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  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 Medical payment increases

FY04 - FY09 Medical and Forensic Examination Payments

Payment Information  Reasonable and customary charges  Medical payment increases 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  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 Us Crime Victims Compensation Program 700 S. Clearwater Lane P.O. Box Boise, ID Fax