACEMENT › Section 16.07.37.700 - RESIDENTIAL CARE FACILITIES

Current through August 31, 2023
Residential care facilities provide a more intensive setting
				  than treatment foster care. Residential care facilities in Idaho are licensed
				  under IDAPA 16.06.02, "Child Care Licensing" to provide residential care for
				  children and staffed by employees who cover assigned shifts. Children placed in
				  residential care facilities receive services that may include the following:
				  assessment, supervision, treatment plan development and implementation,
				  documentation, behaviorally focused skill building, service coordination or
				  clinical case management, consultation, psychotherapy, psychiatric care, and
				  twenty-four (24) hour crisis intervention. Placement into a residential care
				  facility for children eligible for services under Section
				  107 of these rules is based on the
				  documented needs of the child and the inability of less restrictive settings to
				  meet the child's needs. (3-17-22)
01.
Prior Authorization
. Prior authorization must be obtained from an
				authorized representative in the Department's Division of Behavioral Health for
				placement of a child in a residential care facility where the Division of
				Behavioral Health is making full or partial payment. (3-17-22)
02.
Payment
. When care is
				purchased from private providers, payment will be made in accordance with a
				contract authorized by the Department, based on the needs of each child being
				placed and the services to be provided. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.37 - CHILDREN'S MENTAL HEALTH SERVICES › ALTERNATE CARE PLACEMENT › Section 16.07.37.800 - SIX MONTH REVIEWS FOR CHILDREN IN ALTERNATE CARE PLACEMENTS

Current through August 31, 2023
A review is to occur at the end of a six (6) month period for
				  any child in an alternate care placement. The Department will conduct a case
				  review to assure compliance with all applicable state and federal laws, and to
				  ensure the treatment plan focuses on the goals of safety, permanency,
				  effectiveness of treatment, and well-being of the child. The Department may
				  request the court hold a review hearing for the child in accordance with
				  Section 16-2407(3), Idaho
				  Code. (3-17-22)
01.
Notice of
				Six Month Review
. The parent or guardian, foster parent of a child, or
				relative providing care for the child is to be provided with notice of their
				right to be heard in the six (6) month review. In the case of an Indian child,
				the child's tribe and any Indian custodian must also be provided with notice.
				This must not be construed to require that any foster parent, or relative
				providing care for the child be made a party to the review solely on the basis
				of the receipt of such notice. Participants have the right to be represented by
				the individual of their choice. (3-17-22)
02.
Procedure in the Six Month
				Review
. The parties who received notice will be given the opportunity to
				participate in the case review. (3-17-22)
03.
Members of Six Month Review
				Panel
. The six (6) month review panel must include a Department employee
				who is not in the direct line of supervision in the delivery of services to the
				child or parent or guardian. The review panel may include agency staff, staff
				of other agencies, officers of the court, members of Indian tribes, and
				citizens qualified by experience, professional background, or training. Members
				of the panel will be chosen by and receive instructions from an authorized
				representative in the Department's Division of Behavioral Health, to enable
				them to understand the review process and their roles as participants.
				(3-17-22)
04.
Considerations
				in Six Month Review
. Whether conducted by the court in a review hearing
				or a Department review panel, under state law, federal law and regulation, each
				of the following must be addressed in a six (6) month review: (3-17-22)
a. Determine the extent of compliance with
				the treatment plan; (3-17-22)
b.
				Determine the extent of progress made toward alleviating or mitigating the
				causes necessitating the placement; (3-17-22)
c. Review compliance with the Indian Child
				Welfare Act, when applicable; (3-17-22)
d. Determine the safety of the child, the
				continuing need for and appropriateness of the child's placement; and
				(3-17-22)
e. Project a date by
				which the child may be returned and safely maintained at home or placed for
				adoption, guardianship, or other permanent placement.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.000 - LEGAL AUTHORITY

Current through August 31, 2023
Sections
				16-2403 and
				66-317, Idaho Code, authorize the
				Department to promulgate rules appointing designated examiners and designated
				dispositioners. Sections
				56-1003 and
				56-1004, Idaho Code, authorize the
				Director to adopt rules to administer a mental health program. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.001 - SCOPE

Current through August 31, 2023
These rules set forth the qualifications, appointment
				requirements, appointment process, duration of appointment, revocation of
				appointment, and requirements for reappointment for designated examiners and
				designated dispositioners in Idaho. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.002 - INCORPORATION BY REFERENCE

