N.J. Admin. Code § 10:55-1.4

Current through Register Vol. 56, No. 12, June 17, 2024

Section 10:55-1.4 - Requirements for program participation as prosthetic and orthotic services provider

(a) An approved Medicaid and NJ FamilyCare fee-for-service provider of prosthetic and orthotic services shall be responsible for the following:

1. Assuring that an appliance furnished by the approved facility conforms to the prescriber's prescription and the description of the appliance as set forth in the accepted nomenclature by the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Incorporated; fitting the appliance properly to the extent that the beneficiary's condition(s) permits; and providing maximum efficiency and comfort consistent with the condition(s) of the beneficiary for whom the appliance is prescribed;

2. Assuming liability for defective materials over which the provider has (or should have had) control;

3. Agreeing to accept return of an appliance when the prescribing physician, after appropriate evaluation of the appliance(s), determines that the appliance(s) does not conform to the prescription and description of the appliance set forth in the accepted nomenclature by the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Incorporated; and/or does not fit properly, and/or is not of acceptable quality, and/or does not provide maximum efficiency and comfort consistent with the condition of the beneficiary for whom it is prescribed, and refabricating the appliance; and

4. Warranting against defective material and workmanship (except for parts normally worn from natural use) for a period of one year from date of delivery to and acceptance by the beneficiary. If it is found that either the material or the workmanship is defective, the provider shall be allowed a reasonable opportunity to make such adjustment and/or corrections or replacement without additional charge to the Medicaid and NJ FamilyCare program, or the beneficiary.

i. The warranty shall not apply to an appliance corrected/altered as a result of a change in the beneficiary's physical condition (anatomical change).

ii. The warranty shall not apply to a misused appliance or an appliance altered by other than the original provider.

N.J. Admin. Code § 10:55-1.4

Amended by R.2000 d.134, effective 4/3/2000.
See: 31 N.J.R. 3964(a), 32 N.J.R. 1206(a).
In (a), substituted references to beneficiaries for references to recipients throughout, substituted a reference to Medicaid and NJ KidCare fee-for-service providers for a reference to providers in the introductory paragraph, and substituted a reference to Medicaid and NJ KidCare programs for a reference to programs in the introductory paragraph of 4.
Amended by R.2004 d.406, effective 11/1/2004.
See: 35 N.J.R. 4417(a), 36 N.J.R. 4963(a).
Amended by R.2011 d.080, effective 3/7/2011.
See: 42 N.J.R. 2179(a), 43 N.J.R. 622(a).
In (a)1 and (a)3, substituted a comma for "and" following "Orthotics" and inserted "and Pedorthics".