Section 22 - Health Needs

Policy

Infant Formula Program for HIV Mothers and Infants (PDF 117 KB)

22.1.1 Health Services Program

Policies

Drug Program Changes: OxyContin (PDF 137 KB)

Mass Notification FNI Health Coverage (PDF 39 KB)

Medical Supply Expiry (PDF 99 KB)

Social Allowance Health Services (SAHS) Health Cards update (PDF 185 KB)

Form

Children's Opti-Care

Dental Claim (PDF 383 KB)

Health Services provides coverage for essential drug, dental and optical supplies and services for eligible participants and children-in-care. Outlined below is a summary of benefits:

Drugs	Dental	Optical
Participants may receive drug benefits from enrolment. To receive benefits, participants must have a prescription from a physician. They can take the prescription to a pharmacy and indicate that they are receiving income assistance. Pharmacists will access the Drug Product Information Network (DPIN), which will confirm participant and product eligibility. If pharmacists cannot confirm eligibility, they will contact DPIN Help Desk staff directly at 786-8000 or 1-800-663-7774 for authorization. DPIN Help Desk staff will consult with field staff as required to determine eligibility.	Participants may receive dental services after three months of enrolment, except general assistance adults who must wait 6 months. Emergencies can be met during the waiting period. To receive benefits, participants see a dentist, or denturist, indicate they are receiving income assistance and present their Health Services card if they have one. Agreements with the Manitoba Dental Association and the Manitoba Denturists Association lists services covered and fees. All dentists and denturists have a copy of the applicable agreement. If dentists or denturists need additional authorization, they will contact Health Services staff directly at 945-8767.	Participants may receive optical supplies and services after three months of enrolment, except general assistance adults who must wait six months. Emergencies can be met during the waiting period. To receive benefits, participants see a service provider, indicate they are receiving income assistance and present their Health Services card if they have one. Service providers are aware of the services covered and fees, and the Department has an agreement with the Opticians of Manitoba. If they need additional authorization, they will contact Health Services staff directly at 945-3051.
Field staff should not authorize drug purchases.	Field staff should not authorize dental treatment.	Field staff should not authorize optical benefits.

22.1.2 Health Services

Policy

Palliative Care Drug Access Program (PDF 74 KB)

Health Services cards provide pre-authorization for certain dental and optical supplies and services as indicated in the agreements with dental and optical service providers. Cards are issued to most participants, except general assistance, after a three-month waiting period. The waiting period is based on the case effective date.

During the waiting period, drug benefits and emergency dental and optical benefits may be covered. Requests for emergency benefits should be directed to Health Services for authorization.

A current Health Services card should be recovered from the participant when a holder is found ineligible for all income assistance, enters a care institution in which coverage is not required, or is found to be misusing the card. The card should be returned, within two weeks of cancellation to Health Services.

22.1.3 Test of Need

The actual cost of essential drugs, dental and optical needs may be included in the test of need. However, when calculating an applicant's needs, staff should deduct any amounts received through other programs, such as Pharmacare. Only the net cost to the participant should be included in the test of need.

22.1.4 General Assistance Participants

General assistance participants are eligible for Health Services, but do not receive Health Services cards. Drug benefits and emergency dental and optical benefits may be approved from enrolment. After a six-month waiting period for adults and a three-month period for children, basic dental and optical needs may be met in accordance with the approved services and fees. To access service, participants should see an appropriate service provider who will call Health Services for authorization. Field staff should not authorize Health Services benefits.

22.1.5 Participants with Alternative Health Coverage

Participants who have health services coverage from an alternate source are expected to access health services from that source. Typically, the alternate source would be either a private health plan or coverage through the federal government for First Nations and Inuit peoples. Health Services cards are not issued in these cases. If a service is covered by Health Services, but not by the alternate health coverage, Health Services staff will review the request and approve as appropriate.

[SAMIN Procedure: The SAHS field in SAMIN should be coded to N and the SAHS expiry date should be left blank.]

22.1.6 Health Card Only

Where the applicant's resources are sufficient to meet all basic living costs, other than health care, eligibility for Health Services only may be considered. If the applicant's actual health care costs, or an allowance for health expenses of $10.00 per adult, per month, exceeds the household's available resources, enrolment for Health Services may be granted. The $10.00 allowance used in the Health Services test of eligibility is never to be included in calculating of cash grants. Applicants must not be enrolled for a Health Services card unless they are eligible on a long-term basis. However, regular re-assessments of health card eligibility must be conducted. Health costs must be verified and averaged to reflect the ongoing need, and must be recorded on file as confirmation of eligibility.

Regular wait periods for dental and optical benefits apply, as outlined in section 22.1.1. Emergencies can be met during the wait period. Prescription drug benefits are available upon determination of eligibility.

Participants receiving SAHS or Rewarding Work Health Plan benefits are also eligible to receive Rent Assist, Manitoba Child Benefit, and 55Plus.

22.1.7 Single Grant

Where an applicant has sufficient resources to meet his or her basic monthly living costs but claims to be unable to meet the cost of an immediate health need, the participant may be eligible for a single grant. Single grants may be issued for drug, emergency dental and optical needs, as well as medical equipment. Eligibility is determined by comparing the applicant's surplus financial resources over a six-month period to the health cost in question. If the applicant will have insufficient resources to meet the total cost of the health need, a single grant by voucher or special cheque may be issued by field staff, after consulting with Health Services staff. When calculating an applicant's needs, staff should deduct any amounts received through other programs, such as the Manitoba Health Eyeglasses Program for persons 65 years of age and over.

Single grants are not intended to cover the cost of an applicant's Pharmacare deductible. The Pharmacare program requires that all applicants pay for, without exception, a minimum annual deductible as set by the program. Although the basic deductible amount cannot be waived, should the applicant experience an annual income reduction of at least ten per cent, the applicant may contact the Pharmacare program and request a deductible recalculation using his or her current, year-to-date income level.

The Pharmacare program may be reached at (204) 788-2506 (English) or (204) 788-2520 (French).

22.1.8 (deleted)

22.1.9 Hospital Patients

Participants who are residents of general, mental health or extended treatment hospitals may be provided only, on an item-by-item basis, health services with such things as: dentures, emergency dental work outside of hospital, glasses, prosthetic/orthotic devices and emergency ambulance service. These health costs are not covered by Manitoba Health, Insured Benefits (MHIB). Physiotherapy, occupational and speech therapy services provided to participants in such hospitals are covered by MHIB and is the responsibility of the hospital.

22.1.10 Personal Care Home Residents

Before authorizing health costs not covered by Manitoba Health for persons residing in personal care homes, the participant's personal account must be checked and any excess resources applied to the essential health need.

(See Section 18.3.3 Residential Care Facilities, Chronic Care Facilities, Community Residences And Personal Care Homes for EIA policy for status aboriginal persons off-reserve).

22.1.11 Rewarding Work Health Plan

Policy

Rewarding Work Health Plan (PDF 152 KB)

All EIA participants who have found employment and no longer require or are eligible for income assistance, may be eligible for up to 24 months of EIA prescription drug, dental and optical coverage under the Rewarding Work Health Plan (RWHP). The Provincial Services Branch of Family Services is responsible for the administration of eligible health benefits to individuals receiving the RWHP.

To be eligible for the RWHP, participants must

have employment income as defined by the program (i.e., income that is subject to earnings exemption) at the time the income assistance case closes. This would not include income like training allowances, employment insurance benefits and CPP benefits;
Have been enrolled on income assistance for three consecutive months under the single parent or persons with disabilities categories in order to receive this benefit for the first time.
Have been enrolled on income assistance for six consecutive months under the General Assistance case category in order to receive this benefit for the first time.
If these participant groups return to EIA and then secure other employment, there is no monthly income assistance enrolment prerequisite and these participants may immediately receive the RWHP upon EIA case closure.

The RWHP is not available to participants leaving EIA to employment who are eligible for First Nations Non-Insured Health Benefits (FNIHB). However, if some members of the household are not eligible for health coverage under FNIHB, the RWHP may be considered for eligible household members where other RWHP enrolment conditions have been met.

Eligibility for the RWHP is based on participants leaving income assistance due to/with employment earnings. There is no ongoing income test required while participants are receiving this benefit.

RWHP participants who move out of Manitoba must advise the Provincial Services Branch and they will no longer be eligible for prescription drug, dental or optical coverage.

Participants who become eligible for alternate supplementary health benefit coverage must also advise the Provincial Services Branch. These participants will be expected to use their new health benefit coverage first, but may be eligible for a supplement from RWHP up to coverage levels allowed by EIA.

RWHP coverage will end when participants have received the benefit for 24 consecutive months. Provincial Services will forward an advance letter to participants notifying of the pending RWHP expiry.

Participants receiving the RWHP are also eligible to receive Rent Assist, Manitoba Child Benefit, and 55Plus income supplements.

22.1.12 Drug Purchases - By Cash

To prevent claims to the provincial Pharmacare program, it is necessary for an EIA office to obtain the official Pharmacare receipt before reimbursing any income assistance participant for a cash purchase of prescription drugs. Field staff must call DPIN Help Desk staff at 204-786-8000 or 1-800-663-7774 to receive approval to provide a cash reimbursement to a participant.

