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 D e v e r e c o n s i d e r a t i o n d e c i s i o n o f M a y 1 6 1 \ 2 0 1 4 w h e r e i n t h e a n i n s u l i n p u m p . 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 d i s a b i l i t y 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 i n s u l i n p u m p a s a n y o f 1 . 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 , a s p r o v i d e d i 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 i l i t i e s R e g u l a t 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 ) ( a ) o 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 s e 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 ) ( c 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 o n s 6 . a s 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 e 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 !;J r a l h e a l t h s u p p l e m e n t s ] ; s 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 d S c h e d u l e E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # '. 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 " m i n i s t r y ' ' ) 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 r e q u e s t f o r f u n d i n g f o r 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 t h a t t h e t h e f o l l o w i n g : n s e c t i o n 3 . 1 2 o f S c h e d u l e C o f t h e E m p l o y m e n t a n d i o n ( " E A P W D R " ) ; f S c h e d u l e C o f t h e E A P W D R ; c t i o n s 3 t o 3 . 1 1 o f S c h e d u l e C ; ) , 2 ( 2 ) a n d 2 ( 2 . 1 ) o f S c h e d u l e C ; o f S c h e d u l e C ; o r 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 e c t i o n 6 9 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 i r e c t C .
P A R T E S u m m a r v o f F a c t s T h e e v i d e n c e b e f o r e t h e m i n i s t r y a t t h e t i m e o f r e c o n s i d • D e c e m b e r 1 s t , 2 0 0 0 a l e t t e r f r o m m i n i s t r y t o a p p e • J a n u a r y 2 3 r d , 2 0 0 1 a l e t t e r f r o m H e a l t h A s s i s t a n c i n s u l i n p u m p ; • D e c e m b e r 2 2 n d , 2 0 0 0 a l e t t e r f r o m p h y s i c i a n t o m f r o m a n i n s u l i n p u m p ; • J a n u a r y 1 6 t h , 2 0 0 1 l e t t e r f r o m B C B e n e f i t s R e c o a n i n s u l i n p u m p . • D e c e m b e r 1 0 t h , 2 0 0 8 a l e t t e r f r o m m i n i s t r y t o a p p • M a r c h 1 o t h , 2 0 0 9 a l e t t e r M a r c h 1 0 t h , 2 0 0 9 f r o m m • J u n e 5 t h , 2 0 0 9 a l e t t e r f r o m m i n i s t r y a p p r o v i n g a p b e p r o v i d e d m o n t h l y w i t h a r e v i e w d a t e o f J u n e 3 • A u g u s t 1 o t h , 2 0 0 9 a l e t t e r d a t e d f r o m m i n i s t r y a p w h i c h w i l l b e p r o v i d e d m o n t h l y w i t h a r e v i e w d a t e • N o v e m b e r 1 4 t \ 2 0 1 2 a l e t t e r f r o m t h e a p p e l l a n t , r e q u e s t i n g c o v e r a g e f o r g l u c o s e s e n s o r s f o r h i s i • D e c e m b e r 4 t h , 2 0 1 2 a l e t t e r f r o m m i n i s t r y t o a p p e a p p e l l a n t ' s r e q u e s t f o r g l u c o s e s e n s o r s ; • J a n u a r y 1 4 t h , 2 0 1 3 a l e t t e r f r o m m i n i s t r y a p p r o v i n a u t o m a t i c r e n e w a l a n d n o e n d d a t e . • J a n u a r y 3 0 t h , 2 0 1 3 a l e t t e r f r o m m i n i s t r y a p p r o v i n • F e b r u a r y 2 5 t h , 2 0 1 4 i n v o i c e f r o m m e d i c a l s u p p l y ( c o n t i n u o u s g l u c o s e m o n i t o r ) s t a r t e r k i t a t n o c h a • F e b r u a r y 2 1 s t , 2 0 1 4 a l e t t e r d a t e d t o a p p e l l a n t f r o p u r c h a s e o f a n i n s u l i n p u m p . • t h e l e t t e r i n d i c a t e s t h a t t h e a p p e l l a n t r e c e i o f w a r r a n t y d a t e o f J a n u a r y 4 t h , 2 0 1 3 . T h e f o l l o w i n g r e a s o n f o r r e p l a c e m e n t t e c h n i c f e a t u r e s r e q u i r e d b y p a t i e n t/ s u p p o r t e d b y • F e b r u a r y 2 5 t h , 2 0 1 4 f a x t o H A B r e q u e s t i n g c o v e r a s u p p l i e s o f a p p r o x i m a t e l y $ 5 7 3 . 5 0 ; • F e b r u a r y 2 6 t h , 2 0 1 4 a l e t t e r o f m e d i c a l n e c e s s i t y n e e d f o r i n s u l i n p u m p ; • i n t h i s l e t t e r t h e e n d o c r i n o l o g i s t ( s p e c i a l i d e p e n d a n t f o r s e v e r a l y e a r s ( 4 0 + ) a n d t h • h a s d e m o n s t r a t e d a n a b i l i t y t o s e l f • i s m o t i v a t e d t o a c h i e v e a n d m a i n t a d e m o n s t r a t e s c o m p l i a n c e w i t h d i e t i m p l e m e n t a t i o n o f a n i n s u l i n p u m p • d o e s n o t m e e t e l i g i b i l i t y c r i t e r i a f o r • e x h i b i t s h y p o g l y c e m i a , n o c t u r n a l h t h e s p e c i a l i s t r e p o r t s t h a t t h e a p p e l l a n h a l t i n s u l i n d e l i v e r y w h e n g l u c o s e l e v e p r o l o n g e d a n d s e v e r e h y p o g l y c e m i a o c o n t i n u o u s g l u c o s e m o n i t o r i n g ) . • M a r c h 1 3 t h , 2 0 1 4 H A B M e d i c a l S u p p l y D e c i s i o n S • M a r c h 1 3 t h , 2 0 1 4 a l e t t e r f r o m t h e m i n i s t r y t o a p p e s u o o l e m e n t i n s u l i n P u m p . