Alberta Aids to Daily Living (AADL) Online Training

Transcription

1 () Online Training Introduction to Online Modules () Purpose: Provide information about the Program. Clinicians must complete these modules. Information is also useful to other stakeholders. Vendors and those wishing to become vendors should also view these modules. 1

2 Module 1.1 Introduction () Purpose of Module 1.1: Overview of the Program. Various roles and processes in. Links to resources. () What is?: Supplementary health benefit program. Provides assistance to Albertans with chronic health conditions. Wide range of medical equipment and supplies funded. is the funding body for the equipment and supplies. 2

3 () Mandate The () program helps Albertans with a long-term disability, chronic illness or terminal illness maintain their independence in their home or community through the provision of medical equipment and supplies to meet their basic, medically assessed needs. Background is a provincial government program established in March Governed by the Alberta Public Health Act and and Extended Health Benefits Regulation. works in close partnership with Alberta Health Services (AHS). works in cooperation with health professionals, authorizers and vendors to assist eligible Albertans. How does Work? Two Models Authorizer/Vendor Client assessed by Authorizer Client selects Vendor Vendor provides benefit to Client Vendor bills Client and Specialty Supplier Client selects Specialty Supplier Client is assessed by a Specialty Assessor at the Specialty Supplier Specialty Supplier provides benefit to Client Specialty Supplier bills Client and audits Specialty Supplier 3

4 General Principles does not reimburse clients for benefits already purchased. Authorizations must be completed by an Authorizer or Specialty Assessor. Benefits must be provided by an Vendor or Specialty Supplier. Clients are given a choice of Vendor or Specialty Supplier. Must have demonstrated clinical need to receive benefits. General Principles Benefits are for a chronic, long-term or palliative condition. Only benefits listed on the Approved Product Lists (APLs) are funded by. Benefits have a maximum quantity, frequency and price. Benefit areas: Mobility Medical/Surgical Hearing and Augmentative Communication Prosthetics and Orthotics, Seating, and Footwear Respiratory Benefits There are different policies and procedures, and Approved Product Lists for each benefit area. Each benefit area has dedicated benefit clerks and a program manager. See for a detailed listing. Program Managers are health care professionals: Oversee benefit area Review appeals and exceptions Lead policy development Benefit Clerks: Process authorizations Provide information about the Program and benefits to clients, authorizers and vendors Perform post-audits 4

5 Eligibility Must be a permanent resident of Alberta. Must have a valid Alberta Personal Health Number (PHN). Require the benefit due to a long-term disability or chronic illness (six months or longer) or be end-stage palliative. Assessed by a qualified authorizer, assessor, or specialty assessor. Meet additional eligibility criteria outlined in each specific benefit section. Valid client declaration completed and signed by client on either the 1250, 1251 or separate client declaration form. does not reimburse for benefits that are already purchased. Cost-Share is a cost-share program. The client is responsible for 25% of the maximum cost, pays 75% of the maximum cost. The client s cost-share amount has a maximum. Between July 1 and June 30 each year, a family will only have to pay a maximum of $500. Clients can be cost-share exempt if they are low income. Client is responsible for payment of any upgrade costs. Upgrade charges do not count towards the maximum $500 per benefit year cost-share amount. Key Players Client Authorizer Assessor Vendor Specialty Supplier Specialty Assessor 5

6 Resources General Brochure The General Brochure outlines: benefits available Client eligibility requirements Where to get equipment and supplies How to access benefits Cost-sharing and how to apply for cost-share exemption Authorizers can add their contact information to the back panel Website The website has information pertaining to all aspects of the program general policy and procedures manual manuals for specific benefit groups Forms Vendor lists Contact list for employees Important bulletins will be posted on the front page of the website has an subscription feature for stakeholders who wish to receive updates. 6

7 Program 10th Floor, Milner Building Street Edmonton, Alberta T5J 0Z2 Phone: ; to call toll-free, first dial Deaf/hearing impaired callers within Alberta using a TTY can reach the provincial government by dialing in Edmonton or throughout Alberta. Fax: