Medical Supplies and Equipment Bulletin - Orthotic, Custom Footware and Prosthetic Benefits - February 2001
Help on accessing alternative formats, such
as PDF, MP3 and WAV files, can be obtained in the alternate
format help section.
 (55
KB)
The Non-Insured Health Benefits (NIHB) Program
provides supplementary
health benefits, including Medical Supplies and Equipment, to
eligible First Nations and Inuit throughout Canada.
This NIHB Medical Supplies and Equipment Bulletin is a revised
version of the November 2000 Bulletin. It provides information
about the orthotic, custom footwear and prosthetic benefits provided
under the NIHB Program. It includes an overview of NIHB policy,
the prior approval process and replacement and warranty guidelines.
Providers can find more detailed information in the NIHB MS&E
Provider Information Kit. Information is also available on the
NIHB web site at http://www.hc-sc.gc.ca/fnihb/nihb/mse/provider_kit.pdf.
In January 1999, a review of the MS&E benefits was undertaken
as part of a larger effort to improve the management of the NIHB
Program and to ensure that the benefits reflect client needs, current
clinical practices, changes in health care delivery and NIHB policy.
Changes to this category of MS&E benefits were implemented on
December 1, 2000. The range of benefits provided remains the same
although additional benefit codes have been added to the benefit
lists to clearly identify eligible benefits and to enable the NIHB
Program to perform comprehensive benefit utilization analysis and
audit activities.
New prescriber, provider and diagnostic and assessment requirements
for these benefit categories were implemented December 1, 2000.
PRESCRIBERS FOR:
LIMB AND BODY ORTHOTIC DEVICES
Class I (soft) orthotic device: Physician.
Class II (rigid) orthotic device: Medical or surgical
specialist in the field of physiatry, orthopedics, plastic surgery,
neurology, rheumatology, pediatrics, geriatrics or general surgery.
Class III (custom made) orthotic device: Medical or surgical
specialist in the field of physiatry, orthopedics, plastic surgery,
neurology, rheumatology, pediatrics, geriatrics or general surgery.
CUSTOM MADE FOOTWEAR
Medical or surgical specialist in the field of physiatry, orthopedics,
plastic surgery, neurology, rheumatology, pediatrics, geriatrics,
general surgery or infectious diseases.
CUSTOM MADE INTERNAL FOOTWEAR DEVICES (foot orthotics) AND
MODIFICATIONS TO STOCK FOOTWEAR
Physician or medical or surgical specialist in the field of
physiatry, orthopedics, plastic surgery, neurology, rheumatology,
pediatrics, geriatrics, general surgery or infectious diseases.
PROSTHETIC DEVICES
Medical or surgical specialist in the field of physiatry, pediatrics,
orthopedics, ophthalmology, general surgery or infectious diseases.
PROVIDERS FOR:
LIMB AND BODY ORTHOTIC DEVICES
Class I (soft): Certified Orthotist( c), chiropodist,
podiatrist.
** Note: foam cervical collar, abdominal support, hernia truss
and sacral or lumbosacral support, cloth or elastic braces with
or without steel stays can be provided by pharmacy and MS&E
providers
Class II (rigid), Class III (custom made): Certified
Orthotist CO( c), Certified Prosthetist CP( c) or Certified Prosthetist
Orthotist CPO( c) as certified by the Canadian Board for the
Certification of Prosthetists and Orthotists (CBCPO), chiropodist,
podiatrist.
CUSTOM MADE FOOTWEAR, CUSTOM MADE INTERNAL FOOTWEAR DEVICES
AND MODIFICATIONS TO STOCK FOOTWEAR
Certified Orthotist CO( c), Certified Prosthetist Orthotist
CPO( c), Chiropodist, Podiatrist.
PROSTHETIC DEVICES
Breast prosthesis: Certified fitter.
Eye prosthesis: Certified ocularist as certified
by the National Examining Board of Ocularists (NEBO).
Limb prosthesis: Certified Prosthetist CP( c)
or certified Prosthetist Orthotist CPO( c) as certified by the
Canadian Board for the Certification of Prosthetists and Orthotists
(CBCPO).
 Prior Approval Process
The NIHB Prior Approval Form for Orthotics, Custom Footwear,
Prosthetics and Pressure Garments must be completed for all
orthotic, custom footwear, prosthetic and pressure garment and
pressure orthotic benefits. The client must have a prescription
from an approved prescriber and take it to an approved provider,
as listed above. The Form must be fully completed including the
medical diagnosis and detailed assessment (with casting or measurements
when applicable). Under Section 4 (Equipment or Supplies Requested
), the provider must describe the manufacturing techniques and
materials to be used and indicate whether an in-house or external
laboratory will be used to manufacture the device.
The Form, the prescription and any supporting medical documentation
must be returned to the First Nations and Inuit Health Branch (FNIHB)
Regional Office for review. If a prior approval is granted, a PA
number will be provided for billing purposes. Only then should
the provider proceed with the fabrication/ fitting/ dispensing.
If a prior approval is not granted, the provider will be advised
of the reason and will be asked to inform the client of his or
her right of appeal. The client must sign the Form when receiving
the benefit and the document should be kept on file by the provider.
NIHB MS&E Claim Form
The client address section of the NIHB MS&E Claim Form must
be completed prior to sending to First Canadian Health for payment.
If the address field is not completed, the Form will be returned
to the provider for completion.
Please note that claims dated over one year from the date
of service will not be considered for payment.
|
