Module C Part 2 Outline

Transcription

1 Alberta Aids to Daily Living Primary Module C: Part 2 OT/PT Pediatric Equipment Need: (K) APL Module C Part 2 Outline Overview Pediatric Equipment Authorizer Qualifications Eligibility criteria Pediatric Equipment (K) Vendors Form & Process Example 2 Overview Pediatric Equipment Pediatric Equipment includes: Bathing & Toileting aids Positioning aids for feeding Standing frames to enable the child to participate in school and home activities Walking Aids Features/Options on some pediatric equipment Ability to grow equipment Ability to accommodate changes in development Positioning devices lateral supports, head supports, chest straps, pummels Tilt 3 1

2 Overview Equipment is either formal recycle or non recycle. Formal Recycle Pediatric Walkers Pediatric Standing Frames Non Recycle Pediatric Equipment: Toilet Supports Commodes/Shower Commodes Bath Seats/Chairs Floor Sitters 4 Overview Pricing is either benchmark or set for each product Product Specific Pediatric Walkers Pediatric Standing Frames Benchmark Toilet Supports Commodes/Shower Commodes Bath Seats/Chairs Floor Sitters 5 Benefit Specific Eligibility Specialized Pediatric Equipment (K) Pediatric Equipment Must meet general eligibility criteria plus: Be under the age of 18 years Condition must be stable Toilet Support & Commodes Must provide additional rationale for some of the features. Refer to the APL Commodes are benchmark, level of funding depends on eligibility Must have a wheel in shower to be eligible for funding for wheeled shower commode. Only one type of benefit per function. Cannot authorize funding for a shower commode if client has any other toileting or bathing aid 6 2

3 Benefit Specific Eligibility Specialized Pediatric Equipment (K) Pediatric Walkers Only replaced if walker cannot be grown to accommodate client s size. Standing Frames Only replaced if stander cannot be grown to accommodate client s size. Must complete AADL Assessment Summary for Pediatric Standing Frames with functional goal related to independence in activity participation. Client can only have one stander, not eligible for one at home and one at school. 7 Approved Product Lists - Benchmark 8 Approved Product Lists - Benchmark 9 3

4 10 Approved Product Lists-Recycle Recycle equipment is recycled through an AADL vendor. Upgrade costs may occur for some equipment. Ensure clinical rationale is included on the Authorization Process Pediatric Equipment 12 4

5 Authorization Process (Steps) Assessment QFR Assessment includes clinical assessment of need and eligibility. Assessment date is when you have completed the assessment, including eligibility confirmation and appropriate equipment choice. Trial Trials are necessary for all equipment. Authorization Equipment Provided Authorization forms are required. Check rationale requirements and include on form. Add QFR approval #. Attach any additional forms required. Vendor sets up equipment and provides to client. Authorizer must follow up to ensure appropriate fit. 13 Authorization Process Assessment Client agrees to cost share and upgrade costs as these need to be collected prior to vendor refurbishing or ordering equipment Authorization form submitted to AADL AADL checks for completeness and returns invalid authorization forms to authorizer Eligibility, clinical rationale, all parts completed, additional forms attached AADL orders from vendor Vendor collects cost share and any upgrade costs Vendor refurbishes equipment if recycled or orders from manufacturer Informs AADL order has been placed & provides S/N Equipment Provision Vendor provides equip to client/ authorizer Follow up from authorizer and vendor as required Vendor submits claim to AADL Authorization Form: Authorization Forms Must be mailed, except for palliative which may be faxed. One benefit per form 15 5

6 Repairs and Returning Equipment Formally Recycled AADL Equipment Client has AADL owned equipment AADL will fund repairs and ongoing maintenance Client no longer requires equipment Contact equipment vendor to arrange to return equipment OR Internally transfer to another client using an authorization form. Equipment is recycled or surplused If equipment cannot be refurbished it will be surplused If equipment can be refurbished it is provided to another AADL client 16 Replacing Equipment - QFR Process Specialized Pediatric Equipment (K) Ensure no competing equipment is in place (B, C & G benefits) Submit QFR for condition changes No QFR required for pediatric growth one full size and current equipment cannot be grown. Be sure to include supporting documentation on 1250 form if no QFR needed. 17 Example Need: Client Residence and Diagnosis Code List Authorization form (1250) 18 6

7 Please complete an authorization form for the following example. Include as much information as you have from the case study. 19 Example Specialized Pediatric Equipment (K) Clair has CP and is now ready to start toilet training. She has a wheel-in-shower and bathtub in her home and is getting too heavy to lift into the bathtub onto the bathseat she received in the past. You notice there are toilet supports, commodes and shower commodes to choose from on the APL. What/how do you choose? You decide she needs a wheeled shower commode rather than another toilet support and/or bathseat. She requires a shower commode with the tilt feature. She needs the butterfly harness and possibly a tray for use as an activity tray while toileting for an extended period of time. Refer to the APL (K) Pediatric Equip. list on slide 8. What code do you use? How would you determine the cost of the tray? Is it an upgrade and if so do you need to advise the parents first? 20 Questions 21 7