Policy E-06: Added (c) to reflect policy (no change). April 1, 2013 Policy E-09: Added more information to reflect changes in QFR process.

Alberta Health Alberta Aids to Daily Living Stationary Commodes, Mattress Overlays, Transfer Pole-Aids and Transfer Bed Rails Benefits Policy & Procedures Manual July 1, 2013

Transfer Bed Rails Benefits, Policy and Procedures Manual July 1, 2013 Revision History Description Policy E-10: Added information under Catalogue E801 and deleted Fixed Height under E802. Overall manual formatting revisions, including updating of all policy numbers. Policy E-01: Revised chart for consistency with B and C charts. Policy E-03: Minor word changes to reflect policy and to increase clarity. Policy E-04: Added more information to increase clarity and for consistency with B and C policies. Date July 1, 2013 April 1, 2013 April 1, 2013 April 1, 2013 April 1, 2013 Policy E-06: Added (c) to reflect policy (no change). April 1, 2013 Policy E-09: Added more information to reflect changes in QFR process. April 1, 2013 Policy E-10: Rearranged in numerical order. April 1, 2013 2013 Government of Alberta 2

Table of Contents Policy E 01... 4 Process to Obtain E Benefits... 4 Policy E 02... 5 Authorizer... 5 Policy E 03... 6 Eligibility Restrictions... 6 Policy E 04... 7 Quantity and Frequency Limits... 7 Policy E 05... 8 Insurance Coverage... 8 Policy E 06... 9 AADL Benchmark Pricing... 9 Principal Rules about AADL Benchmark Pricing... 9 Policy E 07... 11 AADL Standards for Warranty, Equipment Limitations and Liability Insurance... 11 7.1 Warranty... 11 7.2 Equipment Limitations... 11 7.3 Liability Insurance... 11 Policy E 08... 12 Process for Ordering Benefits... 12 Policy E 09... 13 Quantity and Frequency Review Requests... 13 Policy E 10... 14 Benefit Information... 14 2013 Government of Alberta 3

Policy E 01 Process to Obtain E Benefits Client needs equipment/supplies Client is referred to an AADL Authorizer Client assessed by Authorizer Authorizer MUST check eligibility - If Client is OVER quantity, the Authorization will not be Accepted QFR approval required prior to authorizing benefit NO Client Eligible for Benefit? YES Review assessment and need with client Complete Authorization form (1250) Distribute as instructed on bottom of form COST SHARE CLIENT - Client pays vendor 25% - Program pays 75% FULL BENEFIT ASSISTANCE Program Pays 100% Vendor submits claim electronically after benefit supplied Claim processed by Accounts Payable 2013 Government of Alberta 4

Policy E 02 Authorizer OT, PT or RN. 2013 Government of Alberta 5

Policy E 03 Eligibility Restrictions AADL does not provide stationary commodes, mattress overlays, transfer pole-aids and transfer bed rails for: Short-term use. Client must need to use the equipment for over six months. Use in acute care facilities or Continuing Care Centres. The equipment may be ordered as part of a discharge plan when client is returning to the community. Select equipment carefully Assessment should be done in the client's home environment whenever possible, to prevent authorization of unsuitable product. Equipment which has been purchased by AADL and is found to be inappropriate for the client's home may not be replaced by AADL 2013 Government of Alberta 6

Policy E 04 Quantity and Frequency Limits The quantity and frequency limit for stationary commodes, mattress overlays and transfer bed rails is one per four-year period. A QFR will not be required for clients who need a transfer bed rail as part of the hospital bed assembly and who have had a transfer bed rail within the preceding four year period. Authorizers should provide an explanation to this effect in the special instructions section. After the four year period, equipment should only be replaced when it is worn out or the client s condition has changed and equipment no longer meets the clinically assessed basic need. The quantity and frequency limit for transfer poles is one per 10 year period. When considering quantity limits, take into account that some products listed in the B and G sections of the manual are in the same benefit group as those in section E : A client can have only one item in this benefit group. A client can have only one benefit per function. Transfers to/from bed are considered as a separate function from other transfers. For example: Wheeled commodes from the G section are in the same group as the stationary commodes in the E section and raised toilet seats (RTS) in the B section. A client may have only one toileting aid, either a commode or RTS. 2013 Government of Alberta 7

Policy E 05 Insurance Coverage The AADL Program does not replace equipment that has been lost, stolen, abused or damaged. Clients must be advised that they should purchase insurance to cover the cost of replacements should the equipment be lost, stolen, or damaged. 2013 Government of Alberta 8