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # e r a t i o n : l l a n t d e n y i n g t h e a p p e l l a n t ' s r e q u e s t f o r i n s u l i n p u m p . e B r a n c h ( H A B ) a p p r o v i n g a p p e l l a n t ' s r e q u e s t f o r i n i s t r y e x p l a i n i n g t h e m e d i c a l b e n e f i t t o t h e a p p e l l a n t n s i d e r a t i o n D e c i s i o n r e g a r d i n g a p p e l l a n t ' s r e q u e s t f o r e l l a n t d e n y i n g h i s r e q u e s t f o r i n s u l i n p u m p ; i n i s t r y a p p r o v i n g a p p e l l a n t ' s r e q u e s t f o r i n s u l i n p u m p ; p e l l a n t ' s r e q u e s t f o r b l o o d g l u c o s e s e n s o r s w h i c h w i l l o t h , 2 0 1 O ; p r o v i n g a p p e l l a n t ' s r e q u e s t f o r b l o o d g l u c o s e s e n s o r s o f J u n e 3 0 t h , 2 0 1 O ; w i t h a l e t t e r o f s u p p o r t f r o m h i s d o c t o r a t t a c h e d , n s u l i n p u m p ; l l a n t , w i t h H A B D e c i s i o n S u m m a r y a t t a c h e d , d e n y i n g g a p p e l l a n t ' s r e q u e s t f o r b l o o d g l u c o s e s e n s o r s w i t h g a p p e l l a n t ' s r e q u e s t f o r i n s u l i n p u m p t r a n s m i t t e r . c o m p a n y f o r i n s u l i n p u m p w h i c h i n c l u d e d a C G M r g e ; m m e d i c a l s u p p l y c o m p a n y r e g a r d i n g t h e a p p e l l a n t ' s v e d a n i n s u l i n p u m p o n J a n u a r y 4 t h , 2 0 0 9 w i t h a n o u t l e t t e r i n d i c a t e s t h a t t h e a p p e l l a n t r e p o r t e d t h e a l f e a t u r e s d o e s n o t h a v e t e c h n i c a l p h y s i c i a n ' s l e t t e r o f m e d i c a l n e c e s s i t y . g e f o r i n s u l i n p u m p a n d m o n t h l y c o n s u m a b l e c o m p l e t e d b y a s p e c i a l i s t e x p l a i n i n g t h e a p p e l l a n t ' s s t ) i n d i c a t e s t h a t t h e a p p e l l a n t h a s b e e n i n s u l i n a t t h e a p p e l l a n t ; m o n i t o r b l o o d g l u c o s e l e v e l s f r e q u e n t l y ; i n b l o o d g l u c o s e c o n t r o l ; a r y a n d i n s u l i n r e g i m e n s r e q u i r e d f o r s u c c e s s f u l ; o t h e r g o v e r n m e n t i n s u l i n p u m p p r o g r a m s ; y p o g l y c e m i a , g a s t r o p a r e s i s a n d n e u r o p a t h y ; t r e q u i r e s a r e p l a c e m e n t i n s u l i n p u m p t o a u t o m a t i c a l l y l s r e a c h a p r e d e t e r m i n e d t h r e s h o l d t o p r e v e n t r m a n a g e n o c t u r n a l h y p o g l y c e m i a ( w i t h u s e o f u m m a r y d e n y i n g a p p e l l a n t ' s r e q u e s t f o r i n s u l i n p u m p ; l l a n t d e n y i n g t h e a p p e l l a n t ' s a p p l i c a t i o n f o r h e a l t h
APPEAL# '. • Request for reconsideration dated April 16 th , 2014; On the Letter of Medical Necessity form dated February 26 th , 2014, the specialist has diagnosed the appellant with hypoglycemia, retinopathy, gastro-paresis and nocturnal hypoglycemia and that he requires a replacement insulin pump to continue pump technology so the insulin pump will automatically halt insulin delivery when glucose levels reach a pre-determined threshold. The specialist continued, this is to prevent prolonged and severe hypoglycemia or manage nocturnal hypoglycemia (with use of continuous glucose monitoring). On the same formatted form under "The following conditions exist with the patient:" the specialist indicates that: a) the patient has demonstrated ability to self-monitor blood glucose levels frequently; b) patient is motivated to achieve and maintain improved blood glucose control; c) patient demonstrates compliance with dietary and insulin regimens required for successful implementation of an insulin pump; and d) this patient does not (emphasis indicated on form) meet eligibility criteria for government insulin programs. In the Notice of Appeal under reasons for appeal, the appellant stated that current legislation does not factor in current technology; and, exceptional situation necessitates special consideration. The appellant did not attend the hearing. The appellant had completed a Release of Information form indicating that he wanted his representative (AR -appellant's representative) to attend the hearing and the AR could make decisions on his behalf. Before the hearing commenced the AR requested an adjournment to further edit or correlate the appellant's evidence, information that was not before the Reconsideration officer, but had been submitted to the Reconsideration Branch. The AR provided the following documentation (20 pages) to the panel: 1 . Pages 1-5 are appellant's Request for Reconsideration fax confirmation. 