CRIME VICTIMS COMPENSATION PROGRAMFee 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 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 Fines paid on criminal convictions Victims of Crime Act Grant (VOCA) Recovery efforts

Restitution—$287,386 Subrogation—$163,694

Donations

Benefits Medical Mental health counseling Wage replacement Funeral Dependent death benefits Family assistance benefits Sexual assault forensic examinations

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? Traffic related crimes

Exceptions: DUI/BUI, intentional infliction, hit and run

Replacement of damaged or stolen property

Pain and suffering damages Pre-existing conditions

Cases Filed By Crime Type – 2009

Victims Served by Age

Payments by Service Type

Payment Information Reasonable and customary charges Medical payment increases

FY04 - FY09 Medical and Forensic Examination Payments

$1,619,072$1,687,689 $1,776,488

$2,575,009 $2,580,272 $2,614,907

1,500,000

1,700,000

1,900,000

2,100,000

2,300,000

2,500,000

2,700,000

FY04 FY05 FY06 FY07 FY08 FY09

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 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 Establishes an allowable amount based

on Relative value unit x conversion factor CPT codes Place of service code Hospital size

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) 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 Explanation of benefits

Issued at time of payment Indicates CVCP payment Advise of any balance that may be billed to

claimant

Notification Denial Notice

Issued at time of denial Indicates denial reason Advises claimant of appeal rights

Notification Claims status report

Issued on the 15th of each month Indicates status of all pending claims for

each provider

Contact UsCrime Victims Compensation Program

700 S. Clearwater LaneP.O. Box 83720

Boise, ID 83720-0041208-334-6080 800-950-2110

Fax 208-332-7559www.crimevictimcomp.idaho.gov