Equipment (POC 13)

This policy provides direction on the approval of equipment, including special equipment, to those Veterans who are eligible to receive treatment benefits.

Purpose

This policy provides direction on the approval of equipment, including special equipment, to those Veterans who are eligible to receive treatment benefits.

Policy

General

1. For the purpose of this policy, a reference to the term “Veteran” is interpreted to include all individuals eligible for equipment, including special equipment.
2. Special equipment is any device or aid authorized by the Minister that is designed to enable the user to cope with the effects of a disease, disorder or injury, by facilitating medical stabilization, assisting in the performance of activities of daily living and/or restoring their function. Examples of special equipment include wheelchairs, walkers, power mobility devices (see policy entitled Power Mobility Equipment), transfer/lift devices (see In-Home Lifting and Transporting Devices policy), hospital equipment, and ergonomic equipment, among others.
3. If a Veteran satisfies the applicable eligibility criteria (see paragraph 6), access to special equipment may be authorized on the basis of a recommendation and prescription by a health professional approved by Veterans Affairs Canada (VAC). (See Health Care Professionals policy.)
4. Veterans Affairs Canada should be satisfied that the special equipment is the most appropriate response to the health-related needs of the Veteran and may not be authorized merely for convenience or as a lifestyle choice.
5. As a general principle, special equipment should be approved based on a hierarchy of interventions. That is, simpler, less costly equipment should be considered before more complex and costlier equipment. For example, consideration should first be given as to whether a bath seat and hand held shower will meet hygienic needs just as effectively as a bath lift. Similarly, it should be determined whether a Veteran can manage transfers by using a higher seat or a transfer pole, instead of a lift chair.

Eligibility

6. Veterans who are eligible to receive treatment benefits under the Veterans Health Care Regulations are eligible to receive equipment or special equipment if they meet one of the following criteria:
   1. The special equipment that is funded must relate to the disability benefits entitled condition (commonly referred to as having A-line coverage). The need for the requested equipment item must be clearly demonstrated (refer to the Treatment for a Disability Benefits Entitled Condition policy); or
   2.  Veterans who have eligibility, other than for a disability benefits entitled condition, and who require equipment (commonly referred to as having B-line coverage). Individuals eligible for treatment benefits as per this policy may only be authorized to receive equipment to the extent that the equipment is not available under a provincial/territorial health care system where the Veteran resides, or if applicable, from the Canadian Armed Forces, or if the cost of the equipment is not recoverable from a third party (refer to the policy entitled Requirement to Access Provincial Programs and Costs Recoverable From third Parties).

Approval of Items on Benefit Grids

7. Authorization of funding for special equipment requires that the decision maker provides a rationale to support the decision to approve payment. A rationale should address that the intervention will not pose a risk to others or to the Veteran’s health, well-being or progress within the treatment process. The need for and appropriateness of the special equipment must be confirmed in each case, based on the evidence available.
8. The need for special equipment is demonstrated if it is:
   1. prescribed by an approved health professional;
   2. appropriate to restore independent functioning and/or medical stabilization;
   3. determined that the equipment would be appropriate, beneficial and safe; and
   4. identified as a resource appropriate to achieve a treatment-related goal.

Approval of Items Not Appearing on Benefit Grids

9. Special equipment not listed in the benefit grids may be approved if:
   1. the equipment has been prescribed by an approved professional; and
   2. the equipment’s effective response to the Veteran’s health-related needs is supported by research and has been validated by a VAC health professional (e.g. medical, nursing).

Activity-Specific Sport Equipment

10. Veterans may be eligible for an activity-specific manual device required for an existing disability benefits entitled condition (section 6.a)) and/or any other eligible health condition (section 6.b)) that will allow them to participate in a recreational or competitive sport that requires a locomotor activity (running, jumping, skating, etc). The Veteran must have a desire to engage in regular performance of a sport, a specific goal, and a demonstrated commitment related to the specific sport for which the equipment is required. There is no requirement that the device must assist in the performance of activities of daily living. Activity-specific prosthetics should still be considered under Prostheses (see Prostheses policy).

