IN THIS ISSUE

The Assistive Devices Program (ADP), like many other Ministry of Health and Long-Term Care programs, makes use of regular evaluation processes to ensure that the services and supports provided to clients meet their needs. The program manager and four senior program coordinators, who design and develop operational policy including eligibility criteria for medical devices funded by the program, work with external health care providers to ensure that up-to-date evidence based best practices are used in all service delivery models. There are two major ways that these best practices are used :

• When new medical devices (equipment or supplies) are evaluated for potential inclusion under funded products, external experts are invited to participate on a medical devices work group that includes ministry staff. The working group provides advice on medical eligibility criteria, target group of clients, and replacement periods. The resulting service delivery model for the new devices is then presented to the relevant standing committee for discussion and approval prior to implementation.
• When manufacturers request to add new products, samples will be sent to an external evaluation centre for over a specified period of time. The evaluation of the product will include, ease of use, performance, safety, durability, reliability, and appropriate warranties to ensure accepted standards are met. This often occurs when an outdated product is replaced with a newer model.

In cases where the product is significantly complex and not similar to other devices currently funded, a referral request is made to the Medical Advisory Secretariat within the ministry for a full technological assessment. These assessments analyze safety, effectiveness, cost-effectiveness, quality of life as well as ethical, legal and social issues related to the use of the technology. This type of assessment was used for Bone Anchored Hearing Aids (BAHA) which are now being funded by the program.

The increased use of evidence-based decision making within the program and across the ministry will enhance system accountability. It will also continue to encourage innovation in developing new technology that will improve quality of life for people with disabilities in Ontario.

Because many people are not always aware of government programs, the ADP allows registered vendors to inform Ontario residents about the ADP if they are inquiring about an assistive device. People should be given an opportunity to determine if they are eligible to access the program for funding assistance. Refer to Section 545 of the
ADP Policies and Procedures Manual for more details.

However, the ADP prohibits the active solicitation of existing program clients. Registered vendors must not contact clients who have previously accessed the program to inform them that they may be eligible for a replacement. Replacement devices are not automatic.

Vendors must not distribute the ADP application form to people who have not requested the form. If a client does request the form, it must not contain the name of any prescriber, authorizer or vendor. Refer to Section 535 of the
ADP Policies and Procedures Manual for more details.

The ADP registered vendors are allowed to advertise their ability to sell the ADP approved devices. They can also indicate their registration status with the program, but only under the following conditions :

• the vendor must identify all brands and models of devices carried by the vendor;
• the vendor must not give one brand or model prominence over another;
• there must not be a reference to the percentage or dollar amount paid by the program or the client

If all of the above conditions are met, the ADP registered vendors may use the following terminology in their advertising, "ADP Registered Vendor” or "Registered with the Assistive Devices Program (ADP).” Vendors should note that the Ministry of Health and Long-Term Care or the ADP does not issue business registrations or licenses.

Vendors who do not comply with the above conditions are in contravention of their contract with the ADP. If the program is made aware of inappropriate advertising, the vendor will be contacted and instructed to withdraw their ads. To avoid the expense of having to withdraw ads, it is strongly suggested that vendors contact the program to ensure compliance with program policy, before placing advertisements in newspapers, journals, flyers and/or Web Sites. Refer to Section 540 of the ADP Policies and Procedures Manual for more details.

The Respiratory Services Standing Committee, through its various task forces, has been working on issues such as, education for clients accessing the Ventilator Equipment Pool, and reviewing the ADP for respiratory equipment and supplies. The committee is also very close to finalizing a new Home Oxygen Program application.

Two task forces (one for pediatrics and one for adults) have recently completed a review of the Enteral Feeding program. The task forces looked at the ADP's current policies on eligibility, funding models, and application process. Recommendations made by the task forces were presented at a vendor session on August 13, 2003. All vendors registered with the program for Enteral Feeding were invited. The program was very pleased with the turnout. The ADP will be working on the task forces recommendations over the next few months.

The Prosthetics and Orthotics Standing Committee welcomes new member, Prosthetist/Orthotist, Patrick Reilly (Hamilton).

Please review all Prosthetics and Orthotics application forms for completeness and accuracy, prior to submitting them to the ADP. This will help the program process the forms as quickly as possible.

To assist in determining a new client's eligibility for funding, a vendor may request a copy of their client's previous ADP funding history. To request this information, a signed copy of the Release of Information About Previous Funding form should be faxed to the ADP office at (416) 327-8192. Refer to Appendix H in the ADP Policies and Procedures Manual for details.

The Request for Special Approval form must be completed in full. All items that will be on the Application for Funding form must be included, along with specific rationale for the requested replacements. For example, if the funding request is for both a socket and a foot, rationale for both needs to be documented. Only then can the ADP respond as quickly as possible to the request.

To obtain information regarding the status of a submitted application, refer to the Remittance Advice report that you receive from the Ministry of Health and Long-Term Care, Supply and Financial Services Branch in Kingston. When an application is noted as 'approved' on this report, the invoice should then be submitted to the Ministry of Health and Long-Term Care, Supply and Financial Services Branch, ADP and ODB Payments, 3^rd Floor, 49 Place D'Armes, P.O. Box 48, Kingston ON K7L 5J3.

For devices requiring the clinic delivery model (all amputee team members, including the team physician, certified prosthetist and the rehabilitation assessor, meet together with the client), ensure that all dates on the Application for Funding form reflect the actual clinic date. All dates should therefore be the same. Applications will be returned to the vendor if this information is not correct.

