SERVICE SPECIFICATIONS FOR ORTHOTIC SERVICES
1. SERVICE OBJECTIVES
1.1. The objective of Orthotic Services is to provide Clients with timely access to appropriate Orthoses to support their return to independence, work or education.
1.2. ACC defines Orthoses as pre-fabricated, customised, or custom made externally applied devices used to improve and support function.
2. SERVICE ELIGIBILITY
2.1. Access to the Orthotic Service is available to Clients who have been referred to the Service in accordance with this Service Schedule.
2.2. Orthotic Services may only be provided and paid for under this Service Schedule if such services are not provided as part of any other ACC-funded services including:
2.2.1. Public Health Acute Services (PHAS) as defined in the Accident Compensation Act 2001;
2.2.2. Inpatient treatment under the Elective Services Contract;
2.2.3. Orthotics required for up to six weeks post discharge date from Elective Services;
2.2.4. Hand Therapy services;
2.2.5. Urgent Care Clinic services;
2.2.6. Rural General Practice services;
2.2.7. Clinical Services;
2.2.8. Physiotherapy services; and
2.2.9. Minor foot surgery performed within the scope of practise of a podiatric surgeon or podiatrist as defined by the New Zealand Podiatrists Board.
2.3. Orthotic Services may only be provided and paid for under this Service Schedule if such services are provided by:
2.3.1. Orthotists – may provide consultations and orthoses, and
2.3.2. Podiatrists – may provide orthoses only.
3. ORTHOTIC SERVICE CONSULTATIONS
3.1. Consultations by Podiatrists must be provided and invoiced under the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) 2003 Regulations.
3.2. Orthotists may provide the following Orthotic Service consultations under this Service Schedule.
3.3. Initial Consultation (to be used for first assessment only). An Initial Consultation is a face-to-face assessment carried out once for a Client for each Claim and includes:
3.3.1. provision of information and advice to the Client regarding the process for assessing and fitting Orthoses and expected timeframes;
3.3.2. a thorough and accurate assessment of the need for an Orthosis;
3.3.3. ensuring that there is clinical evidence that the requirement for an Orthosis directly relates to the covered Personal Injury;
3.3.4. the identification of the most appropriate and cost effective Orthosis;
3.3.5. provision and fitting of an Orthosis, if required; and
3.3.6. education of the Client in the use and care of the Orthosis.
3.4. An Initial Consultation can be either Simple or Complex taking into account best practice and the complexity of the Client’s injury.
3.4.1. A Simple Initial Consultation is where a Client’s needs can be assessed and provided for in a maximum of one appointment and one follow up appointment.
3.4.2. A Complex Initial Consultation is where the Client’s needs require an initial appointment and may include the measurement and fabrication of a customised orthosis and the arrangement for more than one follow up consultation for fitting and/or review.
3.5. Follow-up Consultation(s) with the Client, where required, may include:
3.5.1. provision and fitting of an Orthosis (including a trial fitting);
3.5.2. education of the Client in the use and care of the Orthosis;
3.5.3. reviewing the fit and function of a previously supplied Orthosis; or
3.5.4. assessing a Client’s existing Orthosis for repairs or replacement.
3.6. Prior Approval for Orthotists’ Consultations
3.6.1. A Simple Consultation and one follow up consultation will be funded by ACC without prior approval.
3.6.2. A Complex Consultation with up to three follow up consultations will be funded by ACC without prior approval.
3.6.3. Where further follow up consultations are required the Supplier will submit a request for funding approval, using the template supplied by ACC, to the Treatment Assessment Centre.
126.96.36.199. The request will include a clinical rationale to support the additional consultations required.
188.8.131.52. ACC will provide notice in writing to the Supplier and the Client of its decision to accept or decline (at ACC’s sole discretion) the request for funding approval for further Orthotic consultations.
3.7. Customisation or fabrication of an orthosis is not included in the Consultation price.
4. PROVISION OF ORTHOSES – ORTHOTISTS AND PODIATRISTS
4.1. An Orthotist or Podiatrist may provide an Orthosis to a Client when:
4.1.1. An Orthotist is undertaking a Consultation in accordance with Part B, clause 3; or
4.1.2. A Podiatrist is undertaking a Consultation in accordance with the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) 2003 Regulations.
4.2. Prior Approval for Orthoses
4.2.1. The cost of Orthoses up to the limits specified in Part A, clause 4 (Service Items and Prices) will be funded by ACC without prior approval.
4.2.2. Where the cost of the Orthoses exceeds the prior approval limit specified in Part A, clause 4, the Supplier will submit a request for funding approval to the Treatment Assessment Centre using the template supplied by ACC.
