February 2021 February 2021 Canadian Ostomy Reimbursement The
February 2021
February 2021 Canadian Ostomy Reimbursement & The Disability Tax Credit Rosemary Hill, RN, BSc. N, CWOCN, WOCC(C) DTC Committee Catherine Harley RN, IIWCC , e. MBA NSWOCC Chief Executive Officer Erin Rajhathy RN, BSc. N, MCl. Sc-WH, NSWOC, WOCC(C) NSWOCC Community Engagment
February 2021 Objectives • Define the NSWOC role in assisting people living with an ostomy in accessing funding to support the purchase of ostomy supplies. • Determine the current reimbursement available for ostomy supplies in each province and territory across Canada. • Navigate ostomy funding for First Nations, Inuit and Metis people through Non-Insured Health Benefits. • Provide information on the Disability Tax Credit (DTC) eligibility criteria and how to fill out the DTC application form.
February 2021 Canadian Statistics : 2013 • 70, 000 individuals living with an ostomy in Canada • 13, 000 new ostomy surgeries performed annually Source: Padilla L. Transitioning With an Ostomy: The Experience of Patients With Cancer Following Hospital Discharge [master’s thesis]. Ottawa, ON, Canada: University of Ottawa; 2013.
February 2021 Ostomy Patients Need Support • An ostomy is an abdominal opening that allows the collection of human waste into a pouch or other device. • Ostomy patients experience complications that affect their quality of life and add to their reliance on the health system. • NSWOCs improve outcomes for ostomy patients and prevent complications through preoperative consultation, stoma marking, postoperative education and mental health support. SOURCE: Le. Blanc, K. , Whiteley, I. , Mc. Nichol, L. , Salvadalena, G. , & Gray, M. (2019). Peristomal medical adhesive-related skin injury: Results of an international consensus meeting. Journal of Wound, Ostomy and Continence Nursing. More than 80% of ostomy patients experience a complication within two years after surgery
February 2021 Canadian Healthcare System There is no single, national health system. . . • 14 single-payer, universal & public systems : 10 provinces, 3 northern territories. • Federal government delivers primary & supplementary health services to select populations, including First Nations, Inuit & Me tis people, veterans, military personnel & inmates in Federal prisons.
February 2021 The Financial Impact of Living in Canada With an Ostomy A Cross-sectional Survey Kimberly Le. Blanc, Corey Heerschap, Lina Martins, Britney Butt, Samantha Wiesenfeld, Kevin Woo J Wound Ostomy Continence Nurs. 2019; 46(6): 505 -512. Published by Lippincott Williams & Wilkins
February 2021 The Financial Impact of Living in Canada With an Ostomy Conclusions • Living with an ostomy impacts Canadians financial well-being. • Geographical location of the individual with an ostomy has a significant impact on the availability of resources. • There are considerable differences in funding among provinces such as flat rate funding, funding based on a percentage of costs, income-based funding, and no funding. • Despite different funding bundles, out-of-pocket expenses are the same across the provinces. • Findings suggest that accessibility to an NSWOC can potentially reduce peristomal complications and aid in cost containment.
February 2021 Costs of Ostomy Supplies 9
February 2021 Out-of-Pocket Experience? 10
February 2021 Move from…………. Financial stress Anxiety 11
February 2021 Adequately supported……. 12
February 2021 Understanding the Roles Source: Joe Mc. Reynolds, President, Mc. Reynolds & Associates, May 2014 13
February 2021 Source: Joe Mc. Reynolds, President, Mc. Reynolds & Associates, May 2014
February 2021 Ostomy Reimbursement • We will be addressing “Publicaly Funded” programs that support Ostomy Supplies – provincially and federally. Purchasing • Important to understand how each Province reimburses for the money spent & how receipts are issued and accepted • The guidelines & rules vary by Province
February 2021 Ostomy Reimbursement by Province & Territory
February 2021 Newfoundland & Labrador : Prescription Drug Program Eligibility • Residents of NL&L who hold a Dept of Health & Community Services Prescription Drug card • Available to those who have: • 65 Plus plan guaranteed income supplement (GIS) • Old Age Security Benefits ( OAS) • The Foundation Plans • Income support benefits through the Dept of Advanced Education & Skills • Children- child, youth & family services • Individuals in supervised care
February 2021 Newfoundland & Labrador : Prescription Drug Program Types of Ostomies Covered • A permanent functioning colostomy, ileostomy or urostomy Authorization: • Client must be enrolled in the Foundation Plan or 65 Plus Plan prior to coverage authorization Access to Supplies : • Purchased through third party – suppliers original receipts must be submitted to the government
February 2021 Newfoundland & Labrador : Prescription Drug Program Coverage: 100% for those in Foundation Plan 75% for Ostomy Subsidy program for people in 65 Plus plan 0% for those not enrolled in either plan * As of Nov. 2018, residents can apply to the Special Assistance Program where coverage has client contribution based on income & cost of supplies.
February 2021 Prince Edward Island : PEI Pharmacare Eligibility • Permanent PEI resident as defined by the Drug Cost Assistance Act • Must have • a valid PEI Health Card • filed your most recent income tax return in PEI; and • be registered with the Ostomy Supplies Program. Types of Ostomies Covered • a permanent ostomy – urostomy, colostomy or ileostomy
February 2021 Prince Edward Island : PEI Pharmacare What ostomy supplies are eligible for coverage? • Skin wafers • Ostomy pouches • Adhesive removers • Skin barrier wipes • Stoma powders, pastes and barrier rings • Ostomy belts
February 2021 Prince Edward Island : PEI Pharmacare Application Process • Health care professional ( NSWOC, NP or Physician) submits a Health Care Provider Ostomy Supplies Program Registration Form on patient’s behalf. • The patient must also complete and submit an Ostomy Supplies Program Patient Application Form which is required to verify income with the Canada Revenue Agency.
February 2021 Prince Edward Island : PEI Pharmacare Coverage • Depending on household income, you may be eligible for up to 100 per cent coverage to assist with the out-of-pocket cost of eligible ostomy supplies to a maximum of $2, 400 per full program year from July 1 -June 30. • If you apply past July 1 your eligible amount will be pro-rated to reflect the percentage of time remaining until June 30.
February 2021 Prince Edward Island : PEI Pharmacare Annual Household Income Eligible Coverage $0 - $20, 000 100% $20, 001 - $40, 000 95% $40, 001 - $50, 000 90% $50, 001 - $100, 000 70% $100, 001 or greater 60%
February 2021 Prince Edward Island : PEI Pharmacare • You must pay for your supplies at your local pharmacy/home health centre, and request a detailed invoice listing all supplies purchased. • All claims must include an Ostomy Supplies Claim Submission Form • If you have private insurance, you can submit a detailed invoice for your supplies along with your insurer statement showing the remaining out-of-pocket expense. • If you do not have private insurance, you can submit a detailed invoice for your supplies. Claims can be submitted to: • PEI Pharmacare Attention: Manual Claims PO Box 2000 Charlottetown, PE C 1 A 7 N 8 • You may submit your invoices and Ostomy Supplies Claim Submission Form monthly, or every two – three months. Invoices older than 6 months will not be eligible. • Eligible ostomy supplies must be purchased in Canada.
February 2021 New Brunswick : Social Development Health Services Eligibility • Department of Social Development clients and their dependents who hold a valid white Health Card indicating - “Supplementary” in the BASIC HEALTH ELIGIBILITY section or - “OS. ” (Ostomy Supplies) in the ADDITIONAL HEALTH ELIGIBILITY section • Department of Social Development clients who hold a valid yellow Health Card that indicates - a “Y” under the OTH in the VALID ONLY FOR box and Clients must not have any other medical coverage to be eligible for full benefits.
February 2021 New Brunswick : Social Development Health Services Types of Ostomies Covered • This program covers supplies directly related to the management of: • A colostomy, ileostomy or urostomy Authorizer • NSWOC, NP, Physician Access to Supplies • Supplies purchased through third party suppliers • Brand name products only considered when generic products are not available or do not meet clients needs • Client buys products & submits the original prescription receipts
February 2021 New Brunswick : Social Development Health Services Coverage • 100% for clients with special needs who qualify for assisted healthcare under section 4. 4 of the Family Income Security Act and Regulations • 0% for the general public
February 2021 Nova Scotia: Boarding, Transportation & Ostomy Program : Gov’t of NS Dept Health & Wellness Eligibility • Nova Scotia Residents holding a valid Nova Scotia Health Card • Cancer patients with a gross annual income of less than $25 k per year • 65 years of age • No prescription drug coverage under any other plan or program • Pay an annual premium based on household income • Under 65 Long Term Care Pharma. Care Plan
February 2021 Nova Scotia: Boarding, Transportation & Ostomy Program : Gov’t of NS Dept Health & Wellness Types of Ostomies Covered • Permanent functioning colostomy, ileostomy or urostomy Authorizers • Assessment & authorization by a physician Access to Supplies • Purchased through third party suppliers • Selected from governments approved supply list
February 2021 Nova Scotia: Boarding, Transportation & Ostomy Program : Gov’t of NS Dept Health & Wellness Coverage • 100% for : • cancer patients with annual family income less than $25, 500 per year • Those enrolled in the under 65 Long Term Care Pharma. Care Plan • Clients enrolled in Senior’s Pharma. Care Program not covered by private health insurance • Clients with income above $25, 500 , premiums are charged based on income • Single seniors earning less than $22, 986 will not pay a premium while those earning $22, 986 to $35, 000 will pay up to $424. 00 per year • Couples with combined income of between $26, 817 & $40, 000 will each pay a reduced premium of less than $424 per year
February 2021 Quebec: Regie/Quebec Health Insurance Board Eligibility • Quebec resident holding a valid Quebec Health Insurance card Types of Ostomies Covered • Surgery that has resulted in a permanent or temporary (no time limit) functioning colostomy, ileostomy or urostomy Authorizers • Assessment & authorization by a physician
February 2021 Quebec: Regie/Quebec Health Insurance Board Access to Supplies • Purchased through third party suppliers • No approved supply or vendor list
February 2021 Quebec: Regie/Quebec Health Insurance Board Coverage • Fixed grant of $800 per temporary ostomy – 2 equal installments • $1, 228 permanent ostomy annually directly paid to the client • Clients registered under the Quebec’s Last Resort Financial Assistance program are fully reimbursed for any purchase over the annual amount of $1, 228
February 2021 Ontario: Assistive Devices Program Ministry of Health and Long-Term Care Eligibility • All residents in Ontario with a valid Ontario Health Insurance (OHIP) Types of Ostomies Covered • Permanent functioning ostomy • Temporary lasting > 6 months Authorizers • Physician • Nurse Practitioner
February 2021 Ontario: Assistive Devices Program Ministry of Health and Long-Term Care Access to Supplies • There are no approved vendors • Free to purchase from any supplier Coverage • A fixed grant of $975 per ostomy paid direct to the person annually in two installments • A fixed grant of $1, 300 per ostomy paid direct to the person annually in two installments if the person is: • Receiving other provincial funding such as Ontario Works, Ontario Disability Support Program, or Assistance to Children with Severe Disabilities • A resident in Long-Term Care
February 2021 Ontario: Extended Health Benefit Ministry of Children, Community and Social Services For those who, are no longer eligible for ODSP because 1. Income is too high, and 2. You and your family have high health costs To qualify: Looks at income to calculate how much ODSP you should get. Some income reduces ODSP (i. e. , CPP, employment, child support) If your income reduction is greater than ODSP amount, you would no longer be eligible for ODSP
February 2021 Health Benefits: Extended Health Benefit Ministry of Children, Community and Social Services
February 2021 Health Benefits: Extended Health Benefit Ministry of Children, Community and Social Services
February 2021 Ontario: Municipal Programs City of Ottawa: Essential Health and Social Supports (EHSS) program EHSS helps Ottawa residents who cannot afford to pay for health items or services needed not available through other programs. Eligibility: Anyone who is low income with limited savings may apply Coverage: Individual assessment City of Toronto: Toronto Employment & Social Services (TESS) Authorizer: Physician or Nurse Practitioner Coverage: • Temporary: Will cover the cost of needs up to a max of 6 months • Permanent: Will cover the cost up to 3 months until ADP kicks in and remaining 25% based on individual assessment
February 2021 Manitoba : Ostomy Program Eligibility • Manitoba Residents who are registered for the Manitoba Ostomy Program through the Winnipeg Regional Health Authority Types of Ostomies Covered Surgery that has resulted in a permanent or temporary ( no time limit) functioning colostomy, ileostomy or urostomy Authorizers • Assessment & authorization by an NSWOC Access to Supplies • Purchased through the province’s HSC Material Handling program
February 2021 Manitoba : Ostomy Program Coverage • 100% for ostomy supplies • All ostomy supplies are ordered through the HSC Materials Handling program at 0% co-payment
February 2021 Saskatchewan Aids to Daily Living (SAIL) Drug Plan & Extended Benefits Ostomy Program Eligibility • Saskatchewan Resident holding a valid Saskatchewan health services number Types of Ostomies Covered Surgery that has resulted in a permanent or temporary ( no time limit) functioning colostomy, ileostomy or urostomy Authorizers • Assessment & authorization by an NSWOC Access to Supplies • Purchased through third party suppliers • No approved supply or vendor list
February 2021 Saskatchewan Aids to Daily Living (SAIL) Drug Plan & Extended Benefits Ostomy Program Coverage • 50% reimbursement for ostomy supplies • 100% for patients registered under the Paraplegia Program
February 2021 Alberta Aids to Daily Living (AADL) benefits program Eligibility • Alberta Resident holding an Alberta Health Care Insurance Plan ( AHCIP) Card Types of Ostomies Covered • Chronic permanent functioning colostomy, ileostomy or urostomy • Temporary ostomy not expected to have reversal within 6 months of the original surgery • Paediatric clients and clients with an esophagectomy, cecostomy, or fistula Authorizers • Assessment & authorization by an NSWOC Access to Supplies • Purchased through the province’s approved vendor and supply list
February 2021 Alberta Aids to Daily Living (AADL) benefits program Coverage • Households making less than the following amounts receive 100% reimbursement • • • Single taxable income less than $20, 970 Couple- no children with taxable income less than $33, 240 Parents & taxable income are less than $39, 250 Those making more than amounts listed above receive 75% coverage Clients pay 25% of the cost of the program benefits up to a maximum of $500 per family per benefit year which is July 1 to June 30
February 2021 British Columbia Pharma. Care Program Eligibility • British Columbia Residents registered for the Fair Pharma. Care Program • Must have a valid BC Care Card & have filed income tax for the past 2 years for the Fair Pharma. Care Program Types of Ostomies Covered • Surgery that has resulted in a permanent or temporary ( no time limit) functioning colostomy, ileostomy or urostomy Authorizers • Clients can enroll online without a medical practitioner or prescription Access to Supplies • Supplies must be purchased through the province’s Ministry of Health approved vendor and supply list(currently under revision with NSWOC input)
February 2021 British Columbia Pharma. Care Program