There is no reimbursement of prescription amounts paid directly by persons receiving the Rewarding Work Health Plan.

22.1.13 Prescription Drugs - Control Procedures

The Health Services Program provides basic coverage for essential prescription drugs. Prescription drug abuse occurs when a participant receives drugs without a legitimate medical reason. Abuse also occurs where a participant obtains unnecessary or duplicate prescriptions. If this action is deliberate it may constitute an offence under the Criminal Code, Food and Drugs Act or the Narcotic Control Act.

When a case of suspected abuse is identified, it is handled as follows:

Employment and Income Assistance (EIA) is notified of suspected abuse by the Provincial Drug Program; or
EIA staff notify the Provincial Drug Program that they suspect the participant of abuse and request that a review is completed by the Provincial Drug Programs to verify the suspicion.
EIA staff interview the participant and present the Department's information and advise the participant of the implications of defrauding the EIA program. The Manager of Investigations may assist with the interview process.
The participant's explanation is obtained and documented in Case Notes on the EIA file.
If the explanation is satisfactory, no other steps need to be taken other than notification of the explanation to the Provincial Drug Program. If the explanation is not satisfactory, the EIA Director or designate may suspend automatic prescription drug authorization by the DPIN system.
The following procedures must be completed by EIA staff when suspending automatic prescription drug authorization:

The Provincial Drug Program is notified of the decision.
The participant is notified of the decision in writing.
The participant is advised they must select one general practitioner and one pharmacy for further drug purchases.
The Income Supplement Management Information Network (SAMIN) is updated so that future Health Services cards will not be automatically issued to the participant.
EIA will complete a bring-forward for one year to review the case to determine if automatic coverage should be reinstated.
The EIA Director or designate and the Manager of Investigations may decide to pursue prosecution following the review.

22.1.14 Chiropractic Treatment

Forms

Chiropractic Claim (PDF 41 KB)

Chiropractic Preauthorization (PDF 71 KB)

Assistance may be granted for chiropractic services above the maximum annual amount payable by Manitoba Health. Requests for treatment must be approved by the Chiropractic Review Panel. Chiropractors are supplied with forms which they send directly to the Chiropractic Review Panel at 102-114 Garry Street. The program may provide coverage at the applicable Manitoba Health rates and the Manitoba Health authorized range of services apply. Chiropractic x-rays are not covered by the program.

22.2.1 Physicians' Fees

Medical assessments or reports

Manitoba Health's Insured Benefits Branch does not insure the cost of medical assessments or reports required by a third party. Such costs may be paid by EIA where:

the medical examination is required to determine or review eligibility for income assistance under the disability category or,
a participant requires a driver's licence for medical or employment reasons, and must provide the Motor Vehicle Branch with a medical report to prove driving capability.

The Insured Benefits Branch establishes the payment rates according to the physician's area of specialty. In addition to the established payment rates, EIA may provide an additional $45.00, over and above this payment rate, to the physician for completing the EIA Disability Assessment Report. Rates may be obtained from the Supervisor, Physicians' Registry, Manitoba Health, at 204-786-7101. Nurse Practitioners, if in private practice, may be eligible to receive the additional amount of $45.00 payment for the completion of EIA Disability Assessment Reports.

Transfer of Medical Files

According to the Manitoba Medical Association (MMA), the charge for copying a patient medical records or file is at the discretion of the physician. As is the case with all uninsured services, financial hardship and ability to pay must be taken into account in the determination of what if any fee is to be charged, and is not provided for by EIA.

Tray Fees (also known as Uninsured Disposable Supplies)

Most diagnostic tests or minor procedures can be performed in a hospital facility or hospital clinic where the cost of the disposable supplies is covered through the hospital operating budget.

While the Employment and Income Assistance (EIA) Program will not compel participants who require tests or procedures of an elective nature to access these services through hospitals, staff are to encourage participants to have diagnostic tests and minor procedures performed at these facilities where neither the participant nor the EIA Program incurs costs.

If the participant still chooses that such tests or minor procedures be provided in a physician’s office, staff may approve tray fees (which are the supplies) up to the following rates: $18.00 for minor or $45.60 for major diagnostic tests or procedures.

Manitoba Health Insured Services provides the physician with payment for the examination and the cost of any diagnostic test or procedure performed during an office visit. According to the Manitoba Medical Association (MMA) the physician has the discretion to set the amount charged for disposable items and the only stipulation is that the disposable items must bear a direct relation to actual costs incurred. Patients can request a breakdown of the invoice to determine what service and/or supply would constitute the payment of the tray fee.

There may be circumstances that require special consideration which should be brought forward to the Program Specialists for review and/or approval.

