Alberta Aids to Daily Living (AADL) Primary Module B Part 2 OT/PT/RN Small Bathing & Toileting Equipment (B) Transfer Aids & Mattress Overlays (E) Musculoskeletal Supports (S) Module B Part 2 Outline : Small bathing and toileting equipment Mattress overlays Transfer aids and accessories Musculoskeletal (soft) supports Authorizers General eligibility criteria Benefit specific information Authorization process Case study 2 Benchmark Benefits Small Bathing and toileting equipment, Mattress Overlays, Transfer aids and Accessories, musculoskeletal supports are benchmark benefits. Price Maximums listed product may be provided at lower than maximum price. Vendor must offer at least one basic model at or below benchmark price. Product provided must meet the generic description on the Approved Product List. If product is outside of generic description not funded. Client may upgrade to a higher model, however only the maximum price will be covered by AADL. Products not on the Approved Product List Basic need - choose the simplest product which meets the client s basic need Client cost must pursue alternate funding resource 3 1
Small Bathing and Toileting Bathseats and benches Stationary commodes Grab bars Raised toilet seats and armrests Mattress Overlays Alternating air pressure and pump Foam cell Foam with air cell insert Gel Transfer Aids Transfer poles and accessories Transfer bed rails Transfer boards 4 Musculoskeletal (Soft) Supports Back supports Abdominal supports Hernia supports 5 Authorizers Primary range for Occupational Therapists, Physiotherapists and Registered Nurses Competency expectations Pressure reduction surfaces Wound assessment and treatment Pressure reduction product knowledge 6 2
Eligibility Criteria Meets general AADL eligibility Meets benefit specific eligibility criteria Assessed by an OT, PT or RN Authorized by an AADL Authorizer For long-term use only If in acute care - is part of definitive discharge plan 7 Eligibility: Residence House/Apartment & Supportive Living (level 2) Bathing & Toileting Mattress Overlays Transfer Aids Musculoskeletal Support Supportive Living (Level 3,4) & LTC Musculoskeletal Supports Supportive Living means: Congregate living sites with multiple levels of care whether private or public Level of care is determined by AHS support may be provided through private or public funds. 8 Eligibility: Benefit Specific AADL will fund one item per function Equipment with dual purpose Quantity and frequency limits Heavy duty equipment weight requirements 9 3
Eligibility Criteria: Benefit Specific Musculoskeletal Supports Chronic non-operable conditions Prescription should include: client s diagnosis type of support that is required 2 per year Extend authorization with a Correction & Change form and attach new prescription Add fitting fee 10 11 Assessment (Healthcare provider) Identify clients needs Confirm eligibility Client selects vendor Discuss costs and AADL program Equipment trial MSK Support measure client Authorization (Authorizer) Confirm no previous benefits (IVR) Complete and submit authorization form Provide copy to vendor AADL confirms client and benefit eligibility and enters on e- business Benefit Provision (Vendor) Requests/receives cost-share and/or upgrade from client Fits and provides MSK support or provides equipment Client follow-up as required 12 4
Authorization Form Use 1250 Authorization Form One authorization form per benefit area (B, E, and S) E.g. Include all small bathing and toileting on same form (must be from same vendor) Large bathing and toileting equipment must be on separate forms as these are processed by two different areas. B benefits vs. G benefits. Include all required rationale Indicate weight for heavy duty items Additional benefit specific criteria e.g. prescription 13 Approved Product List (APL) 14 Cancellation Contact the vendor to cancel the authorization and to make sure it has not already been provided. Contact AADL by fax do not rely on leaving a voice message. Use Authorization Correction and Change form to correct or change an authorization if benefit has not yet been provided. Must be mailed in for equipment. 15 5