P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e r e c o n s i d e r a t i o n d e S o c i a l I n n o v a t i o n ( t h e m i n i s t r y ) d a t e d 1 3 M a r c h 2 0 1 -_ f u n d i n g f o r a C P A P m a c h i n e a n d m a s k u n d e r s e c t i o P e r s o n s w i t h D i s a b i l i t i e s R e g u l a t i o n . T h e m i n i s t r y d u n d e r p a r a g r a p h ( d ) ( i i ) o f s e c t i o n 6 9 a n d s e c t i o n 3 ( 1 h i s r e q u e s t d i d n o t m e e t t h e c r i t e r i o n t h a t t h e r e a r e c o s t o f o r o b t a i n t h e m e d i c a l e q u i p m e n t o r d e v i c e . T w a s n o t e l i g i b l e u n d e r s u b s e c t i o n 6 9 ( a ) o f t h e R e g u t h r e a t e n i n g n e e d f o r a C P A P m a c h i n e , h u m i d i f i e r a n P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b S c h e d u l e C , s e c t i o n s 3 a n d 3 . 9 . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L c i s i o n o f t h e M i n i s t r y o f S o c i a l D e v e l o p m e n t a n d 4 t h a t f o u n d t h a t t h e a p p e l l a n t w a s n o t e l i g i b l e f o r n 6 9 o f t h e E m p l o y m e n t a n d A s s i s t a n c e J Q_ r _ _ _ e t e r m i n e d t h a t t h e a p p e l l a n t w a s n o t e l i g i b l e ) ( b ) ( i i ) o f S c h e d u l e C o f t h e R e g u l a t i o n b e c a u s e n o r e s o u r c e s a v a i l a b l e t o t h e f a m i l y u n i t t o p a y t h e h e m i n i s t ry a l s o d e t e r m i n e d t h a t t h e a p p e l l a n t l a t i o n a s t h e r e i s n o e v i d e n c e o f a d i r e c t a n d l i f e • d m a s k . i l i t i e s R e g u l a t i o n ( E A P W D R ) , s e c t i o n 6 9 , a n d
PAR T E -Summa r of F acts The m i nistry did not appea r a t t he hearing. A f t e r c onfi he aring, th e hea r ing p roc ee d e d in acc ord anc e with _ _ _ Regulatio n. Th e evidenc e before the mini s try a t reco n sid era tion included the • From the minist r y's f iles, as s e t ou t in t he reconsid servi ce s only (MSO) c lient of th e mi nistr y in his • The foll owi n g doc umentat ion f axed to the mi worker at a hospital on 18 Dec emb er 20 1 3: a) A Medica l Equipme n t Request an d Jus completed b y t h e ap pellant ' s physician. T he app amputat i on belo w right knee , h yperte n sion, at a pnea and os teo a rthritis of left knee. The needed. A resp i ra to ry therapis t al s o sign ed for m o f th e s ame da te, s pe cifyi ng ne ed f o r a C ce r tifying th at he assessed the medical needs med ical equip ment will s atis fy his med ical b) A Su m ma r y Repor t -Ox im et ry on an ov h ospital 30 /31 Oc t ober 2 013. Th e conclusion: a uto CPAP is r ecommende d an d follo w-up c) Price q uotes from a res p ira tory equip ment 1. C PAP m o nthly rent al @ $ 160 pe r m o $ 3 5 pe r month and WI SP C PA P mas 2 . Min ist r y Philip s Re spir o n ics System O System O ne hea ted h um idif ier for CPAP, $465; less CPAP month 2 months and less heated humidifier rent 3. Ministry Philips Respironics System On Philips Res piro ni cs System One CPAP, $1795; WISP CPAP mask, $259. Total= $2519. d) The appellant's bank statements for the periods ending mid-September, mid-October and m i d -November 2 013 . The mid-November closing balance in the appella account was $5979.96. The closing balance in his savings account was $110.42. • The ministry's decision letter dated 06 February 2014, with accompanying detailed reasons, denying the appellant's request for a Wisp CPAP mask and 2 month trial rental of a standard CPAP