01.
Commission. The Idaho
Industrial Commission. (3-31-22)
02.
Crime Victim's Compensation
Program. The program administered by the Crime Victim's Bureau of the
Idaho Industrial Commission under the Crime Victim's Compensation Act.
(3-31-22)
03.
Employer. The employer at the time of the criminally injurious
conduct on which the Application for Compensation is based. (3-31-22)
04.
Medical Services. Words and
terms used for determining the allowable payment for medical services under
these rules are defined in Subsections
010.04.a. through 010.04.h.
(3-31-22)
a. "Allowable payment" means the
lower of the charge for medical services calculated in accordance with this
rule or as billed by the provider. (3-31-22)
b. "Ambulatory Surgery Center (ASC)" means a
facility providing surgical services on an outpatient basis only.
(3-31-22)
c. "Hospital" is any
acute care facility providing medical or rehabilitation services on an
inpatient and outpatient basis. (3-31-22)
i.
Large Hospital means any hospital with more than one hundred (100) acute care
beds. (3-31-22)
ii. Small Hospital
means any hospital with one hundred (100) acute care beds or less.
(3-31-22)
d. "Provider"
means any person, firm, corporation, partnership, association, agency,
institution, or other legal entity providing any kind of medical service
related to the treatment of a claimant for benefits under the Idaho Crime
Victims Compensation Act. (3-31-22)
e. "Medical Service" means medical, surgical,
dental, mental health, or other attendance or treatment, nurse and hospital
service, medicine, apparatus, appliance, prostheses and related service,
facility, equipment and supply. (3-31-22)
f. "Reasonable" means a charge does not
exceed the Provider's "usual" charge and does not exceed the "customary"
charge, as defined in Paragraph 010.04.h. (3-31-22)
g. "Usual" means the most frequent charge
made by an individual Provider for a given medical service to non-industrially
injured patients. (3-31-22)
h.
"Customary" 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. (3-31-22)
05.
Wages. Means the wages at
the time of the criminally injurious conduct on which the Application for
Compensation is based and includes non-cash remuneration such as lodging and
meals provided by the Employer and gratuities such as tips, which are not paid
by the employer, but that are received by the victim in the normal course of
his employment. (3-31-22)