Purchase, Rental, or Lease to Buy

11. In order to ensure that treatment benefits items are obtained in the most cost effective manner, the following criteria may be used in arriving at decisions to purchase, rent or lease to buy:
    1. Where indicated in the benefit grid, two separate quotes detailing the cost estimates for the equipment required in order to address the Veteran’s health-related needs. In exceptional circumstances (for example, in communities where only one provider is available), a single estimate from one provider may be permitted.
    2. Equipment purchase and rentals require pre-authorization as specified in the benefit grids.
    3. An item may be purchased when renting or leasing to buy has been determined not to be cost effective.
       1. During the initial review process, when it is determined that renting an item of equipment over a specified period of time will exceed its purchase price, the equipment should be leased with the option to purchase once a specified amount has been expended in rental charges.
       2. For ongoing rental agreements, when it is determined that the equipment rental has/will result in payments exceeding the purchase price, the rental agreement should, where possible and when determined appropriate under the circumstances, be terminated and the equipment purchased.
12. Rental agreements may be approved:
    1. That have been prescribed or recommended for use during a limited period of time, and when purchase of the item would exceed the projected total rental charge;
    2. For terminally ill Veterans, where purchase of the item would not be warranted;
    3. a) For life support or respiratory purposes, where frequent medical assessment and follow-up are involved;
    4. For items requiring frequent and extensive maintenance;
    5. For items requested by Veterans on a trial basis or recommended by VAC health professionals on a trial basis in order to establish their therapeutic or rehabilitative value;
    6. For items requiring specialized supervision to operate;
    7. For items subject to relatively rapid technological advances; or
    8. For items relatively new to the marketplace but that have received a notice of compliance from Health Canada.

Ownership

13. Special equipment approved for a Veteran becomes the property of the Veteran. VAC assumes no ownership of, or legal responsibility for, the equipment.
14. As the owner of the equipment, the Veteran is responsible for the removal and disposal of any equipment that is no longer needed, or where it is determined that the equipment can no longer be safely operated. The owner is also responsible for any required restoration of that place of residence following removal of equipment.

Maintenance and/or Repairs

15. Maintenance of items obtained through rental or lease-to-buy agreements are normally the responsibility of the provider. Required maintenance may, however, be paid through maintenance or service charges where applicable.
16. The Veteran, a caregiver, or another responsible person must be able to provide reasonable care of a power mobility device, such as ensuring that the device is properly stored, protected from the elements, charged, etc.
17. Payment may be authorized for maintenance and/or repairs of special equipment that was purchased and is no longer covered by warranty. Consideration may be given to paying reasonable service charges where extensive travel or other costs are involved in making the necessary repairs, where such costs are not covered under warranty.

Training

18. Certain items require training in their use (e.g. respiratory equipment, glucose meters and blood pressure machines). This training must be supplied by the provider and included as a condition of the equipment purchase, rental or lease-to-buy agreement.
19. During routine follow-up, VAC health professionals should ensure that the Veteran continues to use the equipment properly. Equipment providers may be requested to supply any additional training that is required.

Special Equipment in Health Care Facilities

20. Funding for special equipment that is normally provided by a health care facility should not be approved as an additional expense to VAC.
21. Funding for special equipment that is not normally provided by a health care facility may be approved, as outlined in the relevant benefit grid, as an additional expense to VAC if the item is:
    1. a replacement of a similar item previously covered by VAC prior to admission; or
    2. an effective response to the Veteran’s health-related needs which has been prescribed by the treating physician, medical specialist, or other approved health professional; and approved by the delegated decision maker (see Business Processes for POC 13).
22. The health care facility must agree in writing that the item may be placed/installed in the facility, and that it will be used exclusively by the Veteran for whom it was purchased.
23. Prior to approving an item for a Veteran in a health care facility, the delegated decision maker should take into consideration the current needs of the Veteran, and whether or not the item will meet future needs, if a Veteran’s discharge from the health care facility is anticipated

References

Veterans Health Care Regulations, subsection 4(b)

Power Mobility Equipment policy

In-Home Lifting and Transporting Devices policy

Health Care Professionals policy

Treatment for a Disability Benefit Entitled Condition policy

Requirement to Access Provincial Programs policy

Guide to Treatment Benefits, Health-related Travel and VIP (Blue Cross)