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 M i n i s t r y o f S o c i a l " m i n i s t r y " ) r e c o n s i d e r a t i o n d e c i s i o n d a t e d M a r c h 2 8 r e q u e s t f o r f u n d i n g f o r m e d i c a l p u r p o s e s , s p e c i f i c a l " R e q u e s t e d I t e m s " ) . T h e a p p e l l a n t i s a r e c i p i e n t o f 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 t h e R e q u e s t e 1 . 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 , a c c e s s o r y C 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 f o r P e r 2 . m e d i c a l s u p p l i e s , a s p r o v i d e d i n s e c t i o n 2 ( 1 ) 3 . m e d i c a l e q u i p m e n t o r d e v i c e s , a s p r o v i d e d i n 4 . a t h e r a p y s e r v i c e , a s p r o v i d e d i n s e c t i o n s 2 ( 5 . a n y h e a l t h s u p p l e m e n t u n d e r a n y o t h e r s e c t i 6 . a h e a l t h s u p p l e m e n t f o r a p e r s o n f a c i n g a d i r 6 9 o f t h e E A P W D R . 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 A P W D R s e c t i o n 6 2 [ g e n e r a l h e a l t h s u p p l e m e n t s ] ; d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g h e a l t h n e e d ] ; a n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( t h e , 2 0 1 4 w h e r e i n t h e m i n i s t r y d e n i e d t h e a p p e l l a n t ' s l y a p e a k f l o w m e t e r a n d s a l i n e s o l u t i o n ( t h e d i s a b i l i t y a s s i s t a n c e , a n d t h e m i n i s t r y d e t e r m i n e d d I t e m s a s a n y o f t h e f o l l o w i n g : o r s u p p l y , a s p r o v i d e d i n s e c t i o n 3 . 9 o f S c h e d u l e 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 ( " E A P W D R " ) ; ( a ) o f S c h e d u l e C o f t h e E A P W D R ; s e c t i o n s 3 t o 3 . 1 1 o f S c h e d u l e C ; 1 ) ( c ) , 2 ( 2 ) a n d 2 ( 2 . 1 ) o f S c h e d u l e C ; o n s o f S c h e d u l e C ; o r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g n e e d u n d e r s . s e c t i o n 6 9 [ h e a l t h s u p p l e m e n t f o r p e r s o n s f a c i n g d S c h e d u l e C .
APPEAL# '. PART E -Summary of Facts The information before the ministry at the time of reconsideration included the following: o The appellant is designated as a person with disabilities (PWD) and is a recipient of disability assistance. • The appellant's physician provided the appellant with a prescription (dated November 27, 2013) for a peak flow meter "to improve his care/management." At appeal, the appellant's oral testimony included the following: • He has severe sleep apnea and qualified for a Bi-Pap machine in 2009; • The appellant also suffers from asthma which requires the inhaling of a number of medications. He has a Nebulizer to facilitate this. • In November 2013 the appellant's physician provided a prescription for saline solution to keep his breathing equipment sterile. This prescription was not included in the appeal record. • The ministry provided the appellant with funding for saline solution on a three month basis, ending mid-April 2014. • A peak flow meter assists persons with severe asthma to record their peak expiratory flow and those readings allow the monitoring of the effectiveness of the medications. • The appellant did not recall being asked by the ministry to submit an assessment by a respiratory therapist as part of the Medical Equipment Request form. The appellant's advocate submitted a two-page document which substantially reiterated the above noted oral evidence. When asked for its position on admissibility of this document the ministry stated that it took no position. As they provided additional detail regarding the history of this appeal, the panel accepted both the document and the appellant's oral testimony as being in support of the information and records that were before the ministry at the time of reconsideration, in accordance with section 22(4) of the Employment and Assistance Act. The appellant, through his advocate, acknowledged that the assessment by a respiratory therapist is a requirement, but said it had been held up by a backlog of practitioners and by the ministry's inadvertent failure to include a copy of the Medical Equipment Request in the appellant's file. The ministry's representative stated that the ministry would assist in having an assessment done. The ministry relied on its reconsideration decision. EM1 003(10/06/01)
