I APPEAL# PART C Decision under Appeal The Appellant appeals the rv inistry of Social Development and Social Innovation (Ministry) reconsideration decision dated Mayl 16, 2014 in which the Ministry denied the Appellant's request for a blue max shoe horn, an e-• reachrr deluxe, a molded stocking/stocking aid, and a seating cushion as a health supplement undE r the Employment and Assistance for Persons with Disabilities Regulation (EAPWDRJ. The Vlinistry found that the requested items are not eligible under the following sections of EAPWI R Schedule C: 1. Positive Airway Press Jre Devices, section 3.9; 2. Medical supplies, sec ion 2(1)(a); 3. Health supplements, ection~ 3 and 3.1 to 3.11; 4. Therapy pursuant to~ ectiom~ 2(1)(c), 2(2), and 2(2.1); and 5. Remaining health su~ olements, sections 2.1, 2.2, 4, 4.1, and 5 -9. The Ministry further found th it the requested items do not meet the legislated criteria as a nutritional supplement pursuant to sect on 67 or as a life-threatening health need under section 69 of the EAPWDR. PART D Relevant Legisl ~tion Employment and Assistance "or Persons with Disabilities Regulation sections 62, 67, 69 and Schedule C, Health Supplerrents, sections 2(1)(a) and (c), 2(2), 2(2.1), 2.1, 2.2, 3, 3.1 -3.11, 4, 4.1 and 5 -9.
I APPEAL# PART E -Summa The evidence before the Mi istry at the reconsideration included: 1. A prescription from a phy ician dated May 12, 2014 stating that the Appellant requires "EZ reacher, high density cushion, sock ad, and lshoe horn to maintain hip precaution to maintain independent living." 2. The Appellant's Request f Reconsideration dated May 7, 2014 with the following attached documents: (a) A letter from the Ministry o the Appellant dated April 7, 2014 denying the requested items as they are not eligible items accord g to the EAPWDR. (b) A Ministry Medical Equip ent Request and Justification form signed by a physician on April 2, 2014. The physician indicat d that ~he Appellant's medical condition is Hip Dysplasia, and recommended a "shoe horn, 8Z reacher, stocking, and cushion". The form was also endorsed by a therapist on April 2, 2014 w state~ that the Appellant "will require the following equipment to follow the post op [illegible] deman ed by the surgery: shoe horn, reacher, sock aid, and 4 x 16 x16 foam cushion". (c) A Hip and Knee Surgery atient Equipment List from a Health Authority date stamped April 2, 2014. Items that are check arked for hip surgery patients include a "High density (firm) foam cushion ... needed for going ome in the car"; and "Dressing equipment (long handled reacher, long handled shoe horn and sock aid". These items are noted as not being available through the Red Cross and must be purchas Ia t a medical supply store. (d) A quotation from a medi I supply store dated April 1, 2014 for "Blue max shoe horn, E-Z reacher delux, molded stocking sock id, and seating cushions 4 in. x 18 in. x 18 in.", with a total cost of $130.98. (e) A copy of EAPWDR legi ation. (f) A 3-page submission fro the Appellant dated May 7, 2014 in which she stated that she is wholly dependent on her (male) ro mate~ to assist her with daily living activities including dressing, bathing, toileting, shopping, eal preparation, cleaning, etc. In addition, while the Appellant is home bound she is restricted to he bed because she has not been provided with a seating cushion to allow her to sit on other furniture a iae from her bed, commode, and raised toilet seat. She stated that she is also at risk of injury to her ip replacement and risks dislocation without the appropriate cushion during transportation to med a (g) A copy of a publication fr rr l appointments. the BC Human Rights Coalition titled Human Rights Law: An Overview (provided for infor. ational purposes). (h) A copy of a publication fr m the BC Human Rights Coalition titled Before Filing a Complaint. (i) A letter from a registered ocial worker and an occupational therapist addressed To Whom it May Concern and dated April 9, 14. It states that the Appellant underwent "right total hip arthroplasty April 7, 2014". Her medical onditior requires that she maintain 90 degree hip flexion precautions at all times for three months, a the e-z reacher, molded stocking/sock aid, shoe horn and seating cushion are medically requir d adaptive devices needed to protect the hip from dislocation during day-to-day activity. The item are medically necessary for a safe and successful recovery from surgery.
