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Alberta Health

Alberta Aids to Daily Living Custom-Made Footwear Benefits

Policy & Procedures Manual

August 1, 2013

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Alberta Health, Alberta Aids to Daily Living Program Manual, Manual F, Custom-Made Footwear Benefits, Policy and Procedures Manual August 1, 2013

© 2013 Government of Alberta 2

Revision History Description Date

Update Manual August 1, 2013

Policy F-01: Update Policy August 1, 2013







Policy F-14: New August 1, 2013

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Table of Contents Policy F – 01 .................................................................................................................... 5

Custom-Made Footwear Benefits Background ........................................................................... 5 Policy Statement .................................................................................................................................... 5

Policy F - 02 ..................................................................................................................... 6 Process for Obtaining Custom-Made Footwear Benefits ............................................................ 6

Policy Statement .................................................................................................................................... 6 Procedure .............................................................................................................................................. 6 Process for Obtaining Custom-Made Footwear Benefits ....................................................................... 7

Policy F - 03 ..................................................................................................................... 8 Eligibility Criteria for Custom-Made Footwear Benefits .............................................................. 8

Policy Statement .................................................................................................................................... 8 Procedure .............................................................................................................................................. 9

Policy F - 04 ................................................................................................................... 10 Diagnostic Coding ..................................................................................................................... 10

Policy Statement .................................................................................................................................. 10 Procedure ............................................................................................................................................ 10

Policy F – 05 .................................................................................................................. 11 Choice of Custom-Made Footwear Specialty Supplier ............................................................. 11


Policy F – 06 .................................................................................................................. 12 Custom-Made Footwear Quantity and Frequency Limits ......................................................... 12


Policy F – 07 .................................................................................................................. 14 Changing Custom-Made Footwear Providers ........................................................................... 14


Policy F – 08 .................................................................................................................. 16 Service Dates ............................................................................................................................ 16


Policy F – 09 .................................................................................................................. 17 Statement of Account ................................................................................................................ 17


Policy F – 10 .................................................................................................................. 18 Custom-Made Footwear Suppliers Qualifications ..................................................................... 18


Policy F – 11 .................................................................................................................. 19 Custom-Made Footwear Specialty Suppliers Roles and Responsibilities ................................ 19


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Policy F – 12 .................................................................................................................. 22 Custom-Made Footwear Client Roles and Responsibilities ...................................................... 22


Policy F – 13 .................................................................................................................. 23 Approved Custom-Made Footwear Specialty Supplier List ...................................................... 23


Policy F – 14 .................................................................................................................. 24 Validation Certificate ................................................................................................................. 24


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Policy F – 01

Custom-Made Footwear Benefits Background

Policy Statement

1. Clients must meet general AADL criteria and specific clinical eligibility criteria for AADL Custom-Made Footwear.

2. AADL Custom-Made Footwear benefits available to eligible clients include:

Custom-Made Footwear for 1st Degree Deformity, 2nd Degree Deformity, and 3rd Degree Deformity.

Partial Foot Replacements.

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Policy F - 02

Process for Obtaining Custom-Made Footwear Benefits

Policy Statement

Clients and Custom-Made Footwear providers will follow the AADL procedure for obtaining and providing Custom-Made Footwear benefits.

Procedure

Clients:

1. Follow process outlined on page 7 of this policy.

Specialty Suppliers:

1. Follow process outlined on page 7 of this policy.

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Process for Obtaining Custom-Made Footwear Benefits

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Policy F - 03

Eligibility Criteria for Custom-Made Footwear Benefits

Policy Statement

1. Clients must meet the general AADL eligibility criteria and have:

A structural bony deformity of the foot such as with talipes equino varus, severe arthritis and resultant deformity, or neurological damage to the foot with resultant deformity or stablilized gross edema. If clients cannot wear a modified, or special off-the-shelf shoe for these reasons, they are eligible for this benefit.

Clients must be ambulatory.

A physician who is a member in good standing of the College of Physicians and Surgeons of Alberta must prescribe Custom-Made Footwear.

A generic prescription from a physician stating:

a) Specific benefit requested, and

b) Other information related to foot problems and/or specific instructions.

2. AADL does not provide Custom-Made Footwear benefits for:

Non-ambulatory clients.

Clients only able to pivot and/or stand for transfers.

Clients who refuse to try off-the-shelf footwear.

Edema management.

Post-operative conditions.

Exclusive use for sports, recreation or rehabilitation purposes.

3. AADL does not provide Custom-Made Footwear for clients having problems finding the appropriate off-the-shelf footwear because they have oversized, or undersized feet, extra width/depth needs, a split size requirement, problems with edema, lesions or acute post-operative conditions.

4. A leg length discrepancy indicates a need for a shoe elevation, and not Custom-Made Footwear.

5. It is recognized that some orthotic devices (such as Ankle Foot Orthosis) may cause fitting problems, but this does not indicate a need for Custom-Made Footwear.

6. Clients are eligible for one pair of Custom-Made Footwear every year based on clinical need.

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Procedure

Clients:

1. Obtain a prescription from a physician.

2. Contact the AADL Program for a list of specialty suppliers. Vendor lists are available on the AADL website at http://www.health.alberta.ca/services/AADL-approved-vendors.html.

3. Must try off-the-shelf footwear such as extra width, extra depth before being deemed eligible for Custom-Made Footwear.


1. Confirm client eligibility.

2. In cases of ineligibility, may suggest alternate footwear options.

3. Obtain physician’s prescription from client.

4. Enter authorization on E-Business.

5. Complete all required assessment documentation.

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Policy F - 04

Diagnostic Coding

Policy Statement

Diagnostic coding must be provided to assist in determining client eligibility for benefits.

Procedure


1. Indicate the exact diagnostic code on the AADL E-business authorization form. Choices are listed in the drop down box on the AADL E-business “Create/Maintain” authorization screen.

2. If “Other” is used, must indicate the specific diagnosis in the AADL E-business Client Benefit note.

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Policy F – 05

Choice of Custom-Made Footwear Specialty Supplier

Policy Statement

Clients have a choice of specialty supplier.

Procedure

Clients:

1. Select a specialty supplier from the AADL approved Custom-Made Footwear Vendor list.

AADL:

1. Maintains a list of AADL approved Custom-Made Footwear Specialty Suppliers that authorizers and clients may access for Custom-Made Footwear information and services.

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Policy F – 06

Custom-Made Footwear Quantity and Frequency Limits

Policy Statement

1. Clients are eligible to receive Custom-Made Footwear benefits per the quantity and frequency listed on the AADL Approved Product List – Custom-Made Footwear Benefits.

2. Clients are eligible for one pair of Custom-Made Footwear every twelve months.

3. AADL recognizes that some clients may prefer to have two pairs of Custom-Made Footwear at one time to accommodate for different seasons or environments. As AADL does not provide duplicate benefits, clients may elect to receive a future pair of footwear early. Therefore a client may receive two pairs of footwear in the first year and no additional pairs in the second year. This is not considered over-quantity and therefore a Quantity and Frequency Review request QFR is not necessary.

For Clients who have chosen the early second pair of footwear, further early replacement (third or fourth pair in the two-year period) will only be considered by a Quantity and Frequency Review Request that clearly demonstrates a significant change in clinical condition. AADL will not provide additional footwear (third or fourth pair in the two-year period) if the original two pairs of footwear are worn out within the two-year period.

Procedure

Clients:

1. If clients elect to receive a second pair of footwear early, must acknowledge the increase in frequency of eligibility for replacement from one year to two years.

2. Follow the Quantity and Frequency Review (QFR) process as outlined in the general AADL Program Manual for situations of significant change in condition.

