HomeVA ProstheticsVA Handbook 1173.1 - Prosthetics EligibilityResponsibility for Rendering Services

1.5. Responsibility for Rendering Services

a. Prosthetic and Sensory Aids Services (PSAS) Programmatic Responsibilities. PSAS programmatic responsibilities will include, but are not limited to the following:

(1) Inspecting and evaluating artificial limbs and other custom-fitted devices for which replacements have been requested, and authorizing replacement of identical appliances when no medical problem is evident.

(2) Evaluating custom-fitted appliances prior to delivery to patients, and recommending acceptance or rejection of such items to prescribing physicians, clinic teams, or special committees.

(3) Authorizing the issuance of a second appliance when indicated.

(4) Coordinating with the facility AMMS Service, or other office responsible for the acquisition program at the facility, the establishment of local contracts that will expedite delivery of prosthetic appliances and/or services.

(5) Taking action to effect a beneficiary service contract for the purchase, delivery, set-up, instructional use and recovery of medical equipment. Items of equipment and supplies may include, but are not limited to the following items: hospital beds, trapeze assemblies, mattresses, over-the-bed tables, bedside commodes, patient lifts, oxygen equipment and respirators. Provisions for repair and storage may be included in these contracts. NOTE: Compliance with JCAHO and CARF Home Standards is required.

(6) Establishing formal systematic follow-up procedures to review all pending orders.

(7) Counseling beneficiaries concerning their eligibility to receive prosthetic appliances, devices, accessories, repairs, replacements, spares, and related training. NOTE: Notations of counseling are documented in appropriate medical records of beneficiaries.

(8) Providing liaison support and assistance to other facilities regarding the procurement and delivery of prosthetic items and services.

(9) Implementing, maintaining, and monitoring a VA equipment accountability program in accordance with this manual.

b. Procurement Actions. All procurement actions for prosthetic items and/or services for Prosthetic Representatives, who are legally eligible for such treatment, will be approved by their immediate supervisor. The exception to this policy concerns requests for automobile adaptive equipment, which require the approval of the VISN Prosthetic Representative, and the Chief Consultant, Prosthetic and Sensory Aids Service (PSAS) SHG, VA Central Office.

c. Facilities without a Chief, PSAS

(1) The Chief of Staff will designate a staff physician to be responsible for the clinical aspects of the Prosthetic Program. This physician will be professionally responsible for the supervision of the development of prescriptions for appliances, evaluation of appliances prior to delivery to the veteran, condemnation of existing devices, and determination of the need for repairs. The administrative aspects of the program include, the determination of eligibility and/or entitlement; procurement; repairs, etc., will be supervised by the VISN Prosthetic Representative designated by VISN Director.

(2) An employee designated as prosthetic purchasing agent is responsible to the VISN Prosthetic Representative for all processing, clerical, accounting, and reporting duties inherent in the administration of a limited Prosthetics Program.

d. Prosthetic Service Area (PSA)

(1) The Directors of each of the VA medical centers will identify the geographical area to be served by each health care facility.

(2) Each medical center with a prosthetics program will provide all prosthetic services, consistent with its primary service area, including the administration of the Automobile Adaptive Equipment, HISA, Home Oxygen Therapy, and Clothing Allowance Programs, etc.

e. Furnishing of Special and/or Experimental Appliances. Replacement of an experimental appliance still considered in the experimental phase will not be authorized without specific VHA Headquarters approval in each case.

f. Furnishing of Appliances to Beneficiaries in other Federal Facilities, Non-VA Nursing Homes or other Institutions, State Veterans Homes, and Penal Institutions

(1) Other Federal Facilities. Appliances required for treatment in another Federal facility will normally be furnished under the Federal reciprocal per diem rate. When the other Federal facility is unable to furnish the appliances, or the item is not within the purview of the reciprocal per diem rate and is necessary for completion of hospital treatment or to affect discharge, the device will be provided by the Prosthetic Service with PSA responsibility authorizing the hospitalization.

(2) Non-VA Nursing Homes or Other Private Institutions

(a) Prosthetic appliances, medical equipment, and supplies will not be furnished to a veteran receiving community nursing home care at VA expense if the community nursing home is required by contract to provide that appliance, equipment, or supply item. Items normally required by contract are those which are for general use, e.g., hospital beds, mattresses, trapeze assemblies, side rails, over-bed tables, bedside tables, etc. Items which are not required to be furnished by a community nursing home by contract are those which are intended for the personal use of the veteran, e.g., artificial limbs, braces, hearing aids, eyeglasses, walkers, canes, crutches, wheelchairs, cushions, etc.

(b) Prosthetic appliances, medical equipment, and supplies will not be furnished to a resident of a State veterans home on whose behalf VA aid payments are being made if the home is required to provide the appliance, equipment, or supply item by regulation. Items normally required by regulation are those which are for general use, e.g., hospital beds, mattresses, trapeze assemblies, side rails, over-bed tables, bedside tables, etc. Items which are not required to be furnished by a State home regulation are those which are intended for the personal use of the veteran, e.g., artificial limbs, braces, hearing aids, eyeglasses, walkers, canes, crutches, wheelchairs, cushions, etc.