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e o n a p p e a l i s w h e t h e r t h e m i n i s t r y ' s d e c i s s u p p o r t e d b y t h e e v i d e n c e o r i s a r e a s o n a b l e a p p l i c c i r c u m s t a n c e s o f t h e a p p e l l a n t . I n p a r t i c u l a r , w a s i t 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 t h e R e q u e s t e d I t e m s a 1 . 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 , a c c e s s o r y C 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 f o r P e r 2 . m e d i c a l s u p p l i e s , a s p r o v i d e d i n s e c t i o n 2 ( 1 ) 3 . m e d i c a l e q u i p m e n t o r d e v i c e s , a s p r o v i d e d i n 4 . a t h e r a p y s e r v i c e , a s p r o v i d e d i n s e c t i o n s 2 ( 1 5 . a n y h e a l t h s u p p l e m e n t u n d e r a n y o t h e r s e c t i 6 . a h e a l t h s u p p l e m e n t f o r a p e r s o n f a c i n g a d i r 6 9 o f t h e E A P W D R . T h e r e l e v a n t l e g i s l a t i v e p r o v i s i o n s a r e d e s c r i b e d a s E A P W D R S c h e d u l e C G e n e r a l h e a l t h s u p p l e m e n t s 2 ( 1 ) T h e f o l l o w i n g a r e t h e h e a l t h s u p p l e m e n t s t h a t m a i s e l i g i b l e u n d e r s e c t i o n 6 2 [ g e n e r a l h e a l t h s u p p l e ( a ) m e d i c a l o r s u r g i c a l s u p p l i e s r e u s a b l e , i f t h e m i n i s t e r i s s a t i s f i ( i ) t h e s u p p l i e s a r e r e q u ( A ) w o u n d c a r e ; ( B ) o n g o i n g b o w ( C ) c a t h e t e r i z a t i ( D ) i n c o n t i n e n c e ( E ) s k i n p a r a s i t e ( F ) l i m b c i r c u l a t i ( i i ) t h e s u p p l i e s a r e ( A ) p r e s c r i b e d b ( B ) t h e l e a s t e x p ( C ) n e c e s s a r y t o ( i i i ) t h e r e a r e n o r e s o u r c t h e s u p p l i e s ; ( a . 1 ) t h e f o l l o w i n g m e d i c a l o r s u r d i s p o s a b l e o r r e u s a b l e , i f t h e m i n p a r a g r a p h ( a ) ( i i ) a n d ( i i i ) a r e m e ( i ) l a n c e t s ; ( i i ) n e e d l e s a n d s v r i n a e s E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # i o n t o d e n y t h e R e q u e s t e d I t e m s i s r e a s o n a b l y a t i o n o f t h e a p p l i c a b l e e n a c t m e n t i n t h e 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 t e r m i n e t h a t t h e s a n y o f t h e f o l l o w i n g : o r s u p p l y , a s p r o v i d e d i n s e c t i o n 3 . 9 o f S c h e d u l e 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 ( " E A P W D R " ) ; ( a ) o f S c h e d u l e C o f t h e E A P W D R ; s e c t i o n s 3 t o 3 . 1 1 o f S c h e d u l e C ; ) ( c ) , 2 ( 2 ) a n d 2 ( 2 . 1 ) o f S c h e d u l e C ; o n s o f S c h e d u l e C ; o r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g n e e d u n d e r s . f o l l o w s : y b e p a i d f o r b y t h e m i n i s t e r i f p r o v i d e d t o a f a m i l y u n i t t h a t m e n t s ] o f t h i s r e g u l a t i o n : t h a t a r e , a t t h e m i n i s t e r ' s d i s c r e t i o n , e i t h e r d i s p o s a b l e o r e d t h a t a l l o f t h e f o l l o w i n g r e q u i r e m e n t s a r e m e t : i r e d f o r o n e o f t h e f o l l o w i n g p u r p o s e s : e l c a r e r e q u i r e d d u e t o l o s s o f m u s c l e f u n c t i o n ; o n ; ; c a r e ; o n c a r e ; y a m 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 , e n s i v e s u p p l i e s a p p r o p r i a t e f o r t h e p u r p o s e , a n d a v o i d a n i m m i n e n t a n d s u b s t a n t i a l d a n g e r t o h e a l t h ; 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 c o s t o f o r o b t a i n g i c a l s u p p l i e s t h a t a r e , a t t h e m i n i s t e r ' s d i s c r e t i o n , e i t h e r i s t e r i s s a t i s f i e d t h a t a l l t h e r e q u i r e m e n t s d e s c r i b e d i n t i n r e l a t i o n t o t h e s u p p l i e s : ;