I APPEAL# (i) A copy of a health author y publication titled Recovering from Hip or Knee Joint Replacement Surgery: How to Care for Ye urself at Home. The publication recommends sitting on a raised chair or bed and using adaptive aids such as a long-handled reacher, sock aid, and shoe horn when getting dressed. The Ministry relied on its rec )nsideration decision and did not provide any additional submissions for the hearing. The Ministry nc ed that the Appellant is a recipient of disability assistance and therefore meets the basic eligibility rec uirement for health supplements provided under section 62 and Schedule C of the EAPWDR The Ministry also acknowledged that the requested items were prescribed by the Appellant'• medical practitioner.
I APPEAL# PART F Reasons for Pa el Decision The issue on appeal is whet er the Ministry's reconsideration decision of May 16, 2014 denying the Appellant's request for a blu max shoe horn, an e-z reacher deluxe, a molded stocking/stocking aid, and a seating cushion on th basis that the request does not meet the eligibility criteria set out in Schedule C and sections 67 nd 69 of the EAPWDR, was reasonably supported by the evidence or was a reasonable applicatio of the applicable enactment in the circumstances of the Appellant. Legislation -EAPWDR 62 General health supple nts (1) Subject to subsections (1 1) and (1.2), the minister may provide any health supplement set out in section 2 [general health su /emer,ts] or 3 [medical equipment and devices] of Schedule C to or for a family unit if the health su jeme17t is provided to or for a person in the family unit who is (a) A recipient of disabilit assistance The Ministry acknowledged at the Appellant is eligible for health supplements pursuant to section 62 but found that the Appell nt was not eligible for the requested items under the following sections of the EAPWDR: 67 Nutritional supplement (3) The minister may provid a nutritional supplement for a period of 3 calendar months to or for a family unit if the supplement s provided to or for a recipient of disability assistance or a dependent child of a recipient of disabili assistance if 69 Health supplement for ersons facing direct and imminent life threatening health need The minister may provide to famil~ 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 or a person in the family unit who is otherwise not eligible for the health supplement under this regul tion, and if the minister is satisfied that (a) the person faces a direct nd im'[Tlinent life threatening need and there are no resources available to the person's family unit wi h which to meet that need, (b) the health supplement is ecessary to meet that need, (c) the person's family unit is receivihg premium assistance under the Medicare Protection Act, and (d) the requirements specifie in th~ following provisions of Schedule C, as applicable, are met: (i) paragraph (a) or (f) of sec on (2) (1); (ii) sections 3 to 3.12, other t an paragraph (a) of section 3 (1 ). The Ministry found that the pellant was not eligible for the requested items under the following sections of EAPWDR Sched le C: Schedule C -Health Suppl 2 (1) The following are the h alth supplements that may be paid for by the minister if provided to a family unit that is eligible und r sectibn 62 [general health supplements] of this regulation: (a) medical or surgical suppli s that are, at the minister's discretion, either disposable or reusable, if the minister is satisfied that I of the following requirements are met:
I APPEAL# (i) the supplies are required or one of the following purposes: (A) wound care; (B) ongoing bowel care requ red due to loss of muscle function; (C) catheterization; (D) incontinence; (E) skin parasite care; (F) limb circulation care; (ii) the supplies are (A) prescribed by a medical ractitioner or nurse practitioner, (B) the least expensive sup ies appropriate for the purpose, and (C) necessary to avoid an i inent and substantial danger to health; (iii) there are no resources a ailabl 1 to the family unit to pay the cost of or obtain the supplies. ( c) subject to subsection (2) a service provided by a person described opposite that service in the following table, delivered in ot more than 12 visits per calendar year, (i) for which a prescribed by medical practitioner or nurse practitioner has confirmed an acute need, (ii) if the visits available und r the Medical and Health Care Services Regulation, B.C. Reg. 426/97, for that calendar year have en provided and for which payment is not available under the Medicare Protection Act, and (iii) for which there are no re ources available to the family unit to cover the cost: Item Service __ ,_ Pr -ovi -ded - b y _.