22.2.2 Out - of - Province Medical Costs

Policy

Out of Province Medical Travel Requests (PDF 127 KB)

Employment and Income Assistance funds are not to be applied to any out-of-province medical costs. All such claims will be processed directly by the Out-of-Province Claim Department of Manitoba Health, Insured Benefits Branch.

22.2.3 Extra Billings from Physicians

Where a participant attends a physician who chooses to practice outside of the insured provincial program and charges fees in excess of the Manitoba Health, Insured Benefits negotiated schedule, no assistance shall be granted for resulting extra billings.

22.2.4 Out-Of-Province Medical Premiums for New Arrivals to Manitoba

Insured health benefits provided by Manitoba Health are available to new residents of the province after a 90-day waiting period. To assist new participants within the 90-day waiting period, the following procedures are applicable:

At intake, the applicant should be advised to register under the Manitoba Health, Insured Benefits plan, and the health plan registration number from the province of origin should be recorded.
A written statement of the premium status of the new arrival should be obtained from the province of origin.
Upon receipt of confirmation of coverage or notice of premium due, any costs may be granted to ensure that the applicant maintains province of origin health insurance benefits to completion of the 90-day waiting period.

22.3.1 Transportation - Health Reasons

Form

Medical Mileage Transportation (PDF 30 KB)

Schedule A, section 9 of the Regulation provides the authority to approve the cost of transportation to medical appointments.

An appointment card, medical lab requisition form or verbal confirmation from a clinic or medical office is required to issue transportation funds for single appointments, as well as recurring appointments where the cheapest mode of transportation available is being used. For recurring appointments where a more-expensive mode of treatment is needed for health reasons, a one-time note from a regulated health professional involved with the participant’s care is required. Authorized regulated health professionals include:

physicians,
registered dieticians,
psychologists,
registered physician assistants,
registered nurse practitioners,
registered psychiatric nurses,
licensed practical nurses,
registered nurses,
midwives,
registered Social Worker,
registered occupational therapist, and
mental health worker (non-regulated, must be directly involved in client care).

Other verification considered:

appointment card,
list of scheduled treatments, or
medical lab requisition form

Where participants require transportation to a medical centre, the following methods of transportation should be used in the order listed:

Public transportation (bus, train, or airplane) or participants own vehicle chargeable at the equivalent rate of the cheapest available public transportation;
If method 1 is not available, participant's own vehicle at:
North of 53rd parallel: 22 cents per km.
South of 53rd parallel: 20 cents per km.
If methods 1 and 2 are not available, a licensed carrier (taxicab) at approved prevailing rates.
If methods 1, 2 and 3 are not available, a privately-owned vehicle at the rates indicated above under point 2.

NOTE:

Privately-owned vehicles cannot be legally hired when a licensed carrier is available in the area.
The participant must hire and pay the owner of the privately-owned vehicle and submit receipts in order to be reimbursed by the EIA office. At no time should an EIA worker hire or pay the owner of the privately-owned vehicle directly.

The above priority list of methods of transportation may be altered at the discretion of the EIA director or designate in the following situations:

when the physical or mental condition of the participant makes it impossible to use public transportation (e.g., a person using a wheelchair, etc.);
when related expenses (those other than actual fares) such as meals, hotel, babysitting costs, etc., may result in higher total costs than incurred in using another form of transportation;
in emergency situations;
when groups of participants might be able to use taxis, private vehicles, etc., more economically than by individually using public transportation; and\or
when rural participants are not able to use an urban bus system.

Under normal circumstances, payment will be made to provide transportation only to the nearest centre where appropriate treatment facilities are available. Under exceptional circumstances, this provision may be waived at the discretion of the EIA director or designate (e.g., when the participant has a long-standing contact with a doctor other than one who is in practice at the nearest centre or when the participant has been referred to another doctor by a doctor who is in practice at the nearest centre). NOTE: When participants choose to attend a more distant medical centre where transportation costs are higher, they may do so and claim the lesser amount.

Approval of Costs for Medical Escorts

EIA may consider costs for health-related transportation and meals (where required) for medical escorts to enable participants to attend essential health/medical appointments providing these supports are not already paid for by Manitoba Health, Seniors and Active Living (MHSAL). These costs may be approved as a health need and in accordance with standing EIA health transportation and meals guidelines and rates (see Section 22.3.1 and 22.3.7). Accommodation-related costs (for both participants and medical escorts as required) may also be considered where physicians refer participants to essential medical treatment in another community and where travel distance or appointment time require an overnight stay.