2. Page 6 -statutory interpretation principles for section 7 and 8 Interpretation Act; 3. Page 7 to 1O -submission from the AR providing information to support the appellant's position; 4. Page 11 and 12 -Fax cover page with a separate sheet dated May 15 th 2014 and signed by the specialist providing further explanation of the his comments contained in the Letter of Medical Necessity which was signed on February 26 th , 2014. In the notes the specialist explains that the insulin pump was covered by Medical Services plan 5 years ago at the insistence of the endocrinologist at the time; and that there are multiple reasons for continuing insulin pump therapy, including, Hypoglycemia unawareness with autonomic neuropathy therefore hypoglycemia potentially life threatening; Gastro-paresis (proven on gastric ...u ndiscernible word ... study) Very low overnight insulin requirements of 0.1 -0.2 units/hour from 2000 to 0400 (this is not possible with injection therapy). 5 . Page 13 to 16 -Facsimile Transmittal Sheet dated February 25 th , 2014 from Reimbursement Assistance Center to HAB with Letter of Medical Necessity, letter dated February 21 st , 2014 from supplier of insulin pump providing the company policy on replacement of insulin pumps and appellant's reason for requesting a replacement pump and an invoice from supplier for a new insulin pump; 6. Page 17 and 18 -letter from HAB to appellant explaining rationale for denying appellant's request for insulin pump. 7. Page 19 and 20-HAB Decision Summary dated March 13 th 2014. On the Request for Reconsideration form it indicates the appellant had until April 17 t \ 2014 to make a submission. On April 16 th , 2014 the AR requested a 20 day extension and was advised by the Reconsideration Branch that all submission(s) had to reach that office before noon on May 16 th , 2014 to be considered before the Reconsideration Decision was rendered. The AR advised that the material listed from 1 to 5 was sent to the Reconsideration Branch initially and items listed 2 to 4 were faxed May 16th, 2014 at 10:54am prior to the deadline of noon May 15 t \ 2014. When the AR reviewed the Reconsideration decision she learned that the material listed 2, 3 and 4 were not considered by the Reconsideration officer at the time of Reconsideration. The AR was advised to a eal the Reconsideration decision if the a ellant did not a ree with the ministry's EAAT 003( 10/06/01)
APPEAL# � reconsideration decision. The AR was not given an explanation or reason on why the documents were not considered by Reconsideration officer but only told that the information would not have changed the decision. When the AR received the Appeal Record she noted that the material listed in items 2 to 4 were not included in the Appeal Record either and has therefore presented them to the panel for consideration. The ministry stated they were not aware the extension had been approved but did not object to the panel receiving these documents for consideration. The panel did not grant the appellant's request for an adjournment because the documents could be reviewed during the course of the hearing and accepted the documents for consideration. The AR agreed. The panel finds that the material listed under items 1, 5, 6 and 7 are contained in the Appeal Record and are not considered new evidence as these documents were before the ministry at the time of Reconsideration. The panel finds Item 2 is a submission for argument and does not contain evidence. The panel finds item 3 and item 4 do contain information being in support of the information and records that were before the ministry at the time of reconsideration and are admissible as evidence in accordance with section 22(4) of the Employment and Assistance Act. At the hearing the AR stated that on January 23 rd , 2001 and again, on March 1 o'h, 2009 the ministry approved an insulin pump for the appellant and on August 1o 'h, 2009 approved blood glucose sensors for the pump. The AR stated that the appellant's current insulin pump and the insulin pump he is requesting both have a glucose monitoring meter inside the