Current through August 31, 2023
American Psychiatric Association: Diagnostic and Statistical
				Manual of Mental Disorders, Fifth Edition, (DSM-5) Washington, DC, American
				Psychiatric Association, 2013, is hereby incorporated by reference under this
				chapter of rules. Copies of the manual are available from the American
				Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA
				22209-3901. A copy of the manual is also available for public review at the
				Department of Health and Welfare, 450 West State Street, Boise, Idaho, 83702.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.009 - CRIMINAL HISTORY AND BACKGROUND CHECK REQUIREMENTS

Current through August 31, 2023
Each individual who is seeking appointment as a designated
				examiner or designated dispositioner, or both, must comply with the provisions
				in IDAPA 16.05.06, "Criminal History and Background Checks." An individual who
				is seeking appointment is available to practice as a designated examiner or
				designated dispositioner on a provisional basis at the discretion of the
				Department once the individual has completed the following: (3-17-22)
01.
Submission Of Criminal History
			 Check Application
. An individual has submitted their criminal history
			 and background check application; (3-17-22)
02.
Application Review
. The
			 completed application has been reviewed by the Regional Behavioral Health
			 Program Manager or the State Hospital Administrative Director of the region
			 where the applicant intends to practice, and no disqualifying crimes or
			 relevant records are disclosed on the application. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.010 - DEFINITIONS

Current through August 31, 2023
For the purposes of these rules, the following terms apply:
				(3-17-22)
01.
Advanced Practice
			 Registered Nurse
. An individual licensed as an Advanced Practice
			 Registered Nurse under Title 54, Chapter 14, Idaho Code. (3-17-22)
02.
Clinical Professional Counselor
			 (LCPC)
. An individual licensed as a Clinical Professional Counselor
			 under Title 54, Chapter 34, Idaho Code. (3-17-22)
03.
Clinical Social Worker
			 (LCSW)
. An individual licensed as a Clinical Social Worker under Title
			 54, Chapter 32, Idaho Code. (3-17-22)
04.
Department
. The Idaho
			 Department of Health and Welfare. (3-17-22)
05.
Designated Dispositioner
. A
			 designated dispositioner is a designated examiner employed under contract with
			 the Department and designated by the Director. (3-17-22)
06.
Designated Examination
. An
			 evaluation by an appointed mental health professional to determine if an
			 individual is mentally ill and if the individual is either likely to injure
			 themselves or others or is gravely disabled due to mental illness.
			 (3-17-22)
07.
Designated
			 Examiner
. A designated examiner is a psychiatrist, psychologist,
			 psychiatric nurse, social worker, or such other mental health professional as
			 may be designated under these rules. (3-17-22)
08.
Director
. The Director of
			 the Idaho Department of Health and Welfare or their designee.
			 (3-17-22)
09.
Division
. The Department's Division of Behavioral Health.
			 (3-17-22)
10.
Marriage and
			 Family Therapist (LMFT)
. An individual licensed as a Marriage and Family
			 Therapist under Title 54, Chapter 34, Idaho Code. (3-17-22)
11.
Masters of Social Work
			 (LMSW)
. An individual licensed as a Masters of Social Work under Title
			 54, Chapter 32, Idaho Code. (3-17-22)
12.
Physician
. An individual
			 licensed as a Physician to practice medicine under Title 54, Chapter 18, Idaho
			 Code. (3-17-22)
13.
Physician
			 Assistant
. An individual licensed as a Physician Assistant under Title
			 54, Chapter 18, Idaho Code. (3-17-22)
14.
Professional Counselor
			 (LPC)
. An individual licensed as a Professional Counselor under Title
			 54, Chapter 34, Idaho Code. (3-17-22)
15.
Psychologist
. An individual
			 licensed to practice psychology in Idaho under Title 54, Chapter 23, Idaho
			 Code. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.200 - MINIMUM QUALIFICATIONS AND REQUIREMENTS FOR APPOINTMENT AS A DESIGNATED EXAMINER

Current through August 31, 2023
To be appointed and practice as a designated examiner in Idaho,
				an applicant must meet the following minimum qualifications and requirements:
				(3-17-22)
01.
Required
			 License
. Each applicant maintains their professional licensure for the
			 duration of their appointment and be one (1) of the following: (3-17-22)
a. Physician; (3-17-22)
b. Psychologist; (3-17-22)
c. Advanced Practice Registered Nurse;
			 (3-17-22)
d. Clinical Professional
			 Counselor; (3-17-22)
e.
			 Professional Counselor; (3-17-22)
f. Clinical Social Worker;
			 (3-17-22)
g. Masters Social Worker;
			 (3-17-22)
h. Marriage and Family
			 Therapist. (3-17-22)
i. Physician
			 Assistant. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.300 - MINIMUM QUALIFICATIONS AND REQUIREMENTS FOR APPOINTMENT AS A DESIGNATED DISPOSITIONER