__.... Registered with -------College of Traditional Chinese 1 acupuncture acupuncturist Medicine under the Health Professions Act College of Chiropractors of I 2 chiropractic British Columbia under chiropractor the Health Professions Act (B.C. Reg. 420/2008) College of Massage Therapists 3 massage th apy massage therapist of British Columbia under the Health Professions Act College of Naturopathic 4 naturopathy naturopath Physicians of British Columbia under the Health Professions Act College of Podiatric Surgeons of 5 non-surgical British Columbia under podiatrist podiatry the Health Professions Act (B.C. Reg. 169/2010) College of Physical Therapists of 6 physical ther py physical therapist British Columbia under the Health Professions Act
I APPEAL# (2) No more than 12 visits p r calendar year are payable by the minister under this section for any combination of physical ther py services, chiropractic services, massage therapy services, non-surgical podiatry services, n turopathy services and acupuncture services. (2.1) If eligible under subsec ion (1) (c) and subject to subsection (2), the amount of a general health supplement under section 6 of this regulation for physical therapy services, chiropractic services, massage therapy services, n-surgical podiatry services, naturopathy services and acupuncture services is $23 for each visit 2.1 Optical supplements 2.2 Eye examination suppl ments 3 Medical equipment and vices (1) Subject to subsections ( ) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.12 of this SI hedule are the health supplements that may be provided by the minister if (a) the supplements are pro ded to a family unit that is eligible under section 62 {general health supplements] of this regulati n, and (b) all of the following requir ments are met: (i) the family unit has receiv the pre-authorization of the minister for the medical equipment or device requested; (ii) there are no resources a ilable to the family unit to pay the cost of or obtain the medical equipment or device; (iii) the medical equipment o device is the least expensive appropriate medical equipment or device. (2) For medical equipment o devices referred to in sections 3.1 to 3.8 or section 3.12, in addition to the requirements in those se tions and subsection (1) of this section, the family unit must provide to the minister one or both oft following, as requested by the minister: (B.C. Reg. 197/2012) (a) a prescription of a medic I practitioner or nurse practitioner for the medical equipment or device; (b) an assessment by an oc pational therapist or physical therapist confirming the medical need for the medical equipment or de ice. (2.1) For medical equipment r devices referred to in section 3.9 (1) (b) to (g), in addition to the requirements in that section · nd subsection (1) of this section, the family unit must provide to the minister one or both of the f lowing, as requested by the minister: (a) a prescription of a medic I practitioner or nurse practitioner for the medical equipment or device; (b) an assessment by a resp atory therapist, occupational therapist or physical therapist confirming the medical need for the me ical equipment or device. (3) Subject to subsection (6), the minister may provide as a health supplement a replacement of medical equipment or medic I device, previously provided by the minister under this section, that is damaged, worn out or not fu ctioning if (a) it is more economical to r · place than to repair the medical equipment or device previously provided by the minister, an (b) the period of time, if any, et out in sections 3.1 to 3.12 of this Schedule, as applicable, for the purposes of this paragraph, as passed. (4) Subject to subsection (6), the minister may provide as a health supplement repairs of medical equipment or a medical devi e that was previously provided by the minister if it is more economical to re air the medical e ui men or device than to re lace it.
