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Volume 53, No. 4

B.C. Reg. 61/2010

The British Columbia Gazette,

Part II

March 9, 2010

B.C. Reg. 61/2010 , deposited March 5, 2010, pursuant to the EMPLOYMENT AND ASSISTANCE ACT [Section 35 (2)] and the EMPLOYMENT AND ASSISTANCE FOR PERSONS WITH DISABILITIES ACT [Section 26 (2)]. Order in Council 135/2010, approved and ordered March 4, 2010.

On the recommendation of the undersigned, the Administrator, by and with the advice and consent of the Executive Council, orders that, effective April 1, 2010, the Employment and Assistance Regulation, B.C. Reg. 263/2002, and the Employment and Assistance for Persons with Disabilities Regulation, B.C. Reg. 265/2002, are amended as set out in the attached Schedule.

— R. COLEMAN, Minister of Housing and Social Development ; B. PENNER, Presiding Member of the Executive Council .

Schedule

EMPLOYMENT AND ASSISTANCE REGULATION

Section 76 of the Employment and Assistance Regulation, B.C. 263/2002 is repealed and the following substituted:

Health supplement for persons facing direct

and imminent life threatening health need

76 The minister May provide to a family unit any health supplement set out in sections 2 (1) (

a) and (f) [general health supplements] and 3 [medical equipment and devices] of

Schedule C, if the health supplement is provided to or for a person in the family unit who is otherwise not eligible for the health supplement under this regulation, and if the minister is satisfied that

(

a) the person faces a direct and imminent life threatening need and there are no resources available to the person's family unit with which to meet that need,

(

b) the health supplement is necessary to meet that need,

(

c) the person's family unit is receiving premium assistance under the Medicare Protection Act , and

(

d) the requirements specified in the following provisions of

Schedule C, as applicable, are met:

(

i) paragraph (

a) or (

f) of section (2) (1);

(ii) sections 3 to 3.11, other than paragraph (

a) of

section 3 (1).

Section 1 of

Schedule C is amended by adding the following definition:

"pedorthist" means a person who is certified by and in good standing with the College of Pedorthics of Canada; .

3 Sections 3 and 3.1 of

Schedule C are repealed and the following substituted:

Medical equipment and devices

(1) Subject to subsections (2) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.11 of this

Schedule are the health supplements that May be provided by the minister if

(

a) the supplements are provided to a family unit that is eligible under

section 67 [general health supplements] of this regulation, and

(

b) all of the following requirements are met:

(

i) the family unit has received the pre-authorization of the minister for the medical equipment or device requested;

(ii) there are no resources available to the family unit to pay the cost of or obtain the medical equipment or device;

(iii) the medical equipment or device is the least expensive appropriate medical equipment or device.

(2) For medical equipment or devices referred to in sections 3.1 to 3.8, in addition to the requirements in those sections and subsection (1) of this section, the family unit must provide to the minister one or both of the following, as requested by the minister:

(

a) a prescription of a medical practitioner or nurse practitioner for the medical equipment or device;

(

b) an assessment by an occupational therapist or physical therapist confirming the medical need for the medical equipment or device.

(3) Subject to subsection (6), the minister May provide as a health supplement a replacement of medical equipment or a medical device, previously provided by the minister under this section, that is damaged, worn out or not functioning if

(

a) it is more economical to replace than to repair the medical equipment or device previously provided by the minister, and

(

b) the period of time, if any, set out in sections 3.1 to 3.11 of this Schedule, as applicable, for the purposes of this paragraph, has passed.

(4) Subject to subsection (6), the minister May provide as a health supplement repairs of medical equipment or a medical device that was previously provided by the minister if it is more economical to repair the medical equipment or device than to replace it.

(5) Subject to subsection (6), the minister May provide as a health supplement repairs of medical equipment or a medical device that was not previously provided by the minister if

(

a) at the time of the repairs the requirements in this

section and sections 3.1 to 3.11 of this Schedule, as applicable, are met in respect of the medical equipment or device being repaired, and

(

b) it is more economical to repair the medical equipment or device than to replace it.