Current through August 31, 2023
To be appointed as a designated dispositioner in Idaho, an
				applicant must meet the following minimum qualifications and requirements.
				(3-17-22)
01.
Appointment as a
			 Designated Examiner
. Applicants for designated dispositioner are also
			 appointed as a designated examiner by the Director. (3-17-22)
02.
Required Experience and
			 Abilities
. Each applicant has received training on the available
			 treatment alternatives, types of treatment available for appropriate placement,
			 and level of care requirements all within Idaho. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.400 - APPOINTMENT OR REAPPOINTMENT AS A DESIGNATED EXAMINER OR DESIGNATED DISPOSITIONER

Current through August 31, 2023
Each applicant seeking an appointment or reappointment as a
				designated examiner or designated dispositioner, must submit the following
				information to the Regional Behavioral Health Program Manager of the region
				where they intend to practice or the State Hospital Administrative Director of
				the hospital at which they intend to practice. (3-17-22)
01.
Complete an Application
.
			 Each applicant completes and signs an application using forms approved by the
			 Department. (3-17-22)
02.
Provide Verification of Credentials
. Each applicant provides the
			 Department with the following: (3-17-22)
a. A
			 current resume that documents: (3-17-22)
i.
			 The applicant's degree, the date the degree was awarded, and the school from
			 which the degree was received; and (3-17-22)
ii. How the applicant meets the requirements
			 under Subsection 200.02 of
			 these rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.500 - DURATION OF APPOINTMENT AS DESIGNATED EXAMINER OR DESIGNATED DISPOSITIONER

Current through August 31, 2023
01.
Appointment
. Appointment expires one (1) year from the date of
			 appointment, unless the designated examiner or designated dispositioner applies
			 for, and is granted, a reappointment. (3-17-22)
02.
Reappointment
. Reappointment
			 expires two (2) years from the date of such appointment. (3-17-22)
03.
Expiration of Appointment Upon
			 Leaving Department Employment
. When an individual serving as a
			 designated dispositioner leaves the employ of the Department, their designation
			 of dispositioner is suspended, until such time that the appointment expires, or
			 the individual is under contract with the Department as a designated
			 dispositioner. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.07.39 - DESIGNATED EXAMINERS AND DISPOSITIONERS › Section 16.07.39.700 - REVOCATION OF APPOINTMENT AS DESIGNATED EXAMINER OR DESIGNATED DISPOSITIONER

Current through August 31, 2023
The Department may deny, suspend, or revoke the appointment or
				reappointment of designated examiners and designated dispositioners, or both,
				under the following procedures: (3-17-22)
01.
Emergency Denial, Suspension,
			 Revocation of Appointment or Reappointment
. The Department will deny,
			 suspend, or revoke appointment or reappointment, without prior notice, when
			 conditions exist that endanger the health or safety of any client.
			 (3-17-22)
02.
Written Request
			 for Denial, Suspension, or Revocation of Appointment or Reappointment
.
			 In the absence of an emergency, a written request from the Regional Behavioral
			 Health Program Manager or State Hospital Administrative Director will be made
			 to the Division stating the reason(s) for the requested denial, suspension, or
			 revocation of an appointment or reappointment. (3-17-22)
03.
Grounds for Revocation of
			 Appointment or Reappointment
. The Department may deny, suspend, or
			 revoke an appointment or reappointment for any of the following reasons:
			 (3-17-22)
a. Failure to comply with these
			 rules. (3-17-22)
b. Failure to
			 furnish data, information, or records as requested by the Department.
			 (3-17-22)
c. Revocation or
			 suspension of the applicant's professional license. (3-17-22)
d. Refusal to participate in a quality
			 assurance process as requested by the Department. (3-17-22)
e. Inadequate knowledge or performance as
			 demonstrated by repeated substandard peer or quality assurance reviews.
			 (3-17-22)
f. Misrepresentation by
			 the applicant in their application, or in documents required by the Department,
			 or by an appointee in which there is a criminal, civil, or administrative
			 determination that they have misrepresented the facts or the law to the court
			 or administrative agency. (3-17-22)
g. Conflict of interest in which an appointee
			 exploits their position as a designated examiner or designated dispositioner
			 for personal benefit. (3-17-22)
h.
			 A criminal, civil, or administrative determination that an appointee has
			 committed fraud or gross negligence in their capacity as a designated examiner
			 or designated dispositioner. (3-17-22)
i. Substantiated disposition of a child
			 protection referral or adult protection referral. (3-17-22)
j. Failure to correct within thirty (30) days
			 of written notice, any unacceptable conduct, practice, or condition as
			 determined by the Department to be detrimental to public health or safety.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.000 - LEGAL AUTHORITY