3. Are responsible for the cost of the footwear if the QFR is denied.

Specialty suppliers:

1. Confirm client consumption on the AADL E-business “PHN Inquiry” screen. 2. Advise client of quantity and frequency limits. 3. Documentation procedure:

a. If it is over one year since the client was provided with a similar benefit and the client has not chosen an early second pair of Custom-Made Footwear, document the quantitative rationale for replacement on the AADL E-Business Client Benefit Note screen.

b. If it is prior to the one year period since the client was provided with a similar benefit, follow the QFR process as outlined in the General AADL Program Manual.

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c. If the client elects to receive a second pair of Custom-Made Footwear early, inform AADL Program Benefit Clerk who will update the AADL system. Do not submit a QFR. This is not considered additional quantity or frequency of the benefit.

The new eligibility date for replacement of the Custom-Made Footwear will be two years from the service date of the first pair of Custom-Made Footwear. Ensure the Validation Certificate for the second pair of footwear states “2 years” for eligibility for replacement when the client signs the third section.

Example:

Aug 1, 2013: Client receives first pair of Custom-Made Footwear

Date client is eligible for replacement: Aug 1, 2014

Client elects to receive second pair of Custom-Made Footwear early

Oct 15, 2013: Client receives second pair of Custom-Made Footwear

Date client is eligible for replacement: Aug 1, 2015

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Policy F – 07

Changing Custom-Made Footwear Providers

Policy Statement

Clients must be attended by only one Custom-Made Footwear provider at a time.

Clients must not switch providers during the fabrication process of Custom-Made Footwear, unless prior approval is given by AADL.

Procedure

Clients:

1. Responsible for giving current provider the opportunity to provide footwear that meets the client’s needs.

2. Contact the AADL Program Manager regarding concerns on service or device.

3. Submit a formal “AADL Complaint” if applicable. http://www.health.alberta.ca/documents/AADL-Complaint-Form.pdf

Custom-Made Footwear Specialty Suppliers:

1. Check E-Business to verify if client has been provided Custom-Made Footwear benefits by AADL. If yes, contact AADL benefit clerk to find out who was the previous Custom-Made Footwear Specialty Supplier.

2. Refer client back to original service provider for ongoing service and follow-up with footwear benefits.

a. If client refuses to return to previous Specialty Supplier, the provider must not provide service to the client unless the client is willing to fund the services privately.

b. If a client is eligible for replacement, see point 3.

3. May choose to contact previous Specialty Supplier to discuss transferring care to the new Custom-Made Footwear povider.

a. Advise AADL Program Manager if agreement of a transfer of care is reached.

4. Do not submit a Quantity and Frequency Review for a request to switch Specialty Supplier.

5. Advise the client to submit a formal “AADL Complaint” if applicable. http://www.health.alberta.ca/documents/AADL-Complaint-Form.pdf

6. Contact AADL Program Manager for advice as required.

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AADL:

1. Reviews client’s concerns via formal complaint process.

2. Refers client to a multidisciplinary team for assessment if available.

3. Recommends change of Specialty Supplier if appropriate.

4. Takes a credit on Custom-Made Footwear that has been determined not to be appropriate for the client.

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Policy F – 08

Service Dates

Policy Statement

The service date used for submitting claims for Custom-Made Footwear is the date the client signs the final section of the Custom-Made Footwear Validation Certificate.

Procedure


1. Indicate the service date on the claim according to the date the client received the benefit.

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Policy F – 09

Statement of Account

Policy Statement

Specialty Suppliers must provide every client with a Statement of Account for each benefit invoiced to the AADL Program. The Statement of Account must include the AADL contribution and cost-share portion of each benefit (when applicable).

Procedure


1. Provide client with a Statement of Account for AADL benefits when invoiced to the AADL Program.

2. For cost-share clients, identify the AADL contribution and the client’s cost-share contribution for each benefit.

3. For cost-share exempt clients, identify AADL’s contribution for each benefit.

4. Retain a copy of Statement of Account on client file.

AADL

1. Conducts audits to identify discrepancies of costs between the claims received and the Statement of Account received by the client.

