ADP Today Newsletter January 2006 Winter Issue

IN THIS ISSUE

The Ministry of Health and Long-Term Care (MOHLTC) has made a commitment to improved accountability. As part of this commitment, the Assistive Devices Program (ADP) is conducting the second biannual Customer Satisfaction Survey. ADP will use the feedback from the survey to assess the current level of client satisfaction with the program and to design improvements to service delivery models for the twelve major device categories.

One of the Ministry’s priorities is to invest in community health care through new funding for alternate levels of care, and enhanced acute home care. To support this key priority, the Home Oxygen Program (HOP) has introduced a new pilot project, the Hospital Replacement Program (HRP) which provides funding assistance to clients who need short-term oxygen therapy to prevent hospitalization or, in the case of hospitalization, allows the individual to be discharged earlier into the community. The pilot project will be funded for 2005-06 and 2006-07 with an annual target of 1500 acute clients and the effectiveness will be evaluated independently in early 2007.

Our program delivery will be enhanced through improvements in the registration process for vendors and new and improved contracts for vendors and authorizers. ADP will provide easier access to program information through additions in the ADP web section. Improving our information systems will help us enhance system performance to meet future business requirements.

Program staff have been working with the Ministry's Legal Services Branch to update the current agreement that has been in use for many years. All ADP registered authorizers will be asked to sign the new agreement in the near future. The agreement will set out the responsibilities of the Ministry of Health and Long-Term Care and health professionals registered as authorizers with the ADP. It will also incorporate the ADP Policies and Procedures Manual as well as device specific administration manuals and compliance with the Personal Health Information Protection Act, 2004 (PHIPA).

Hospital Replacement Program (HRP)
On August 1, 2005, the Home Oxygen Program (HOP) implemented a 2-year pilot project which allows individuals to access funding for short-term (up to 60 days) oxygen therapy. This means patients with an acute respiratory condition may avoid hospitalization or be eligible for early hospital discharge with the use of home oxygen therapy.

More information on the HRP and the medical eligibility criteria is available in the HRP section.

Revised Medical Eligibility Criteria for the Regular Home Oxygen Program
On September 1, 2005, the HOP introduced medical eligibility criteria for individuals who do not exhibit hypoxemia at rest but do demonstrate hypoxemia on exertion and improved exercise tolerance with supplemental oxygen therapy. These applicants must have their need for oxygen therapy assessed by a Respirologist or an Internist with an expertise in respiratory medicine.

Palliative Care Funding Program
On April 1, 2005, the HOP introduced changes to the Palliative Care Funding Program, whereby eligible applicants are entitled to one 90-day palliative care claim period. This includes applicants who have previously received funding assistance through the regular HOP. HOP continues to require applicants who need funding assistance beyond the 90-day claim period to apply to the regular HOP. However, HOP will now accept an oximetry study instead of arterial blood gases to demonstrate that the medical eligibility criteria has been met.

ADP program staff are currently reviewing service delivery models in the limb prostheses, breast prostheses and pressure modification devices categories, with the objective to streamline access for eligible clients.

In August 2005, device manuals with updated pricing were released in the Ocular Prostheses and Orthotics categories. In the Orthotics category, the organization of the device listings was also updated. Work continues to be done to ensure that all products funded by the ADP are included in the Orthotics manual.

Wheelchair, Positioning and Ambulation Aids Standing Committee
New members recently welcomed to the committee include ADP authorizer Lai Chi Chow and manufacturer representatives Tish Hansen and Douglas Macmillan.

Providing ADP Related Mobility Services to Residents of Long-Term Care Homes
Long-Term Care Homes (LTCH) may enter into agreements with ADP Registered Vendors to provide the homes with certain equipment and services. All ADP policies and procedures regarding the assessment of ADP clients, and the sale of ADP funded equipment must be upheld.

A joint memorandum was issued on October 5, 2005 by the ADP and the Long-Term Care Homes Branch clarifying the rights of LTCH residents, and the role of ADP Registered Authorizers and Vendors.

The ADP eligibility criteria, the right of the client regarding choice of vendor, and the roles of the ADP authorizer and vendor remain unchanged for Long-Term Care Homes. A resident of a home may be referred to an authorizer when the need for a personalized mobility device has been identified.

The authorizer will inform their client and/or legal representative about ADP eligibility criteria, policies, and procedures. The authorizer will conduct a comprehensive clinical assessment, identify the need for mobility equipment and ADP eligibility, provide a complete prescription for the device required, and submit the application to ADP for review. He or she will also provide a list of ADP Registered Vendors within the adjacent community to their client and/or legal representative, from whom the client may choose to purchase the prescribed equipment.

Vendors are obligated to inform their customers about the Assistive Devices Program and refer them to ADP and/or an ADP Registered Authorizer for further information. Working with the authorizer and client, the vendor will provide assessment and trial equipment, offer their support in choice and set-up of the equipment to meet the client’s specific needs and preferences, and provide quotes to ADP when applicable and to the client as requested.

ADP clients must be given a choice of vendor. The client may be informed about an agreement the home may have with a particular vendor but must not be advised or expected to purchase their equipment from this vendor.

Product Manuals
The product manuals for ambulation aids and pediatric standers (Section 3), wheelchairs (Section 4), and positioning devices (Section 5) are updated regularly and include all newly listed devices. To receive a copy of an updated manual, please fax a request to the ADP office, including your ADP authorizer/vendor registration number and your full mailing address or e-mail address.

A reminder to all visual aids and communication aids authorizers and vendors, there are no substitutions allowed where an ADP catalogue code is assigned to a specific device. If in doubt, contact the program coordinator for clarification.