Current through August 31, 2023
This chapter is adopted under the legal authority of 72-301,
				72-301A, 72-304, 72-327, 72-432, 72-508, 72-528, 72-602, 72-803, and 72-806,
				Idaho Code. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.001 - TITLE AND SCOPE

Current through August 31, 2023
01.
Title
. The title of this chapter is "Administrative Rules Under
			 the Worker's Compensation Law" IDAPA 17, Title 01, Chapter 01.
			 (3-23-22)
02.
Scope
.
			 This chapter includes the Industrial Commission's worker's compensation rules.
			 (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.002 - WRITTEN INTERPRETATIONS

Current through August 31, 2023
The Industrial Commission uses the following guidelines for
				implementing the EDI reporting requirements set out in this Chapter:
				(3-23-22)
01.
EDI Guide and
			 Tables
. The Idaho Industrial Commission Claims EDI Implementation Guide
			 and Trading Partner Tables ("EDI Guide and Tables"). The Idaho Industrial
			 Commission Claims EDI Implementation Guide and Trading Partner Tables are
			 available on the Commission's website at
https://iic.idaho.gov/
.
			 (3-23-22)
02.
EDI
			 Implementation Guide
. International Association of Industrial Accidents
			 Boards and Commissions (IAIABC) EDI Claims Release 3.0 or, after September 14,
			 2023, Release 3.1, Implementation Guide ("EDI Implementation Guide"). The
			 IAIABC Claims Release 3.0 and Release 3.1 Implementation Guides are available
			 at the IAIABC website at
https://www.iaiabc.org
. (4-6-23)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.010 - DEFINITIONS

Current through August 31, 2023
The definitions set forth in Chapter 72, Idaho Code apply to
				these rules. In addition, the following terms have the meaning set forth below:
				(3-23-22)
01.
Adjustor
.
			 Means an individual who adjusts worker's compensation claims.
			 (3-23-22)
02.
Ambulatory
			 Payment Classification
. Means the payment system adopted by CMS for
			 outpatient services (3-23-22)
03.
Available Funds
. Means a sum of money to which a Charging Lien may
			 attach. It does not include any compensation paid or not disputed to be owed
			 prior to Claimant's agreement to retain the attorney. (3-23-22)
04.
Ambulatory Surgery Center
.
			 Means a facility providing medical services on an outpatient basis only.
			 (3-23-22)
05.
Approval by
			 Commission
. Means the Commission has approved attorney fees in
			 conjunction with an award of compensation or an LSS or otherwise in accordance
			 with Section 802 of this
			 rule upon a proper showing by the attorney seeking to have the fees approved.
			 (3-23-22)
06.
Average
			 Wholesale Price
. Means the average wholesale price for medicine obtained
			 from pricing data provided by the original manufacturer of that medicine to
			 industry-wide compilers of drug prices, e.g., Red Book and Medi-Span.
			 (3-23-22)
07.
Charge
.
			 Means the expense or cost. For hospitals and ASCs, "charge" means the total
			 charge. (3-23-22)
a. Acceptable charge. Means
			 a charge calculated in compliance with Section
			 803 of this rule or as billed by
			 the Provider, whichever is lower, or the charge agreed to pursuant to a written
			 contract. (3-23-22)
b. Customary
			 charge. Means a charge that has an upper limit no higher than the 90th
			 percentile, as determined by the Commission, of usual charges made by Idaho
			 Providers for a given medical service. (3-23-22)
c. Reasonable charge. Means a charge that
			 does not exceed the Provider's "usual" charge and does not exceed the
			 "customary" charge. (3-23-22)
d.
			 Usual charge. Means the most frequent charge made by an individual Provider for
			 a given medical service to non-industrially injured patients.
			 (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.011 - ABBREVIATIONS