I APPEAL# (5) Subject to subsection (6) the minister may provide as a health supplement repairs of medical equipment or a medical devi e that was not previously provided by the minister if (a) at the time of the repairs he reqLirements in this section and sections 3.1 to 3.12 of this Schedule, as applicable, are met in respect of the medical equipment or device being repaired, and (b) it is more economical to pair the medical equipment or device than to replace it. (6) The minister may not pro ide a replacement of medical equipment or a medical device under subsection (3) or repairs of ,edical equipment or a medical device under subsection (4) or (5) if the 1 minister considers that the edical equipment or device was damaged through misuse. 3.1 Medical equipment an devices canes, crutches and walkers 3.2 Medical equipment an devices wheelchairs 3.3 Medical equipment an devices wheelchair seating systems 3.4 Medical equipment an devices -scooters 3.5 Medical equipment an devices bathing and toileting aids (1) The following items are h. alth supplements for the purposes of section 3 of this Schedule if the minister is satisfied that the i m is medically essential to facilitate toileting or transfers of a person or to achieve or maintain a per on's positioning: (a) a grab bar in a bathroom (b) a bath or shower seat; (c ) a bath transfer bench wit hand held shower; (d) a tub slide; (e) a bath lift; (f) a bed pan or urinal; (g) a raised toilet seat; (h) a toilet safety frame; (i) a floor-to-ceiling pole in a athroom or bedroom; U) a portable commode chai (k) a standing frame for a pe son for whom a wheelchair is medically essential to achieve or maintain basic mobility; (I) a positioning chair for a p rson for whom a wheelchair is medically essential to achieve or maintain basic mobility; (m) a transfer aid for a pers n for whom the transfer aid is medically essential to transfer from one position to another. (2) The period of time referr to in section 3 (3) (b) of this Schedule with respect to replacement of an item described in subsect n (1) of this section is 5 years from the date on which the minister provided the item being repl ced. 3.6 Medical equipment and devices hospital bed 3. 7 Medical equipment and devices pressure relief mattresses 3.8 Medical e ui ment and devices floor or ceilin lift devices
I APPEAL# 3.9 Medical equipment an devices positive airway pressure devices (1) Subject to subsection (4 of this section, the following items are health supplements for the purposes of section 3 of this chedule: (a) if all of the requirements 1 et out in subsection (2) of this section are met: (i) a positive airway pressur device, (ii) an accessory that is requ ed to operate a positive airway pressure device, or (iii) a supply that is required o 1 operate a positive airway pressure device; (b) if the minister is satisfied hat the item is medically essential to monitor breathing, (i) an apnea monitor, ii) an accessory that is requi . d to operate an apnea monitor, or (iii) a supply that is required operc:;1te an apnea monitor; (c) if the minister is satisfied hat th 1 item is medically essential for clearing respiratory airways, (i) a suction unit, (ii) an accessory that is requr ed to operate a suction unit, or (iii) a supply that is required 1 operc:;1te a suction unit; (d) if the minister is satisfied hat the item is medically essential for clearing respiratory airways, (i) a percussor, (ii) an accessory that is requi ed to operate a percussor, or (iii) a supply that is required operate a percussor; (e) if the minister is satisfied hat the item is medically essential to avoid an imminent and substantial danger to health, (i) a nebulizer, (ii) an accessory that is requi ed to operate a nebulizer, or (iii) a supply that is required p operate a nebulizer; (f) if the minister is satisfied t I at the item is medically essential to moisturize air in order to allow a tracheostomy patient to brea ihe, (i) a medical humidifier, (ii) an accessory that is requi ed to operate a medical humidifier, or (iii) a supply that is required I operate a medical humidifier; (g) if the minister is satisfied hat the item is medically essential to deliver medication, (i) an inhaler accessory devi e, (ii) an accessory that is requi ed to operate an inhaler accessory device, or (iii) a supply that is required operate an inhaler accessory device; (2) The following are the req irements in relation to an item referred to in subsection (1) (a) of this section: (a) the item is prescribed by medical practitioner or nurse practitioner; (b) a respiratory therapist ha perforrned an assessment that confirms the medical need for the item; I (c) the minister is satisfied th t the item is medically essential for the treatment of moderate to severe sleep apnea. 3.10 Medical equipment an devices -orthoses (1) In this section, "orthosis" means; (a) a custom-made or off-the shelf foot orthotic; (b) custom-made footwear; c a ermanent modification o footwear;
