ADP Today Newsletter December 2004 Fall/Winter Issue

IN THIS ISSUE

The Ministry of Health and Long-Term Care has made a firm commitment to accountability as well as providing a more transparent and cost effective use of healthcare funding, through monitoring, performance measures and reporting to stakeholders on results.

The Assistive Devices Program (ADP) has an ongoing process of establishing performance targets and ensuring they are met on a consistent basis. Quality improvements have been identified in service delivery areas and new processes designed and implemented through advice from our four standing committees for wheelchairs and positioning, sensory, prosthetics and orthotics and respiratory services.

The ministry has made a commitment to a health system that is easier for the client to understand and to navigate. To reach this objective, staff will enhance the ADP website so that clients have easier access to information on what products are funded and how to access this support. Furthermore, the ministry has committed to providing easier access for clients to the right services. Staff have also committed to initiate a customer satisfaction survey with recent clients to assess the service they received and to design improvements to address any barriers.

The ministry is committed to a health system that delivers quality results, efficiently and effectively. As a result, ADP staff are working with key healthcare providers and consumers through the standing committees to analyze current service delivery models and identify improvements in policy and process. Staff will continue to use clinically based evidence and best practices when evaluating new products for listing and when making changes to current eligibility criteria.

The focus during the next fiscal year will be to continue to implement the new pricing framework and monitoring the results to make adjustments as required. Through this mechanism, staff will provide residents with fair and affordable access to a range of devices and provide vendors with a fair and predictable return on their investment.

Implementation of the fixed pricing funding model on August 1, 2004, required the ADP to send out an amendment to the ADP contracts to all vendors affected by this change. Staff have taken this opportunity to review all current contracts. ADP staff have met with the ministry's Legal Services Branch and all ADP registered vendors will be asked to sign new updated vendor contract before the end of 2004. The new contract will incorporate the ADP Policies and Procedures Manual as well as device specific manuals. It is hoped that the new contract will assist ADP registered vendors to better understand their contractual requirements with the ministry.

On August 1, 2004, a new ADP approved price of $978.00 was introduced for Continuous Positive Airway Pressure (CPAP) Systems. As well, the ADP now provides funding assistance for Auto-titrating Positive Airway Pressure (APAP) Systems.

In response to concerns voiced by vendors about the new price not reflecting a fair margin, staff have completed another analysis. Recognizing that small vendors have less ability to negotiate discounts with manufacturers, the second analysis used only small vendor costs. It has been determined that to ensure a fair margin, the ADP approved price for CPAP and APAP systems has been increased from $978.00 to $1,040.00 effective August 1, 2004.

In order to ensure that applications signed by a physician on or after August 1, 2004 are processed at the new price, the ADP automatically adjusted the price from $978.00 to $1,040.00 until October 31, 2004. After October 31, 2004, applications that indicate a price of $978.00 are being returned to the vendor for correction.

The ADP provides funding assistance for a complete CPAP or APAP system. For ADP purposes, a CPAP or APAP system consists of a CPAP/APAP device, heated humidifier, basic mask and headgear, carrying case, six ft. tubing, all necessary caps and filters, power cord and patient instruction manual.

If a client requires items that are not part of the basic CPAP or APAP system, the respiratory vendor may invoice the client for 100 per cent of the cost of these items.

Vendors who offer ADP clients a service package, must provide the client with the option to purchase the service package separately and not as a mandatory service when purchasing the CPAP or APAP device.

The ADP expects all respiratory vendors registered with the ADP to ensure that their clients are instructed in the appropriate and safe use of the equipment. Respiratory vendors may provide additional services such as an extended warranty, yearly pressure checks and calibrations or pressure adjustments. The vendor may offer these services to the client at a cost separate from the funding support provided by the ADP.

When submitting a request for funding assistance for enteral feeding pumps and supplies, two ADP Equipment Supply Authorization (ESA) forms must be completed and submitted to the ADP. One ESA form will list the enteral feeding pump and one ESA form will list the required enteral feeding supplies. This ensures that the ADP approved amount for enteral feeding pumps is not included in the approved amount for the supplies.

Program staff are meeting with stakeholders to help establish an up-to-date funding model to help revise pricing in prosthetics and orthotics, beginning in 2005.

The P&O Standing Committee welcomes back Karen Litman. The committee will be meeting in the Fall of 2004.