(iii) ventila tor supplies required for the essential operation or sterilizat ventila tor; ( i v) tracheostomy supplies; (a.2) consumabl e medical supplies, if the re q u irements are met: ( i ) t he supplies a re requ ( i i) all the r e quir e ments t he s up plies; ... Section 2(1.1) of S c he dule C, provide s th at fo r the purposes of subsecti include nutr itional supplements, food, vita mins, minerals or prescription me Section 2(1 )(c) prov i des that the fol lowing item s are h e alth supplements if se rvice f o r acupunc ture, chiropractic, massage th erap y , n atu ro Section 2(1 )(f) of Schedul e C provides that the follo w in g items are a r e m et: t he l east expe n sive app rop riat e m ode of t ranspor tation. Secti on 2( 3) of Sch edu le C provid es that "If the m ini s ter pro v i d Sche du le C of t he Di sabili ty Bene fi t s Progr a m Reg ulation, B.C. Re 75/9 7 or t h e Y o uth Works Regulatio n , B.C. Re g . 77/97, as appli repe a led, t he m inister may c ontinu e to provide that b e nefi t t o or fo t he same terms and c o nditio ns as p revi ously u nti l the earlier of (a) the date the cond i t i o ns o n whi ch t he m i nist e r paid t he (b) the date the person cease s to receiv e di sab i lit y a ss ist Sectio n 2.1 of Sc hedule C pr o vid es th at t he foll o wing are the optical suppleme 6 2. 1 of the EAPW D R: ba sic e yew ear and re pairs, p re-a u thoriz Sectio n 2.2 of Schedule C prov ides th at th e mini s t er m a y pay a an e ye examination i f the other criteri a of t h e section are met . Medi ca l eq uipment a nd de vic e s 3 ( 1 ) Subject to sub sections (2) to ( 5 ) of this section, the me d i cal o f thi s Sc hedul e are t he h ea lth supp l e ments t h at may b e (a ) the supplements are provided to a family unit that is eligible under secti regulation, and (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 r e quested; (ii ) there a re n o r e s ources available to the family unit t (iii) the medical equipment or device is the least expensive appropria (2) For medical equipment or devices referred to in sections 3.1 to 3.8 and subsection (1) of this section, the family unit must provide to the min requested by the minister: ( a) a prescription of a medical practitioner or nurse practitioner for the medical equipment or device; (b) an assessment by an occupational therapist or physical equipment or device. ... EAAT 00 3 (10/06/0 1 ) � APPEAL# i o n of a minister is satisfied that a ll of the follo wing i red to thicken foo d; d es cr i bed in pa r a graph ( a) (ii) a nd ( ii i) ar e met i n r elation to o n 2(1 )(a ) , " medical or surgical supplies" do not dic a tions. the ot h e r c riter i a of the sec tion are met: a pathy, non-surgical pod ia t r y , physiot herapy. hea lth supplements if the other criteria of the section e d a bene f it to or for a person u nde r section 2(3) of g . 79 /9 7, t he Inc ome Assistance Re g ulation, B.C . Reg. cable, for the m onth during whi ch t he re g u l atio n was r t h at per s o n as a s up pl e ment under t his r egulatio n on t h e follow in g date s: benefi t are no longer m et; a nce. n t s t h at may be provid ed under Section ed eyew ear and re pair s . health supplement under Sec tion 6 7.2 o f the E APWDR f or equip men t a nd d e v i ces describ ed in sectio n s 3 . 1 to 3.11 pro v i d e d by t he m in ist er if o n 62 [general health s upple ments] of this o pa y the cost of or ob ta in the medical equipment or device; te medical equipment or device. , in ad dition to the re quirements in t h ose se c t io n s ister on e or both of th e foll o w ing , as therapist confirming the medical need for the med ic al