I APPEAL# (d) off-the-shelf footwear rec uired for the purpose set out in subsection (4.1) (a); (e) off-the-shelf orthopaedic ootwear; (f) an ankle brace; (g) an ankle-foot orthosis; (h) a knee-ankle-foot orthosiii>; (i) a knee brace; I U) a hip brace; (k) an upper extremity brace (I) a cranial helmet used for he purposes set out in subsection (7); (m) a torso or spine brace; (n) a foot abduction orthosis ( o) a toe orthosis. (2) Subject to subsections (: to (11) of this section, an orthosis is a health supplement for the purposes of section 3 of this Schedule if (a) the orthosis is prescribed by a medical practitioner or a nurse practitioner, (b) the minister is satisfied U at the orthosis is medically essential to achieve or maintain basic functionality, j (c) the minister is satisfied tr at the orthosis is required for one or more of the following purposes: (i) to prevent surgery; (ii) for post-surgical care; (iii) to assist in physical healirg from surgery, injury or disease; . (iv) to improve physical func1 oning that has been impaired by a neuro-musculo-skeletal condition, and (d) the orthosis is off-the-she t unless; 3.11 Medical equipment an~ devices -hearing instrument I 4 Dental supplements 4.1 Crown and bridgework supplement 5 Emergency dental supplE ments 6 Diet supplements 7 Monthly nutritional supp ement 1 8 Natal supplement 9 Infant Formula
I APPEAL# Appellant's position In her Notice of Appeal date I September 17, 2014 the Appellant argued that the Ministry should not be making decisions about lbr heal'thcare and medically necessary equipment based on legislation that the Ministry cannot follo I with regard to time limits for making a decision, and without a medical degree to know what is in th I best interests of her health, surgical recovery and disability. The Appellant stated that the Mi istry arbitrarily changed the legislation in 2010 without having the medical establishment deter ine what is necessary for people with disabilities. It took her three in-office requests and four pho Ie calls over four months to receive the reconsideration decision and the Ministry had misspelled her 1 ame. The Appellant argued that cl ents are put at greater risk of imminent danger, and are discriminated against on the basis of their I isability whenever the Ministry demonstrates a lack of accountability and understanding of partic !ar situations, and because the Ministry has a culture of refusing client requests in the hope of savi ,b money. She argued that most PWD clients do not understand the reconsideration and appeal ;rocess to fight for their rights, and clients suffer when the Ministry does not follow its own guidelines nd legislation. I In her 3-page submission of ay 7, 2014 the Appellant argued that the Ministry discriminated against her on the basis of her disab lity by denying the medically necessary items that she requested. She argued that the legislation er I ates "adverse differential treatment" by providing medically necessary equipment for some disabiliti ! s but not all. She further argued that the legislation also prevents the provision of a crisis supplem int to prevent imminent danger to the physical health of any person in the family unit. The Appellant submitted tha lher dignity and self-respect are injured because she is forced to choose between using her support onies for medical equipment and items not covered by the Medical Services Plan versus health 1 food. She said that her ability to live independently is significantly affected and she has suffere numerous embarrassing moments from having to rely on her male roommates to assist her with J:dressing, bathing and toileting. The lack of a seating cushion restricts where she can sit and she is at risk of injury to her hip replacement when using transportation. She requested a reconsideration i' f the Ministry's decision so that she would not have to seek a remedy under human rights legislatio I · specifically, to have the (EAPWDR) legislation changed and to ask for compensation for injury to di nity. Panel's jurisdiction The jurisdiction (authority) of ,he Employment and Assistance Appeal Tribunal panel is set out in the Employment and Assistance 1 ct (EAA). Section 24(1) of the EAA provides that, after holding a hearing, the panel must dete 1 ine whether the decision being appealed is reasonably supported by the evidence, or a reasonabl \ application of the applicable enactment in the circumstances of the 1 person appealing the decisio • If the panel finds that the decision under appeal is reasonably supported by the evidence o :a reasonable application of the applicable enactment in the circumstances of an appellan 1, section 24(2)(a) of the EAA expressly states that the panel must confirm the decision under a 1 peal. If the panel finds that the decision under appeal is not reasonably supported by the evidence or l;is not a reasonable application of the enactment to the ~ppellant's. . circumstances, section 24 2 b of the EAA ex ressl states that the anel must rescind the dec1s1on. I