Current through August 31, 2023
The following abbreviations have the meaning set forth below:
				(3-23-22)
01.
APC
. Means
			 Ambulatory Payment Classification. (3-23-22)
02.
ASC
. Means Ambulatory
			 Surgery Center. (3-23-22)
03.
AWP
. Means Average Wholesale Price. (3-23-22)
04.
CMS
. Means Centers for
			 Medicare and Medicaid Services. (3-23-22)
05.
CPT
. Means Current
			 Procedural Terminology. (3-23-22)
06.
EDI
. Means Electronic Data
			 Interchange. (3-23-22)
07.
FROI
. Means First Report of Injury. (3-23-22)
08.
HCPCS
. Means Healthcare
			 Common Procedure Coding System. (3-23-22)
09.
IAIABC
. Means International
			 Association of Industrial Accident Boards and Commissions. (3-23-22)
10.
ISIF
. Means the Industrial
			 Special Indemnity Fund, which is commonly referred to as the Second Injury
			 Fund. (3-23-22)
11.
LSS
. Means Lumps Sum Settlement. (3-23-22)
12.
MSDRG
. Means Medicare
			 Severity Diagnosis Related Group. (3-23-22)
13.
NCCI
. Means National Council
			 on Compensation Insurance. (3-23-22)
14.
NDC
. Means National Drug
			 Code. (3-23-22)
15.
RBRVS
. Means Resource-Based Relative Value Scale.
			 (3-23-22)
16.
RVU
.
			 Means Relative Value Unit. (3-23-22)
17.
SROI
. Means Supplemental or
			 Subsequent Report of Injury. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.012 - LIBERAL CONSTRUCTION

Current through August 31, 2023
Rulemaking before the Industrial Commission should be just,
				speedy, and economical; unless prohibited by statute, the Industrial Commission
				may permit deviation from these rules when it finds compliance with them is
				impracticable, unnecessary, or not in the public interest. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.201 - RULE GOVERNING 72-212(5) EXEMPTIONS

Current through August 31, 2023
01.
Exemptions
. Each person who elects to exempt themselves from
			 coverage or revoke their exemption under Section
			 72-212(5), Idaho
			 Code, must file an IC53 Declaration form with the Industrial Commission. The
			 form is available on the Commission's website. (3-23-22)
02.
Form
. The form must be
			 signed by both the employee and the employer. An original and one (1) copy of
			 the IC53 form shall be filed with the Commission. Upon approval by the
			 Commission, the copy will be returned to the employee filing for an exemption
			 or revocation of an exemption. (3-23-22)
03.
Approval by Commission
. The
			 Commission must approve the exemption or revocation of exemption. The
			 Commission may require verification of information submitted. Fraud or
			 misrepresentation in the information provided will void the exemption or
			 revocation. (3-23-22)
04.
IC53 Form
. If the employer is insured, it is the employer's
			 responsibility to file a copy of the IC53 form with the employer's insurance
			 company. (3-23-22)
05.
Effective Date
. The effective date of the exemption or revocation
			 of exemption shall be the date the properly completed form is received by the
			 Commission. (3-23-22)
06.
Exemption Effective
. The exemption shall remain in effect until a
			 revocation of exemption is filed with the Commission, or, termination of
			 employment with the designated employer, or upon the death of the employee,
			 whichever occurs first. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.302 - RULES GOVERNING CONTINUING REQUIREMENTS TO UNDERWRITE INSURANCE OR SELF-INSURE

Current through August 31, 2023
01.
Insurance
			 Carriers
. An insurance carrier approved under IDAPA 17.01.01.301.01
			 shall comply with the following requirements: (3-23-22)
a. Maintain Statutory Security Deposits with
			 the State Treasurer. (3-23-22)
i. Each
			 insurance carrier shall maintain with the Idaho State Treasurer a security
			 deposit in the amount of twenty-five thousand dollars ($25,000) if approved by
			 the Commission prior to July 15, 1988, or two hundred and fifty thousand
			 dollars ($250,000) if approved subsequently. (3-23-22)
ii. In addition to the security required in
			 Subsection 01.a.i, of this rule, each
			 insurance carrier shall deposit an amount equal to the total unpaid outstanding
			 awards of said insurance carrier. Such deposit shall be in the form permitted
			 by Section
			 72-301, Idaho Code. Surety bonds
			 shall be in the form available on the Commission's website. If a surety bond is
			 deposited, the surety company shall be completely independent of the principal
			 and authorized to transact such business in the state of Idaho. A partial
			 release of security deposited hereunder must be requested in writing and
			 approved by the Commission. (3-23-22)
iii. Securities which are maintained to
			 satisfy the requirements of this rule may be held in the federal reserve
			 book-entry system, as defined in Section
			 41-2870(4), Idaho
			 Code, and interests in such securities may be transferred by bookkeeping entry
			 in the federal reserve book-entry system without physical delivery of
			 certificates representing such securities. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.303 - RULE GOVERNING THE COLLECTION OF PREMIUM TAX ON WORKER'S COMPENSATION INSURANCE POLICIES