I APPEAL# Section 3.1 provides that the following items are health supplements for the purposes of section 3 of the Schedule, if the other criteria of the section are met: a cane, a crutch, a walker, an accessory to a cane, a crutch or a walker. Section 3.2 provides that the following items are health supplements for the purposes of section 3 if the other criteria of the section are met: a wheelchair, an upgraded component of a wheelchair, an accessory attached to a wheelchair. Section 3.3 provides that the following items are health supplements for the purposes of section 3 of the Schedule, if the other criteria of the section are met: a wheelchair seating system, an accessory to a wheelchair seating system. Section 3.4 provides that the following items are health supplements for the purposes of section 3 of the Schedule, if the other criteria of the section are met: a scooter, an upgraded component of a scooter, an accessory attached to a scooter. Section 3.5 provides that the following items are health supplements for the purposes of section 3 of the Schedule, if the other criteria of the section are met: a grab bar in a bathroom, a bath or shower seat, a bath transfer bench with hand held shower, a tub slide, a bath lift, a bed pan or urinal, a raised toilet seat, a toilet safety frame, a floor-to-ceiling pole in a bathroom, a portable commode chair. Section 3.6 provides that the following items are health supplements for the purposes of section 3 of the Schedule, if the other criteria of the section are met: a hospital bed, an upgraded component of a hospital bed, an accessory attached to a hospital bed. Section 3. 7 provides that the following item is a health supplement for the purposes of section 3 of the Schedule, if the other criteria of the section are met: a pressure relief mattress. Section 3.8 provides that the following item is a health supplement for the purposes of section 3 of the Schedule, if the other criteria of the section are met: a floor or ceiling lift device. Medical equipment and devices -breathing devices 3.9 (1) Subject to subsection (4) of this section, the following items are health supplements for the purposes of section 3 of this Schedule: {a) if all of the requirements set out in subsection (2) of this section are met, (i) a positive airway pressure device, (ii) an accessory that is required to operate a positive airway pressure device, or (iii) a supply that is required to operate a positive airway pressure device; {b) if the minister is satisfied that the item is medically essential to monitor breathing, (i) an apnea monitor, (ii) an accessory that is required to operate an apnea monitor, or (iii) a supply that is required to operate an apnea monitor; (c) if the minister is satisfied that the item is medically essential for clearing respiratory airways, (i) a suction unit, (ii) an accessory that is required to operate a suction unit, or (iii) a supply that is required to operate a suction unit; {d) if the minister is satisfied that the item is medically essential for clearing respiratory airways, (i) a percussor, (ii) an accessory that is required to operate a percussor, or (iii) a supply that is required to operate a percussor; (e) if the minister is satisfied that the item is medicallv essential to avoid an imminent and EAAT 003(1 0/06/01)
