Delivery of Orthotics

(A) Proof of Delivery. Orthotics providers must maintain proof of delivery (POD) in the member’s medical record. POD documentation must be made available to the MassHealth agency upon request. Orthotic providers may use one of three methods to deliver orthotics to the member: direct delivery; delivery via shipping; or delivery in anticipation of hospital discharge. The orthotics provider, in conjunction with the member or their designee, will determine the method of delivery. (B) Timelines of Delivery. The orthotics provider must ensure that orthotics are delivered within a reasonable time after receipt of the detailed written order and any required documentation or approval for the item. This includes referring the member to another orthotics provider, when timely delivery cannot be made by the current orthotics provider. The MassHealth agency, or its designee, reserves the right to issue additional subregulatory guidance on reasonableness of delivery times for customized orthotics and specific orthotic items. (C) Direct Delivery. The orthotics provider may deliver the orthotic product directly to the member or dispense the product to the member at the provider’s service location. In this case the POD must be a signed and dated delivery slip. The POD documentation must include: (1) member’s name; (2) sufficiently detailed description to identify the item(s) being delivered (such as, brand name, HCPCS code, narrative description); (3) quantity delivered; (4) date delivered; and (5) member (or member’s designee) signature and date of signature. The date of signature on the delivery slip must be the date that the orthotic product was received by the member or member’s designee. (6) In instances of direct delivery, for purposes of filing a claim for payment, the date of service on the claim must be the date the member received the orthotics, as evidenced by the date of the member’s (or member’s designee) signature on the delivery slip. (D) Delivery via Shipping Service. (1) Providers of orthotics may use a shipping service to deliver orthotic products. (2) If the provider of orthotics utilizes a shipping service, the POD documentation must include a complete tracking record. An example of acceptable POD would include both the provider’s own detailed shipping invoice and the shipping service’s tracking information. Providers may also utilize a return postage-paid signed shipping invoice from the member or the member’s designee as evidence of POD. The POD record must include: (a) member’s name; (b) delivery address; (c) shipping service’s package identification number, orthotics providers’ invoice number or alternative method that links the provider of orthotics’ delivery documents with the shipping service’s records; (d) sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description); (e) quantity delivered; (f) date delivered; and (g) evidence of delivery; (3) If a provider of orthotics utilizes a shipping service, for purposes of filing a claim for payment, the date of service is the date the orthotics was shipped to the member. (E) Delivery to Members in a Facility. Delivery to members in facilities and to members being discharged from facilities to a community dwelling; (1) Delivery of orthotics products to a nursing facility or ICF/IID on behalf of a member: (a) Providers of orthotics may deliver orthotics for a member directly to a nursing facility or ICF/IID. When the provider of orthotics delivers items directly to a nursing facility or ICF/IID, the documentation described in 130 CMR 442.424(C) is required. When a shipping service is used to deliver the item to a nursing facility or ICF/IID, the documentation described in 130 CMR 442.424(D) is required. (b) The date of service on the claim must be the date as specified in 130 CMR 442.424(C)(2) or 130 CMR 442.424(D)(2), as applicable. (2) Delivery in anticipation of discharge from a hospital: (a) A provider of orthotics may deliver an orthotic product to a patient in a hospital for the purpose of fitting or training the patient in the proper use of the item. This may be done up to two days prior to the patient’s anticipated discharge. (b) The date of service for purposes of filing a claim for payment is the date of discharge with the member’s home as the place of service (POS). (c) The provider of orthotics may not bill MassHealth for days prior to discharge, such as days the patient was receiving training or fitting in the hospital.