February 2021 Yukon: Chronic Disease & Disability Benefits Program Eligibility • Yukon Residents holding a valid Yukon healthcare card Types of Ostomies Covered • a chronic permanent functioning colostomy, ileostomy or urostomy Authorizers • Clients must be assessed by an NSWOC, NP or physician Access to Supplies • Through third party suppliers • No approved supply or vendor list
February 2021 Yukon: Chronic Disease & Disability Benefits Program Coverage • 100% for clients registered with the Chronic Disease and Benefits Program • 0% for the general public
February 2021 Northwest Territories Extended Health Benefits Program Eligibility • NWT Residents holding a valid NWT healthcare card registered for the Extended Health Benefits Program Types of Ostomies Covered • Surgery that has resulted in a permanent or temporary (no time limit) functioning colostomy, ileostomy or urostomy Authorizers • Clients must be assessed by an NSWOC, NP or physician Access to Supplies • Through third party suppliers • No approved supply or vendor list
February 2021 Northwest Territories Extended Health Benefits Program Coverage • 100% for prescribed supplies for seniors older than 60 who are permanent residents of NWT & non-indigenous with the Chronic Disease and Benefits Program • 0% for the general public
February 2021 Federal Programs Ostomy Reimbursement
February 2021 Military: National Defense & the Canadian Armed Forces Supplemental Healthcare Eligibility • Must be a Member of the Canadian Armed Forces Types of Ostomies Covered • Surgery that has resulted in a permanent or temporary (no time limit) functioning colostomy, ileostomy or urostomy Authorizers • Clients must be assessed & authorized by a physician Access to Supplies • Through third party suppliers • No approved supply or vendor list
February 2021 Military: National Defense & the Canadian Armed Forces Supplemental Healthcare Coverage • 100% when authorized by a physician
February 2021 RCMP : Public Health Service Plan • 100% coverage when authorized by a physician
February 2021 Non-Insured Health Benefits First Nations, Inuit & Metis People
February 2021 Non-Insured Health Benefits Eligibility Must be a resident of Canada and any of the following: • a First Nations person who is registered under the Indian Act (commonly referred to as a status Indian • an Inuk recognized by an Inuit land claim organization • a child less than 18 months old whose parent is a registered First Nations person or a recognized Inuk • For some clients, a self-government, or First Nations or Inuit health authority may be responsible for providing health benefits. • To access benefit coverage, show a health care provider your client identification to confirm your eligibility with the program. .
February 2021 Non-Insured Health Benefits • The Non-Insured Health Benefits (NIHB) Program recognizes Nurses Specialized in Wound Ostomy & Continence -NSWOC, WOCC(C) may make recommendations for ostomy supplies and fill out and sign the form for Benefit Recommendation Medical Supplies & Equipment. • They may also complete the required ostomy assessment form • NIHB recognizes that, within their scope of practice, RN’s have the competency, skill and knowledge to “renew” ostomy products only after initially prescribed/recommended by a NSWOC, WOCC(C) a NP or MD • This policy change was effective December 17, 2018
February 2021 NIHB process for NSWOC/ WOCC(C) to recommend ostomy products : Step 1: Complete an assessment and determine client needs Step 2: Complete the Template for Benefit Recommendation Medical Supplies and Equipment • Client first and last name • Date of birth • Client Identification (ID) Number- (A unique number used to identify a client who is eligible to receive benefits under the program). • The client ID number may be comprised of one of the following: • A ten (10) digit number currently issued to eligible First Nations clients by Crown-Indigenous Relations and Northern Affairs (CIRNA). • A three (3) digit band number, immediately followed by the five (5) digit family number identifying the family unit within the eligible First Nations client's band. • An alpha prefix followed by an eight (8) digit number issued to certain registered First Nations and recognized Inuit clients by NIHB. • A health plan number issued to recognize Inuit clients by the governments of NWT and Nunavut.