s u b s t a n t i a l d a n g e r t o h e a l t h , ( i ) a n e b u l i z e r , ( i i ) a n a c c e s s o r y t h a t ( i i i ) a s u p p l y t h a t i s r e ( 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 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 ( i i ) a n a c c e s s o r y t h a t i ( i i i ) a s u p p l y t h a t i s r e q ( g ) 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 ( i ) a n i n h a l e r a c c e s s o r ( i i ) a n a c c e s s o r y t h a t i ( 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 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 . ( 3 ) T h e p e r i o d o f t i m e r e f e r r e d t o i n s e c t i o n 3 ( 3 ) ( d e s c r i b e d i n s u b s e c t i o n ( 1 ) o f t h i s s e c t i o n i s ( a ) i n t h e c a s e o f a n i t e m r e f e r r e t h e m i n i s t e r p r o v i d e d t h e i t e m b ( b ) i n t h e c a s e o f a n i t e m r e f e r r e o n w h i c h t h e m i n i s t e r p r o v i d e d t ( c ) i n t h e c a s e o f a n a p n e a m o n 5 y e a r s f r o m t h e d a t e o n w h i c h ( d ) i n t h e c a s e o f a n i n h a l e r a c c p r o v i d e d t h e d e v i c e b e i n g r e p l a c ( e ) i n t h e c a s e o f a n a c c e s s o r y o y e a r f r o m t h e d a t e o n w h i c h t h e ( 4 ) A v e n t i l a t o r i s n o t a h e a l t h s u p p l e m e n t f o r t h e p S e c t i o n 3 . 1 0 p r o v i d e s t h a t e a c h o f t h e f o l l o w i n g i t e m s i s a n o r t s e c t i o n 3 o f t h e S c h e d u l e , i f t h e o t h e r c r i t e r i a o f t h e s e c t i o n a r e a p e r m a n e n t m o d i f i c a t i o n t o f o o t w e a r , a n a n k l e b r a c e , a n a n k l h i p b r a c e , a n u p p e r e x t r e m i t y b r a c e , a c r a n i a l h e l m e t , a t o r s o S e c t i o n 3 . 1 1 p r o v i d e s t h a t t h e f o l l o w i n g i t e m i s a h e a l t h s u p p l e o t h e r c r i t e r i a o f t h e s e c t i o n a r e m e t : a h e a r i n g a i d . S e c t i o n 3 . 1 2 p r o v i d e s t h a t a n o n c o n v e n t i o n a l g l u c o s e m e t e r i S c h e d u l e , i t t h e o t h e r c r i t e r i a o f t h e s e c t i o n a r e m e t . S e c t i o n 4 o f t h e S c h e d u l e p r o v i d e s t h a t t h e h e a l t h s u p p l e m e n t a r e b a s i c d e n t a l s e r v i c e s , i f t h e o t h e r c r i t e r i a o f t h e s e c t i o n a r e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # i s r e q u i r e d t o o p e r a t e a n e b u l i z e r , o r q u i r e d t o o p e r a t e a n e b u l i z e r ; t 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 , s 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 ; t 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 d e l i v e r m e d i c a t i o n , y d e v i c e , s r e q u i r e d t o o p e r a t e a n i n h a l e r a c c e s s o r y d e v i c e , o r u i r e d t o o p e r a t e a n i n h a l e r a c c e s s o r y d e v i c e . 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 ; e 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 b ) o f t h i s S c h e d u l e w i t h r e s p e c t t o r e p l a c e m e n t o f a n i t e m a s f o l l o w s : d t o i n s u b s e c t i o n ( 1 ) ( a ) ( i ) , 5 y e a r s f r o m t h e d a t e o n w h i c h e i n g r e p l a c e d ; d t o i n s u b s e c t i o n ( 1 ) ( a ) ( i i ) o r ( i i i ) , o n e y e a r f r o m t h e d a t e h e i t e m b e i n g r e p l a c e d ; i t o r , s u c t i o n u n i t , p e r c u s s o r , n e b u l i z e r o r m e d i c a l h u m i d i f i e r , t h e m i n i s t e r p r o v i d e d t h e i t e m b e i n g r e p l a c e d ; e s s o r y d e v i c e , o n e y e a r f r o m t h e d a t e o n w h i c h t h e m i n i s t e r e d ; r s u p p l y f o r a n i t e m r e f e r r e d t o i n p a r a g r a p h ( c ) o r ( d ) , o n e m i n i s t e r p r o v i d e d t h e d e v i c e b e i n g r e p l a c e d . u r p o s e s o f s e c t i o n 3 o f t h i s S c h e d u l e . h o s i s w h i c h i s a h e a l t h s u p p l e m e n t f o r t h e p u r p o s e s o f m e t : a c u s t o m m a d e f o o t o rt h o t i c , c u s t o m m a d e f o o t w e a r , e f o o t o r t h o s i s , a k n e e a n k l e f o o t o r t h o s i s , a k n e e b r a c e , a o r s p i n e b r a c e . m e n t f o r t h e p u r p o s e s o f s e c t i o n 3 o f t h e S c h e d u l e , i f t h e s a h e a l t h s u p p l e m e n t f o r t h e p u r p o s e s o f s e c t i o n 3 o f t h e t h a t m a y b e p a i d u n d e r s e c t i o n 6 3 [ d e n t a l s u p p l e m e n t s ] m e t .