machine. • T he a ppellant's Request for Reco n sider a tion dated 25 Febr EAA T003(1 0/06/01) I AP PEAL rm i ng t h at the ministry wa s noti fie d of th e s ection 8 6 (b) of the Em pl oy m e nt and A ssis tance fo l lowi n g: er ation dec ision: t he appell ant is a med ic al mid-70 s. n i st ry on t he a ppell a n t ' s be ha l f from a social t ification fo rm dat ed 12 De cember 2013, e l lant's medic a l c o ndi t i o ns in clude rial f i b r illation, TUPR, severe o bstr uc tive sleep physician in d i ca tes that a CPAP m achine is a Medi cal E quipm ent R e q u es t and Just ificati o n PA P m achin e, hum idi fie r and n a sal ma sk , of th e a ppel la n t a n d the recom mend ed n eeds. e rni ght p ulse ox imet ry of the appell ant done at a "Sev ere s leep d i s or dere d breath ing. A trial o f on cli nical outc o me o n tr eatm ent. " p rov id er da ted 12 December 2 0 13: n th for two m o nths, heate d humidifie r ren t al @ k. To t al = $649. ne C PA P , $ 17 95; Min istr y Ph i lips R espir o n ics l y rental @ $320 for al @ $70 for 2 months. Total = $ 1870. e h eated humidifier for C PA P, $4 65; Ministry n t 's chequ ing u ary 2014, attached to which were:
a) A letter to the appellant from his physician dated 14 February 2014. T " The CPAP mach in e is prescribed for you for o bs tructive sleep apnea. Duri n g y o ide ntified t hat you suffer ed from this condition. Th diminished mentat ion, whi ch was adversely a n d o u t c o m e : ----------------This was identifie d as a medical nec disorder your amputee/pros t hetic rehabilitation were signifi W ith improvement s in this co nditi o i mproved significantly." b) The appell ant's bank stat ement for th e Februa ry. The mid-February c l o sing ba lance his s a vings acc ount , $ 110.48. T he app ell ant's Notic e o f Appeal is d ate d 24 Ma rch 2014. writ es : "Based on the f a cts of my case i t w as unre ve n t i lat or, humidi fier & C PA P mask . " After rec on s iderati on and b efor e t he h eari ng, the a ppel 03 A pril 2014, with t h e fol low i ng i nfor ma t ion: • A lett er to t he ap pel la n t fro m h i s p hysi cian dated "I had p r e vi o usly provided you w ith a letter CPAP ventilat or , h eat ed humid if i e r , a n d CPAP m bee n d iagnosed w it h s e v e re obst ructi v e sl is medi c all y necessary to meet dir ec t and l ob s t ructive slee p apn ea." • The app ella nt 's bank st atement for t he perio d his c he q uing account w as $2006.07, and in his • An email dated 24 Mar c h 201 4 from the appellant's respiratory equipmen appe llant's advocate attach ing the appellant's CPAP compliance data (not included in the appellant's submi ssion). The e-mail states: "The usua co ver the costs of a 2 month rental and then reque rental payment is applied to the total purchase cost." • What purports to be the ministry's guidelines with respect to "NCPAP and BiPAP Breathing Devices . " These guidelines describe a 2-step process: the trial in order to provide time for proper assessment of efficacy of treatment and compliance. If a purchase is requeste d aft er the 3-month trial, a post-CPAP/BiPAP oximetry is required with results that show that treatment with the device is effective. Also required are compliance data from the equipment and/or a letter from the prescribing physician demonstrating adequate and consistent compliance with therapy. The guidelines note that at the r e uired in d ica t in the bu out cost of t he most b EM T00 3(10/06/01) APPEAL I he physician wri tes: management of clini c all y si gnificant ur in patient st ay at [n ame of the hospita l] it was e effects of this conditi on included affecting y ou r re h a bilitation performance ----------essity a s with o u t improvement in your sleep cantly co mpr om i sed. n your function and performance outcome p e riod ending m i d -January 2014 and mid in the chequing account was $2471.87 , and i n Unde r Reasons for Appeal t he appe llan t asona ble to deny p urchas e of a CPAP l a n t's advocate fo rw ar d e d a s ubmiss ion da t e d 24 March 20 14. The physic ian write s: in sup port o f you r fu ndin g applicati on for a as k. Pl ea se be advised that y ou have e ep a p ne a. I h ave i denti f i e d that this eq ui pment ife -th re ate ning health need caused by sev ere e n ding mid-M a rc h 2014. The c lo s ing bal ance in s avin gs ac count, $110.50. t provider to the l process through the ministry is that they s t a 'buy out' quote af terwards. The 2 month f ir s t is ministry f unding of a 3-mo n th bu yout step a quote is as i c e u i men! found to meet the client's
n e e d , w i t h a q u o t e c l e a r l y s h o w i n g a n y d i s c o s t a t e t h a t a n y a d d i t i o n a l r e q u i r e m e n t s , e . g . h d e m o n s t r a t e w h y t h i s i s m e d i c a l l y e s s e n t i a l A t t h e h e a r i n g , t h e a p p e l l a n t ' s a d v o c a t e s t a t e d t h a t B r e a t h i n g D e v i c e s " g U 1 d e l i n e d e s c r i b e d a b o v e f r o m h e h a d n e v e r b e f o r e i n h i s l i f e b e e n a r e c i p i e n t o f m m i n i s t r y w a s i n c o r r e c t i n i n d i c a t i n g i n t h e r e c o n s i d e M S O b e n e f i t s . T h e a p p e l l a n t s t a t e d t h a t h e w a s c u r r e n t l y u s i n g a r u s i n g i t s o m e t i m e i n N o v e m b e r 2 0 1 3 , s h o r t l y a f t e r h s t a r t u s i n g o n e . A s a r e s u l t , h i s c o n d i t i o n h a s s i g n i f a p p e l l a n t ' s a d v o c a t e s t a t e d t h a t I h u m i d i f i e r i s a n i n h u m i d i f i e r b e i n g n e c e s s a r y t o a v o i d d a m a g e t o t h e T h e a p p e l l a n t s t a t e d t h a t h i s b a n k b a l a n c e w a s n o w w o r s e b e c a u s e h e i s n o l o n g e r a b l e t o w o r k , a s h i s d r i v i n g d i f f i c u l t i e s d u e t o h i s r i g h t l e g a m p u t a t i o n . T h e b a l a n c e o f t h e a p p e l l a n t ' s p r e s e n t a t i o n w e n t t o D e c i s i o n , b e l o w ) . A s t h e m i n i s t r y d i d n o t a t t e n d t h e h e a r i n g , t h e p a n e r e f l e c t m i n i s t ry p r a c t i c e r e g a r d i n g a 2 s t e p p r o c e s s p e r i o d i s 2 o r 3 m o n t h s . H o w e v e r , t h e p a n e l a c c e p t s a r g u m e n t r e s p e c t i n g t h e a p p e l l a n t ' s p o s i t i o n f o r t h e m a c h i n e . T h e p a n e l f i n d s t h e o t h e r i n f o r m a t i o n p r o v i d e d b y t h i n f o r m a t i o n b e f o r e t h e m i n i s t r y a t r e c o n s i d e r a t i o n . T o n h i s e a r l i e r l e t t e r r e g a r d i n g t h e m e d i c a l n e e d f o r t u p d a t e t h e a p p e l l a n t ' s f i n a n c i a l s i t u a t i o n . T h e i n f o r m C P A P m a c h i n e i n N o v e m b e r 2 0 1 3 e x p l a i n s t h e p h y " W i t h i m p r o v e m e n t s i n t h i s c o n d i t i o n y o u r f u n c t i o n a T h e p a n e l t h e r e f o r e a d m i t s t h i s i n f o r m a t i o n p r o v i d e d E m p l o y m e n t a n d A s s i s t a n c e A c t . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L u n t s i n c l u d e d f r o m t h e r e n t a l . T h e g u i d e l i n e s a l s o e a t e d h u m i d i t y , m u s t h a v e m e d i c a l j u s t i f i c a t i o n t o i n r e l a t i o n t o t h e c l i e n t ' s m e d i c a l c o n d i t i o n . s h e h a d d o w n l o a d e d t h e " N C P A P a n d B i P A P t h e m i n i s t r y ' s w e b s i t e . � r 1r e � a: p tJ e l l a n t s t a t e d t h a t � i n i s t r y a s s i s t a n c e a n d h i s a d v o c a t e s t a t e d t h a t t h e r a t i o n d e c i s i o n t h a t t h e a p p e l l a n t w a s e l i g i b l e f o r e n t a l C P A P m a c h i n e a n d h u m i d i f i e r . H e b e g a n i s o x i m e t r y t e s t , w i t h h i s p h y s i c i a n o r d e r i n g h i m t o i c a n t l y i m p r o v e d . I n a n s w e r t o a q u e s t i o n , t h e t e g r a l p a r t o f m o d e r n C P A P m a c h i n e s , w i t h t h e s i n u s e s . a b o u t $ 1 5 0 0 ; h i s f i n a n c i a l s i t u a t i o n i s g e t t i n g d r i v e r ' s l i c e n s e h a s b e e n s u s p e n d e d b e c a u s e o f a r g u m e n t ( s e e P a r t F , R e a s o n s f o r P a n e l l i s u n a b l e t o v e r i f y w h e t h e r t h e s e g u i d e l i n e s f o r p r o v i d i n g a C P A P m a c h i n e o r w h e t h e r t h e t r i a l t h e i n f o r m a t i o n p r o v i d e d b y t h e a p p e l l a n t a s m i n i s t r y f u n d i n g t h e p u r c h a s e o f a C P A P e a p p e l l a n t o n a p p e a l t o b e i n s u p p o r t o f t h e h e p h y s i c i a n ' s l e t t e r o f 2 4 M a r c h 2 0 1 4 e l a b o r a t e s h e C P A P m a c h i n e , a n d t h e b a n k s t a t e m e n t s a t i o n t h a t t h e a p p e l l a n t h a d b e g u n r e n t i n g a s i c i a n ' s s t a t e m e n t i n h i s 1 4 F e b r u a r y l e t t e r t h a t n d p e r f o r m a n c e o u t c o m e i m p r o v e d s i g n i f i c a n t l y . " b y t h e a p p e l l a n t u n d e r s e c t i o n 2 2 ( 4 ) o f t h e
PAR T F -Reas o n s for P an el D ecis i o n The iss u e in th is appeal is w hether the minis tr y decis for f un d in g f o r a CPAP mach in e a n d mask under s e support e d by the evide n ce o r was a re asonabl e app the ap pellant . More spe cific ally, the issue i s w hether • the ap pell ant wa s not eligiblelm. de r para grapn@Hi S ched ule C o f the EAPWDR be cau se his r eques res o urce s av ail able to t he family unit to p ay t d evic e , a nd • t he a p pellant w as no t e ligible under section 69(a) a dir ect and li f e -threat ening nee d for a CPAP m T he app lica b le legislati o n is from th e E AP WDR: Hea lth supple ment for pers ons fa c in g d i r ect and imminent life threatening h 6 9 Th e minister may pro vi d e to a fa mily uni t any h ealth su supp leme n ts] and 3 [me dica l equipme nt and d evices] for a p er s on in t he fa mily u nit wh o i s ot herwise not elig if the minis t er is sat i sf i ed that (a ) t he person fa ces a dir e c t an d av ai lable to t he pe rson's fam i l y u (b) t he h eal t h supple ment is necessary to meet that ne ( c) the pe r son' s f amily u nit i s rec Act, an d (d ) the req ui rem ents sp ecifi ed i n met: ( i) para gr a ph (a) or ( f) (ii) sections 3 to 3.12, other th And from Sched ule C of t he EAPWDR: Medical equipment and devices 3 (1) Su bject t o subsectio ns (2 ) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.12 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 regulatio (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 