I APPEAL# The panel has no jurisdictio under the EAA, to rescind a decision under appeal on the basis that the legislation is inadequate, dis riminates against persons with disabilities, or was arbitrarily changed to save the Ministry money as . 1 rgued by the Appellant. The panel acknowledges the Appellant's frustration with reportedly h I ing her name misspelled and not receiving the decision in a timely manner. The reconsideratio decision is dated May 16, 2014 but the Appellant indicated in her Notice of Appeal that she di not receive the decision until September 12, 2014, a delay of approximately four months. The panel further acknowled ! es that the information from the Appellant's physician, social worker, and occupational therapist c 1: nfirms that the items she requested are medically necessary following hip surgery. However, the inistry specifically found that the Appellant was not eligible for a blue max shoe horn, an e-z reac rr deluxe, a molded stocking/stocking aid, and a seating cushion I pursuant to Schedule C and ections 67 and 69 of the EAPWDR and it is the reasonableness of that reconsideration decision tha lthe panel is authorized to determine. The Ministry argued that the following criteria were not m ( Section 3.9 of Schedule C Ministry's position The Ministry was not satisfie, that the requested items are a positive airway pressure device; or an accessory or supply require llto operate a positive airway pressure device pursuant to subsection 3.9(1). The Ministry determi ed that although the requested items were prescribed by a medical practitioner, the information rovided does not establish that a respiratory therapist has performed an assessment that confirms th . medical need for the items or that the items are medically essential for treating sleep apnea pursua I t to sulpsection 3.9(2). Furthermore, the Ministry's policy exception does not apply to the items reque i ed by the Appellant. Panel's decision This section of the EAPWD Is ets out the eli~ibility criteria for a health s~pplement for a positive _ airway pressure device and rlated accessories. The Appellant clearly did not request such a device and the panel finds that the inistry reasonably determined that the Appellant is not eligible for a blue max shoe horn, an e-z reach! r deluxe, a molded stocking/stocking aid, and a seating cushion under section 3.9 of Schedule C. Section 2 1 a of Schedule 1 I Ministry's position I The Ministry argued that the · ppellqnt is not eligible for the items as a medical supply because the items requested are not requ 1 red for one of the purposes set out in subsection 2(1 )(a)(i): wound care, ongoing bowel care, cathete zation, incontinence, skin parasite care, or limb circulation care. The 1 Ministry further submitted th there is no information to establish that the requested items are necessary to avoid an immin int and substantial danger to health pursuant to subsection 2(1 )(a)(ii)(C).
I APPEAL# Panel's decision i This section sets out the eli 'bility criteria for disposable or reusable medical supplies and specifies that such supplies must be f r one of the purposes set out in subsection 2(1 )(a)(i): wound care, ongoing bowel care, cathete lization, incontinence, skin parasite care, or limb circulation care. The evidence from the Appellant her physician, social worker, and occupational therapist was that the items she requested are for est-surgical care and to promote independence following her hip replacement. No evidence ~s presented regarding limb circulation. The panel finds that the Ministry I reasonably determined that he items requested by the Appellant are not for one of the legislated purposes and that the infor ation does not establish that a further criterion (that the requested items are necessary to avoid an i minent and substantial danger to health under subsection 2(1 )(a)(ii)(C)) was met. Sections 2 1 c 2 2 of Schedule C Ministry's position The Ministry argued that a b e max shoe horn, an e-z reacher deluxe, a molded stocking/stocking I aid, and a seating cushion d not meet the criteria as a therapy under these sections which set out that the Ministry may provid I no more than 12 visits per calendar year at a rate of $23 per visit for acupuncture, chiropractic, m ·j ssage, naturopathy, podiatry, and physiotherapy. Panel's decision These sections govern visits o various types of therapists and there is no evidence that the Appellant requested any type of thera 1 • Her physician, social worker, and occupational therapist recommended a shoe horn nd other items further to the Appellant's hip surgery, to promote her recovery and independence. IT here is no recommendation in the Medical Equipment Request and Justification form, physician' prescription, or letter from the social worker and occupational therapist for any of the therapy visits , 1 vered under these sections and the panel finds that the Ministry reasonably determined that t I e Appellant's request does not meet the criteria for therapies under EAPWDR sections 2(1)(c), 2 2), and 2(2.1) of Schedule C. Sections 3 and 3.1 to 3.11 o Schedule C I Ministry's position The Ministry argued that a bl e max shoe horn, an e-z reacher deluxe, a molded stocking/stocking aid, and a seating cushion a ! not health supplements the Ministry is authorized to provide under these sections. The Ministry I ubmitted that it is authorized to provide only the items listed in these sections and the requested i ms do not fall within the items listed ( canes, crutches, walkers, wheelchairs, scooters and a essories; bathroom items including grab bars, a hospital bed, pressure I relief mattress, floor or ceilin ,I lift device, positive airway transfer device and accessories; orthoses and braces; and hearing aid 1. The Ministry further argued that the information provided does not establish that the other legisl 1 ted criteria for these items have been met.