Current through August 31, 2023
This rule governs the collection of premium tax on worker's
				compensation insurance policies. This procedure applies to all worker's
				compensation policies. (3-23-22)
01.
Procedure for Submitting Premium Tax Forms
. The form IC 4008,
			 available on the Commission's website, shall be used to report numbers of
			 policies and the total gross premiums written. The original shall be sent to
			 the Commission; a copy shall also be attached to the reporting entity's annual
			 premium tax statement that is filed with the Idaho Department of Insurance.
			 This form is due to the Commission by July 31 for the reporting period of
			 January 1 through June 30; it is due by March 3 for the reporting period of
			 July 1 through December 31. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.304 - RULE GOVERNING PREMIUM TAX COMPUTATION FOR SELF-INSURED EMPLOYERS

Current through August 31, 2023
01.
Payroll Reports
. No later
			 than March 3rd and July 31st, self-insured employers shall file a semi-annual
			 premium tax report with the Fiscal Department of the Commission. Self-insured
			 employers shall use the Commission's current report form IC 4010, along with
			 the accompanying computation form IC 4010a, available on the Commission's
			 website. The premium tax payment due from a self-insured employer shall be
			 based upon the manual premium calculated for each reporting period, as modified
			 by an experience modification factor calculated by NCCI and submitted to the
			 Commission in accordance with Subsection
			 304.02 of this rule. No other
			 rating factor shall be allowed. If the self-insured employer elects to not
			 provide such experience modification factor, the premium tax will be computed
			 based upon the manual premium only. (3-23-22)
02.
Experience Modification
. A
			 self-insured employer that elects to use an experience modification factor in
			 computing premium tax shall make an annual application to NCCI for an
			 experience modification factor using the NCCI form ERM-6 and paying to NCCI any
			 fees charged for providing that calculation. An NCCI experience modification
			 factor may only be based on the employer's Idaho operations for which
			 self-insured status is authorized. In order to have an experience modification
			 factor considered for any reporting period, an employer must timely submit to
			 the Commission's Fiscal Department: (3-23-22)
a. A copy of the completed form ERM-6 filed
			 with NCCI; (3-23-22)
b. The
			 resulting experience modification factor received from NCCI; and
			 (3-23-22)
c. The completed IC 4010
			 Semi-Annual Premium Tax Form for Self-Insurers and IC 4010a Computation Form.
			 (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.305 - REQUIREMENTS FOR MAINTAINING IDAHO WORKER'S COMPENSATION CLAIMS FILES

Current through August 31, 2023
All insurance carriers, self-insured employers, and licensed
				adjusters servicing Idaho worker's compensation claims shall comply with the
				following requirements: (3-23-22)
01.
Idaho Office
. (3-23-22)
a. All
			 insurance carriers, self-insured employers, and licensed adjusters servicing
			 Idaho worker's compensation claims shall maintain an office within the state of
			 Idaho. The offices shall be staffed by adequate personnel to conduct business.
			 (3-23-22)
b. The insurance carrier
			 or self-insured employer shall authorize and require a member of its in-state
			 staff or an Idaho licensed resident adjuster to service and make decisions
			 regarding claims pursuant to Section
			 72-305, Idaho Code.
			 (3-23-22)
c. As staffing changes
			 occur and, at least annually, the insurance carrier, self-insured employer, or
			 licensed adjuster shall submit to the Commission Secretary the names of those
			 authorized to make decisions regarding claims pursuant to Section
			 72-305, Idaho Code. Each
			 authorized insurance carrier shall designate only one (1) Claims Administrator
			 for each policy of worker's compensation insurance.
			 (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.306 - RULE PROHIBITING USE OF SICK LEAVE OR OTHER ALTERNATIVE COMPENSATION

Current through August 31, 2023
01.
Employee Not Required to Take Sick
			 Leave in Lieu of Compensation
. No employer obligated to pay worker's
			 compensation benefits to an employee as provided by the Worker's Compensation
			 Law may require an employee to accept "sick leave" or other comparable benefit
			 in lieu of the worker's compensation benefits provided by law. Section
			 72-318(2), Idaho
			 Code, specifically provides that no agreement by an employee to waive his
			 rights to compensation under the Worker's Compensation Law shall be valid.
			 (3-23-22)
02.
Election of
			 Sick Leave or Alternative Compensation Prohibited
. Further, an employee
			 may not elect to accept "sick leave" or other comparable benefit from an
			 employer in lieu of worker's compensation benefits to which the employee is
			 entitled under the Worker's Compensation Law. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.307 - RULE GOVERNING REPORTING INDEMNITY AND MEDICAL PAYMENTS AND MAKING PAYMENT OF INDUSTRIAL SPECIAL INDEMNITY FUND ASSESSMENT