eq u ipm ent or device; (iii) the medical equipmen equipment or device. (2.1) For medical equipme n t or devices referred to in that section and subsection (1) of this section, the family unit must provide to the minister one or both of the followin , as re uested b the minister: EAAT003(10/06/01) AP PEAL* · I ion tha t f ound tha t the ap pell ant was not e ligible ct i on 69 of the EAPWDR was rea son a b ly lication of the legislation i n the circ umstances of the minis try w a s reas o n able in det ermi ning tha t ifo f sect i o n 69 and se cti on 3 T1r( b/(ii) o f · ··� � t did n ot m eet the criterion th at the re are no he cost of o r obtain the med ical equipm ent or of th e R egul a tion as the re isno eviden c e of ach ine, humi difi e r and ma sk. ealth n eed pple men t se t o ut in se ctions 2 (1) (a ) a nd (f) [g e nera l health of Sc hedu le C, if t he h ealth suppl ement is prov i de d t o or ible for t he h ea lth su pplement u n der t h is regulation, and imm inen t life threa tenin g nee d a nd the r e are no resou rces nit w ith which to m eet t h at ne ed, ed, eiving premium a ssis t an c e un d e r th e Medicar e P ro t ecti on t h e fo llow ing provisi o ns of S chedu le C , as appl i ca ble, are of section ( 2 ) (1); an paragrap h (a) o f se ct ion 3 ( 1). n, and t or d e vice is the least expensive appropriate medical in sec tio n 3.9 (1) (b) to (g) , in add itio n to the re q uirem ents
( a ) a p r e s c r i p t i o n o f a m e d i c a l p d e v i c e ; ( b } a n a s s e s s m e n t b y a r e s p i r a t c o n f i r m i n g t h e m e d i c a l n e e d f o r M e d i c a r e q w p m e n t a n c n r e v 1 c e s b r e a t fi i n g cf e v i c e s ---3 . 9 ( 1 ) S u b j e c t t o s u b s e c t i o n ( 4 ) o f t h i s s e c t i o n , t h e f o l l o s e c t i o n 3 o f t h i s S c h e d u l e : ( a ) i f a l l o f t h e r e q u i r e m e n t s s e t ( i ) a p o s i t i v e a i r w a y p r e ( i i ) a n a c c e s s o r y t h a t i s ( i i i ) a s u p p l y t h a t i s r e q f ) i f t h e m i n i s t e r i s s a t i s f i e d t h a t a l l o w a t r a c h e o s t o m y p a t i e n t t o ( i ) a m e d i c a l h u m i d i f i e r ( i i ) a n a c c e s s o r y t h a t i s ( i i i ) a s u p p l y t h a t i s r e q ( 2 ) T h e f o l l o w i n g a r e t h e r e q u i r e m e n t s i n r e l a t i o n t ( a ) t h e i t e m i s p r e s c r i b e d b y a m ( b } a r e s p i r a t o r y t h e r a p i s t h a s p e t h e i t e m ; ( c ) t h e m i n i s t e r i s s a t i s f i e d t h a t t t o s e v e r e s l e e p a p n e a . I s s u e s r e s p e c ti n g t h e r e c o n s i d e r a t i o n d e c i s i o n R e n t o r P u r c h a s e ? T h e m i n i s t r y ' s o r i g i n a l d e c i s i o n o f 0 6 F e b r u a r y 2 0 1 4 m a s k a n d a 2 m o n t h t r i a l r e n t a l o f a s t a n d a r d C P A P g i v e n i n t h e d e c i s i o n s u m m a r y w a s t h a t t h e a p p e l l a n e q u i p m e n t . " I n h i s R e q u e s t f o r R e c o n s i d e r a t i o n t h e C P A P v e n t i l a t o r , h e a t e d h u m i d i f i e r a n d m a s k t o h i s m i n i s t r y p u r c h a s i n g t h e c o m p l e t e C P A P p a c k a g e . I n t h e o r i g i n a l d e c i s i o n , c o m p a r i n g r e n t a l c o s t s t o t h e a c o n c l u d e d t h a t t h e a p p e l l a n t ' s " r e q u e s t f o r f u n d i n g t o t h e e l i g i b i l i t y c r i t e r i a . . " T h e a p p e l l a n t ' s p o s i t i o n , a s s u n r e a s o n a b l e f o r t h