Policy E 06 AADL Benchmark Pricing Stationary commodes, mattress overlays, transfer pole-aids and transfer bed rails benefits are priced by the AADL benchmark pricing system. Vendors, authorizers, and AADL staff cooperatively choose a piece of equipment that becomes the basis to set the AADL benchmark price. This choice is reviewed on a regular basis. However, the vendor may offer AADL clients any brand/model of equipment as a benefit under the AADL benchmark price description providing: a) the equipment meets the generic description b) the equipment complies with AADL standards for warranty, limitation, and liability insurance as listed below in 7.0 c) minor replacement parts such as rubber tips/suction cups are obtainable and can be purchased by the client Vendors are responsible for the assembly and servicing of all all stationary commodes, mattress overlays, transfer pole-aids and transfer bed rails benefits provided to a client. Repair costs are the financial responsibility of the client. Principal Rules about AADL Benchmark Pricing: Clients must be offered a product, which meets the previously listed conditions in 6.0 (a)(b) and (c) available at or below the AADL benchmark price. If, in exceptional circumstances, the vendor does not carry the benefit at or below the AADL benchmark price, he is obligated to inform the client that they may be able to purchase the item at or below the AADL benchmark price from another vendor. If the shelf price of the product that the client chooses is indicated to be below the AADL benchmark price, the vendor is obligated to sell that item at the shelf price. If the shelf price of the product that the client chooses is indicated to be above the AADL benchmark price, the client may choose to obtain it as an AADL benefit, but the client must pay the difference between the AADL benchmark price and the marked shelf price. The difference is not reported to AADL and is not considered part of the $500.00 maximum client contribution. 2013 Government of Alberta 9

Authorizers and clients must be aware that the vendor is not expected to release product until he has received a valid authorization for the benefit. Authorizers and clients must be aware that cost-sharing clients are responsible for cost sharing on the AADL price. The vendor is not expected to release the product if the cost sharing has not been paid. 2013 Government of Alberta 10

Policy E 07 AADL Standards for Warranty, Equipment Limitations and Liability Insurance The supplier is responsible for ensuring that the listed AADL equipment standards are met by any products provided under the Stationary Commodes, Mattress Overlays, Transfer Pole-Aids and Transfer Bed Rails Catalogue Listing. 7.1 Warranty The manufacturer must warrant that the product will be free from defects in material and workmanship for a minimum of three years from the date the equipment was purchased. 7.2 Equipment Limitations Equipment must have been in the North American marketplace for a minimum of one year. 7.3 Liability Insurance Equipment provided must have a minimum two million dollars comprehensive general liability insurance provided by the manufacturer. 2013 Government of Alberta 11

Policy E 08 Process for Ordering Benefits Authorizers should follow these steps: assess client's equipment needs in their home environment; confirm client eligibility including residence and past benefit consumption; complete the AADL authorization form including benefit number, and model/brand if necessary; and submit the AADL copy of the 1250 form to AADL and send vendor copy to vendor of client choice. 2013 Government of Alberta 12

Policy E 09 Quantity and Frequency Review Requests If the client is over quantity/frequency for the benefit and the current benefit no longer meets the needs of the client, the authorizer faxes a Quantity and Frequency Review (QFR) form indicating the change in client condition and how it necessitates replacement of the equipment. Once the QFR is approved, the authorizer is notified, sends in a 1250 form to AADL and sends vendor copy to vendor of client choice. Refer to the AADL General Policy Manual available on-line for details on the QFR process. http://www.health.alberta.ca/services/aadl-program-manual.html. 2013 Government of Alberta 13

Mattress Overlays Policy E 10 Benefit Information E400 Alternating Pressure Mattress and Pump Alternating pressure pad system with an adjustable pump that allows for individual comfort settings with 10 minute cycle time, 2.5" heavy-duty, bubble style pad, flaps secure overlay to bed, 78" x 34" x 2.5". Holds 250 lbs. E401 Pump Only (for E400) Previously L220 Previously L221 for L220 E410 Mattress Only (for E400) Alternating pressure pad system that allows for individual comfort settings with 10 minute cycle time, 2.5" heavyduty, bubble style pad, flaps secure overlay to bed, 78" x 34" x 2.5" Holds 250 lbs. Previously L222 for L220 E411 Pressure Reduction Mattress Overlay Previously L228 Therapeutic foam overlay with individual cut articulating cells in three zones, helps ventilate surface. Intended for clients who are at higher risk for skin breakdown. Single Bed Size 33 x 72 x 3.5 thick, fire retardant Soft Skin sleeve. Single Bed Size 33 x 72 x 3.5 thick, fire retardant Soft Skin tubular sleeve. Double Bed Size SP760-000 (no cover). 2013 Government of Alberta 14