I APPEAL# Panel's decision These sections set out eligib llity criteria for canes, crutches, walkers, wheelchairs, scooters and accessories; bathroom item including grab bars, a hospital bed, pressure relief mattress, floor or ceiling lift device, positive ai ay transfer device and accessories; orthoses and braces; and hearing aids. The Appellant did not rquest any of these items and the items she requested do not fall within the definition of any of the it s in these sections. Regarding orthoses, while the requested shoe horn and molded stocking a . for foot use, they do not fall under the legislated definition for orthoses in EAPWDR section 3.10(1) if Schedule C. The panel therefore finds that the Ministry reasonably determined that Appellant is I ot elig,ible for a blue max shoe horn, an e-z reacher deluxe, a molded I stocking/stocking aid, and a eating cushion under these sections. Sections 2.1 2.2 4 4.1 an 5 -9 of Schedule C and EAPWDR section 67 3 Ministry's position The Ministry argued that the equested shoe horn, reacher, stocking, and seating cushion are not one of the supplements in these ections. The eligible supplements include optical and dental procedures; and diet, nutrition, natal, and linfant formula requirements. In addition, the Ministry submitted that the information provided does n ;t establish that the other criteria for these health supplements have been met. Panel's decision These sections list health su ,I plements that the Ministry may fund when the associated eligibility criteria for each supplement re met. The supplements listed include optical and dental procedures; and diet, nutrition, natal, and infant fbrmula requirements. A blue max shoe horn, an e-z reacher deluxe, a molded stocking/st , eking aid, and a seating cushion are clearly not any of these, and the panel finds that the Ministry asonably determined that the Appellant's request is not authorized under these sections. EAPWDR section 69 Ministry's position The Ministry argued that the ppellant does not require a remedy under section 69 (which applies to health supplements set out der sections 2(1) [general heath supplements] and 3 [medical equipment and devices] of S, hedule C) because she is already eligible to receive the health supplements set out under s 1 ctions '.2 and 3 of this Schedule. Section 69 is intended to provide a remedy for persons facing a "irect ahd imminent life-threatening health need who are not otherwise eligible to receive th~se su~ iiements. The Ministry argued that the requested items are not health supplements set out in sectI rs 2 arid 3 of Schedule C and the Appellant's request has not met all the requirements specified insections 2(1 )(a) and (f) and 3 -11 of Schedule C. 11
I APPEAL# i Panel's Decision In order to be eligible for ah ~alth supplement under section 69, the person must be facing a direct and imminent life-threatenin healtH need and not be eligible for health supplements under other sections of the EAPWDR. A.~ noted by the Ministry, the Appellant is eligible to receive the health supplements set out under s ~ctions 2 and 3 of Schedule C because she meets the basic eligibility requirement for health supplc~ments as a recipient of disability assistance pursuant to EAPWDR section 62(1 )(a). The panel 1 1otes that even though she is eligible for supplements under sections 2 and 3, her request must still neet the specific eligibility requirements for the item or supplement. If the items she requested are rot listed in the legislation as eligible items, then the Ministry has no legal authority to provide a h =>a Ith supplement to cover the cost. The panel finds that the Ministry reasonably determined the specific items requested are not eligible under sections 2 and 3 of Schedule C and the Appellar 1 t is thdrefore not eligible for the shoe horn, reacher, stocking, or cushion under EAPWDR section 69. Conclusion The panel finds that the Mini }try's denial of the Appellant's request for a health supplement for a blue max shoe horn, an e-z reacher deluxe, a molded stocking/stocking aid, and a seating cushion is reasonably supported by the evidence and is a reasonable application of the applicable enactment in the circumstances of the ApI rllant. The panel confirms the Ministry's reconsideration decision. !
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