S e c t i o n 4 . 1 p r o v i d e s t h a t t h e h e a l t h s u p p l e m e n t m a y b e p a i d c r i t e r i a o f t h e s e c t i o n a r e m e t . S e c t i o n 5 o f S c h e d u l e C p r o v i d e s t h a t t h e h e a l t h s u p p l e m e n t e m e r g e n c y d e n t a l s e r v i c e s . S e c t i o n 6 o f t h e S c h e d u l e p r o v i d e s t h a t t h e a m o u n t o f a d i e t s s u p p l e m e n t s ] i s s e t o u t f o r v a r i o u s c o n d i t i o n s , i f t h e o t h e r c r i t e S e c t i o n 7 o f t h e S c h e d u l e p r o v i d e s a s f o l l o w s : 7 T h e a m o u n t o f a n u t r i t i o n a l s u p p l e m e n t t h a t m a y b e p r o v i d e r e g u l a t i o n i s t h e s u m o f t h e a m o u n t s f o r t h o s e o f t h e f o l l o w 6 7 ( 1 ) ( c ) : ( a ) f o r a d d i t i o n a l n u t r i t i o n a l i t e m s t h a t a r e p a rt o f a c a l o r i c m o n t h ; ( b ) R e p e a l e d . [ B . C . R e g . 6 B / 2 0 1 0 , s . 3 { b ) . ] ( c ) f o r v i t a m i n s a n d m i n e r a l s , u p t o $ 4 0 e a c h m o n t h . S e c t i o n 8 o f t h e S c h e d u l e p r o v i d e s t h a t t h e a m o u n t o f a n a t a l s u p p l e m e n t s ] i s s e t o u t , i i t h e o t h e r c r i t e r i a o f t h e s e c t i o n a r e m S e c t i o n 9 o f t h e S c h e d u l e p r o v i d e s t h a t t h e m i n i s t e r m a y p r o v o t h e r c r i t e r i a o f t h e s e c t i o n a r e m e t . E A P W D R U n d e r S e c t i o n 6 9 o f t h e E A P W D R , t h e m i n i s t e r m a y p r o v i d e a p e r s o n i n t h e f a m i l y u n i t w h o i s o t h e r w i s e n o t e l i g i b l e f o r t h e h s a t i s f i e d t h a t : ( a ) t h e p e r s o n f a c e s a d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g n e e p e r s o n ' s f a m i l y u n i t w i t h w h i c h t o m e e t t h a t n e e d , { b ) t h e h e a l t h s u p p l e m e n t i s n e c e s s a r y t o m e e t t h a t n e e d , ( c ) t h e p e r s o n ' s f a m i l y u n i t i s r e c e i v i n g p r e m i u m a s s i s t a n c e u n ( d ) t h e r e q u i r e m e n t s s p e c i f i e d i n t h e f o l l o w i n g p r o v i s i o n s o f S c ( i ) p a r a g r a p h ( a ) o r ( I ) o f s e c t i o n ( 2 ) ( 1 ) ; ( i i ) s e c t i o n s 3 t o 3 . 1 2 , o t h e r t h a n p a r a g r a p h ( a ) o f s e c t i o n 3 * 1 . 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 , a c c e s s o r y o T h e a p p e l l a n t a c k n o w l e d g e d t h a t t h e r e q u i r e m e n t f o n o t y e t s a t i s f i e d . O t h e r w i s e , 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 R e q u e s t e d I t e m s t o b e p r o v i d e d a s a p o s i t i v e s u p p l y 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 T h e m i n i s t r y ' s p o s i t i o n , a s s e t o u t i n i t s r e c o n s i d e r a t a p o s i t i v e a i r w a v p r e s s u r e d e v i c e o r a n a c c e s s o r y o r E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L � # u n d e r s e c t i o n 6 3 . 1 f o r c r o w n a n d b r i d g e w o r k , i f t h e o t h e r t h a t m a y b e p a i d f o r u n d e r S e c t i o n 6 4 o f t h e E A P W D R i s u p p l e m e n t t h a t m a y b e p r o v i d e d u n d e r s e c t i o n 6 6 [ d i e t r i a o f t h e s e c t i o n a r e m e t . d u n d e r s e c t i o n 6 7 [ n u t r i t i o n a l s u p p l e m e n t ] o f t h i s i n g i t e m s s p e c i f i e d a s r e q u i r e d i n t h e r e q u e s t u n d e r s e c t i o n s u p p l e m e n t a t i o n t o a r e g u l a r d i e t a r y i n t a k e , u p t o $ 1 6 5 e a c h s u p p l e m e n t t h a t m a y b e p r o v i d e d u n d e r s e c t i o n 6 B [ n a t a l e t . i d e i n f a n t f o r m u l a u n d e r s e c t i o n 6 7 . 