Transfer Bed Rails E420 Transfer Bed Rail Transfer Aid Previously L284 Bed Rail For standard angle iron home-style bed, or for hospitalstyle bed. Rail rotates 360 degrees and locks every 90 degrees. Steel construction, 3 height settings, 300 lbs. maximum user weight. Both attachment options are packed with each rail. Bed Rail Tubular construction fits between mattress and box spring. Rail unlocks with a lift to pivot outward. Bed Rail With mattress strap, holds 300 lbs., has one-piece steel frame fitted with six foam grips to hold it in place between box spring and mattress, two adjustable PVC stabilizer legs for extra stability during use, and mattress strap that attaches to frame. Bed Rail Contoured hand rail, nylon safety strap and foam mattress grips. 2013 Government of Alberta 15

Transfer Pole-Aids E430 Pole Transfer Aid Previously L285 E430 can be used as the catalogue number for the pole package with pole and accessories included or for orders for the pole only. If ordering accessories without the pole, use catalogue numbers below. Not all poles have accessories available. Check with vendor prior to ordering. AADL will purchase one transfer pole per 10 year period for a client. It the client needs a second pole for use in another room; the client must purchase the second pole. Authorizers should try to claim poles that are no longer needed by clients and these poles should be made available for community recycling. Parts for refurbishing can be purchased from the vendors as needed. Floor to ceiling transfer pole 8 ft. (floor adjust) Compression fit, 1.5" diameter pole, 12 diameter round top disc, 4 floor disc, powder coat paint finish, pebbled grip surface. Holds 250 lbs. Compression fit, 19 top disc, 4 floor mount, pebbled grip finish on whole length of pole. Holds 325 lbs. Steel pole, 1.5 diameter, 5 base Textured steel pole, powder coat, spring action on floor and ceiling, 1-5/8 diameter, non-skid foam pads. Accessories available E431 Heavy Duty Pole Transfer Aid E431 Floor to ceiling transfer pole Heavy Duty This pole looks like a regular SuperPole but its interior dimensions are different to be stronger. Supports 450 lbs. Previously L287 Accessories (not available for all poles check with vendor) E432 Trapeze Add-on Kit Accessory Bar & Trapeze Assembly, max. suspended weight 150 lbs, 20 in. long bar, supportive webbing, power coated trapeze 2013 Government of Alberta 16

E433 Extended arm and T-bar with rope 23 arm, rotates Holds 250 lbs E434 Extension for Transfer aid pole Floor to ceiling transfer pole 10 ft. (floor adjust). Holds 250 lbs. Unifit Extension for up to 10 ft. ceiling for superpole 2 ft. extension for 10 ft. ceiling. E435 Superbar Add-on Kit available for regular and heavy duty poles 2013 Government of Alberta 17

Stationary Commodes E800 Stationary Commode Variable Height Aluminum frame with back, armrests, clip on seat. Height adjustable 18-22. Seat 19 x 16. Overall width 21.25. Holds 250 lbs. Previously G001 Chrome plated steel frame, armrests. Height adjustable leg extensions provide 7 inches of adjustment. Snap on seat and lid. Holds 300 lbs. Metal coating, snap on seat, pail with lid, plastic armrest. Adjustable height 16.25-22.25. Holds 250 lbs. E801 Stationary Commode Variable Height Heavy Duty SPECIFY CLIENT WEIGHT ON 1250 FORM Welded steel frame, extra wide clamp on white seat with lid, rectangular pan and pan holder, armrests. Width between arms 21.75, seat 15.5 x 17.75. Seat to floor height 25-31. Holds 450 lbs. Previously G002 SPECIFY CLIENT WEIGHT ON 1250 FORM Painted steel extra wide frame, clip on seat, lid. Width between arms 20.5, seat depth 16. Seat height 18-22. Holds 400 lbs. 2013 Government of Alberta 18

E802 Stationary Commode Extra H.D. (SPECIFY CLIENT WEIGHT) Steel frame, white seat flips up, rectangular pan. Width between arms 30, seat 27.75 x 21. Adjustable height 17 21. Holds 650 lbs. Previously G003 E803 Stationary Commode Drop Arm Chrome plated steel frame, clamp-on seat with lid. Seat height 23.25-25.25, width 17.25. Holds 250 lbs. Accessory: Clamp on footrests. Previously G012 Chrome plated steel, removable backrest, pail lid and splash guard. Width 23, depth 20, seat height 17-21. Holds 300 lbs. Chrome steel frame, foam padded seat, foam handgrips, adjustable height legs, pan included. Height 20-25, depth 18-20, width between arms 18.5, overall width 22. Holds 275 lbs. 2013 Government of Alberta 19

E804 Stationary Drop Arm Commode Extra H.D. (SPECIFY CLIENT WEIGHT) Previously G013 Overall width 26, seat 23 x 18, height adjustable 19-24, oversize drop arm. Holds 650 lbs. Rust resistant powder coated steel arm mechanism snaps into place, 5 position height adjustable from 19.75-23.25. Footprint 28 x 20. Holds up to 700 lbs. 2013 Government of Alberta 20