Wherever possible, participants should seek out family or friends to act in this escort role. Where the assistance of family or friends is not an option and participants are required to access medical escort services provided by community-based health care providers, EIA will consider costs associated with the escorts’ transportation and meal-related costs/needs only. Hourly rates charged by medical escorts for their time will not be covered by EIA. Participants are responsible for these costs and may consider paying for them using their monthly Income Assistance for Persons with Disabilities (IAPD) benefit or other exempted sources of income.

The department may consider costs for medical escort meals (see Section 22.3.7) and accommodations for MHSAL-approved out-of-province medical treatment where a medical escort is also assessed as required to support participant needs. MHSAL is responsible for the to-and-from transportation costs of the medical escort in these instances.

Personal Care Home Residents

EIA may consider costs for health-related transportation and meals (where required) for both EIA personal care home residents and their medical escorts to attend essential health/medical appointments outside of the personal care home that are not paid for by MHSAL. These costs may be approved as a health need following standing EIA health transportation and travel meal guidelines and rates (see Section 22.3.1 and 22.3.7). However, hourly rates charged by medical escorts for their time will not be covered by EIA and are the responsibility of each participant.

Costs for medical escorts accompanying participants for trips to attend medical appointments occurring in hospitals are the responsibility of the personal care home as an insured health service providing residents are expected to return from these appointments to the personal care home within 24 hours.

Control of Possible Abuse

No account is to be forwarded for payment unless the participant has signed the account or the H Form to verify services provided. Periodically, random samples should be selected from the total caseload or from particular communities where there are high transportation costs and these samples should be reviewed for possible abuse.

22.3.2 Wheelchair Transportation - Medical and Related Activities

Policy

The coordination of the Rewarding Work Allowance and Employment Transportation for non-disabled and non-aged categories in areas where public transportation is not available (PDF 121 KB)

Paying Taxi Invoices - Wheelchair Transportation (PDF 130 KB)

Form

Taxi Invoice (PDF 140 KB)

Medical Appointments and Related Activities

EIA participants who require special wheelchair transportation for medical appointments and related activities (including hospital admissions and discharges, physiotherapy, occupational therapy, swimming lessons for therapeutic purposes, Alcoholics Anonymous meetings and group activities organized by Manitoba Possible), should use the following methods of transportation in the order listed:

Public transportation (e.g., Handi-Transit)

If Handi-Transit is available but the participant chooses to use his or her own vehicle or have a friend or a relative provide the transportation, reimbursement may be made, upon request, at the equivalent rate of the least costly available public transportation.
If method 1 is not available, the participant's own vehicle or a friend or relative's vehicle at:
North of 53rd parallel: 22 cents per km
South of 53rd parallel: 20 cents per km
If methods 1 and 2 are not available, commercial wheelchair transportation of the participant's choice at the prevailing rates.
NOTE: To verify currently licensed Commercial Wheelchair Transport Operators and their rates, contact:

Taxicab Board
Transportation and Government Services
206 - 301 Weston Street
Winnipeg, Manitoba R3E 3H4
Phone: 204-945-8919

Handi-Transit

For health related transportation, private wheelchair transportation should not be authorized unless the participant has first tried to book Handi-Transit.

Participants are required to maximize their use of Handi-Transit in the following ways:

Handi-Transit should be booked at least 3 - 7 days in advance when participants have prior notice of an appointment or event.
Participants should schedule medical appointments for times Handi-Transit is available.
Private wheelchair transportation for medical appointments should be authorized one-way only if Handi-Transit is available for the remainder of the trip.

Standing orders with private wheelchair transportation companies may be issued to participants who have regular medical appointments at times when Handi-Transit is not likely to be available. These orders should be issued to the transportation firm in writing for specific days and destinations and should be reviewed at least every three months. Participants with standing orders are still expected to try to book Handi-Transit for these trips.

22.3.3 Emergency Health Transportation

Emergencies may require that indigent persons be transported to health care facilities using special transportation.

Northern Manitoba

North of the 53rd parallel on the west side of Lake Winnipeg and north of the 51st parallel on the east side of Lake Winnipeg, such transportation may be subsidized by the Northern Patient Transportation Program (NPTP) of Manitoba Health, Emergency Services Branch.

Transportation may be categorized as elective, urgent or emergency. Transportation is provided by the most care-effective, cost-efficient mode as defined by medical authority.

Southern Manitoba

South of the noted northern boundaries of the NPTP, the following applies in determining financial responsibility for emergency health transportation:

A person unable to pay for emergency health transportation can seek assistance from the EIA office serving the area. Any person not deemed in need by the EIA authority must assume responsibility for the cost of emergency health transportation.