(6) The minister May not provide a replacement of medical equipment or a medical device under subsection (3) or repairs of medical equipment or a medical device under subsection (4) or (5) if the minister considers that the medical equipment or device was damaged through misuse.

Medical equipment and devices

– canes, crutches and walkers

3.1

(1) Subject to subsection (2) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to achieve or maintain basic mobility:

(

a) a cane;

(

b) a crutch;

(

c) a walker;

(

d) an accessory to a cane, a crutch or a walker.

(2) A walking pole is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices – wheelchairs

3.2

(1) In this section, "wheelchair" does not include a stroller.

(2) Subject to subsection (4) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to achieve or maintain basic mobility:

(

a) a wheelchair;

(

b) an upgraded component of a wheelchair;

(

c) an accessory attached to a wheelchair.

(3) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (2) of this

section is 5 years after the minister provided the item being replaced.

(4) A high-performance wheelchair for recreational or sports use is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices

– wheelchair seating systems

3.3

(1) The following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to achieve or maintain a person's positioning in a wheelchair:

(

a) a wheelchair seating system;

(

b) an accessory to a wheelchair seating system.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 2 years from the date on which the minister provided the item being replaced.

Medical equipment and devices – scooters

3.4

(1) In this section, "scooter" does not include a scooter with 2 wheels.

(2) Subject to subsection (5) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if all of the requirements set out in subsection (3) of this

section are met:

(

a) a scooter;

(

b) an upgraded component of a scooter;

(

c) an accessory attached to a scooter.

(3) The following are the requirements in relation to an item referred to in subsection (2) of this section:

(

a) an assessment by an occupational therapist has confirmed that it is unlikely that the person for whom the scooter has been prescribed will have a medical need for a wheelchair during the 5 years following the assessment;

(

b) the total cost of the scooter and any accessories attached to the scooter does not exceed $3 500;

(

c) the minister is satisfied that the item is medically essential to achieve or maintain basic mobility.

(4) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (2) of this

section is 5 years after the minister provided the item being replaced.

(5) A scooter intended primarily for recreational or sports use is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices

– bathing and toileting aids

3.5

(1) The following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to facilitate transfers of a person or to achieve or maintain a person's positioning:

(

a) a grab bar in a bathroom;

(

b) a bath or shower seat;

(

c) a bath transfer bench with hand held shower;

(

d) a tub slide;

(

e) a bath lift;

(

f) a bed pan or urinal;

(

g) a raised toilet seat;

(

h) a toilet safety frame;

(

i) a floor-to-ceiling pole in a bathroom;

(

j) a portable commode chair.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 5 years from the date on which the minister provided the item being replaced.

Medical equipment and devices – hospital bed

3.6

(1) Subject to subsection (3) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to facilitate transfers of a person to and from bed or to adjust a person's positioning in bed:

(

a) a hospital bed;

(

b) an upgraded component of a hospital bed;

(

c) an accessory attached to a hospital bed.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 5 years from the date on which the minister provided the item being replaced.

(3) The following items are not health supplements for the purposes of

section 3 of this Schedule:

(

a) an automatic turning bed;

(

b) a containment type bed.

Medical equipment and devices

– pressure relief mattresses

3.7

(1) A pressure relief mattress is a health supplement for the purposes of

section 3 of this

Schedule if the minister is satisfied that the pressure relief mattress is medically essential to prevent skin breakdown and maintain skin integrity.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 5 years from the date on which the minister provided the item being replaced.

Medical equipment and devices

– floor or ceiling lift devices

3.8

(1) In this section, "floor or ceiling lift device" means a device that stands on the floor or is attached to the ceiling and that uses a sling system to transfer a person.

(2) A floor or ceiling lift device is a health supplement for the purposes of

section 3 of this

Schedule if the following requirements are met:

(

a) the minister is satisfied that the floor or ceiling lift device is medically essential to facilitate transfers of a person in a bedroom or a bathroom;

(

b) the cost of the floor or ceiling lift device does not exceed $4 200 or, if the cost of the floor or ceiling lift device does exceed $4 200, the minister is satisfied that the excess cost is a result of unusual installation expenses.