1 o f t h e E A P W D R i i t h e g e n e r a l h e a l t h s u p p l e m e n t i i i t i s p r o v i d e d t o o r f o r a e a l t h s u p p l e m e n t u n d e r t h e R e g u l a t i o n a n d i i t h e m i n i s t e r i s d a n d t h e r e a r 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 d e r t h e M e d i c a r e P r o t e c t i o n A c t , a n d h e d u l e C , a s a p p l i c a b l e , a r e m e t : ( 1 ) . * * r s u p p l y ( s . 3 . 9 o f S c h e d u l e C ) r a n a s s e s s m e n t b y a r e s p i r a t o r y t h e r a p i s t w a s i s t h a t t h e o t h e r l e g i s l a t i v e c r i t e r i a a r e s a t i s f i e d a i r w a y p r e s s u r e d e v i c e o r a n a c c e s s o r y o r e d e v i c e . i o n d e c i s i o n , i s t h a t t h e R e q u e s t e d I t e m s a r e n o t a s u n n l v t h a t i s r e a u i r e d t o o p e r a t e a p o s i t i v e
�APPEAL# airway pressure device. The ministry acknowledged that the Requested Items had been prescribed by a medical practitioner as required by section 3.9(2)(a) of Schedule C of the EAPWDR, but said that there was no assessment performed by a respiratory therapist to confirm the medical need for the Requested Items or that they were medically essential for the treatment of moderate to severe sleep apnea, as required by sections 3.9(2)(b) and (c) of Schedule C. Panel Decision In the panel's view, a peak flow meter and saline solution do not constitute a positive airway pressure device. There is also no professional medical evidence before the panel to show that the peak flow meter and saline solution are medically needed by the appellant, or that these Requested Items are medically essential for the treatment of moderate to severe sleep apnea, as required by sections 3.9(2)(b) and (c) respectively. It may be that the Requested Items respectively constitute an accessory (the peak flow meter) and supply (saline solution) for the appellant's nebulizer or Bi-Pap machine (each of which is a health supplement under sections 3.9(1 )(e) and 3.9(1 )(a) respectively), but there is no supporting medical evidence before the panel to verify that the appellant has either a nebulizer or Bi-Pap machine, or that the Requested Items are an accessory or supply for either of those machines. It may be that the assessment of the respiratory therapist which is currently being sought by the appellant will ultimately fill these gaps. However, the panel must make its decision based on the evidence currently before it. Accordingly, the panel finds that the ministry reasonably determined that the Requested Items do not constitute a positive airway pressure device, or an accessory/supply for a positive airway pressure device. 2. Medical supplies (s. 2(1){a) of Schedule C) The appellant advanced no argument with respect to this provision. The ministry's position is that the Requested Items are not required for one of the purposes set out in section 2(1 )(a)(i) of Schedule C, and that there is no evidence to establish that the Requested Items are necessary to avoid an imminent and substantial danger to health. Panel decision The evidence indicates that the Requested Items are not needed for one of the purposes prescribed by section 2(1 )(a) of Schedule C. There is also no supporting evidence with respect to an imminent and substantial danger to the appellant's health. The panel finds that the ministry reasonably determined that these legislated criteria were not satisfied. 3. Other medical equipment or devices (sections 3 to 3.11 of Schedule C) The appellant advanced no argument with respect to these provisions. EAAT 003(10/06/01)
