Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 428.000 - Prosthetics Services › Section 428.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130 CMR
				428.000 have the meanings given in
				130
				CMR 428.402 unless the context clearly
				requires a different meaning. The reimbursability of services defined in
				130 CMR
				428.000 is not determined by these definitions, but by
				application of regulations elsewhere in
				130 CMR
				428.000 and
				130 CMR
				450.000:
Administrative and Billing
				Regulations
.
Accessory Equipment
- equipment that
				is fabricated primarily and customarily to modify or enhance the usefulness or
				functional capability of another piece of prosthetic equipment and that is
				generally not useful in the absence of such prosthetic equipment.
Adjusted Acquisition Cost
- except
				where the manufacturer is the provider, the price paid by the provider to the
				manufacturer or any other supplier for prosthetic devices, customized
				equipment, or supplies, excluding all associated costs such as shipping,
				handling, and insurance costs in accordance with
				130
				CMR 428.422. Where the manufacturer is the
				provider, the adjusted acquisition cost is the actual cost of manufacturing
				such prosthetic devices, customized equipment, or supplies.
American Board for Certification in Orthotics,
				Prosthetics and Pedorthics, Inc. (ABC)
- the national certifying
				and accrediting body for the orthotic, prosthetic, and pedorthic
				professions.
Board of Certification/Accreditation, International
				(BOC)
- a credentialing entity for practitioners and suppliers of
				comprehensive orthotic and prosthetic care.
Certified Mastectomy Fitter (CMF)
- a
				health care professional with current certification through the ABC or BOC who
				is specifically educated and trained in the provision of breast prostheses and
				post-mastectomy services, including patient assessment, formulation of a
				treatment plan, implementation of the treatment plan and follow-up, and
				practice management.
Date of Service
- the date the
				prosthesis is delivered and fitted to the MassHealth member. If the prosthetic
				service involves a series of fittings and adjustments, the date of service is
				the date on which the final adjustment is made. If the prosthetic service
				involves only the provision of a service (for example, a repair), then the date
				of service is the date on which the service was completed.
Discount
- any remuneration or
				reduction of payment of any kind, whether direct or indirect, received by the
				provider.
Nursing Facility
- a licensed facility
				that meets the provider-eligibility and certification requirements of
				130
				CMR 456.404:
Requirements for
				Provider Participation; In-state
or
				130
				CMR 456.405:
Requirements for
				Provider Participation
; Out-of-state and whose members meet the
				medical eligibility criteria under
				130
				CMR 456.409:
Services Requirement for
				Medical Eligibility
. Nursing facilities do not include facilities such
				as rest homes, state schools, and state hospitals.
Nursing Facility Visit
- a visit by a
				provider to a nursing facility for the purpose of providing prosthetic
				services.
Prosthesis (or Prosthetic Equipment)
-
				an artificial replacement for a missing body part, such as an artificial limb
				or total joint replacement.
Prosthetics Provider
- an organization
				or individual that has enrolled with MassHealth and has signed a provider
				contract with the MassHealth agency who meets all applicable requirements of
				130
				CMR 428.404 and
				450.000:
Administrative and Billing Regulations
. Prosthetics providers
				may include providers also enrolled as MassHealth participating durable medical
				equipment (DME) and supplies providers, oxygen and respiratory therapy
				equipment and supplies (OXY) providers, or orthotics services providers, who
				meet all program-specific requirements.
Prosthetic Service
- the purchase,
				customization, fitting, repair, replacement, or adjustment of a prosthesis or
				component part, or other activity performed or equipment provided in accordance
				with 130 CMR
				428.000.
Prosthetic Supplies
- products that
				are:
(1) fabricated primarily and
			 customarily to fulfill a medical purpose;
(2) used in conjunction with a prosthesis or
			 prosthetic equipment;
(3) generally
			 not useful in the absence of a prosthesis; and
(4) non-reusable and disposable.
Prosthetics
- the design, fitting, and
				attachment of an artificial replacement of a missing body part.
Service Facility
- the place of
				business, physically accessible to MassHealth members, where prosthetic
				services, especially those involving fitting, adjustment, repair, and
				replacement of prostheses, are performed. A service facility does not include a
				MassHealth member's place of residence.