22.3.4 Wheelchair Transportation - Social Activities

Persons using wheelchairs are eligible for up to 24 pre-authorized wheelchair transportation trips per year for social activities (e.g., shopping, religious services, sporting events, visiting). The director or designate may waive this maximum in exceptional circumstances. Beyond this provision, transportation costs for social activities are the responsibility of the participant. Participants should be advised to use the least expensive form of transportation possible.

Social Trips - Winnipeg and Brandon Only

Eligible participants residing in Winnipeg and Brandon should be provided with "chits" which will provide the pre-authorization for 24 social trips per year. As each return social trip requires two chits, 48 chits should be provided to cover the period between April 1 and March 31. Participants who are eligible for wheelchair transportation provisions and who enrol after April 1st of each year should be provided with a pro-rated number of chits based on two social trips per month until March 31st. Chits may be used only for transportation services provided by private licensed carriers within Winnipeg and Brandon.

Participants may also use public transportation (e.g., Handi-Transit) for social trips. EIA offices should forward the appropriate number of bus tickets to these participants to ensure they receive up to 24 social trips (48 tickets) per year.

Social Trips - Outside of Winnipeg and Brandon

Participants residing outside of Winnipeg and Brandon are eligible for up to 24 wheelchair transportation trips per year for social activities. Although no restrictions should be placed on when these trips can be used, participants are required to contact their EIA office for authorization prior to each social trip.

In recognition of the greater distances in rural areas, clients may use wheelchair chits for travel to social activities that are located up to 75 km from their place of residence. To meet unique client needs, supervisors may approve trips in excess of this distance at their discretion.

22.3.5 City of Winnipeg Ambulance Department

HS certificate holders may obtain direct service from the City of Winnipeg Ambulance Department without prior authorization from EIA office staff. The Ambulance Department submits block billings directly to HS for service provided.

In cases where a non-valid certificate, or no certificate, is produced by the participant, the Ambulance Department will send the bill directly to the participant who will be required to submit the bill to the EIA office for payment.

22.3.6 Transportation to Evaluation Training Centres

The marketAbilities Program (formerly VRS) assumes financial responsibility for all transportation costs associated with attendance at Evaluation Training Centres.

22.3.7 Traveling Meal Allowances

Where approved as a health need, the maximum traveling meal allowance for rural participants seeking treatment away from their home communities is $17.20 per person per day in the south, and $18.90 per person per day in the north.

Where only one or two meals are required, the following allowances may be provided per person per meal:

Breakfast	$3.60	$4.00
Lunch	$5.30	$5.80
Dinner	$8.30	$9.10

When a participant is away from home and receiving a meal allowance for five days or more per month, the other budgeted food allowance would normally be decreased for all meals provided away from home. The EIA director and designate have discretion to modify or waive this requirement, if circumstances warrant. The budget will be adjusted if the participant is away for 30 days or more unless special circumstances warrant consideration. The EIA director or designate may vary this requirement and document the circumstances on file.

22.3.8 Inter-Municipal Livery Rates

Under authority of the Manitoba Motor Transport Board, Inter-Municipal Livery (ground travel) rates effective July 1, 2008 are as follows:

Round Trip

The toll for a round trip is $1.25 per kilometre ($2.00 per mile) from the point of commencement of the trip to its destination outside the City of Winnipeg and back to the point of commencement.

One-way Trip

The toll for a one-way trip is $2.11 per kilometre ($3.38 per mile) from the point of commencement of a trip to its destination outside the City of Winnipeg.

Waiting Time

The toll for waiting time shall not exceed $25.00 per hour and shall be chargeable at the rate of $6.25 for each period of 15 minutes or part thereof.

These rates include all taxes and apply to all inter-municipal livery operators in Manitoba who are licensed under The Taxicab Act and/or The Highway Traffic Act and shall not be exceeded by EIA payment.

22.3.9 Telephones for Health and Safety Reasons

Schedule A, section 9 of the Regulation provides the authority to approve the costs associated with maintaining a telephone for health reasons.

Approval must be based either on the acceptable written recommendation of a;

physicians,
registered dieticians,
psychologists,
registered physician assistants,
registered nurse practitioners,
registered psychiatric nurses,
licensed practical nurses,
registered nurses,
midwives,
registered Social Worker,
registered occupational therapist, and
mental health worker (non-regulated, must be directly involved in client care), or
on the written approval of the EIA director or designate.

In the case of the former, the recommendation must support the need for a telephone by clearly indicating that the participant or applicant will be at risk without a telephone.

The EIA director or designate may provide approval where:

the need is sufficiently obvious as not to require a health professional's recommendation as there are compelling reasons to indicate a phone is necessary for the applicant's or participant's health and safety;
the health professional's recommendation is not sufficiently clear on the need for a phone but additional knowledge of the case supports the need; or
the health professional does not recommend the phone but knowledge of the case provides compelling reasons (related to health) to support the need.