I �PPEAL# The ministry's position is that the Requested Items are not health supplements that the ministry is authorized to provide under sections 3 to 3.11 of Schedule C of the EAPWDR. The ministry also contends that the evidence does not establish that the other legislated criteria set out in these sections for each of the health supplements have been met. Panel Decision The evidence before the panel indicates that the Requested Items do not constitute any of the health supplements authorized in sections 3 to 3.11 of Schedule C. Accordingly, the panel finds that the ministry reasonably determined that the legislated criteria for these provisions had not been satisfied. 4. Therapvservices (sections 2(1}(c). 2(2} and 2(2.1} of Schedule C) The appellant advanced no argument with respect to these provisions. The ministry's position is that the Requested Items are not any of the therapy services authorized in sections 2(1)(c), 2(2) or 2(2.1) of Schedule C. Panel Decision The evidence before the panel indicates that the Requested Items are not a form of therapy service as identified in sections 2(1)(c), 2(2) or 2(2.1). Accordingly, the panel finds that the ministry reasonably determined that the legislated criteria for these provisions had not been satisfied. 5. Other remaining health supplements (Schedule C) The appellant advanced no argument with respect to sections 2.1, 2.2, 4, 4.1, 5, 6, 7, 8 or 9 of Schedule C. The ministry's position is that the Requested Items are not authorized by any of these remaining provisions of Schedule C. Panel Decision The evidence before the panel indicates that the Requested Items do not meet the legislated criteria for any of the above-noted provisions. Accordingly, the panel finds that the ministry reasonably determined that the legislated criteria for these provisions have not been satisfied. 6.0 Direct and imminent life threatening need (Section 69, EAPWDR) The aonellant advanced no arqument with respect to this provision. EAAT 003(10/06/01)
I APPEAL# The ministry's position is that the appellant is eligible to receive health supplements set out under Schedule C, sections 2(1 )(a) to (f), and section 3 if the legislated criteria are satisfied. The ministry argued that the Requested Items are not health supplements set out in these sections and that the appellant's request does not satisfy all the requirements specified in section 69(d). Panel Decision The evidence before the panel indicates that the appellant is otherwise eligible for health supplements under sections 2 and 3 of Schedule C. Section 69 is meant to apply to family units that are not otherwise eligible. The evidence also indicates that the Requested Items are not a medical or surgical supply identified in section 2(1 )(a), nor a mode of transportation identified in section 2(1 )(f), and that the criteria for health supplements in sections 3 to 3.12 have not been satisfied. Accordingly, the panel finds that the ministry reasonably determined that the Requested Items do not meet the legislated criteria to meet a direct and imminent life threatening need. Conclusion For the foregoing reasons, the panel concludes that ministry's decision is reasonably supported by the evidence. The panel therefore confirms the ministry's decision. EAA T003(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.