February 2021 NIHB process for NSWOC/ WOCC(C) to recommend ostomy products (continued) Step 3: Recommendations including: • Rationale for choosing the product (ie. Goal of treatment based on Best practice –(Good explanation will ensure approval of product) • Type or name of the medical supply or equipment recommended • Quantity recommended • Duration of treatment • Period of validity of the recommendations • Client weight and height, if applicable • Other
February 2021 NIHB process for NSWOC/ WOCC(C) to recommend ostomy products (continued) Step 4 • The recommending NSWOC, WOCC(C) information including: • First and last name • Job Title • Designation/Credentials • RN License number ( from the governing body that you are registered with) • Contact number and email • Written Signature and date( must be dated within the last 12 months)
February 2021 Process for ordering supplies through NIHB : Pharmacies • The pharmacist requires a prescription/recommendation for ostomy supplies covered by NIHB. • This prescription/recommendation must be detailed with an accurate description of each product, product number, quantity in alignment with the recommended replacement guidelines and the duration for a maximum of one year. • This allows the pharmacy to complete their portion of the NIHB General Medical Supplies & Equipment Prior Approval Form including the Benefit Code, Actual Acquisition Cost, Mark-Up and Total Cost. The Provider Information in Section 6 refers to the retailer. • Ostomy products require a correctly completed prescription/recommendation and a NIHB General Medical Supplies and Equipment Prior Approval Form to be approved for coverage by NIHB.
February 2021 NIHB: Medical Supplies and Equipment Guide and Benefit Lists https: //www. sac-isc. gc. ca/eng/1585320116553/1585320137871 • The following Medical Supplies and Equipment lists contain the products and services provided as eligible benefits by the Non-Insured Health Benefits (NIHB) program, along with information on coverage policies, benefit codes, requirements for prior approval, and applicable recommended replacement guidelines. • 13. 0 Medical surgical equipment and supplies benefits list
February 2021 NIHB: Medical Supplies and Equipment Guide and Benefit Lists 13. 3 Ostomy • 13. 3. 1 One piece pouch • 13. 3. 2 Two piece pouch • 13. 3. 3 Ostomy supplies
February 2021 Non-Insured Health Benefits 13. 3. 1 One piece pouch Recommended Prior approval required replacement guidelines Additional details Yes 50 every 3 months Item number 99400730 Item name 1 pc drainable colostomy/ileostomy convex pouch Prescriber Provider MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) 99400906 1 pc, closed-end, colostomy convex pouch MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 120 every 3 months 99400905 1 pc, closed-end, flat, colostomy pouch MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 120 every 3 months 99400406 1 pc, drainable, flat, colostomy/ ileostomy convex pouch MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 50 every 3 months 99400732 1 pc, urostomy convex pouch MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 50 every 3 months 99400731 1 pc, urostomy pouch MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 50 every 3 months
Non-Insured Health Benefits February 2021 13. 3. 2 Two piece pouch Provider Recommended Prior approval required replacement guidelines Additional details Item number Item name Prescriber 99400414 2 pc, closed-end, colostomy/ileostomy pouch system MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 120 every 3 months 99400415 2 pc, drainable, colostomy/ileostomy pouch system MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 30 every 3 months 99400742 2 pc, flange for ostomy system MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 50 every 3 months 99400743 2 pc, system flange/convex pouch system MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 50 every 3 months 99400745 2 pc, system urostomy pouch MD, NP, NSWOC, GEN WOCC(C), (RN renewals only) Yes 30 every 3 months
