Over a decade ago, the Board of Certification/Accreditation, International (BOC), formerly the Board for Orthotist / Prosthetist Certification, was included in the Benefits Improvement and Protection Act of 2000 (BIPA). BIPA generally, and specifically Section 427, establishes the policies for which suppliers can bill the Centers for Medicare/Medicaid Services for the provision of custom-fabricated orthotics and prosthetics. Inclusion in this act is a defining moment in BOC’s history, as it recognizes BOC-certified practitioners and -accredited facilities as “qualified practitioner” and “qualified supplier” within this act.

Below is an excerpt of section 1834 of the Social Security Act, which names BOC among qualified entities established in BIPA. The SSA discusses the procedures associated with BIPA policy. Highlights have been added for emphasis.

SPECIAL PAYMENT RULES FOR PARTICULAR ITEMS AND SERVICES

Sec.1834. [42 U.S.C. 1395m] (a) Payment for Durable Medical Equipment.

(F) Special payment rules for certain prosthetics and custom–fabricated orthotics.—

(i) In general.—No payment shall be made under this subsection for an item of custom– fabricated orthotics described in clause (ii) or for an item of prosthetics unless such item is—

(I) furnished by a qualified practitioner; and

(II) fabricated by a qualified practitioner or a qualified supplier at a facility that meets such criteria as the Secretary determines appropriate.

(ii) Description of custom–fabricated item.—

(I) In general.—An item described in this clause is an item of custom-fabricated orthotics that requires education, training, and experience to custom-fabricate and that is included in a list established by the Secretary in subclause (II). Such an item does not include shoes and shoe inserts.

(II) List of items.—The Secretary, in consultation with appropriate experts in orthotics (including national organizations representing manufacturers of orthotics), shall establish and update as appropriate a list of items to which this subparagraph applies. No item may be included in such list unless the item is individually fabricated for the patient over a positive model of the patient.

(iii) Qualified practitioner defined.—In this subparagraph, the term “qualified practitioner” means a physician or other individual who—

(I) is a qualified physical therapist or a qualified occupational therapist;

(II) in the case of a State that provides for the licensing of orthotics and prosthetics, is licensed in orthotics or prosthetics by the State in which the item is supplied; or

(III) in the case of a State that does not provide for the licensing of orthotics and prosthetics, is specifically trained and educated to provide or manage the provision of prosthetics and custom–designed or –fabricated orthotics, and is certified by the American Board for Certification in Orthotics and Prosthetics, Inc. or by the Board for Orthotist/Prosthetist Certification, or is credentialed and approved by a program that the Secretary determines, in consultation with appropriate experts in orthotics and prosthetics, has training and education standards that are necessary to provide such prosthetics and orthotics.

(iv) Qualified supplier defined.—In this subparagraph, the term “qualified supplier” means any entity that is accredited by the American Board for Certification in Orthotics and Prosthetics, Inc. or by the Board for Orthotist/ Prosthetist Certification, or accredited and approved by a program that the Secretary determines has accreditation and approval standards that are essentially equivalent to those of such Board.