Communication Aids – Device codes re-activated
Some device codes have been re-activated to facilitate leasing, lease buy-outs and the purchase of older models of devices that remain in demand. Device codes which end in the letter "L" pertain to leasing, device codes which end in the letter “P” pertain to purchases. Device codes which end with a number instead of a letter may pertain to either leasing or purchases. These device codes will eventually be replaced with individual lease or purchase codes.

The device codes noted below have been re-activated to facilitate leases and purchases. The prices of these devices will be reviewed in the future as we prepare for Phase 2 of the implementation of the new pricing framework.

• CSHZY401L/P (L/P means: Lease and Purchase, two codes) – Lightwriter SL 35;
• CSHZY600P – Lightwriter Multilingual SL 35;
• CWSM1700P – PCS Metafiles;
• CSHZY4840 – Scan module for SL-35;
• CWAND7111 – Blisswrite;
• CSCZY0035 – Lightwriter SL-5 (in "Low Tech" catalogue); and
• CSCXD001P – Chatbox (in "Low Tech" catalogue).

The device codes noted below have been re-activated to facilitate leases and lease buy-outs only. Prices remain the same since the devices are no longer manufactured.

• CAQE4100L/P – Quick Glance;
• CSHZY500L/P – Multilingual SL25;
• CSHZY201P – Lightwriter SL25 (Lease buy-out only); and
• CSHTN200L – Gemini (Lease only).

The new codes noted below were created to clearly define a device for lease or a device for lease buy-out. These devices are no longer manufactured, but remain in the leasing pool. Prices remain the same.

• CIHND479L and CIHND479P – Freestyle, replaces CIHND4790 and CIHND4791;
• CSHS8465L and CSHS8465P – Dynavox 3100, replaces CSHS84650;
• CSHS8764L and CSHS8764P – Dynamyte 3100, replaces CSHS87640; and
• CSHZY487L and CSHZY487P – Macaw Scanning, replaces CSHZY4870.

For a complete catalogue of ADP communication aids devices, contact Caroline Kuniyasu at: toll free 1-800-268-6021, ext. 78155 or direct 416-327-8155.

Visual Aids – Clarification regarding specialized lenses
Optometrist or ophthalmologist authorizers must use only one code per pair of specialized lenses e.g. VOGND6100 and one code for the frames e.g. VOFND5000 when authorizing a pair of specialized glasses. Please note that some codes for specialized lenses include the frames e.g. VOGND6300. Also, one code per lens can only be used when authorizing contact lenses.

The ADP provides funding towards the cost of glucometers, testing strips and lancets for Ontario residents with diabetes, who require insulin or who have gestational diabetes. This program is administered through the Canadian Diabetes Association (CDA), Ontario Division’s, Monitoring for Health Program. More information can be obtained by contacting the CDA directly at 1-800-361-0796 or 416-408-7064.

ADP also provides an annual grant of $125 to insulin dependent diabetic seniors, 65 years of age and older, to help with the cost of their needles and syringes. Effective January 1, 2006 ADP will increase the annual grant to $170.

Currently, ADP Today is delivered to ADP stakeholders, authorizers and vendors by postal delivery and is also available for downloading from the ADP website. ADP is planning to move away from postal delivery of ADP Today to electronic delivery. Individuals will have the option of downloading the newsletter from the website or receiving an electronic version delivered to their e-mail address. If you wish to be added to the electronic distribution list, please e-mail adptoday@moh.gov.on.ca.

Health care fraud affects everyone. As part of the Ministry’s anti-fraud strategy, a partnership has been established between the Fraud Programs Branch (FPB) and the Ontario Provincial Police (OPP). Ontario is the only province in Canada to partner police officers dedicated to health care fraud investigations.

The role of the Ministry’s FPB is to provide proactive leadership to protect health care resources from fraudulent and criminal activity and to increase health care fraud awareness and education. The OPP Health Fraud Investigation Team is responsible for the investigation of health care fraud related activity. The MOHLTC/OPP partnership brings investigative expertise and access to the criminal justice system, creating an effective deterrent for those willing to commit fraud.

Types of health care fraud include user fraud, provider fraud and other related criminal activity such as identity theft and personation (with intent). Health care fraud includes billing for services or equipment not rendered or not medically necessary; double billing for the same service or equipment; using a stolen health card to receive benefits not entitled to.

The FPB works closely with the ADP to investigate all reports of potential health care fraud. To report suspected cases of health care fraud, contact the Ministry at 1-888-781-5556.

Reports can also be made anonymously, or by sending an e-mail to the Ministry at reportohipfraud@moh.gov.on.ca.

Public Information

• Previous issues of the "ADP Today" newsletter
• List of assistive devices covered and not covered
• Contacting ADP
• Fact sheets
• Forms (ADP Applications) – View only
• Program information
• Questions and answers
• Links

Health Care Providers

• Contacting ADP
• Standing Committee Members
• ADP Policy and Administration Manuals
• Forms (ADP Applications) – View only
• Previous issues of the "ADP Today" newsletter
• Hospital Replacement Program Pilot Project information
• Memo to Long-Term Care Homes Administrators

The Health Services Division of the Ministry of Health and Long-Term Care administers the Assistive Devices Program (ADP). Through the ADP, the Ministry provides consumer centered support and funding to Ontario residents who have long-term physical disabilities to provide access to personalized assistive devices appropriate for the individual’s basic needs.

Assistive Devices Program
Operational Support Branch
Ministry of Health and Long-Term Care
5700 Yonge Street, 7 ^th Floor
Toronto, Ontario
M2M 4K5
Canada

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