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CRIME VICTIMS COMPENSATION PROGRAM. Fee Schedule Implementation. History. Established in July 1986 A division of the Idaho Industrial Commission Served approximately 28,000 crime victims Paid approximately $36 million on behalf of crime victims

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crime victims compensation program

CRIME VICTIMS COMPENSATION PROGRAM

Fee Schedule Implementation

history
History
  • Established in July 1986
  • A division of the Idaho Industrial Commission
  • Served approximately 28,000 crime victims
  • Paid approximately $36 million on behalf of crime victims
  • 2,384 new applications for benefits were filed in FY09
  • Approximately 83% of the cases served by the program involved criminal conduct against women and children
funding sources
Funding Sources
  • Fines paid on criminal convictions
  • Victims of Crime Act Grant (VOCA)
  • Recovery efforts
    • Restitution—$287,386
    • Subrogation—$163,694
  • Donations
benefits
Benefits
  • Medical
  • Mental health counseling
  • Wage replacement
  • Funeral
  • Dependent death benefits
  • Family assistance benefits
  • Sexual assault forensic examinations
eligibility
Eligibility
  • Crime must occur in Idaho
  • 72-hour reporting requirement
  • One-year filing requirement
  • Cooperation
    • Prosecutor’s office
    • Law enforcement
  • Victim’s conduct must not contribute to injury
  • Felony/DUI mandatory reduction
  • Third party payment sources
  • Injuries that are direct result of the crime
what is not covered
What Is Not Covered?
  • Traffic related crimes
    • Exceptions: DUI/BUI, intentional infliction, hit and run
  • Replacement of damaged or stolen property
  • Pain and suffering damages
  • Pre-existing conditions
payment information
Payment Information
  • Reasonable and customary charges
  • Medical payment increases
payment information12
Payment Information
  • Reasonable and customary charges
  • Medical payment increases
  • Proportionate reduction—April 2008
    • 75% reasonable and customary
    • Through June 30, 2010
    • No provision for balance billing
payment changes
Payment Changes
  • Need for equitable compensation plan
  • Idaho Code 72-1026
    • Adopts workers’ compensation medical fee schedule
    • Effective for services after July 1, 2010
  • Proposed administrative rule
  • Payment may be considered payment in full
    • Reductions—may balance bill up to allowable amount
  • Must use UB04 or CMS 1500
workers comp fee schedule
Workers Comp Fee Schedule
  • Establishes an allowable amount based on
    • Relative value unit x conversion factor
    • CPT codes
    • Place of service code
    • Hospital size
reimbursement rates
Reimbursement Rates
  • Hospitals (inpatient)
    • Large Hospitals (100 or more acute care beds)—85%
    • Small Hospitals (less than 100 acute care beds)—90%
  • Hospitals (outpatient)—80%
  • Ambulatory surgery centers—80%
  • Anesthesia—conversion factor multiplied by base units plus time units
reimbursement rates continued
Reimbursement Rates (continued)
  • Non-hospital services
    • Based on CPT code (RVU x conversion factor)
    • Services without an established CPT code—90%
  • Prescriptions
    • Filled outside of hospital—90%
  • Surgically implanted hardware
    • Actual cost plus 50%
notification
Notification
  • Explanation of benefits
    • Issued at time of payment
    • Indicates CVCP payment
    • Advise of any balance that may be billed to claimant
notification19
Notification
  • Denial Notice
    • Issued at time of denial
    • Indicates denial reason
    • Advises claimant of appeal rights
notification21
Notification
  • Claims status report
    • Issued on the 15th of each month
    • Indicates status of all pending claims for each provider
contact us
Contact Us

Crime Victims Compensation Program700 S. Clearwater Lane

P.O. Box 83720Boise, ID 83720-0041208-334-6080 800-950-2110Fax 208-332-7559www.crimevictimcomp.idaho.gov