Medical Supplies and Equipment Bulletin - October 2003

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The Non-Insured Health Benefits (NIHB) Program provides supplementary
health benefits, including Medical Supplies and Equipment, to
eligible First Nations and Inuit throughout Canada.

The Fall 2003 NIHB Medical Supplies and Equipment Bulletin is to inform you of changes to the respiratory benefits provided under Health Canada's NIHB Program and provides a clear description of the requirements for Continuous Positive Airway Pressure (CPAP) equipment. In addition, a few reminders for various benefit categories are included.

Changes to Respiratory Benefits

Aerosol Therapy Supplies and Equipment

Based on documented research and the Canadian Asthma Consensus Report (1999), it has been proven that the use of MDIs (metered dose inhaler) is preferred to the use of a wet nebulizer for patients of all ages at all levels of severity. In view of this, be advised that as of October 1, 2003, NIHB will only approve the benefit code 99400181 (compressor for children up to 16 years old) as an exception when supported with appropriate medical justification.

Prescriber and Vendor Information for CPAP Requests

Consideration for the funding of CPAP units will be given upon receipt of a medical prescription, a prior approval form, and the following clinical information:

1. Full baseline and treatment polysomnogragh (PSG)* demonstrating diagnosis and response to CPAP or alternative therapy
   
   
2. Clinical information
   • age, sex, height and weight, BMI, sleepiness scale (ESS or SSS)
   • symptoms of sleep disordered breathing and associated risk factors confirmed by the referring physician

* It is recognized that PSG testing may not be readily available in some regions. In such cases, there is a greater need for additional clinical information (outlined below), which is to be submitted with the prior approval form:

1. Level 2 sleep study (includes apnea/hypopnea index, saturation, heart rate, body position) with baseline and treatment results obtained during two separate nights;
   
   or
   
   Nocturnal oxygen saturation and heart rate alone with baseline and treatment results obtained during two separate nights.
   
   
2. Clinical information
   
   • age, sex, height and weight, BMI, sleepiness scale (ESS or SSS)
   • symptoms of sleep disordered breathing and associated risk factors confirmed by the referring physician
   • evidence that PSG testing was sought including specified waiting period confirmed by the referring physician

Note: Prescriptions for interactive CPAP units will not be accepted without appropriate clinical and objective rationale.

Important Reminders

The following information is provided to ensure expedited reviews of prior approval requests for medical supplies and equipment.

Oxygen Benefits

For all Oxygen requests, a prior approval form must be submitted. To avoid unnecessary delays in the reviewing process, please ensure that the following information is submitted accordingly:

1. a current and detailed oxygen prescription identifying flow rates
2. a room air arterial blood gas result (oximetry test results with 5 continuous minutes of monitoring is acceptable for children under 18 years of age)
3. if the P0₂ is between 56 and 59 mm Hg, additional room air oximetry tests to support exercise or nocturnal desaturation, will be required
4. other medical information pertinent to the client's needs is also helpful Please include the prescriber's specialty on the Prior Approval Form.

Orthotic and Prosthetic Benefits

Please indicate the prescriber's speciality on the Prior Approval Form.

Foot Orthosis Benefits

The casting method (plaster of paris mold or foambox) should be indicated on the Prior Approval Form or on the letter signed by the provider. The client's name must also be indicated in the letter. A generic letter from the manufacturer is not sufficient.

When submitting a prior approval form for custom-made footwear, please send drawings and/or pictures of the client's feet. Failure to do so will delay the approval process as we will have to request them from you.

Pedorthists certified by the Pedorthic Association of Canada can provide services to NIHB clients for custom-made footwear. However, each provider must be registered with the NIHB program. If you need information on how to register with the NIHB program, please contact your NIHB regional office.

Audiology Benefits

A Memorandum of Understanding was renewed on January 1, 2003, between four federal departments (Health Canada, Veterans Affairs Canada, National Defence, Royal Canadian Mounted Police) and the Canadian Auditory Equipment Association (CAEA).

This Memorandum has established the price and other conditions, such as warranties, under which hearing aid products from manufacturers are offered to hearing aid dispensers servicing clients of these federal departments.

To ensure efficient and accurate reimbursement of your claim by First Canadian Health, your collaboration is required. When ordering a hearing aid from the manufacturer of your choice, it is important to indicate that the hearing aid will be provided to a NIHB client. To be reimbursed for the hearing aid, you need to submit a copy of the manufacturer's invoice to the NIHB regional office who will authorize the reimbursement by FCH.