Current through August 31, 2023
Pursuant to Section
				72-327, Idaho Code, the state
				insurance fund, every authorized insurance carrier, and self-insured employer
				in Idaho shall report annually to the Industrial Commission the total gross
				amount of medical only and Indemnity Benefits paid on Idaho worker's
				compensation claims during the applicable reporting period. This report is used
				to calculate the pro rata share of the annual assessment for the ISIF, under
				Section 72-327, Idaho Code.
				(3-23-22)
01.
Filing
. The
			 report of indemnity and medical payments shall be filed with the Industrial
			 Commission simultaneously with the first Semi-Annual Premium Tax Report; which,
			 pursuant to Section
			 72-523, Idaho Code, is due each
			 year on March 3rd. (3-23-22)
02.
Form
. The report of indemnity and medical payments shall be
			 submitted in writing on, or in a format substantially the same as the current
			 Form IC2-327, available on the Commission's website. (3-23-22)
03.
Report Required When No Indemnity
			 Paid
. If an entity required to report under this rule has no claims
			 against which indemnity or medical payments have been made during the reporting
			 period, a report shall be filed so indicating. (3-23-22)
04.
Penalty for Late Filing
. A
			 penalty shall be assessed by the Commission for filing the report of indemnity
			 and medical payments later than March 3rd each year. (3-23-22)
a. A penalty of two hundred dollars ($200)
			 for late filing of seven (7) days or less. (3-23-22)
b. A penalty of one hundred dollars ($100)
			 per day for late filing of more than seven (7) days. (3-23-22)
c. A penalty assessed by the Commission shall
			 be payable to the Industrial Commission and be submitted with the April 1
			 payment of the ISIF assessment, following notice by the Commission of the
			 penalty assessment. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.401 - RULE GOVERNING COMPUTATION OF AVERAGE WEEKLY WAGE

Current through August 31, 2023
01.
Amounts Paid over Base Rate
.
			 Sums paid by an employer to an employee, over and above the base rate of
			 compensation agreed upon by the employer and the employee in a contract of
			 hire, which are contingent and dependent upon the employee's increased physical
			 exertion and/or efficiency shall be included in computing the employee's
			 average weekly wage pursuant to Section
			 72-419(4)(a),
			 Idaho Code. Said sums shall not be considered premium pay. (3-23-22)
02.
Fringe Benefits
. Also, in
			 computing the average weekly wage, it shall be presumed that wages include, but
			 are not limited to, cost of living increases, vacation pay, holiday pay, and
			 sick leave. (3-23-22)
03.
Premium Pay
. Further, in computing the average weekly wage, it
			 shall be presumed that premium pay includes, but is not limited to, shift
			 differential pay and overtime pay. (3-23-22)
04.
Examples Not Exclusive
. The
			 above-listed examples shall not be taken as exclusive in computing the average
			 weekly wage. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.402 - RULE GOVERNING CONVERSION OF IMPAIRMENT RATINGS TO "WHOLE MAN" STANDARD

Current through August 31, 2023
01.
Converting Single Rating of Body Part to Whole Person Rating
.
			 Impairment ratings shall be converted in accordance with the Industrial
			 Commission Schedule, Section
			 72-428, Idaho Code, with the base
			 of five hundred (500) weeks for the whole man. (3-23-22)
02.
Averaging Multiple Ratings
.
			 Where more than one (1) evaluating physician has given ratings, these shall be
			 converted to the statutory percentage of the whole man, and averaged for the
			 applicable rating. (3-23-22)
03.
Correcting Manifest Injustice
. In the event that the Commission
			 deems a manifest injustice would result from the above ruling, it may at its
			 discretion take steps necessary to correct such injustice. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.403 - RULE GOVERNING COMPENSATION FOR DISABILITY DUE TO LOSS OF TEETH

Current through August 31, 2023
01.
Compensation for Disability
.
			 A Claimant under the Worker's Compensation Law shall be entitled to
			 compensation for permanent disability for the loss of each tooth other than
			 wisdom teeth at the rate of one tenth of one percent (.1%) of the whole man.
			 The loss of wisdom teeth shall not constitute any permanent disability.
			 Compensation hereunder shall be in addition to payments for medical services
			 including dental appliances and bridgework necessitated by the injury and any
			 income benefits during the period of Claimant's recovery to which the Claimant
			 be entitled. (3-23-22)
02.
Prima Facie Evidence
. This rule and schedule shall be prima facie
			 evidence of the percentage of permanent disability to be attributed to the loss
			 of teeth. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.404 - SUBMISSION OF MEDICAL REPORTS FROM PROVIDERS