e m i n i s t r y t o d e n y t h e p u r c h a s e o r e c o n s i d e r a t i o n d e c i s i o n d e n i e s f u n d i n g " t o p u r c h a s e d e t e r m i n a t i o n o n t h e " n o r e s o u r c e s a v a i l a b l e " c r i t e r i o H u m i d i f i e r i n c l u d e d ? T h e p a n e l i s u n c l e a r a s t o w h e t h e r t h e r e c o n s i d e r a t i C P A P m a c h i n e " i n c l u d e s t h e r e n t a l o f a h e a t e d h u m E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L r a c t i t i o n e r o r n u r s e p r a c t i t i o n e r f o r t h e m e d i c a l e q u i p m e n t o r o r y t h e r a p i s t , o c c u p a t i o n a l t h e r a p i s t o r p h y s i c a l t h e r a p i s t t h e m e d i c a l e q u i p m e n t o r d e v i c e . ---------w i n g i t e m s a r e h e a l t h s u p p l e m e n t s f o r t h e p u r p o s e s o f o u t i n s u b s e c t i o n ( 2 ) o f t h i s s e c t i o n a r e m e t , s s u r e d e v i c e , r e q u i r e d t o o p e r a t e a p o s i t i v e a i r w a y p r e s s u r e d e v i c e , o r u i r e d t o o p e r a t e a p o s i t i v e a i r w a y p r e s s u r e d e v i c e ; t h e i t e m i s m e d i c a l l y e s s e n t i a l t o m o i s t u r i z e a i r i n o r d e r t o b r e a t h e , , r e q u i r e d t o o p e r a t e a m e d i c a l h u m i d i f i e r , o r u i r e d t o o p e r a t e a m e d i c a l h u m i d i f i e r ; o a n i t e m r e f e r r e d t o i n s u b s e c t i o n ( 1 ) ( a ) o f t h i s s e c t i o n : e d i c a l p r a c t i t i o n e r o r n u r s e p r a c t i t i o n e r ; r f o r m e d a n a s s e s s m e n t t h a t c o n f i r m s t h e m e d i c a l n e e d f o r h e i t e m i s m e d i c a l l y e s s e n t i a l f o r t h e t r e a t m e n t o f m o d e r a t e d e n i e d t h e a p p e l l a n t f u n d i n g f o r a W i s p C P A P m a c h i n e . H o w e v e r , o n e o f t h e e x p l a n a t i o n s t " h a s r e s o u r c e s t o p u r c h a s e h i s o w n C P A P a p p e l l a n t c o m p a r e s t h e c o s t ( $ 2 5 1 9 ) o f t h e b a n k b a l a n c e ( $ 2 4 7 1 . 8 7 } a s a r g u m e n t f o r t h e t h e r e c o n s i d e r a t i o n d e c i s i o n , t h e m i n i s t r y u p h e l d p p e l l a n t ' s m i d F e b r u a r y b a n k b a l a n c e , b u t a l s o p u r c h a s e o r r e n t t h i s e q u i p m e n t d o e s n o t m e e t e t o u t i n h i s N o t i c e o f A p p e a l , i s t h a t i t i s f a C P A P v e n t i l a t o r , h u m i d i f i e r a n d m a s k . A s t h e o r r e n t t h i s e q u i p m e n t , " t h e p a n e l w i l l m a k e i t s n o n b o t h o p t i o n s . o n d e c i s i o n r e l a t i n g t o t h e r e n t a l o f a " s t a n d a r d i d i f i e r . T h e o o s i t i o n o f t h e a o o e l l a n t i s t h a t a
modern CPAP unit i nclude s a h eated humidi f i e r and that to the sinuses. The reconsiderat i on decision stated that appellant] is not el i gible for funding for a CPAP machine, re decision, the humidifier accessory is mentioned in con re quest and in rel ation to rental co sts compared to the app guiaehnes prov1aecr5Vtne a ppellan t's advocate on app e.g. heat ed humidif ier, must have medical justificatio in relatio n to the client's m e dical condition. The p a n heated humidifie r is considered part of a "standard CPAP h eated humidifier is i nclude d or not makes no mate The panel will consi d e r e ach part y ' s posit ion respecting the issues u No r esources a vailable Th e p osition of t he minis t r y is t hat in form ati o n p ro vided suffi cie n t f und s to pay the rental co sts of a CP A P machine at $16 mon t h ly and the purchase of a CPAP m ask a t $259. suffi cie n t ass ets to meet h i s genera l healt h supp lement t h e ba la nce o f $2582 . 