22.4.1 Medical Supplies and Equipment

Policies

Adult Incontinence Supply Guidelines (PDF 117 KB)

Changes to the provision of customized seating for wheelchairs (PDF 111 KB)

Communication Devices Program - Rental Fees for EIA Participants (PDF 123 KB)

MedicAlert Bracelets and Hearing Aids (PDF 103 KB)

Provision of Wheelchairs - Administrative Process (PDF 199 KB)

Transitioning of Consumable (Supply) Orders for CDS Clients Turning 18 (PDF 167 KB)

Form

Assistive Technology (PDF 48 KB)

Grab Bar and Transfer Pole Installation (PDF 233 KB)

Medical Equipment Request and Justification (PDF 193 KB)

Medical Supplies Request and Justification (PDF 633 KB)

In Manitoba, the Regional Health Authorities (RHA) have operational responsibility for the Home Care Program including planning, delivery and ongoing management of the services. Home Care services may include personal care assistance, home support, health care, family relief, respite care, medical supplies and equipment, and adult day programs. These services are provided by the RHA's, other contracted health care professionals such as the Victorian Order of Nurses, Community Therapy Services and other service providers.

The Home Care Program provides a base list of medical supplies and equipment available across the province. In Winnipeg, additions to this list would include electric beds, electric Hoyer lifts and ceiling track systems (up to 12 feet). The Home Care Program is responsible for providing the medical equipment and supplies to individuals who have an open Home Care file. For new medical equipment and supply requests, confirmation of eligibility may be determined by contacting the appropriate RHA.

With respect to equipment and supplies, please note the following:

RHA staff will assess equipment and supplies needs for EIA participants who are receiving services from the Home Care Program and arrange for their provision.
Where the equipment is not covered by the Home Care Program, i.e. walkers, raised toilet seats, bath bars, urinals and bedpans, Disability and Health Supports Unit may approve the purchase of such items based on the recommendation of a medical professional.
For EIA participants who are not receiving services from the Home Care Program, Disability and Health Supports Unit would reference the standard base Home Care list as a guide to approve the purchase of medical supplies or equipment.
Disability and Health Supports Unit, are to forward all approved orders for medical equipment and supplies to the Materials Distribution Agency (MDA), a special operating agency of Manitoba Government Services. All orders should be made using the appropriate and approved administrative forms and sent to:

Materials Distribution Agency (MDA)
7 - 1715 St. James Street
Winnipeg, Manitoba R3H 1H3
Main Phone: 204-945-8605
Customer Service: 1-800-561-8313
Equipment Returns: 1-877-632-7867
Fax: 204-945-5077
Medical supplies and equipment not immediately available will be secured by MDA through agreements with relevant health equipment/supply vendors.
Where EIA is approached by Home Care, a participant or advocate to share the cost of a major health related expenditure, the request must be forwarded to the Manager - Disability and Health Supports Unit for approval, regardless of the cost of the item to be purchased.
Hospital discharges must not be delayed when the necessary equipment and supplies required at the time of discharge are not in stock at MDA, or if adequate discharge planning time is not available. In these instances, MDA will secure the required equipment and supplies from the first available vendor for the immediate use of the participant being discharged.

Specialized Supplies and Equipment

Ostomy Supplies

The Winnipeg Regional Health Authority (WRHA) administers the Manitoba Ostomy Program for all Manitobans. Retroactive to April 1, 2004, there will no longer be a co-payment for the participants who use the program. The management and delivery of these ostomy supplies is the responsibility of the WRHA.

Wheelchairs

Wheelchairs requested for EIA participants living in the community are provided through the Manitoba Possible – Manitoba Wheelchair Program (MWP).

All Manitobans living in personal care homes or other institutions are responsible for obtaining their own wheelchair, unless they have been loaned a wheelchair from the MWPat least six months before entering the institution. If individuals were loaned a wheelchair prior to entering the institution, they may continue to use and have it serviced by the MWP. In situations where EIA participants living in personal care homes or institutions require a wheelchair, the EIA program may consider funding the basic and essential wheelchair equipment through the MWP.

The MWP manages the equipment pool of wheelchairs provided by either MWP or purchased by the Department for eligible EIA participants. When participants no longer require their wheelchair, they, or EIA staff are to contact MWP at the below to co-ordinate the return of the wheelchair to the MWP equipment pool.