Current through August 31, 2023
This procedure applies to all open worker's compensation claims
				where medical services are provided and which have not been denied by the
				Payor. (3-23-22)
01.
Procedure
. In all cases in which a particular injury or
			 occupational disease results in a worker's compensation Claim, the Provider
			 shall submit written Medical Reports for each medical visit to the Payor.
			 Payers and Providers may contract with one another to identify specific records
			 that will be provided in support of billings. The Provider shall also submit
			 the same written Medical Reports to the Claimant upon request. These reports
			 shall be submitted within fourteen (14) days following each evaluation,
			 examination, and/or treatment. The first copy of any such reports shall be
			 provided to the Payor and the Claimant at no charge. If duplicate copies of
			 reports already provided are requested by either the Payor or the Claimant, the
			 Provider may charge the requesting party a reasonable charge to provide the
			 additional reports. Whenever possible, billing information shall be coded using
			 CPT. In the case of Hospitals, reports shall include a Uniform Billing Form 04.
			 In the case of physicians and other Providers supplying outpatient services,
			 this reporting requirement shall include a CMS 1500 form. (3-23-22)
a. If an injury or occupational disease
			 results in a Claim, the Employer/Surety or Provider shall submit written
			 reports to the Commission upon request. Such request may either be in writing
			 or telephonic. If a Claim is referred to the Rehabilitation Division, Medical
			 Reports shall be furnished by the Payor or Provider directly to the office that
			 requests such reports. The Payor or Provider shall consider this an on-going
			 request until notice is received that the reports are no longer required.
			 (3-23-22)
b. If the injury or
			 occupational disease results in a time-loss Claim, the Payor shall submit
			 copies of medical records containing information regarding the beginning and
			 ending of disability, releases to work whether light duty or regular duty,
			 impairment ratings, physical restrictions to the Commission. Other Medical
			 Reports shall be submitted to the Commission only upon request.
			 (3-23-22)
c. ISIF shall receive all
			 copies of Medical Reports, without charge, from either the Claimant or the
			 Payor, depending upon who seeks to join it as a party to a worker's
			 compensation Claim. (3-23-22)
d. If
			 the Commission requests Medical Reports from the Payor or Provider, the
			 information shall be provided within a reasonable time period without charge.
			 If information is received for which the Commission has no need, the
			 information may be discarded or destroyed. (3-23-22)
Idaho Administrative Code › Title IDAPA 17 - Industrial Commission › Rule 17.01.01 - ADMINISTRATIVE RULES UNDER THE WORKER'S COMPENSATION LAW › Section 17.01.01.405 - RULE GOVERNING REIMBURSEMENT FOR TRAVEL EXPENSES

Current through August 31, 2023
01.
Mileage Rate
. If Claimant
			 has access to, and is able to operate, a vehicle for transportation covered by
			 Sections 72-432(13)  or
			 72-433(3), Idaho
			 Code, employer shall reimburse Claimant at the mileage rate then allowed by the
			 State Board of Examiners for State employees. Such rate shall be published
			 annually by the Industrial Commission, together with the average state wage for
			 the upcoming period. All such miles shall be reimbursed, with fractions of a
			 mile greater than one-half (1/2) mile rounded to the next higher mile and
			 fractions of a mile below one-half (1/2) mile disregarded. (3-23-22)
02.
Commercial Transportation
.
			 If Claimant has no vehicle, or has access to a vehicle and is reasonably unable
			 to utilize the vehicle for transportation covered by Sections
			 72-432(13)  or
			 72-433(3), Idaho
			 Code, Claimant's employer shall reimburse Claimant the actual cost of
			 commercial transportation as evidenced by actual receipts. Notwithstanding the
			 above provision, no Claimant shall be eligible for reimbursement of the actual
			 cost of commercial transportation where such Claimant is unable to operate a
			 motor vehicle due to the revocation or suspension of driving privileges because
			 Claimant was under the influence of alcohol and/or drugs. (3-23-22)
03.
Request for Reimbursement
.
			 It shall be Claimant's responsibility to submit a travel reimbursement request
			 to the employer. Such request shall be made on a form substantially the same as
			 Industrial Commission Form IC 432(1), posted on the Commission's website. The
			 Claimant must attach to the form a copy of a bill or receipt showing that the
			 visit occurred. The employer shall furnish the Claimant with copies of this
			 form. (3-23-22)
04.
Frequency
			 of Requests
. Claimant shall not request transportation reimbursement
			 more frequently than once every thirty (30) days. However, notwithstanding this
			 provision, should a Claimant request transportation reimbursement more
			 frequently than every thirty (30) days, employer need not issue more than one
			 reimbursement check in any thirty-day (30) period. (3-23-22)