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Policy F – 10

Custom-Made Footwear Suppliers Qualifications

Policy Statement

1. The provider of Custom-Made Footwear benefits must be one of the following:

a. To provide Custom-Made Footwear benefits, including the manufacturing of Custom-Made Footwear the provider must be a Certified Pedorthic Master Craftsman in good standing with the College of Pedorthics of Canada.

b. To provide Custom-Made Footwear, excluding the manufacturing of Custom-Made Footwear the provider must be one of the following:

i. Certified Pedorthist in good standing with the College of Pedorthics of Canada.

ii. Certified Orthotist in good standing with the Canadian Board for Certification of Prosthetists and Orthotsits.

2. The provider must be employed by a facility with an agreement with AADL to provide Custom-Made Footwear benefits.

Procedure


1. Notify AADL when changing employment location.

AADL:

1. Verifies membership with appropriate professional certification body.

2. Provides a Specialty Assessor number.

3. Updates employment location information.

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Policy F – 11

Custom-Made Footwear Specialty Suppliers Roles and Responsibilities

Policy Statement

Custom-Made Footwear Specialty Suppliers assess and fit clients for Custom-Made Footwear benefits and services.

A Certified Pedorthist or a Certified Orthotist is able to provide the following for AADL clients:

Assessment for Custom-Made Footwear.

Casting and measuring for Custom-Made Footwear.

Fitting of Custom-Made Footwear.

A Certified Pedorthic Master Craftsman is able to provide the following for AADL clients:

Assessment for Custom-Made Footwear.

Casting and measuring for Custom-Made Footwear.

Manufacturing Custom-Made Footwear - including:

Measuring, casting and making original shoe lasts;

Designing and making upper patterns;

Manufacturing fitting model of shoes; and,

Lasting and finishing of custom shoes.

Fitting of Custom-Made Footwear.

Procedure


1. Assess clients who have a structural bony deformity of the foot such as with talipes equino varus, severe arthritis and resultant deformity, or neurological damage to the foot with resultant deformity or stabilized gross edema.

2. Ensure:

Clients cannot wear a modified or special off-the-shelf shoe (clients must try off the shelf shoe such as an extra width, extra depth prior to determining eligibility for this benefit).

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Clients are ambulatory.

Clients meet the Custom-Made Footwear benefit eligibility criteria.

Clients are advised of their responsibilities related to program benefits including the expiry date of their Custom-Made Footwear authorization.

Clients sign the “Client Declaration” form.

3. Accept only a generic physician prescription.

4. Contact the AADL Custom-Made Footwear clerk and/or the Manager with concerns, questions, prior approvals, and unusual requests. If eligibility is questionable, an authorization is not to be completed.

5. Complete the on-line authorization as outlined in the On-Line Training Manual within 20 business days of the assessment.

6. Retain on file:

Authorizations

Assessments

Physician’s Generic Prescription

Pedograph

Photograph

Custom-Made Footwear Criteria Document A and B

Documentation, including provider signature, of all AADL client encounters

7. Adhere to the AADL Specialty Supplier Agreement and both the general AADL and Custom-Made Footwear Policies and Procedures.

8. Honour manufacturer’s warranties.

9. Ensure that a Certified Pedorthic Master Craftsman approves the end product of each stage of fabrication of Custom-Made Footwear:

casting

last making

pattern making

upper making

lasting

finishing

10. Provide instructions to Clients on the care, operation and maintenance of any Custom-Made Footwear

11. Use all reasonable efforts to supply the Custom-Made Footwear at the lowest possible cost.

12. Provide clients with a statement of claim indicating AADL’s portion and the client’s portion if applicable.

13. Inform the client that he or she is responsible for all repairs to their Custom-Made Footwear.

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14. Provide appropriate follow-up.

AADL:

1. Ensures Specialty Supplier complies with roles, responsibilities and contractual obligations.

2. Conducts post-audit reviews.

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Policy F – 12

Custom-Made Footwear Client Roles and Responsibilities

Policy Statement

Clients receiving Custom-Made Footwear benefits shall meet the current AADL Custom-Made Footwear eligibility criteria for the benefits they are receiving and must comply with AADL policies and procedures.