pump, the difference is that the requested (new) pump will administer continuous low levels of insulin (0.1 or 0.2ml} when needed but will shut down preventing the appellant from receiving insulin when it is not needed. The AR told the panel that at the present time the appellant's insulin pump is working fine but the warranty period for the pump has expired and the company who provided the pump will not replace it now if the pump stops working. The AR advised the appellant utilizes a pump therapy versus a needle therapy to help control his diabetes. The AR stated the appellant resides with family as he cannot live alone because his glucose levels can drop to dangerous and life threatening levels without warning and within a time span of 15 minutes from the time of his last testing (reading) and without family there to assist him, he could be in a grave and imminent life threatening danger. The panel finds the AR's testimony does contain information in support of the information and records that were before the ministry at the time of reconsideration and is admissible as evidence in accordance with section 22(4) of the Employment and Assistance Act. EAAT003(10/06/01)
APPEAL# '. PART F -Reasons for Panel Decision The issue under appeal is the reasonableness of the Ministry of Social Development and Social Innovation (the "ministry") reconsideration decision of May 16 th , 2014 wherein the ministry denied the appellant's request for funding for medical purposes, an insulin pump. The appellant is a recipient of disability assistance, and the ministry determined that the appellant was not eligible for the insulin pump as any of the following: 1. a non-conventional glucose meter, as provided in section 3.12 of Schedule C of EAPWDR; 2 . medical supplies, as provided in section 2(1)(a) of Schedule C of the EAPWDR; 3. medical equipment or devices, as provided in sections 3 to 3.11 of Schedule C; 4 . a therapy service, as provided in sections 2(1)(c), 2(2) and 2(2.1} of Schedule C; 5. any health supplement under any other sections of Schedule C; or 6. a health supplement for a person facing a direct and imminent life threatening need under section 69 of the EAPWDR. The legislation considered: EAPWDR Health supplement for person facing direct and imminent life threatening health need Section 69 -The minister may provide to a family unit any health supplement set out in sections 2 (1) (a) and (f) [general health supplements] and 3 [medical equipment and devices] of Schedule C, if the health supplement is provided to or for a person in the family unit who is otherwise not eligible for the health supplement under this regulation, and if the minister is satisfied that (a) the person faces a direct and imminent life threatening need and there are no resources available to the person's family unit with which to meet that need, (b) the health supplement is necessary to meet that need, (c) the person's family unit is receiving premium assistance under the Medicare Protection Act, and (d) the requirements specified in the following provisions of Schedule C, as applicable, are met: (i) paragraph (a) or (f) of section (2) (1) ; (ii) sections 3 to 3.12, other than paragraph ( a) of section 3 ( 1). Schedule C General health supplements Section 2 (1) The following are the health supplements that may be paid for by the minister if provided to a family unit that is eligible under section 62 [general health supplements] of this regulation: (a) medical or surgical supplies that are, at the minister's discretion, either disposable or reusable, if the minister is satisfied that all of the following requirements are met: (i) the supplies are required for one of the following purposes: (A) wound care; (B) ongoing bowel care required due to loss of muscle function; (C) catheterization; (D) incontinence; (E) skin parasite care; (F) limb circulation care; EAAT003(10/06/01)
I ADPi::AI :H (ii) the supplies are (A) prescribed by a medical practitioner or nurse practitioner, (B) the least expensive supplies appropriate for the purpose, and (C) necessary to avoid an imminent and substantial danger to health; (iii) there are no resources available to the family unit to pay the cost of or obtain the supplies; (a.1) the following medical or surgical supplies that are, at the minister's discretion, either disposable or reusable, if the minister is satisfied that all the requirements described in paragraph (a) (ii) and (iii) are met in relation to the supplies: (i) lancets; (ii) needles and syringes; (iii) ventilator supplies required for the essential operation or sterilization of a ventilator; (iv) tracheostomy supplies; (a.2) consumable