(3) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (2) of this

section is 5 years from the date on which the minister provided the item being replaced.

Medical equipment and devices

– positive airway pressure devices

3.9

(1) Subject to subsection (4) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if all of the requirements set out in subsection (2) of this

section are met:

(

a) a positive airway pressure device;

(

b) an accessory that is required to operate a positive airway pressure device;

(

c) a supply that is required to operate a positive airway pressure device.

(2) The following are the requirements in relation to an item referred to in subsection (1) of this section:

(

a) the item is prescribed by a medical practitioner or nurse practitioner;

(

b) a respiratory therapist has performed an assessment that confirms the medical need for the item;

(

c) the minister is satisfied that the item is medically essential for the treatment of moderate to severe sleep apnea.

(3) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is

(a) 5 years from the date on which the minister provided the item being replaced, for an item described in subsection (1) (a), and

(b) 1 year from the date on which the minister provided the item being replaced, for an item described in subsection (1) (

b) or (c).

(4) A ventilator is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices – orthoses

3.10

(1) In this section, "orthosis" means any or all of the following:

(

a) a custom-made foot orthotic;

(

b) custom-made footwear;

(

c) a permanent modification to footwear;

(

d) an ankle brace;

(

e) an ankle-foot orthosis;

(

f) a knee-ankle-foot orthosis;

(

g) a knee brace;

(

h) a hip brace;

(

i) an upper extremity brace;

(

j) a cranial helmet used for the purposes set out in subsection (7);

(

k) a torso or spine brace.

(2) Subject to subsections (3) to (11) of this section, an orthosis is a health supplement for the purposes of

section 3 of this

Schedule if

(

a) the orthosis is prescribed by a medical practitioner or a nurse practitioner,

(

b) the minister is satisfied that the orthosis is medically essential to achieve or maintain basic functionality,

(

c) the minister is satisfied that the orthosis is required for one or more of the following purposes:

(

i) to prevent surgery;

(ii) for post-surgical care;

(iii) to assist in physical healing from surgery, injury or disease;

(iv) to improve physical functioning that has been impaired by a neuro-musculo-skeletal condition, and

(

d) for an orthosis other than a custom-made foot orthotic, the orthosis is pre-fabricated unless

(

i) a medical practitioner or nurse practitioner confirms that a custom-made orthosis is medically required, and

(ii) the custom-made orthosis is fitted by an orthotist, pedorthist, occupational therapist, physical therapist or podiatrist.

(3) For an orthosis that is a custom-made foot orthotic, in addition to the requirements in subsection (2) of this section, all of the following requirements must be met:

(

a) a medical practitioner or nurse practitioner confirms that a custom-made foot orthotic is medically required;

(

b) the custom-made foot orthotic is fitted by an orthotist, pedorthist, occupational therapist, physical therapist or podiatrist;

(

c) the minister must be satisfied that failure to provide the custom-made foot orthotic is likely to result in partial or complete amputation of the foot;

(

d) the custom-made foot orthotic must be made from a hand-cast mold;

(

e) the cost of one pair of custom-made foot orthotics, including the assessment fee, must not exceed $375.

(4) For an orthosis that is custom-made footwear, in addition to the requirements in subsection (2) of this section, the cost of the custom-made footwear, including the assessment fee, must not exceed $1 650.

(5) For an orthosis that is a knee brace, in addition to the requirements in subsection (2) of this section, the medical practitioner or nurse practitioner who prescribed the knee brace must have recommended that the knee brace be worn at least 6 hours per day.

(6) For an orthosis that is an upper extremity brace, in addition to the requirements in subsection (2) of this section, the upper extremity brace must be intended to provide hand, finger, wrist, elbow or shoulder support.

(7) For an orthosis that is a cranial helmet, in addition to the requirements in subsection (2) of this section, the cranial helmet must be a helmet prescribed by a medical practitioner or nurse practitioner and recommended for daily use in cases of self abusive behavior, seizure disorder, or to protect or facilitate healing of chronic wounds or cranial defects.