February 2021 Non-Insured Health Benefits 13. 3. 3 Ostomy supplies Item name 99400409 Prescriber Absorbent flake/capsule Provider MD, NP, NSWOC, WOCC(C), RN Recommended Prior approval required replacement guidelines Additional details GEN Yes 2 per year 99400763 MD, NP, NSWOC, WOCC(C), (RN renewals only) GEN Yes 12 per year 99400476 • Adaptor • Connector • Clamp ostomy/catheter Adhesive remover MD, NP, NSWOC, WOCC(C), RN GEN Yes 6 boxes per year 99400400 Belt, ostomy MD, NP, NSWOC, WOCC(C), RN GEN Yes 3 per year 99400401 Convex insert MD, NP, NSWOC, WOCC(C), (RN renewals only) GEN Yes 30 every 3 months 99400402 Filters MD, NP, NSWOC, WOCC(C), RN GEN Yes 2 boxes of 50 per year 99400403 Gel lubricant MD, NP, NSWOC, WOCC(C), RN GEN Yes 12 per year 99400884 Mouldable ring seal MD, NP, NSWOC, WOCC(C), (RN renewals only) GEN Yes 99400782 Mucus dispersant MD, NP, NSWOC, WOCC(C), RN GEN No 99400404 Odor control product, concentrated MD, NP, NSWOC, WOCC(C), RN GEN Yes 12 per year 99400398 Ostomy, barrier powder MD, NP, NSWOC, WOCC(C), RN GEN Yes 3 every 3 months 99400737 Ostomy, irrigation kit MD, NP, NSWOC, WOCC(C), (RN renewals only) GEN Yes 1 every 3 months 99400738 Ostomy, irrigation sleeve MD, NP, NSWOC, WOCC(C), RN GEN Yes 30 every 3 months 99400739 Plastic faceplate MD, NP, NSWOC, WOCC(C), RN GEN Yes 3 every 3 months 99400783 Pouch cover MD, NP, NSWOC, WOCC(C), RN GEN Yes 4 per year 99400411 Protective skin wipes/spray MD, NP, NSWOC, WOCC(C), RN GEN Yes 4 per year 99400408 Skin barrier, paste MD, NP, NSWOC, WOCC(C), RN GEN Yes 3 every 3 months 99400410 Skin barriers/wafer MD, NP, NSWOC, WOCC(C), (RN renewals only) GEN Yes 50 every 3 months 99400412 Stoma cone for irrigation MD, NP, NSWOC, WOCC(C), (RN renewals only) GEN Yes 6 per year Package of 90 For inside pouch only
February 2021 Canada: Interim Federal Health Program Eligibility • Protected persons, including resettled refugees, refugee claimants • Must not be in acute care or LTC facility Types of Ostomies Covered • Permanent functioning ostomy • Temporary Authorizers • Physician • Nurse Practitioner
February 2021 Canada: Interim Federal Health Program Access to Supplies • Prior approval required • Billed through approved vendor Coverage • No maximum $$ • As per usual & customary fees in provinces / territories
February 2021 Disability Tax Credit (DTC) Rosemary Hill BSN CWOCN NSWOC WOCC(C) Feb 2021
February 2021 Objectives • Describe the Disability Tax Credit (DTC) & Eligibility • Share the collaboration of Ostomy Canada & NSWOCC • Detail how an NSWOC can assist ostomy patients with application process • Review the signage section: Physician or NP • Explain the option of a “cover letter” • * Registered Disability Tax Savings Plan*
February 2021 What is the Disability Tax Credit (DTC)? • The Disability tax credit is a non-refundable tax credit that helps persons with disabilities or their supporting persons reduce the amount of income tax they may have to pay • Who Qualifies? - Ostomy patients who have had their stoma for >12 months and or have permanent ostomy • https: //www. canada. ca/en/revenue-agency/services/formspublications/forms/t 2201. html
February 2021 Information about the DTC: www. cra. gc. ca/dtc or Call 1 -800 -959 -8281
February 2021 Background Collaboration OSTOMY CANADA SOCIETY (OCS) & NSWOCC DISABILLITY TAX CREDIT COMMITTEE Implemented in 2017
February 2021 Committee Members • Ann Durkee-Mac. Isaac, DTC Committee Chairperson • Ann Ivol, President Ostomy Canada Society • Rosemary Hill, NSWOCC Past President • Cathy Harley, NSWOCC CEO • Joan Peddle, NSWOC – Kathy Esligar, NSWOC • Murray Wolfe, Pharmacist • Ian Mac. Neil and Peter Folk, Ostomy Canada Society • Elaine Jeffery, Ostomy Halifax Chapter
February 2021 Marketing of the DTC • Introduction to both associations & members • Pamphlets approved and printed • Uploaded to both websites • Introduction to both magazines • “Did you Know? ” emailed to every physician’s webmaster and website in Canada • Distribution >15000 to NSWOC, Ostomy Canada Members, Pharmacists, Physicians and Suppliers
February 2021 Form Completion
February 2021 • If you have had your ostomy for several years or more and previously have not claimed DTC then you would likely check the YES box • CRA will back date approximately 10 years PAGE 1
February 2021 Take Note: PAGE 2
February 2021 PAGE 3
February 2021 Statements to Include: I (insert name) have a permanent irreversible (Choose item that applies)– ileostomy, urostomy, colostomy and I am markedly restricted in eliminating bowel functions with a device. I spend an inordinate amount of time to personally manage my (choose item that applies) bowel/bladder functions 100% of the time. Page 4 – leave blank X I have had an ostomy utilizing a pouching system for a continuous period of time since (XXXX – insert year) and this situation is not going to change in the future.
