La. Admin. Code tit. 50 § XVII-301

Current through Register Vol. 50, No. 11, November 20, 2024

Section XVII-301 - Accreditation Requirements

A. Effective for dates of service on or after January 1, 2009, all providers seeking Medicaid reimbursement for prostheses, orthoses, prosthetic services and orthotic services must be accredited by the American Board of Certification in Orthotics, Prosthetics and Pedorthics, or by the Board of Certification/Accreditation, International.

1. These accreditation provisions shall not apply to a licensed optometrist or a licensed ophthalmologist, and shall not prohibit a licensed occupational therapist or a licensed physical therapist from practicing within his scope of practice.

B. For the purposes of this Section, Orthosis shall not include prefabricated or direct-formed orthotic devices or any of the following assistive technology devices commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility:

1. commercially available knee orthoses (used following sports injury or surgery);

2. upper extremity adaptive equipment;

3. wrist gauntlets;

4. finger and hand splints;

5. low-temperature formed plastic splints;

6. trusses;

7. elastic hose;

8. fabric or elastic supports;

9. corsets;

10. face masks used following burns;

11. canes and crutches;

12. wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair;

13. cervical collars; and

14. dental appliances.

C. For the purposes of this Section, prosthesis shall not include:

1. artificial eyes;

2. artificial ears;

3. artificial noses;

4. dental appliances;

5. ostomy products; and

6. eyelashes and wigs.

D. A provider who is not accredited and provides prosthetic/orthotic services or devices to a recipient and accepts Medicaid reimbursement shall be fined $2,500 per violation and shall be required to reimburse the Medicaid Program for the cost of the service(s) or device(s).

E. Effective for dates of service on or after April 1, 2010, all providers seeking reimbursement for prosthetic and orthotic services and devices must be accredited by one of the following Medicare deemed accreditation organizations:

1. The Joint Commission (JC);

2. National Association of Boards of Pharmacy (NABP);

3. Board of Certification/Accreditation International ;

4. The Compliance Team, Inc.;

5. American Board for Certification in Orthotics and Prosthetics, Inc. (ABC);

6. The National Board of Accreditation for Orthotic Suppliers (NBAOS);

7. Commission on Accreditation of Rehabilitation Facilities (CARF);

8. Community Health Accreditation Program (CHAP);

9. HealthCare Quality Association on Accreditation (HQAA); or

10. Accreditation Commission for Health Care, Inc. (ACHC).

F. Verification of accreditation must be received by the department on or before March 31, 2010. A provider's prior authorization privileges will be revoked on April 1, 2010 if this verification is not received.

La. Admin. Code tit. 50, § XVII-301

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:85 (January 2005), repromulgated LR 31:1597 (July 2005), amended LR 34:2638 (December 2008), repromulgated LR 35:71 (January 2009), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:520 (March 2010).

AUTHORITY NOTE: Promulgated in accordance with R. S. 36:254 and Title XIX of the Social Security Act.