(8) For an orthosis that is a torso or spine brace, in addition to the requirements in subsection (2) of this section, the brace must be intended to provide pelvic, lumbar, lumbar-sacral, thoracic-lumbar-sacral, cervical-thoracic-lumbar-sacral, or cervical spine support.

(9) Subject to

section 3 of this Schedule, the limit on the number of orthoses that May be provided for the use of a person as a health supplement for the purposes of

section 3 of this

Schedule is the number set out in Column 2 of Table 1 opposite the description of the applicable orthosis in Column1.

Table 1

Item

Column 1

Orthosis

Column 2

Limit

custom-made foot orthotic

1 or 1 pair

custom-made footwear

1 or 1 pair

modification to footwear

1 or 1 pair

ankle brace

1 per ankle

ankle-foot orthosis

1 per ankle

knee-ankle-foot orthosis

1 per leg

knee brace

1 per knee

hip brace

upper extremity brace

1 per hand, finger,

wrist, elbow or shoulder

cranial helmet

torso or spine brace

(10) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an orthosis is the number of years from the date on which the minister provided the orthosis being replaced that is set out in Column 2 of Table 2 opposite the description of the applicable orthosis in Column 1.

Table 2

Item

Column 1

Orthosis

Column 2

Time period

custom-made foot orthotic

4 years

custom-made footwear

1 year

modification to footwear

1 year

ankle brace

2 years

ankle-foot-orthosis

2 years

knee-ankle-foot orthosis

2 years

knee brace

4 years

hip brace

2 years

upper extremity brace

2 years

cranial helmet

2 years

torso or spine brace

2 years

(11) The following items are not health supplements for the purposes of

section 3 of this Schedule:

(

a) a prosthetic and related supplies;

(

b) a plaster or fiberglass cast;

(

c) a hernia support;

(

d) an abdominal support;

(

e) a walking boot for a fracture;

(

f) an item primarily for recreation or sports.

Medical equipment and devices – hearing aids

3.11 A hearing aid is a health supplement for the purposes of

section 3 of this

Schedule if

(

a) the hearing aid is prescribed by an audiologist or hearing aid dealer or consultant, and

(

b) an audiologist or hearing aid dealer or consultant has performed an assessment that confirms the need for a hearing aid.

EMPLOYMENT AND ASSISTANCE FOR PERSONS WITH

DISABILITIES REGULATION

Section 69 of the Employment and Assistance for Persons with Disabilities Regulation, B.C. 265/2002, is repealed and the following substituted:

Health supplement for persons facing direct

and imminent life threatening health need

69 The minister May provide to a family unit any health supplement set out in sections 2 (1) (

a) and (f) [general health supplements] and 3 [medical equipment and devices] of

Schedule C, if the health supplement is provided to or for a person in the family unit who is otherwise not eligible for the health supplement under this regulation, and if the minister is satisfied that

(

a) the person faces a direct and imminent life threatening need and there are no resources available to the person's family unit with which to meet that need,

(

b) the health supplement is necessary to meet that need,

(

c) the person's family unit is receiving premium assistance under the Medicare Protection Act , and

(

d) the requirements specified in the following provisions of

Schedule C, as applicable, are met:

(

i) paragraph (

a) or (

f) of section (2) (1);

(ii) sections 3 to 3.11, other than paragraph (

a) of

section 3 (1).

Section 1 of

Schedule C is amended by adding the following definition:

"pedorthist" means a person who is certified by and in good standing with the College of Pedorthics of Canada; .

6 Sections 3 and 3.1 of

Schedule C are repealed and the following substituted:

Medical equipment and devices

(1) Subject to subsections (2) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.11 of this

Schedule are the health supplements that May be provided by the minister if

(

a) the supplements are provided to a family unit that is eligible under

section 62 [general health supplements] of this regulation, and

(

b) all of the following requirements are met:

(

i) the family unit has received the pre-authorization of the minister for the medical equipment or device requested;

(ii) there are no resources available to the family unit to pay the cost of or obtain the medical equipment or device;

(iii) the medical equipment or device is the least expensive appropriate medical equipment or device.