8 2 in m i d-F eb r uary 2014 . The a ppellan t's position, a s set ou t in th e Request for b ank sta teme nts indicat e th at h e has only $ 2 471.87 heate d h umidi fier a nd C PA P mas k cost $25 1 9.00 . At the hearing, ba lanc e f ell to about $1500 while t he c ost of the buy-d is counts af ter 2 month s ren t a l . In e it her case , a s the availab le resour ces, the appellant subm its he meet s ar g ue s that ii is unreas o na ble to ex pect hi m to rent availa ble f und s would soon r un out. Panel findings The evidence is that the appellant had, in mid-February at the time of reconside $2582 in his bank accounts. (The amount cited in the appellant's Request for Reconsideration did not include approximately $11 0 in his savings account.) As the panel's jurisdiction is to ass reasonableness of the ministry' s reconsidera tion decision, the panel considers th comparison to be the appellant's bank balance at the time the reconsideration decision was made, not the balance at some later time, as the appellant has argued in referring to his bank balance at the t ime of the hearing. T he panel notes that a CPAP mask is not an item that can be rented, while the basic humidifier has been rented by the appellant, at $160/month for the former and $35/month for the latter, for a total of $195/month. Considering that the mask has already been purchased by the appellant, the panel finds that, given the appellant's bank balance at the time of reconsideration was $2582, the ministry was reasonable in determining that there were sufficient resources available to the a ellant to rent the e ui ment. EMT 003(10/06/01) I APPEA a humidifier i s ne c e ss a r y to prevent damage the mini stry "has dete rmined that [the n t al, and m ask . . . " El s e where in the nect i on with the appe llant's 1 8 Decembe r 2013 el lan t ' s bank balance. The mi nistry e al suggests that any additional requirements, n to dem onstrate w hy th is is me d icall y essen t ial el will not make a deter mination on whet her the machine." As will be s e en below, whe ther a rial differe n ce to the panel ' s decisio n. n de r a p peal . by t h e ap pellan t demonstrates that he ha s 0 m ont hly, a humidifier at $36 Th e appel lant' s ba n k bal ances sho w that h e h a s costs through his o w n re sou r ces as he h a d R ec o n sideration, i s that th e appellant's latest in h is bank acco unt whil e the CPAP vent i l ator , t he a ppel la nt testified that his bank o u t w ould be $18 70 a f te r taking into a ccount c ost of the CPA P pa cka g e is gre ater than hi s t h e "no resources availa ble " cr i t erion. H e furt h e r the equipment o n a m onth-t o -mon t h bas i s , a s his r a tion, approximatel y ess th e e a ppropriate machine and a
