01. Commission. The Idaho Industrial Commission.
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.
03. Employer. The employer at the time of the criminally injurious conduct on which the Application for Compensation is based.
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.
a. “Allowable payment” means the lower of the charge for medical services calculated in accordance with this rule or as billed by the provider.
b. “Ambulatory Surgery Center (ASC)” means a facility providing surgical services on an outpatient basis only.
c. “Hospital” is any acute care facility providing medical or rehabilitation services on an inpatient and outpatient basis.
i. Large Hospital means any hospital with more than one hundred (100) acute care beds.
ii. Small Hospital means any hospital with one hundred (100) acute care beds or less.
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.
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.
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.
g. “Usual” means the most frequent charge made by an individual Provider for a given medical service to non-industrially injured patients.
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.
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.