2024-04-02 09:38:05
Adults are compensated on the same terms
Previously, complex orthopedic footwear was reimbursed every 6 months only for patients with rheumatoid arthritis and diabetes. From April 1 all people with disabilities will be guaranteed compensation for orthopedic footwear on the same terms.
“From now on, adult patients, regardless of diagnosis, are compensated every six months with two pairs of custom-made complex orthopedic footwear. The base price of the first pair of footwear is compensated by 100%, and the base price of the second pair produced during the year is compensated by 70%.
We predict that this will require an additional 900,000. of the Compulsory Health Insurance Fund’s funds per year”, says Giedrius Baranauskas, Head of the Medical Equipment Reimbursement Department of the State Sick Fund under the Ministry of Health (VLK).
As before, the base price of both pairs of orthopedic footwear is reimbursed 100% in the first year of award.
Another important innovation is that from now on, for the first time, an orthopedic traumatologist, surgeon, physical medicine and rehabilitation doctor, and again an endocrinologist will be able to prescribe orthopedic footwear for diabetic foot complications. This will significantly shorten the patient’s path to receive orthopedic products reimbursed by the Mandatory Health Insurance Fund (PSDF).
According to the VLK, this year, a total of 3.6 million was allocated from the PSDF for the compensation of custom-made complex orthopedic footwear. EUR, i.e. almost 1.1 million euros more than last year.
Updated prescribing conditions for children
From April, the revised indications for the prescription of custom-made orthopedic footwear and shoe inserts come into force.
Compensatory foot inserts due to congenital or acquired flat feet and other foot deformities can now be given to children from 7 years of age. However, after foot plastering, after foot or calf surgery, when the foot is rigid or there are certain symptoms, as well as due to neuromuscular diseases, foot inserts can also be prescribed for children aged 4 to 7 years.
Similar award conditions will apply to individually produced children’s orthopedic footwear. It can be given to children from 7 years old. Orthopedic footwear reimbursed by PSDF funds can also be given to children up to 7 years old after foot plastering, foot, lower leg surgical treatment or due to neuromuscular diseases.
For children with cerebral palsy, hemiplegia, tetraplegia, rheumatic diseases, polyarthropathy, “horse’s foot”, arthrogryposis or lymphedema, the conditions for prescription of complex orthopedic footwear made to order will not change.
More stringent requirements
According to G. Baranauskas, last year, during the control procedures carried out by the health insurance specialists, it was noticed that the doctors, when providing remote consultations regarding the prescription of orthopedic footwear, do not always thoroughly examine the patients. Therefore, it has now been established that all consultations of doctors regarding the prescription of orthopedic technical means must be carried out only in a contact manner.
Another innovation is that from now on, orthopedic companies or business entities will have to apply premiums for partially reimbursed orthopedic technical devices or medical devices.
“It has been observed that some orthopedic companies apply lower premiums or do not apply them at all for partially reimbursed orthopedic technical devices. However, as representatives of organizations uniting people with disabilities note, premiums discipline patients, encourage them to choose manufacturers more responsibly and to take into account the quality of these devices more,” explains G. Baranauskas.
In addition, according to the specialist, from now on, orthopedic companies and business entities will have to submit copies of documents related to the correction, repair, replacement and warranty service of orthopedic technical equipment or medical equipment to VLK. This is expected to prevent potential abuse.
According to G. Baranauskas, there will be innovations in this field next year as well, so during this year all orthopedic companies producing foot inserts and orthopedic footwear must prepare for a qualitative leap in 2025.
“From next year, a new requirement will be applied to all orthopedic companies – a 3D scan of the foot will have to be performed during the production of both foot inserts and orthopedic footwear, and this data will have to be uploaded to the VLK Orthopedics and Medical Equipment Information System.”
In this way, the aim is to ensure the quality of orthopedic footwear and foot insoles, to improve the control of companies and to implement the patients’ wish to receive information about the effectiveness of the products”, says the VLK representative.
More information for patients
Limb prostheses can be manufactured and fitted to patients by orthopedic companies employing orthopedic technologists trained for this work. In order to inform the disabled in more detail about the companies producing limb prostheses and to remind them of the possibility of choosing an orthopedic company, information about orthopedic technologists working in orthopedic companies will be published on the website of the health insurance companies. Orthopedic companies themselves will have to provide this information to VLK.
Also, patients who have received a notification from VLK about the possibility to order a new limb prosthesis will be provided with more detailed information about choosing an orthopedic company.
According to G. Baranauskas, in order to reduce the administrative burden on orthopedics companies, VLK plans to digitize the process of submitting reports, which indicate the numbers of parts of limb prostheses, to the Information System of Orthopedics and Medical Devices. Therefore, from now on, the order of limb prostheses will be able to be carried out only when the set of parts of the limb prosthesis has been approved in this system.
2024-04-02 09:38:05