(3) Penal Institutions. Appliances and/or repairs will be furnished to eligible veterans serving sentences in penal institutions who can present themselves for the required medical treatment. Before processing the application, prison officials must be advised and there must be an understanding that the veteran be able to report to the field facility, or to such other place as the field facility may direct, for any necessary measurements, fittings, or follow-up examinations. VA accepts no responsibility for the veteran's custody or actions during absence from the penal institution; written acknowledgment of same should be obtained prior to scheduling treatment. VA facility police will be notified whenever an incarcerated veteran is being treated.

g. Furnishing Appliances to Beneficiaries Residing or Sojourning in Foreign Countries or in Territories or Possessions of the United States

(1) Prosthetic appliances, sensory aids, aids for the blind, medical equipment, medical supplies, and/or repairs thereto will be furnished to eligible service-connected veterans sojourning or living in foreign countries or in U.S. Territories or possessions by referring the requests to the VA Health Administration Center, Denver, CO. Veterans residing in Canada will contact the VA Medical Center, White River Junction, VT. Stump socks and hearing aid batteries will be issued by the DDC, Denver, CO.

(2) Eligible beneficiaries who reside in a foreign country are entitled to prosthetic services at any VA facility with PSA responsibility when visiting the United States.

h. Furnishing of Appliances to Allied Beneficiaries Residing in the United States.

Appliances will be furnished to allied beneficiaries residing in the United States by the Prosthetic Service with PSA responsibility in accordance with M-1, Part I, Chapter 24.

i. Furnishing of Appliances as Loaned Items

(1) Any items or DME valued at $6,000 or more furnished to eligible beneficiaries may be loaned. Such loaned items will be prorated at 20 percent per year, and dropped as a loaned item upon being de-valued to zero dollar amount. Items and or DME may be loaned as "short-term" to beneficiaries with temporary disabling conditions or with poor prognoses, irrespective of cost.

Items previously loaned, but returned to VA and subsequently issued as a "VA stock" item will not be routinely loaned again. Examples include, but are not limited to hospital beds, wheelchairs, invalid lifts, etc.

(2) Form Letter (FL) 10-219, Notice to Veteran of Loan of Medical Accessories and Receipt Therefore, as provided through the correspondence option of the prosthetic software will be used to notify the veteran of the terms and conditions of the loan.

(3) Veterans with items and/or DME on loan will be permitted to take the items and/or DME to a new residence within another field facility's PSA. Records will be transferred to the responsible field facility to permit the necessary follow-up. Reclamation will be managed by the Prosthetic Service with PSA responsibility where the beneficiary resides.

(4) Loan items and/or DME provided to beneficiaries for which VA receives payment from a private insurance company under the Medical Care Cost Recovery (MCCR) Program will be permanently issued and dropped from all loan records.

(5) Whenever a veteran is initially furnished items and/or DME on a loan basis, FL 10-426a, Information Letter-Major Medical Equipment, will be provided advising the veteran of VA's policy concerning repairs, maintenance, recovery, etc. This form should be utilized via the correspondence option of the prosthetic software for recording to VA Form 10-2319 (ADP), Record of Prosthetic Service.

(6) Prior to initiating recovery action on any items and/or DME, the Prosthetic Service will make a comparison of the cost of recovery and the residual value of an item to determine the economic feasibility of recovery.

j. Replacement and Second Appliances

(1) Appliances will not be replaced until a feasibility determination is made by an authorized VA official that the current appliance is unsatisfactory for further use by the beneficiary.

(2) Second appliances may be furnished to eligible beneficiaries only after determination of need in each specific case. Such determination will be based on the seriousness of the disability, availability of adequate local facilities for prompt repair of the particular appliance and individual need of the beneficiary concerned.

(3) Replacement and second appliances that are serviceable and still meet the veteran's overall need, as determined by the Prosthetics Activity in consultation with the contractor and inhouse VA medical center committees, will not be replaced for the sole purpose of obtaining a newer model of the same or similar equipment. When substantiated abuse of the equipment can be documented as the basis to expedite replacement, the average useful life of the appliance will be established from the date of issue and applied in determining if replacement will be made.

k. Prosthetic Stock Items.

(1) A supply of prosthetic stock items is authorized for any VA facility to meet the immediate needs of the veteran population. This may include a variety of items of medical equipment, non custom-fitted appliances and select medical supplies. These items will be maintained and accounted for by Prosthetic Program Officials, or a designated official, in a VA field facility not having an established Prosthetic program.

(2) Program officials will compare issue and stock control record balances with the actual shelf inventory not less than on a quarterly basis. Stock record adjustments will be made for normal differences and an investigation will be made if abnormal and frequent discrepancies are discovered. Item usage will be reviewed to adjust stock and re-order levels on a locally established basis and should not exceed a 30-day supply.

(3) When equipment is stored by a contractor under the provisions of a local beneficiary delivery and/or service contract, program officials will review inventory levels on a monthly basis and compared to the stock control record affecting the delivery and/or service contract.

(4) Program officials will routinely inspect stock items during inventory reconciliation with special consideration given to appliances that deteriorate because of age or climatic conditions, that require special storage facilities such as refrigeration, darkness, security provisions, require repair or modification, or are surplus because of age, condition, or obsolescence, etc. Items which are identified as being excess to needs should be turned-in to Acquisition and Materiel Management Service, or the facility Accountable Officer, via VA Form 2237, Request, Turn-in, and Receipt for Property or Services.

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