Procedure

Clients:

1. Provide the Specialty Supplier with a generic physician’s prescription.

2. Are aware that if off-the-shelf footwear such as extra width, extra depth will meet their clinical needs they are not eligible for Custom-Made Footwear and aware that this alternative must be trialed prior to Specialty Supplier determining eligibility for Custom-Made Footwear.

3. Are aware that Custom-Made Footwear provided by AADL is for “function” not for “cosmetics”.

4. Are aware that it is their responsibility to repair and maintain their Custom-Made Footwear. Clients are eligible for two pairs of Custom-Made Footwear per two year period; replacements are based on need as determined by the Specialty Supplier.

5. Are aware that AADL does not provide early replacement of lost, stolen or damaged Custom-Made Footwear.

6. Are aware that AADL will assist with replacement of worn Custom-Made Footwear only when it is no longer economically feasible or safe to repair, or when there is a significant change in their foot condition. This requires a Quantity and Frequency Review (QFR) request.

7. Comply with Specialty Supplier policies regarding abuse-free facility environments. Failure to comply may result in the supplier declining further services.

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Policy F – 13

Approved Custom-Made Footwear Specialty Supplier List

Policy Statement

AADL will only provide funding to eligible clients who receive their benefits from the “Approved List of Custom-Made Footwear Vendors”.

Procedure

Clients:

1. Select a Specialty Supplier from the current Custom-Made Footwear Vendor list available upon request or on the AADL website.

AADL:

1. Provides clients with information in writing upon request, or refers to AADL website.

3. Maintains list of approved Specialty Suppliers.

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Policy F – 14

Validation Certificate

Policy Statement

The Validation Certificate is a document intended to ensure accountability and clarify expectations for all parties involved in the provision of Custom-Made Footwear.

The Validation Certificate is a three part form, in that the client will sign this form on three separate occasions:

1. At time of assessment: acknowledging agreement to the type of footwear being provided.

2. During fabrication of device: acknowledging receipt of footwear.

3. After final provision of the device: acknowledging satisfactory fit and function of footwear.

The AADL Program Manager should be contacted if the client refuses or feels they are unable to sign the form.

Procedure


1. Discuss footwear to be provided and ensure client understands their responsibilities.

2. Have client sign first section of Validation Certificate prior to starting fabricating the footwear.

a. Provide client with a copy of the Validation Certificate if requested and retain the original on the client’s file.

3. Upon providing footwear to the client to trial, have the client sign the second section of the Validation Certificate to confirm receipt.

4. Once the device is completed and the final fitting complete, the client must sign the Validation Certificate to confirm satisfactory fit and function of the footwear.

a. The client should be provided with a reasonable length of time to trial the footwear prior to being asked to sign the Validation Certificate. For some clients, the trial period may be very short. A client may be able to sign both the second and third sections on the same day.

b. The client should only sign once all concerns are addressed.

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c. The Specialty Supplier should not submit a claim for the footwear until the last section of the Validation Certificate is signed by the client, which is considered the service date for the footwear.

d. If the client fails to return for the final fitting or refuses to sign the final section of the Validation Certificate, the Specialty Supplier may claim for a portion of the cost of the footwear as follows:

Provide AADL with a copy of the Validation Certificate signed in first two sections.

Provide evidence of attempts to resolve issues or contact client for follow-up.

Provide catalogue numbers and cost for unclaimed items to AADL. AADL will provide billable amount.

e. Clients who are unable to return for follow-up may sign and submit the final section of the Validation Certificate by alternate methods (i.e., fax or mail).

Clients:

1. Fully read and understand the Validation Certificate prior to signing it.

2. Contact the AADL Program Manager if they are unable to sign the Validation Certificate.

AADL:

1. Responds to questions and concerns from Specialty Suppliers or clients regarding the Validation Certificate.

2. May request copies of the completed Validation Certificates.

3. Reviews cases of client refusal to sign Validation Certificate.

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