(2) For medical equipment or devices referred to in sections 3.1 to 3.8, in addition to the requirements in those sections and subsection (1) of this section, the family unit must provide to the minister one or both of the following, as requested by the minister:

(

a) a prescription of a medical practitioner or nurse practitioner for the medical equipment or device;

(

b) an assessment by an occupational therapist or physical therapist confirming the medical need for the medical equipment or device.

(3) Subject to subsection (6), the minister May provide as a health supplement a replacement of medical equipment or a medical device, previously provided by the minister under this section, that is damaged, worn out or not functioning if

(

a) it is more economical to replace than to repair the medical equipment or device previously provided by the minister, and

(

b) the period of time, if any, set out in sections 3.1 to 3.11 of this Schedule, as applicable, for the purposes of this paragraph, has passed.

(4) Subject to subsection (6), the minister May provide as a health supplement repairs of medical equipment or a medical device that was previously provided by the minister if it is more economical to repair the medical equipment or device than to replace it.

(5) Subject to subsection (6), the minister May provide as a health supplement repairs of medical equipment or a medical device that was not previously provided by the minister if

(

a) at the time of the repairs the requirements in this

section and

section 3.1 to 3.11 of this Schedule, as applicable, are met in respect of the medical equipment or device being repaired, and

(

b) it is more economical to repair the medical equipment or device than to replace it.

(6) The minister May not provide a replacement of medical equipment or a medical device under subsection (3) or repairs of medical equipment or a medical device under subsection (4) or (5) if the minister considers that the medical equipment or device was damaged through misuse.

Medical equipment and devices

– canes, crutches and walkers

3.1

(1) Subject to subsection (2) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to achieve or maintain basic mobility:

(

a) a cane;

(

b) a crutch;

(

c) a walker;

(

d) an accessory to a cane, a crutch or a walker.

(2) A walking pole is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices – wheelchairs

3.2

(1) In this section, "wheelchair" does not include a stroller.

(2) Subject to subsection (4) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to achieve or maintain basic mobility:

(

a) a wheelchair;

(

b) an upgraded component of a wheelchair;

(

c) an accessory attached to a wheelchair.

(3) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (2) of this

section is 5 years after the minister provided the item being replaced.

(4) A high-performance wheelchair for recreational or sports use is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices

– wheelchair seating systems

3.3

(1) The following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to achieve or maintain a person's positioning in a wheelchair:

(

a) a wheelchair seating system;

(

b) an accessory to a wheelchair seating system.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 2 years from the date on which the minister provided the item being replaced.

Medical equipment and devices – scooters

3.4

(1) In this section, "scooter" does not include a scooter with 2 wheels.

(2) Subject to subsection (5) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if all of the requirements set out in subsection (3) of this

section are met:

(

a) a scooter;

(

b) an upgraded component of a scooter;

(

c) an accessory attached to a scooter.

(3) The following are the requirements in relation to an item referred to in subsection (2) of this section:

(

a) an assessment by an occupational therapist has confirmed that it is unlikely that the person for whom the scooter has been prescribed will have a medical need for a wheelchair during the 5 years following the assessment;

(

b) the total cost of the scooter and any accessories attached to the scooter does not exceed $3 500;

(

c) the minister is satisfied that the item is medically essential to achieve or maintain basic mobility.

(4) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (2) of this

section is 5 years after the minister provided the item being replaced.

(5) A scooter intended primarily for recreational or sports use is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices

– bathing and toileting aids

3.5

(1) The following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to facilitate transfers of a person or to achieve or maintain a person's positioning:

(

a) a grab bar in a bathroom;

(

b) a bath or shower seat;

(

c) a bath transfer bench with hand held shower;

(

d) a tub slide;

(

e) a bath lift;

(

f) a bed pan or urinal;

(

g) a raised toilet seat;

(

h) a toilet safety frame;

(

i) a floor-to-ceiling pole in a bathroom;

(

j) a portable commode chair.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 5 years from the date on which the minister provided the item being replaced.

