§1225.1. Purchase of prostheses, orthoses, prosthetic services, and orthotic services by a
state agency from an accredited facility; Medicaid reimbursement; definitions;
penalties
A.
(1)Any state agencies which utilize funds to pay for prostheses, orthoses,
prosthetic services, or orthotic services shall only purchase such services, prostheses, or
orthoses from an accredited facility.
(2)No reimbursements from the state Medicaid program shall be paid for prostheses,
orthoses, prosthetic services, or orthotic services except to an accredited facility.
B. As used in this Section, the following terms shall have the following meanings,
unless the context clearly indicates otherwise:
(1)"Accredited facility" means any facility that is accredited by the American Board
for Certification in Orth
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§1225.1. Purchase of prostheses, orthoses, prosthetic services, and orthotic services by a
state agency from an accredited facility; Medicaid reimbursement; definitions;
penalties
A.(1) Any state agencies which utilize funds to pay for prostheses, orthoses,
prosthetic services, or orthotic services shall only purchase such services, prostheses, or
orthoses from an accredited facility.
(2) No reimbursements from the state Medicaid program shall be paid for prostheses,
orthoses, prosthetic services, or orthotic services except to an accredited facility.
B. As used in this Section, the following terms shall have the following meanings,
unless the context clearly indicates otherwise:
(1) "Accredited facility" means any facility that is accredited by the American Board
for Certification in Orthotics, Prosthetics, and Pedorthics, or by the Board for
Orthotist/Prosthetist Certification which provides prostheses, orthoses, prosthetic services,
or orthotic services.
(2) "Orthosis" means a custom fabricated brace or support that is designed based on
medical necessity. Orthoses shall not include prefabricated or direct-formed orthotic devices,
or any of the following assistive technology devices: commercially available knee orthoses
used following injury or surgery, upper extremity adaptive equipment, finger splints, hand
splints, wrist gauntlets, face masks used following burns, wheelchair seating that is an
integral part of the wheelchair and not worn by the patient independent of the wheelchair,
fabric or elastic supports, corsets, low-temperature formed plastic splints, trusses, elastic
hose, canes, crutches, cervical collars, and dental appliances, such as those commonly carried
in stock by a pharmacy, department store, corset shop, or surgical supply facility.
(3) "Orthotic services" includes the science and practice of evaluating, measuring,
designing, fabricating, assembling, fitting, adjusting, or servicing of an external device for
the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction,
disease, injury, or deformity. Orthotic practice provides continuing patient care in order to
assure proper fit and function of the orthotic device by periodic evaluation.
(4) "Prosthesis" means an artificial limb designed to maximize function, stability,
and safety of the patient. Prosthesis also means an artificial medical device that is not
surgically implanted and that is used to replace a missing limb. The term shall not include
artificial eyes, ears, noses, dental appliances, ostomy products, or devices such as eyelashes
or wigs.
(5) "Prosthetic services" includes the science and practice of evaluating, measuring,
designing, fabricating, assembling, fitting, aligning, adjusting, or servicing of a prosthesis
through the replacement of external parts of a human body lost due to amputation or
congenital deformities to restore function, cosmesis, or both.
C. Any person who does not provide services from an accredited facility as defined
in Paragraph (1) of Subsection B, or any organization or facility which is not accredited as
defined in Paragraph (1) of Subsection B, and accepts payment from a state agency for
prostheses, orthoses, prosthetic services, or orthotic services shall be fined twenty-five
hundred dollars per violation and shall reimburse the state agency for the cost of the
prostheses, orthoses, or services.
D. Any person who does not provide services from an accredited facility as defined
in Paragraph (1) of Subsection B, or any organization or facility which is not accredited as
defined in Paragraph (1) of Subsection B, and is reimbursed from the state Medicaid program
for prostheses, orthoses, prosthetic services, or orthotic services shall be fined twenty-five
hundred dollars per violation and shall reimburse the state Medicaid program for the cost of
the prostheses, orthoses, or services.
E. Any fines collected pursuant to this Section shall be deposited in the state general
fund after compliance with the requirements of Article VII, Section 9(B) of the Constitution
of Louisiana relative to the Bond Security and Redemption Fund.
F. Nothing in this Part shall prohibit a licensed occupational therapist or a licensed
physical therapist from practicing within his scope of practice. In addition, the provisions
of this Part shall not apply to a licensed optometrist, ophthalmologist, podiatrist, or
orthopedist.