In terms of purchase, the panel notes that the quoted purchase cost of the total p CPAP machine a nd hu mi difier, n ot taking into ac count $2 519, Thi s amou nt i s l ess th at t he appel lant's m id-Februa the re wer e sufficient reso urces a v a i la b le at tha t time for _ _ _ -1be p a nel's view,_a_ _m o_r_e _ appropri ate comparison _ mu the minis try that he had gone ahead and bought the mask and rent November 2013. Consider ing sub-paragra p h (i) of section re qu i ring the pre-authorizati o n of th e minis ter, (legislation because it was not awa re that the a ppell a nt was already using the equipment when the made) it would be unreasonable for the a p pe llant to expect the ministr already made without pre-authorization. The quoted cost for th discounts for 2 months rental paid by the appellan t , is $1870. appellant's bank balanc e at the time of reconsideration, reasonable in determin ing t hat the "no resources available" crite Direc t and i m mi ne nt life t hre atenin g n eed In th e reco n s i d er at i o n dec ision, the m i nis try did not have available to p hysici a n of 24 Ma rch 20 14 an d relied o n the p h ysi cian f o und that the info rmation pro vided in t his lette r subs a s re q uir ed und e r p ara gra ph (2)(c ) of s ectio n 3 . 9 of Schedu th e item is m e dically essen tial for the tr eatment of m po s ition of the minis t r y that the information does not appe l lant's l i f e is at ri sk. The ap pell a nt' s position re lie s on the phys ician' s sta i dentifi ed tha t this eq u i pm en t is med i ca lly n ec ess ary caused by se vere obstruct i v e sle ep ap nea . " A t t he hea pers on wit h se vere sleep apnea, witho ut CPA P treatm The app ellan t subm i t s that th e new evidence from the m et. Panel findings The panel not e s that th e legislation requi res that the minister is satisfied that the person faces a direct and imminent life thre atening need. While the physician's letter of 24 March 2014 confirms that the appellant's s evere obstructive sleep apne a gives rise to the direct and life-threatening need for the CPAP equipment, the panel notes that, given the opportunity, the physician has not addressed how th i s n eed is "imminent." More spe cifically, the phys ician equipment, the appellant is at immediate risk of death. t he m inis try was rea sonable i n determining that the appel out i n th e first part of subsection 69 of t he EAPWDR. Conclusion On the basis of the foreaoina, the panel finds that the ministrv's decision to denv the aooellant's EAAT 003(10/06/01) I APPEAL ackag e -mas k, discounts availa ble because of p rior r ental is r y b ank bal anc e of $2582, indic ating that t he appe ll a nt to purcha se th e equipment,. In st take into a ccount the appellan t not advisi ng ed the CPAPeq u ipment in �  3(1)(b) of Sch edu le C o f th e EAPWDR, not cited by the ministry presumably request was y to cover costs that he h as e C PAP machine an d hum i difier, after As thi s amount is also within the t he p a nel f inds that the mi nistry w as rion had not bee n met. i t the l e t ter fr o m th e app e lla nt's ' s l etter of 1 4 F eb ru ary 20 14. Th e min istry tan t i ates the m edical ne ed for a CPAP ma chin e le C of the EA PWD R as c onf irmi ng that ode r a te t o s e vere sleep apne a. However i t i s t he de mons tr a t e th a t withou t a CPAP machine the teme nt in hi s l e t ter of 2 4 Mar c h 2 01 4 : "I have to mee t dire c t a nd lif e -thr e ate ning he alth nee d r ing, the ap pe llan t's ad voc ate also argue d a ent, w a s a lways at r isk of fata l cor onary a rre st. phy si cia n demon strate s tha t th i s c rit e rion i s was not explained how, without the CPAP Withou t such information, the panel finds that lant' s request d id not meet the c rit eri on s et
I APPEAL request for funding for a CPAP machine and mask under section 69 of the EAPWDR was reasonably supported by the evidence. The panel therefore confirms the ministry's decision. EAAT 003( 10/06/01)
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.