Medical equipment and devices – hospital bed

3.6

(1) Subject to subsection (3) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if the minister is satisfied that the item is medically essential to facilitate transfers of a person to and from bed or to adjust a person's positioning in bed:

(

a) a hospital bed;

(

b) an upgraded component of a hospital bed;

(

c) an accessory attached to a hospital bed.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 5 years from the date on which the minister provided the item being replaced.

(3) The following items are not health supplements for the purposes of

section 3 of this Schedule:

(

a) an automatic turning bed;

(

b) a containment type bed.

Medical equipment and devices

– pressure relief mattresses

3.7

(1) A pressure relief mattress is a health supplement for the purposes of

section 3 of this

Schedule if the minister is satisfied that the pressure relief mattress is medically essential to prevent skin breakdown and maintain skin integrity.

(2) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is 5 years from the date on which the minister provided the item being replaced.

Medical equipment and devices

– floor or ceiling lift devices

3.8

(1) In this section, "floor or ceiling lift device" means a device that stands on the floor or is attached to the ceiling and that uses a sling system to transfer a person.

(2) A floor or ceiling lift device is a health supplement for the purposes of

section 3 of this

Schedule if the following requirements are met:

(

a) the minister is satisfied that the floor or ceiling lift device is medically essential to facilitate transfers of a person in a bedroom or a bathroom;

(

b) the cost of the floor or ceiling lift device does not exceed $4 200 or, if the cost of the floor or ceiling lift device does exceed $4 200, the minister is satisfied that the excess cost is a result of unusual installation expenses.

(3) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (2) of this

section is 5 years from the date on which the minister provided the item being replaced.

Medical equipment and devices

– positive airway pressure devices

3.9

(1) Subject to subsection (4) of this section, the following items are health supplements for the purposes of

section 3 of this

Schedule if all of the requirements set out in subsection (2) of this

section are met:

(

a) a positive airway pressure device;

(

b) an accessory that is required to operate a positive airway pressure device;

(

c) a supply that is required to operate a positive airway pressure device.

(2) The following are the requirements in relation to an item referred to in subsection (1) of this section:

(

a) the item is prescribed by a medical practitioner or nurse practitioner;

(

b) a respiratory therapist has performed an assessment that confirms the medical need for the item;

(

c) the minister is satisfied that the item is medically essential for the treatment of moderate to severe sleep apnea.

(3) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an item described in subsection (1) of this

section is

(a) 5 years from the date on which the minister provided the item being replaced, for an item described in subsection (1) (a), and

(b) 1 year from the date on which the minister provided the item being replaced, for an item described in subsection (1) (

b) or (c).

(4) A ventilator is not a health supplement for the purposes of

section 3 of this Schedule.

Medical equipment and devices – orthoses

3.10

(1) In this section, "orthosis" means any or all of the following:

(

a) a custom-made foot orthotic;

(

b) custom-made footwear;

(

c) a permanent modification to footwear;

(

d) an ankle brace;

(

e) an ankle-foot orthosis;

(

f) a knee-ankle-foot orthosis;

(

g) a knee brace;

(

h) a hip brace;

(

i) an upper extremity brace;

(

j) a cranial helmet used for the purposes set out in subsection (7);

(

k) a torso or spine brace.

(2) Subject to subsections (3) to (11) of this section, an orthosis is a health supplement for the purposes of

section 3 of this

Schedule if

(

a) the orthosis is prescribed by a medical practitioner or a nurse practitioner,

(

b) the minister is satisfied that the orthosis is medically essential to achieve or maintain basic functionality,

(

c) the minister is satisfied that the orthosis is required for one or more of the following purposes:

(

i) to prevent surgery;

(ii) for post-surgical care;

(iii) to assist in physical healing from surgery, injury or disease;

(iv) to improve physical functioning that has been impaired by a neuro-musculo-skeletal condition, and

(

d) for an orthosis other than a custom-made foot orthotic, the orthosis is pre-fabricated unless

(

i) a medical practitioner or nurse practitioner confirms that a custom-made orthosis is medically required, and

(ii) the custom-made orthosis is fitted by an orthotist, pedorthist, occupational therapist, physical therapist or podiatrist.