184.108.40.206. The request will include a clinical rationale to support the Orthoses required.
220.127.116.11. ACC will provide notice in writing to the Supplier and the Client of its decision to accept or decline (at ACC’s sole discretion) the request for funding approval.
5. SERVICE REQUIREMENTS
5.1. Customisation and fabrication of orthoses may be undertaken by the Supplier or subcontracted to a specialist orthotic fabrication service.
5.2. The Supplier will advise ACC if the Client needs to be referred to other services where clinically necessary and appropriate.
5.3. The Supplier will:
5.3.1. maintain and update Client records with appropriate clinical information;
5.3.2. meet timeframes and key deliverables; and
5.3.3. ensure that any Orthoses recommended:
a) are suitable for their intended purpose, and
b) represent the most cost effective solution to meet the identified injury related need.
5.4. The Supplier will provide the Services in accordance with the Operational Guidelines for Orthotic Services which are available on the ACC website.
5.4.1. The Operational Guidelines may be updated from time to time.
5.4.2. If there is a conflict between the Operational Guidelines and this Service Schedule the provisions of this Service Schedule take precedence.
6. SERVICE COMMENCEMENT
6.1. The Services will commence for a Client on receipt by the Supplier of:
6.1.1. In the case of Services provided by an Orthotist:
18.104.22.168. a referral from a registered medical practitioner who is a specialist in orthopaedics, sports and exercise medicine, rehabilitation medicine, musculoskeletal medicine, internal medicine - rheumatology, general practice; or
22.214.171.124. a referral from a health practitioner who is a physiotherapist or podiatrist; or
126.96.36.199. a referral from ACC.
6.1.2. In the case of Service provided by a Podiatrist:
188.8.131.52. self referral by a Client; or
184.108.40.206. a referral from a registered medical practitioner who is a specialist in orthopaedics, sports and exercise medicine, rehabilitation medicine, musculoskeletal medicine, internal medicine - rheumatology, general practice; or
220.127.116.11. a referral from a health practitioner who is a registered physiotherapist or podiatrist; or
18.104.22.168. a referral from ACC.
6.2. The Supplier will return any referral if it contains inadequate information and request further details before accepting the referral.
7. SERVICE SPECIFIC QUALITY REQUIREMENTS
7.1. The Supplier will ensure that Orthotic Services are only carried out by Service Providers who:
7.1.1. are accredited members of the New Zealand Orthotics & Prosthetics Association (NZOPA); or
7.1.2. are registered with the Podiatrists Board of New Zealand and hold a current Annual Practising Certificate.
7.2. Podiatrists will only provide Orthotic Services in relation to issues affecting lower limbs and the foot within their professional scope of practice.
7.3. All new Service Providers will be orientated to the Service Provider role by the Supplier. This will include
7.3.1. provision of a position description for the Service Provider role; and
7.3.2. familiarisation with the service requirements of this Service Schedule.
ACC Orthotic Contract!
VERY EXCITING CHANGES TO THE ACC ORTHOTIC CONTRACT, ALLOWING EASIER ACCESS TO ORTHOTIC TREATMENT.
%100 FREE ORTHOTIC TREATMENT UNDER ACC*
Get Premium Quality Orthotics for your patients
*must have a registered ACC claim and a referral from either an Orthopaedic Surgeon, Sports Physician, rehabilitation medicine, musculoskeletal medicine, internal medicine, Rheumatologist. General Practitioner or a Physiotherapist.
Changes in the new ACC Orthotic contract (effective from 1st July 2017), GP's and Physiotherapists can now also for the first time refer patients directly for Orthoses.
IMPORTANT: Both consultation and products will be covered 100% by ACC for Orthoses. Orthoses that cost less than $300 can be provided immediately, without needing prior approval from ACC. Approval time for high-end custom-made orthotics will be less than 10 days (down from up to 6 weeks), with the option of faster approvals in emergency cases.
That’s where we come in. Our experts at Shore Orthotics have been providing custom-made, effective Orthotics of the highest quality for decades. We work closely with Orthopaedic Surgeons and Sports Physicians, and are specialists in Gait Analysis, custom foot orthotics and complex braces. We make all of our Orthotics in-house, including EVA, High Density Plastezote and Carbon Foot Orthotics – so they will be just right for your patient and ready quickly. Private patient will enjoy the efficient service and value. As we make most of our product in-house, there are financial savings that we pass on to the patients.
– Orthopaedic Surgeons and Sports Physicians, trust us with their Patients, why not trust us with yours.
– When other options have failed try us, or why not start with us!
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