medical supplies, if the minister is satisfied that all of the following requirements are met: (i) the supplies are required to thicken food; (ii) all the requirements described in paragraph (a) (ii) and (iii) are met in relation to the supplies; ... Section 2(1.1) of Schedule C, provides that for the purposes of subsection 2(1 )(a), "medical or surgical supplies" do not include nutritional supplements, food, vitamins, minerals or prescription medications. Section 2(1)(c) provides that the following items are health supplements if the other criteria of the section are met: a service for acupuncture, chiropractic, massage therapy, naturopathy, non-surgical podiatry, physiotherapy. Section 2(1)(f) of Schedule C provides that the following items are health supplements if the other criteria of the section are met: the least expensive appropriate mode of transportation. Section 2(3) of Schedule C provides that "If the minister provided a benefit to or for a person under section 2(3) of Schedule C of the Disability Benefits Program Regulation, B.C. Reg. 79/97, the Income Assistance Regulation, B.C. Reg. 75/97 or the Youth Works Regulation, B.C. Reg. 77/97, as applicable, for the month during which the regulation was repealed, the minister may continue to provide that benefit to or for that person as a supplement under this regulation on the same terms and conditions as previously until the earlier of the following dates: (a) the date the conditions on which the minister paid the benefit are no longer met; (b) the date the person ceases to receive disability assistance. Section 2.1 of Schedule C provides that the following are the optical supplements that may be provided under Section 62.1 of the EAPWDR: basic eyewear and repairs, pre-authorized eyewear and repairs. Section 2.2 of Schedule C provides that the minister may pay a health supplement under Section 67.2 of the EAPWDR for an eye examination if the other criteria of the section are met. Medical equipment and devices Section 3 (1) Subject to subsections (2) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.11 of this Schedule are the health supplements that may be provided by the minister if (a) the supplements are provided to a familv unit that is eligible under section 62 {general health EAAT 003(10/06/01)
s u p pl eme nt s ] of this r e gulation, a n d (b) all of the following requi re m e nts are met: (i) the family unit has received the pre-authorization of the minister for the medical or device reques ted ; (ii) t here a re no resour ces av ai l ab l e to th e family unit to pay equ ip ment or device; (i ii) the medical e q uipme nt o r dev i ce is the leas t (2) For medical equipment or devices refe r re d to in sections 3.1 to 3.8, in addition to th sections and subsection (1) of this sectio n, the family unit must provide to the minist followin g, as requested by the min ister: ( a) a p rescriptio n of a m edical practiti o ne r o r nurse practiti (b) an assessm e nt b y an occupat i on al the r api s t o r medica l equ ipment or device ... . Section 3.1 provides that th e foll owi n g ite ms are heal th supplement Schedule, if the o ther c rite r i a of the section ar e m et: a c a cru t ch or a wa l k e r. Sec tion 3 . 2 prov ides that th e f o l lowi n g items a re hea lth sup criteri a of the sec tion are m et: a whe elc ha ir, an up grade to a wh eel chair. Section 3 .3 provides that t he fo llowing ite ms are h ealth sup Sch edule, i f th e othe r cri t eri a of the sect io n are me t: a whee wheelch a ir seat in g sys te m . Section 3.4 prov i de s t hat the follo w ing i t em s are healt h s S ch edule , if t he o the r criteria of t he section are met: a s c ac ce ss ory a tt a ched to a s cooter. Se ction 3.5 provides th at the following items ar e hea lth supp Sch edule, if th e other c r i ter i a o f t he sec t ion a r e met: a g ra transfe r ben ch with ha n d h e ld shower, a tub slid e, a bath lift, s afety frame, a f loor to -c eili ng p o le i n a b athroom , a p o rtable Section 3 . 