(3) For an orthosis that is a custom-made foot orthotic, in addition to the requirements in subsection (2) of this section, all of the following requirements must be met:

(

a) a medical practitioner or nurse practitioner confirms that a custom-made foot orthotic is medically required;

(

b) the custom-made foot orthotic is fitted by an orthotist, pedorthist, occupational therapist, physical therapist or podiatrist;

(

c) the minister must be satisfied that failure to provide the custom-made foot orthotic is likely to result in partial or complete amputation of the foot;

(

d) the custom-made foot orthotic must be made from a hand-cast mold;

(

e) the cost of one pair of custom-made foot orthotics, including the assessment fee, must not exceed $375.

(4) For an orthosis that is custom-made footwear, in addition to the requirements in subsection (2) of this section, the cost of the custom-made footwear, including the assessment fee, must not exceed $1 650.

(5) For an orthosis that is a knee brace, in addition to the requirements in subsection (2) of this section, the medical practitioner or nurse practitioner who prescribed the knee brace must have recommended that the knee brace be worn at least 6 hours per day.

(6) For an orthosis that is an upper extremity brace, in addition to the requirements in subsection (2) of this section, the upper extremity brace must be intended to provide hand, finger, wrist, elbow or shoulder support.

(7) For an orthosis that is a cranial helmet, in addition to the requirements in subsection (2) of this section, the cranial helmet must be a helmet prescribed by a medical practitioner or nurse practitioner and recommended for daily use in cases of self abusive behavior, seizure disorder, or to protect or facilitate healing of chronic wounds or cranial defects.

(8) For an orthosis that is a torso or spine brace, in addition to the requirements in subsection (2) of this section, the brace must be intended to provide pelvic, lumbar, lumbar-sacral, thoracic-lumbar-sacral, cervical-thoracic-lumbar-sacral, or cervical spine support.

(9) Subject to

section 3 of this Schedule, the limit on the number of orthoses that May be provided for the use of a person as a health supplement for the purposes of

section 3 of this

Schedule is the number set out in Column 2 of Table 1 opposite the description of the applicable orthosis in Column 1.

Table 1

Item

Column 1

Orthosis

Column 2

Limit

custom-made foot orthotic

1 or 1 pair

custom-made footwear

1 or 1 pair

modification to footwear

1 or 1 pair

ankle brace

1 per ankle

ankle-foot orthosis

1 per ankle

knee-ankle-foot orthosis

1 per leg

knee brace

1 per knee

hip brace

upper extremity brace

1 per hand, finger,

wrist, elbow or shoulder

cranial helmet

torso or spine brace

(10) The period of time referred to in

section 3 (3) (

b) of this

Schedule with respect to replacement of an orthosis is the number of years from the date on which the minister provided the orthosis being replaced that is set out in Column 2 of Table 2 opposite the description of the applicable orthosis in Column 1.

Table 2

Item

Column 1

Orthosis

Column 2

Time period

custom-made foot orthotic

4 years

custom-made footwear

1 year

modification to footwear

1 year

ankle brace

2 years

ankle-foot orthosis

2 years

knee-ankle-foot orthosis

2 years

knee brace

4 years

hip brace

2 years

upper extremity brace

2 years

cranial helmet

2 years

torso or spine brace

2 years

(11) The following items are not health supplements for the purposes of

section 3 of this Schedule:

(

a) a prosthetic and related supplies;

(

b) a plaster or fiberglass cast;

(

c) a hernia support;

(

d) an abdominal support;

(

e) a walking boot for a fracture;

(

f) an item primarily for recreation or sports.

Medical equipment and devices – hearing aids

3.11 A hearing aid is a health supplement for the purposes of

section 3 of this

Schedule if

(

a) the hearing aid is prescribed by an audiologist or hearing aid dealer or consultant, and

(

b) an audiologist or hearing aid dealer or consultant has performed an assessment that confirms the need for a hearing aid.

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