On October 1, 2004, service delivery changes were implemented in the Orthotics category. All registered vendors, authorizers and rehabilitation assessors received a new Policy Manual at that time. The two main changes to ease client access to ADP funding were the removal of the clinic assessment requirement and the inclusion of family physicians as prescribers for most orthotic devices. These changes were recommended by an Orthotics Task Force. More details can be found in the Orthotics Administration Manual. The client fact sheet has also been revised to reflect these changes.

The ADP continues to work with the P&O Standing Committee and task forces to identify changes in service delivery. These changes will ensure improved client access to the funding of compression garments and devices in these categories.

Updated pricing was implemented on August 1, 2004. The device listings are now organized and written generically. This is intended to allow more flexibility for the authorizer and certified fitter in determining the best garment for the individual client. It will also eliminate the need for an approved and listed manufacturer to apply to have a described type of garment listed with the ADP. The latter benefit will help to ensure that some new products are made available immediately for those clients who need them.

Updated prices and revised device codes for mobility devices are now in effect. ADP policies and procedures related to eligibility criteria for funding assistance, application submission and equipment listing, remain unchanged.

The authorizer date on the ADP application form is the day that the prescribing therapist (ADP authorizer) completes the clinical assessment and finalizes the equipment prescription for the ADP applicant. This date may not be changed. The old ADP device codes and pricing format must be used when the authorizer date was prior to August 1, 2004. The new device codes and pricing format must be used for all authorizer dates commencing August 1, 2004. If any changes are required to an application form that was submitted with the authorizer date prior to August 1, 2004, the old device codes and pricing format must be used. Application forms that are submitted with incorrect codes will be sent back to the authorizer for correction.

ADP authorizers may prescribe positioning devices (seating) that must be fabricated using raw materials using coding from the Custom Fabricated (CF) device codes. All commercially available modular seating devices must be coded using the Non-Designated (ND) device codes. When custom modifications are required to an ADP listed modular seating device, authorizers may use code SEMND2005. The CF codes and ND codes are not interchangeable.

ADP eligible individuals may receive funding assistance towards the purchase of an Adult Wheeled Walker Type 1 (MW1) or an Adult Wheeled Walker Type 2 (MW2) and a wheelchair at the same time. Type 1 (MW1) and Type 2 (MW2) replace the previous Category 1 (MWA) wheeled walkers. Adult Wheeled Walkers Type 3 (MW3) replaces the previous Category 2 (MWB) wheeled walkers. ADP funding assistance is not provided towards the purchase of a Type 3 (MW3) wheeled walker and a manual or power wheelchair.

When the intent is to fulfill mobility requirements beyond the scope of ADP funding guidelines, the applicant may request to use their ADP funding towards the purchase of another device (Section 1. 2. 6 Policy and Procedures Manual). The ADP portion will be for the basic device prescribed, excluding options and accessories. The vendor may charge the client no more than the ADP price for the upgraded device.

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 task force has been assembled to make recommendations to the ADP regarding eligibility criteria for the Communication Aids category. Members include ADP registered speech-language pathologists and occupational therapists from across the province including authorizers working at ADP designated clinics and individual authorizers working in the community. There is also academic representation and other representation from the field of augmentative and alternative communication. The target date for the task force to complete its work is December 2004.

For any voice entry hardware and software, please use ADP catalogue number/code CWAND800P (MS-DOS voice entry hardware and software) and for voice entry software only, use catalogue number/code CWCND960P (Dictate – French). Catalogue number/code, descriptions and prices will be updated during Phase 2 of the implementation of the new pricing framework.

For "Writing With Symbols" use ADP catalogue number/code CWSM1302L (for lease) or CWSM1302P (for purchase). Please note that CWSDJ300L and CWSDJ300P no longer exist in the ADP approved list of communication aids.

The new ADP approved price for the Servox Electronic Speech Aid (CSLSM0002) is $909 and the ADP contribution of (75 per cent) is $681.75. The price is effective August 2004.

Audio book playback machines can be authorized by ADP registered authorizers who may be vision rehab workers, specialist teachers of the blind, rehabilitation teachers as well as ADP registered High Technology Visual Aids Sight Enhancement authorizers or sight substitution authorizers.

Low-tech writing aids such as the Perkins Brailler, ID Mate or VoiceMate, may be authorized by ADP registered authorizers who are specialist teachers of the blind or rehab teachers as well as ADP registered High Technology Visual Aids Sight Substitution authorizers.

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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