February 2021 Other examples of statements to describe the effects of the ostomy impairment on activities of daily living. You and your Physician/NP can use these, or a variation of these, to describe your personal situation. • I have multiple bowel movements a day (5 -7 times) which require the emptying/cleaning of the ostomy pouch. • I need to provide meticulous skin care due to minimize excoriation of the skin around the stoma. • I irrigate the colostomy daily to have a bowel moment; this procedure takes 45 -60 minutes to do. • To manage my urostomy, I need to prepare, clean and sanitize night time bags • Due to the ostomy surgery, I have developed a hernia where my ostomy is; the hernia impairs the seal of my pouching system.
February 2021 Future Initiatives: CRA & NSWOCC collaboration – Include signing authority by an NSWOC
February 2021 Cover Letter Helpful if Retroactive Request Date: February 14, 2021 Re: Disability Tax Credit certificate Form 6729 To Whom It May Concern: I was diagnosed with Bladder Cancer in and had surgery that left me with a permanent Urostomy which I continue to live with and look after since 2015. I am currently 80 years old. The surgery has impacted most everything I do however, I have learned to live with the resulting permanent Urostomy. I spend more time in the bathroom every day than the average person looking after the stoma and cleaning and changing my appliance when necessary. It is only recently that I have been advised that I may qualify for a Disability tax credit(DTC), hence this application. I seek your confirmation that I qualify for the DTC and then I ask to consider that this application be retroactive – to perhaps 2015. Thank you in advance, for considering my application and reviewing this letter. Sincerely, XXXXXXX PHN 0123 456 789
February 2021 Registered Disability Savings Plan The Registered Disability Savings Plan (RDSP) is a long-term savings plan to help Canadians with disabilities and their families save for the future. If you have an RDSP, you may also be eligible for grants and bonds to help with your long-term savings. You should consider opening a RDSP if you have a long-term disability and are: Eligible for the Registered DISABILLITY TAX CREDIT * under the age of 60 ( if you are 59, you must apply before the end of the calendar year in which you turned 59 *A Canadian resident with a Social Insurance Number (SIN) and *looking for a long-term savings plan.
February 2021 Summary • Inform your Ostomy patients about the DTC • Confirm Eligibility: Individuals with an Ostomy of 12 months or greater • Have DTC pamphlets available in your Outpatient Clinic • Know the application process and where to find the forms • Templates available form & cover letter
February 2021 Thank you! Question period office@nswoc. ca
February 2021 References & Resources • Source: Padilla L. Transitioning With an Ostomy: The Experience of Patients With Cancer Following Hospital Discharge [master’s thesis]. Ottawa, ON, Canada: University of Ottawa; 2013. • Non-Insured Health Benefits: Medical Equipment and Supplies • https: //www. sac-isc. gc. ca/eng/1585320116553/1585320137871 • • https: //www. canada. ca/en/indigenous-services-canada/services/non-insured-healthbenefits-first-nations-inuit. html • https: //www. princeedwardisland. ca/en/information/health-pei/ostomy-suppliesprogram
February 2021 For further information: • office@nswoc. ca
- Slides: 90