Orthotic Services Provided to Members in Facilities

(A) Nursing Facilities. MassHealth pays for the purchase and repair of orthotics provided for the personal exclusive use of a member residing in a nursing facility. (B) Hospitals. MassHealth does not pay orthotics providers for the purchase or repair of orthotics provided to a hospitalized member, except for orthotics that are prescribed for home use after discharge. The orthotics provider must document the member’s discharge plan in the member’s record. Documentation must indicate that the date of discharge was the date the claim was submitted for the purchase or repair of the prescribed item. (C) Intermediate Care Facilities for the Intellectually Disabled (ICF/IID). (1) MassHealth pays orthotics providers for the purchase and repair of custom-fabricated orthotics provided for the personal exclusive use of a member residing in an ICF/IID only if the customization precludes the use of the item by subsequent residents in that institution. (2) MassHealth does not pay orthotic providers for the purchase or repair of orthotics that are not custom-fabricated provided to a member residing in an ICF/IID, except for therapeutic shoes for diabetics, modifications and inserts, and associated repairs, provided for the personal exclusive use of a member residing in the ICF/IID. (D) Date of Service for Delivery to Facilities. 130 CMR 442.424 governs the date of service to be used for claims for orthotics delivered to members in facilities.