The Wheelchairs, Positioning and Ambulation Aids Standing Committee welcomes new members :

• Authorizers, Denise DeLaat (Ottawa), Margo Russell (Belleville) and Karen Trenholm (London)
• Health Care Consultant, Tricia Harvey (Toronto)
• Consumer, Etta Ginsberg-McEwan (Toronto)
• Research Engineer, Patricia O'Neill (Ottawa)
• Vendors, Randy Courish (Windsor) and Jim Migliazza (Thunder Bay), and
• Manufacturer Representative, Rob McLellan (St. Catharines)

The ADP funds equipment that meets an individual's basic and essential mobility requirements on a regular daily basis, as defined by the ADP for funding purposes. The equipment must be required primarily for use within the individual's permanent residence and to access a mode of transportation. The ADP does not fund equipment used solely for exercise programs, at school, work, sports or for occasional use. The ADP authorizer must personally conduct a full functional assessment and prescribe all components of the device for which the individual meets the ADP eligibility criteria. Assessments, whenever possible, should be conducted in the individual's permanent residence. Manual dynamic tilt wheelchairs should not be prescribed solely for the purpose of activities such as sleep, meal times or relaxation.

Funding is available to modify the ADP approved devices under MOCM (pediatric standers), WCM2 (wheelchairs) and SECM (positioning devices). The size of the equipment may need to be changed to accommodate the user's growth and/or to make specific adjustments so that the equipment may be used functionally. Labour charges on all requests must not exceed $40.00 per hour. The ADP authorizer must provide rationale for all requests. Vendor quotes must be detailed and itemized separately for WCM2 and SECM. The ADP does not provide funding towards the cost of equipment repairs or maintenance, and such charges must be excluded from requests.

Updates have been made to the product manuals, Ambulation Aids and Pediatric Standers (Section 3), Wheelchairs (Section 4), and Positioning Devices (Section 5), and include all newly listed devices. To receive an updated copy, please fax a written request to the ADP office (416) 327-8192 and include your ADP authorizer/vendor registration number along with your full mailing address.

All application forms submitted must contain original signatures. Photocopied or faxed application forms are not acceptable. Under exceptional circumstances a photocopy of the application form can be re-signed by all parties and mailed, couriered or dropped off in person to the ADP office.

ADP registered authorizers are reminded that a new device cannot be authorized until it has received an ADP catalogue number. Application forms received where the device is authorized before it has been assigned an ADP catalogue number cannot be approved.

Send all credit notes to Ministry of Health and Long-Term Care, Supply and Financial Services Branch, ADP and ODB Payments, 3 ^rd Floor, 49 Place D'Armes, P.O. Box 48, Kingston ON K7L 5J3. Credit notes are not processed in Toronto.

The Peer Review Team has scheduled five peer review site visits for this fall.

If a Hearing Device application form is denied, the ADP registered vendor and the client receive a letter from the claims assessor notifying them of the denial. The original application form is not returned to the vendor. The vendor should contact the ADP claims assessor who sent the letter if he or she has any questions.

All hearing aid vendors must provide a unique invoice number (one that has not been used in the past) in Section 5 of each Hearing Device application form. The ADP cannot provide payment for application forms that do not contain unique invoice numbers.

ADP registered high technology authorizers are reminded to complete separate application forms, one for sight enhancement devices and one for sight substitution devices, and provide the correct clinic number when authorizing devices for clients.

Ninety one per cent of clients who responded to the survey reported overall satisfaction with the program. The survey was distributed in February 2003 to over 1,000 randomly selected clients. The response was very good. In total, 441 complete surveys were received by the April 30, 2003 deadline.

Almost half of respondents reported being repeat users of the program. Seniors, at 61 per cent, were the largest group of respondents. More women than men responded, at 56 per cent compared to 42 per cent. The highest number of responses came from Central East and Central West Ontario.

Two key elements in the program's service delivery process, how services are provided by either ADP or an ADP service partner (Registered Authorizer or Vendor), and the device or medical supplies provided, both received the highest reported satisfaction, at 89 per cent each. Communications about the program, and access to the program, received the lowest reported satisfaction, at 78 per cent and 62 per cent respectively.

Specific service items respondents are satisfied with the most include :

• receiving the device or medical supplies recommended, at 93 per cent
• service staff being courteous, at 92 per cent
• receiving the device or medical supplies they needed, at 90 per cent
• service staff being competent, at 89 per cent

Specific service items respondents are least satisfied with include :

• amount paid for the device or medical supplies, at 59 per cent
• accessing information about the program, at 60 per cent
• ADP funding towards the device or medical supplies, at 64 per cent
• knowing what to do if there is a problem, at 70 per cent

When respondents were asked if they got what they needed from the program, 94 per cent said yes. Ninety two per cent reported that they are using the device or medical supplies. Some of the benefits of using the device or medical supplies respondents identified included:

• improved quality of life
• better mobility, and
• being able to better cope with their condition

The program is reviewing the survey results in order to identify improvement initiatives. Thank you to all clients who responded.

The Health Services Division of the Ministry of Health and Long-Term Care has the responsibility for administering the Assistive Devices Program (ADP). Through the ADP, the Ministry provides funding to Ontario residents with physical disabilities to purchase personalized assistive devices and supplies, to support them in independent living.

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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