Medical Supplies and Equipment Bulletin May 2004
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The Non-Insured Health Benefits (NIHB) Program
provides supplementary
health benefits, including Medical Supplies and Equipment, to
eligible First Nations and Inuit throughout Canada.
The purpose of this bulletin is to clarify questions from providers
on the provision of custom-made foot orthotics and shoes under
the
NIHB Program.
PLEASE NOTE THAT THE DESCRIPTION OF BENEFIT CODE 99400167 IS CUSTOM-MADE
FOOTWEAR WHICH MEANS "CUSTOM-MADE SHOES".
CASTING TECHNIQUES RECOGNIZED BY THE NIHB PROGRAM FOR
THE PROVISION OF CUSTOM-MADE FOOT ORTHOSIS (CUSTOM -MADE INTERNAL
FOOTWEAR DEVICES)
Following a comprehensive review of scientific literature, NIHB
policies regarding the provision of custom-made foot orthosis were
developed in consultation with clinical experts in the field of
biomechanics and the provision of foot orthosis.
At the time of the implementation of the NIHB policies and guidelines,
the technical and scientific evidence regarding assessments, impression
(casting) techniques and materials were reviewed as were the newer
computerized techniques. The result of this review was confirmed
by a study in 2002 (J AM Podiatr Med Assoc 92 (5): 261-268, 2002)
which compared four methods currently available for taking a negative
impression of the foot for the purpose of fabricating a foot orthotic
device. Those four methods are:
- Non-weight bearing plaster casting
- Partial-weight bearing foam impressions
- Partial-weight bearing laser scanning
- Non-weight bearing laser scanning
The study compared the reliability and accuracy of these methods.
The study found that foot measures are significantly influenced
by the method used to obtain a negative foot impression. The study
concluded that the methods differed in reliability and plaster
casting may be preferable to the other three methods when it is
important to capture the forefoot-to-rearfoot relationship, as
in fabricating a functional orthosis.
The accuracy of each casting technique and its ability to capture
forefoot to rearfoot positions were the main criteria used to determine
that only the following two methods of casting are accepted by
the NIHB Program in dispensing a functional device:
- plaster of Paris bandage wrap / slipper cast
- contact digitizing method
The NIHB Program does not accept the use of a foam box, laser
or optical scanning devices for the dispensing of functional foot
orthosis. These methods demonstrate a significant reduction in
accuracy and reliability in obtaining the positional relationships
regardless of the experience of the practitioner.
Functional and Accommodative Foot Orthosis
Functional Foot orthosis: A device intended
to maintain or promote foot function around a neutral/congruous
sub talar joint, utilising various biomechanical theoretical principals.
This device allows for pronation and supination to occur within
the accepted normal functional, anatomical and temporal range of
motions of the joints of the foot therefore preventing pathological
compensatory motions and limiting excessive end range of motion.
Accommodative Foot Orthosis: A device intended
to transfer pressure away from a painful area and redistribute
this pressure to the rest of the foot. No attempt is made to control
motion around a joint but rather to control ground reaction forces
around a specific anatomical location. Accommodative devices are
indicated in the presence of a rigid deformity, arthritic joint
or painful chronic skin lesion. This device is also for high risk
patients with peripheral vascular disease and/or neuropathy who
are prone to ulceration.
Please note that for those high risk patients, where joint range
of motion are within normal limits, a functional / semi functional
device will be expected to be used with accommodation for specific
lesions. For these patients a plaster of Paris bandage wrap / slipper
cast MUST be used.
Approved Provider Qualifications
After reviewing the educational and training standards of various
educational institutions, as well as the licensing procedures and
the ability of regulatory bodies to monitor health professional
practice in Canada, the following are the only providers accepted
by the NIHB Program for the provision of custom-made shoes, custom-made
foot orthotics and modifications to stock footwear:
- Orthotists certified (CO©) by the Canadian
Board for the Certification of Prosthetists and Orthotists (CBCPO);
- Prosthetist Orthotist (CPO©) certified by the
CBCPO;
- Doctor of Podiatric Medicine registered with provincial and
territorial regulatory bodies
- Podiatrist and Chiropodist registered with
provincial and territorial regulatory bodies,
- Canadian certified Pedorthist Clinicians (CPed©) holding
registration with the Canadian College of Pedorthists
Submitting Prior Approvals for Custom-made Shoes
When requesting a prior approval for custom-made shoes, you MUST
include templates / drawing / tracing of the contour of the feet
and/or photographs with the prior approval form. Please understand
that it is very difficult to assess suitability of custom-made
shoes with templates alone. Where possible, photographs are preferred.
Important Information Regarding the Processing of Prior Approval
Requests
The following information is often missing on a prior approval
form. To ensure approvals are processed promptly, please complete
all sections before submitting the form.
Section 2: Prescriber Information
Doctors Name
For custom-made shoes you MUST also indicate the medical specialty
of the physician after his name.
While it is recognized that access to a medical specialist may
be an issue in some areas, a prescription from a specialist is
required for the first issue of custom-made shoes.
Please note that a prescription from a general practitioner is
accepted for custom-made internal footwear devices (99400169, 99400170,
99400624) and modifications to stock footwear (99400171).
Licence number, Telephone and Fax numbers
Please ensure this information is clearly indicated.
Item being requested
Please identify the item that is being requested. (e.g.: custom-made
shoes or custom-made foot orthosis).
Section 3: Client Health Information
Diagnosis
The diagnosis and the client's "SYMPTOMS" must be listed.
(e.g.: heel pain / arch pain, metatarsalgia, tendinitis, pain -
indicate location).
This information MUST be indicated by the provider on the prior
approval form. This is required by NIHB consultants when assessing
the device and the related biomechanical assessment.
Explanation of benefit requirement based on clinical
Assessment
This must include basic biomechanical / medical assessment information.
From your assessment, what is causing the clients symptoms? (e.g.:
excessive pronation - pronation syndrome - pes planus (flat feet)
- bunions - hallux valgus - claw toes / hammer toes, etc.).
Section 4: Equipment or Supplies Requested
Please ensure the following information is indicated when applicable:"
- imprint technique
- manufacturing technique
- material to be used
- design of shoes (e.g.: rocker soles, shanks, flares, etc.)
- side of the body
- itemized replacement parts if it is a repair
- warranty details
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