Assistive Devices Program Respiratory Equipment and Supplies What kinds of respiratory equipment and supplies does the Assistive Devices Program (ADP) fund? apnea/cardiorespiratory monitors medication compressors (portable and stationary) high output air compressors airway clearance devices suction machines and the associated supplies tracheostomy tubes and the associated supplies continuous positive airway pressure systems (CPAP) autotitrating positive airway pressure systems (APAP) bi-level positive airway pressures systems (BPAP) Apnea monitors are covered for infants who meet specific medical criteria. The ADP will not provide funding assistance for items purchased before the date that the prescribing physician or nurse practitioner signs the ADP Application for Funding for Respiratory Equipment and Supplies form. Who can apply? Any permanent resident of Ontario who has a valid Health Card issued in their name, has a respiratory illness or dysfunction resulting in a need for respiratory equipment and supplies and meets the ADP medical eligibility criteria. ADP does not pay for equipment available under the Workplace Safety & Insurance Board or to Group A veterans for their pensioned conditions. ADP does not provide funding assistance to people residing in acute or chronic care hospitals and long-term care home.
How do I apply? To receive funding assistance for the following devices you must be assessed by a physician or nurse practitioner, preferably a specialist in respiratory illness: apnea/cardiorespiratory monitors; medication compressors; high output compressors; airway clearance devices; suction machines and associated supplies; tracheostomy tubes and supplies The physician or nurse practitioner will identify the equipment and supplies you require and confirm your eligibility for ADP funding assistance. To receive funding assistance for CPAP/APAP/BPAP: you must be assessed by a physician who works at a sleep clinic registered with the ADP. Eligibility for ADP funding assistance is based on established medical eligibility criteria and is different for each product. An Application for Funding for Respiratory Equipment and Supplies form must be submitted to the ADP. The form is completed and signed by you or your agent, the physician or nurse practitioner, and the ADP registered vendor. How much does ADP pay? For respiratory equipment the ADP pays 75% of the ADP approved price. You will pay the remaining 25%. For apnea/cardiorespiratory monitors, the ADP funds 75% of the ADP approved monthly rental price. For the supplies associated with suction machines and tracheostomy tubes, you will receive an annual grant. If you are receiving social assistance benefits from Ontario Works, Ontario Disability Support Program or Assistance to Children with Severe Disabilities you may be eligible to receive more funding assistance. 2
March/2014 Queen s Printer for Ontario Will my health insurance company cover my share of the cost? Many will. If you have private medical coverage, check with your insurer or agent to see if they will pay your share of the cost. Where can I get my respiratory equipment and supplies? Equipment must be purchased from a respiratory vendor of your choice registered with the ADP. We advise you to shop around among ADP registered vendors as services may vary. Supplies may be purchased from any vendor or supplier of your choice, regardless of their registration status with the ADP, who sells these products. Can I replace my respiratory equipment if my medical condition changes or my device is no longer working? If you experience a change in your medical condition please see your physician or nurse practitioner for an assessment of your needs. If your equipment is not in good working order and cannot be repaired at a reasonable cost, the ADP may contribute towards the cost of a replacement, if the device is no longer under warranty. ADP will not pay for the replacement of equipment lost, stolen or damaged through misuse. You are encouraged to buy private insurance to cover these possibilities. For More Information Ministry of Health and Long-Term Care Assistive Devices Program 7th Floor, 5700 Yonge Street Toronto, ON M2M 4K5 Toronto 416-327-8804 Toll-free 1-800-268-6021 TDD/TTY 416-327-4282 TDD/TTY 1-800-387-5559 Fax 416-327-8192 e-mail: adp@ontario.ca 3
WHAT'S THE COST OF TREATING SLEEP APNEA? The Assistive Devices Program (ADP) in Ontario states that ALL vendors MUST supply a patient with: A CPAP machine with humidifier, hose and MASK for $860.00 ADP pays 75% of the cost or $645.00 directly to the vendor you purchase your CPAP machine from. ADP will provide funding once every five years. You pay $215.00. NOTE - If you require a speciality mask i.e. nasal pillows or a full face mask there may be an additional fee. Many insurance companies cover this cost and the cost of future supplies. CONTACT your insurance company and ASK the following: 1. What's covered at time of purchase and how much? A. What about an extra mask, filters or hose at time of purchase? B. Extended warranty? C. Chin or mask straps? D. Compliance package? 2. What coverage exists for future replacement of masks, filters, hoses etc. 3. What information and/or forms do they require for payment (i.e. paid invoice, prescription, ADP form) Should you have any questions please ask your sleep tech or contact the sleep lab Name/phone # of Insurance Company and plan number: 2014 March 01
ADP Funding Eligibility for Respiratory Devices Dear Patient: Please see below the ADP criteria for funding to replace your CPAP device. 505 Requests for a Replacement Device 505.01 Clients who have received ADP- funded respiratory Devices and continue to meet the general (see the ADP Manual, Policy 300, Eligibility Criteria for Program Benefits) and Medical Eligibility Criteria (see Part 3, Applicant Eligibility Criteria for Respiratory Equipment), are eligible to re-apply for Funding either during or after the designated minimum funding period has expired, if there is: a documented change in the Client s medical/respiratory status and the ADP funded respiratory Device no longer meets the Client s basic respiratory needs, as defined by the ADP; or damage due to normal use and wear, and the Client confirms that the respiratory Device is no longer under warranty and the cost of the repair is more than one third of the original purchase price. Ref: ADP Respiratory Equipment Policy and Administration Manual September 2012 Should you have any questions about your eligibility for funding please contact the Assistive Devices Program. The Assistive Devices Program (ADP) can be reached in the following ways: By Mail: Ministry of Health and Long-Term Care Assistive Devices Program 7th Floor, 5700 Yonge Street Toronto, ON M2M 4K5 By Telephone, Fax or E-mail: Tel: Toronto 416-327-8804 Toll-free 1-800-268-6021 TDD/TTY 416-327-4282 TDD/TTY 1-800-387-5559 Fax 416-327-8192 e-mail: adp@ontario.ca 2014 September MJM