6 provides t hat th e foll o wing ite m s are health supp Sched u l e, if the other criteria of the section are met: a hospital bed, an upgr an accessory attached to a hospital bed. Se ction 3.7 provides that the following item is a heal th supplement for Schedule, if the other criteria of the section are met: a pressu 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 Section 3.9 provides that the following item is a health supplement for the purposes of section 3 of the Schedu le, if the other criteria of the sec tion are met: positive airway pressure device. Section 3.1O provides that each of the following items is an p u rp os e s of section 3 of t he Schedule, i f t h e other criteria custom-made footwear, a permanent modification to footwear, an ankle brace, an ankle-foot orthosis, a knee ankle-foot orthosis, a knee brace, a hin brace, an unner extremity brace, a cranial helmet, a torso or spine EMT 003(10/06/01) � A PPEAL# equipment the c ost of or obtain the med ical e xpensive appropr i a t e medical equi p m ent or device. e req uirements in those er one or both of t he o ne r for the medical equipment or device; p h y sical therapis t confirming the medical need for the s for t he pu rposes of section 3 of t he ne, a cru t c h , a walker, an accessor y to a ca n e, a plements fo r the purpose s of section 3 i f the other d c omp on ent of a whe elchai r, an access or y att a c hed plements fo r t h e p ur p oses of section 3 o f t he lchair s e a t ing s ystem, an accesso ry to a upple ments fo r th e pu r po s es of s ect i o n 3 of the ooter, an u p g raded c o mpo n ent of a s c ooter, an lements fo r t he purp o se s of sect i o n 3 of t he b bar in a bath ro om, a ba th or sh owe r se a t, a bath a bed p an o r ur inal, a raised to ilet seat, a toi l et c omm ode chair . lements for th e purposes of sec ti on 3 of the a d ed component of a hospital bed, the purposes of section 3 of the re relief mattress. or ceiling lift device. o rt hos is w hi ch is a h ealth supplem e nt for the o f the s e ction are met: a cus tom-ma de foot o rthotic,
brace . Se ction 3 .1 1 prov i des that th e followi ng ite m is a hea lt h S chedul e, if t he other c ri teria o f the sec tion are met: a h Me dical Equ ipment and dev ice s -non-con ventio n al Sect ion 3.12 (1) I n this s ection, "non-conventio na l gl uc ose meter " inc (a) a c ontinuo us gluco se monitoring met er, a nd (b) a tal king glucos e meter . ( 2 ) A non-co nventional gluco se meter is a h ea lth s upp l e th e minist e r is satisfi ed th at (a) the g l ucose meter is m ed i cally esse ntial to test b (b) the person fo r wh om the non-conventi onal glucos con venti onal gluco se meter . (3 ) Th e perio d o f t im e ref erred to in sect i on 3 (3 ) (b) of t con venti onal gl u cose meter is 5 ye ar s f rom the date on which the mini r epla ced. Secti on 4 of S ch edul e C provi de s that the h e alth s upp l e s u pple m e nt s] are basic d e n ta l se rvices, if th e o th er criteri Section 4.1 pr ovides that the healt h su p ple ment m ay be p the other crite ria of the secti on are met. S e ction 5 of Sc hedule C provid es t hat t he he alth suppleme EAP W DR is em erge ncy de nt a l services. Sec t ion 6 of S che du le C provides t hat t he a mo unt of a di [ diet s upp le m e nts] is s e t o ut fo r var i ous cond itions, if the oth Sec t ion 7 o f Schedule C pro vid e s as f o llo ws: T he am ount of a nut r itiona l s uppl em ent th a t may be p rov regulation is the sum of the amounts for those of the following items s ectio n 67 (1 ) (c ): (a) for additional nutritional items that are part of a caloric supplementation to a regular dietary to $165 each month; (b) Repealed. [B.C. Reg. 68/2010 , s. 3 (b).] ( c) for vitamins and minerals, up to $40 each month. S e ct ion 8 of the Sch edule provides that the amount of a natal 68 [natal supplements] is set out, if the other criteria of the section are met. Section 9 of the Schedule provides that the minister may provide infant formula under section 67.1 of the EAPWDR if th e o th e r c r iteria of the section ar e m e t. Eligibility for insulin pump as medic al eguipment The EAPWDR Schedule C, section 3 sets out the general requirements for all medical equipment/devices and section 3(1 )(b) EAPWDR states the minister may provide the least expensive appropriate medical device described in section 3.1 to 3.12 if, i the famil unit has received the EMT 003(10/06/01) APPEAL # � suppl em ent fo r th e purpos es of sect i on 3 o f the e arin g aid. g lu cose meter s ludes ment for the purp o ses of se ction 3 of t h is Sc h edule if l ood gluco se level s, an d e m et er has b e en pr e scr ibe d is unable t o use a his Sch e d ule with re spect to r epla cem e n t of a n o n ster prov i ded t h e gl ucose mete r being m e nt tha t may be p aid under s ectio n 6 3 [ dental a of the section a re me t . a id u nd er se cti on 63.1 for crown and bridge work , if n t tha t may be paid fo r u nd er Secti on 64 of the et supp lem ent tha t may be provided u n de r sec ti on 66 e r criteria of the s ect ion are met. ide d u n der section 67 [nut r it i on al suppl e ment ] of t his specif ied as required in the req ues t u nder intake , up supplement that may be pro v ided u nder s e c tio n re-authorization of the minister for the
me d ica l equipment or dev ice re quested; (ii) there are no resources available to the f of or o bt a in the medical e q ui p m ent. The ministr y's po s itio n is the fami ly h as requested authorization for canno t p rovi de medical equipment wit hout legislated authority and an insu described i n sect ion 3 of Schedule C o f EAP WDR. The ministry accepts that finances to p urchase an insulin pum p , how e ver , t h e ministry resources a vailabl e, i.e. Min istry of H ealth, Canadian D ia The AR argued that the insulin pump requested by the appellant is only availa and th at the appellant's applicati on to Ministry of H e alth (PharmaCare) fo The AR a rgu e d t h a t th e appell a nt had bee n provide d an insulin pump on two previous occasions and it did seem right t h a t his request to have the insulin pump replaced be de Schedule C Se c t ion 3( 1) sta tes that t h e med ic a l equipment Schedule C are the health supplements that may be pro met. Panel Decision Av ailab le reso urc es -S ection 3{1){b) Sc h edu le C The pan el finds t hat t h ere i s n ot suffic ient i nfo rmat ion before the panel resources avai l able t o obtai n a n in s uli n pump . The pane by t h e m ini s try in t he pas t , the ministr y mu st be co mply wi v ary f ro m the legis l ation se t o u t in EAPWDR o r EAPWD T h e pa nel f inds that th e m in istry reasonably dete r m in ed EAPWDR w ere not satisfie d . A N o n-Conven tional Glucos e Me ter -section 3 . 12 Sch The minis tr y' s p osition i s t h a t an insulin pump is n o t a Non-defin i ti on set out in se ction 3.12 (2 ) EA PWDR. T h e ministr and a continuous glucose monitoring meter uses a tin y sensor inserted un in tiss ue fluid. T he m inistry argu e s that g l u cose meters do and then a transmitter will send this information via ra d io w monitor. The ministry argued that these devices provide real-time measurem b e displayed at 5-minute or 1-minute inter vals. The ministry argues it is continuous glucose mon itoring meter or a talking glucose meter and not a g dispensing syst e m. It is the a pp e llant's position there is a c ontinu o u s g l u c ose monitoring which was provided by the ministr y in 2009 and the insulin pump that is being requested is also equipped with a continuo u s glucose monitoring me t e r. Panel Decision The panel finds the appellant's request was for funding for an insulin pump and not a continuous glucose monitoring meter although his current insulin pump, which was provide with a continuous glucose meter. The panel finds the meaning of a continuous glucose meter does not include the term insulin pump. EMT 003(10/06 / 0 1) I A P PEAL# a mily unit to pay the cost th e insu lin pump however the ministry lin pump is not a scheduled item the app e l l ant does not h ave the i s no t s ati s fied that the appellant does no t hav e b e tes Associati on) t o obtain the medical equ ipment. b l e from the req u es ted supplier r an insulin pump ha d been denie d. n 't n i ed. and devic es descr i bed in section 3.1 to 3 . 2 of vid ed by the minister if all the legislated crit eria a re t h at the ap pellant exh austed all l f i n ds that al thoug h a n ite m may have b e en prov ided t h t he curr e nt l egi slati on and has no di scretion to A. t h a t all the legisla t e d c ri teri a s e t ou t in sec tion 3(1 ) ( b) edu le C, M ed i cal Equipm e nt and Devices Conv entional Gluco se met er and d o es not m ee t t h e y 's pos i tion i s tha t i nsulin pu mps disp ens es in sul in d e r the skin to check glucose l eve ls not di spen se insulin, simp ly monitor glucose level s aves from the se nsor to a pager-like wirele ss ents of glucose levels which can only authorized to provide a l ucose monitoring an d insulin meter i nsid e the present insulin p um p d by the ministry in 2009, is equipped
The pane l finds t he m inistry 's d ecision that the app el lan an i nsulin pu mp is no t a n o n -c on ventional glucose meter as d was reasonable. O the r medi cal equ ipment o r devices (se ction s 3. 1 to 3 The ap pellant a dvanc e d no argu men t wi th respec t t o th The mi n i s t ry' s pos i t i o n is that t he in sulin pump is not a hea provide un d er s e c t ions 3. 1 to 3.11 of Sc h e d ule C of the evide n ce does not establ is h th at the othe r leg islated crite sup pl ement s hav e been met. Panel De c i s i on T h e ev ide nce befor e the p anel i n dicate s that the insul in pu s u pp lem ent s a ut h o r iz ed in sect ions 3.1 t o 3.11 of Sch e d Acc o rdingly, the p anel fi n ds that the ministry reasonably prov i si ons h a d not been s a tisfied. In suli n Pump as medic al sup ply -(sect io n 2(1) / a) Sc The appe llant advan c e d no argument w ith res pect to these The m i nistry's posi tion is t hat the insulin pu mp is n ot a di of the p ur p oses set out in sectio n 2(1)(a)(i) EAPWDR; nor c on s umable me dic a l suppl ies a s s e t ou t in se c t ion 2( 1)( a.1 Panel Dec isi on The evide n ce be fo re the panel ind i ca tes that t he i n sul i n supplies as id e ntified in section s 2(1) ( a) , 2 (1)(a.1) or 2(1)( Accordingly, the panel finds that the ministry reasonably determined that the legislated criteria for these prov i si on s had no t been satisfied. Other remai n ing health supplements (Schedule C) The a ppellant a dvanced no ar gument with respect to sections 2.1, 2.2, 4, 4.1, 5, 6, 7, 8 or 9 of Th e m inistry's p osition is t hat the insulin pump is not author Schedule C. Panel Decision The evidence be f ore the panel indic ates that the insulin pum the above-noted provisions. Accordingly, the panel finds that the ministry reasonably determined that the legisl oro v isio ns have n ot bee n s atisfied. EAAT003(10/06/01) '. AP PEAL# t c o u ld not be p rovided with a n i nsuli n pu mp bec ause efined in secti on 3.12, Sche dule C of EAPWDR .1 1 of Sche d ul e C) ese pr o visions. lt h suppleme n t that the m i n i s t ry is authorized t o E A PWDR. The ministry also con t en d s that the ria s et out in th ese sect ions f o r ea c h of the he alth mp doe s n ot con s t itut e a ny of th e he a lt h ul e C. de t e r m in e d that th e legi slated cri te r ia f or t hese hedul e C) prov i sions. spos abl e or reusab le me di cal supp l y r e q ui r e d for one s ur g ical s u ppli e s s e t ou t in s e ction 2(1 )(a.1) o r ) E A PWDR. pump is n o t either d isp o sabl e or reu sable medical a . 2 ). Sched u le C. i zed by any of thes e remaining p rovisi o n s of p does not meet the legislated criteria for any of at e d criteria for these
Direct and i mmi n ent life thr eaten ing n eed /S ection 69, EAPW T he mi nistry's position is that t h e a pp e llant is eligibl e to receive sections 2(1)(a) to (f), and s ection 3 if t he legisla t e d criteria a pum p is not a hea lt h s up plement s et out in th ese sect ions could not prov id e an y rationale on why the ministry app knowledg e , an insulin pump has never bee n listed as medical equipment/device in Schedule C section EAPWD. The ministry stat ed they onl y have authori ty to provide items under section 69 EAPWDR listed i n section 3, Sched ule C EAPWDR. The AR argues the be n e fi t o f t he new pump is that t he pump appellant's glucose levels at sm a ll a mo u n ts (0.i or 0.2 units) and, if necessary, can shut down if glucose levels are too high preventing the appellan t from rece iving too muc argued all this informa tion i s determined by t he monitoring insulin pump technology has extended t he a p pe l l ant's life does n ot continue his reg ime and co n t in u e to take advantag with hi s noct urnal h yp oglyce m ia , h is life will cont inue t o be comp lete d t h e L et te r o f Medical N e c e s sity he did n't give te c hnology. P ane l Decision T he evid e nce be f ore the p an e l ind icates t h a t the appellant is sec tions 2 and 3 of Schedule C. Sect ion 69 i s mea nt t o d o meet t h e leg i slated cri t e r i a. As pr eviou sly di scusse d , t a medic a l or surgic al su p pl y identif ied in s e c tio n 2 ( 1 ) (a ) , no 2 ( 1)(1 ), a nd that the criteria f or hea lth suppl em ents in s ectio C o n cl usio n For t he fore go ing reas ons, th e pa n e l concludes that min ev i dence. T he panel ther efore conf i rms the minis try's decision. E AA T003(10/06/01) A P PEAL# '. DR ) h e alth su pple ments se t out un de r Schedule C, re satisfied. The ministry argue d that the ins ulin w h ich i s a req uir em en t o f section 69 ( d ). The ministry roved t h e insulin pump in 200 9, as to t he mi n ist r y's 3 t h at are can dispense the i nsulin a t night subjec t to the h insulin which is equally dangerous. The A R t e chno l og y with in the pump . The AR s tated t hat th e expectancy and t he appellant is concerned that if h e e o f the la tes t techno l o gy to a ssist him , e s p eciall y at risk. T he AR add ed w h e n the spec i alist hi s ful l opi n ion and base d his a s ses sment on the new o therwis e el i g i b le for h eal th su p plement s u nder ap ply to famil y unit s t hat are not otherwise e ligibl e but h e e vid e n ce a lso ind ica tes t ha t an insulin p ump is no t r a mod e o f t ra ns port a t ion id e nt ified in sect io n ns 3 t o 3.12 have not be en sa ti s fied. is try ' s deci sion is re ason ab ly suppor ted by the
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.