Manitoba Possible – Wheelchair Services

1857 Notre Dame Avenue

Winnipeg MB, R3E 3E7

Tel: (204) 975-3250; Toll-Free: 1-800-836-5551;
TTY: 1:800-856-7934; TTY: (204) 975-3239

Fax: (204) 975-3240

Wheelchair Repairs

EIA will pay for basic and essential repairs and maintenance on wheelchairs that have been purchased by EIA. EIA does not pay for repairs and maintenance on a spare wheelchair that a participant may have. The MWP is responsible for the cost of repair and maintenance on equipment they own.

Temporary Mobility Equipment

EIA participants with a temporary medical condition requiring a wheelchair may be provided with a short-term, category 1 (i.e. manual) wheelchair rental. A Medical Equipment Request and Justification Form must be submitted to the Disability and Health Supports Unit (DHSU) by a regulated health professional indicating the medical need. The request must indicate why basic crutches or canes are not appropriate and the mobility need can only be met via a wheelchair. Rental costs can be approved as a health need. Initial wheelchair approval periods should be for up to three months only. Extensions to this period may be considered where circumstances warrant, but the overall rental term should not exceed six months.

Wheelchair Seating Components

Wheelchair seating components are provided for individuals for whom postural support is identified as a basic and essential need to enable safe and effective use of a wheelchair. All wheelchair seating request must be submitted to the Disability and Health Supports Unit (DHSU) via a Wheelchair Seating Component Request and Justification Form completed by an Occupational Therapist (OT) or Physiotherapist (PT) licensed to practice in Manitoba. In order to qualify for wheelchair seating, confirmation of a permanent mobility base (wheelchair) is required.

Quantity and Frequency Limits

The DHSU provides funding for one seating system per client
Seating components may be replaced if:

a. changes in the client’s anatomical measurements support the size change
b. there are significant changes to the functional, postural or medical status of the client
c. there is significant wear of the current seating system that places the client at risk
Seating components will not be replaced:

a. if the current seating is assessed as continuing to meet client’s postural and functional need
b. to accommodate client’s preference
c. if the items are lost or stolen.

Wheelchair Elevators, Lifts and Ramps

Manitoba Housing’s Residential Adaptation Program for Disabilities (RAD) provides funding for wheelchair ramps and modifications to low-income Manitobans, including persons on EIA. This includes low-income renters if landlords are willing to engage in the partnership. The Disability and Health Supports Unit may assist with the costs of lifts and ramps if no other options are available, such as securing alternate wheelchair-accessible housing in the community.

EIA does not provide funds for scooters

Manitoba Health does not supply these items:

Manitoba Home Oxygen Therapy Program

Participants must meet eligibility criteria for acceptance in the program as assessed by a provincially designated physician. Oxygen concentrators and accessories are provided through the Home Care Program.

The standard for ongoing provision of equipment necessitates blood gas testing after three months and yearly thereafter. Testing can be arranged through a physician who forwards the results to the Home Care Coordinator.

Portable Oxygen Cylinders and Carts

Although not covered by the Home Care Program, small portable oxygen cylinders and carts are available for rental or purchase through oxygen suppliers. The oxygen portion of this cost can be claimed through Pharmacare.

Prosthetic and Orthotic Devices

Devices of this nature are normally covered as an insured service under The Health Services Insurance Act and its Regulations, and are not available through the Materials Distribution Agency.

Breast Prostheses, Elastic Stockings, and Hearing Aids

The Disability and Health Supports Unit will deal directly with the appropriate supplier.

Request Procedure for Emergencies

Following the receipt of the required Medical Authorization, the Disability and Health Supports Unit will determine if an emergency exists. Where an emergency is deemed to exist, the DHSU will contact the Materials Distribution Agency (MDA) to provide the required item(s). Where MDA does not have the required item(s) in stock, it will secure the required item from the first available vendor for the immediate use of the participant.

Eligibility

Eligibility under EIA should be determined, prior to ordering.

Continuous Positive Airway Pressure (CPAP) Machines and Related Consumables/Supplies

Health, Seniors and Active Living (HSAL) charges a $500.00 co-payment fee to all eligible patients requiring new, or replacement CPAP machines as prescribed by the Misericordia Health Centre’s Sleep Disorder Clinic (SDC). HSAL pays CPAP machine costs over the $500 co-payment fee, but only for eligible patients diagnosed with Obstructive Sleep Apnea (OSA). The co-payment fee also includes a year’s supply of common CPAP consumables including masks, filters, humidifier chambers, hoses, and other specific accessories as prescribed by the SDC.   Patients are responsible for all CPAP-related consumable and delivery costs once the initial co-payment supplies are exhausted.

The CPAP machine co-payment requirement is not waived for EIA participants and may be provided as a health need where eligibility criteria are met.   Requests for single grants to meet the CPAP co-payment costs by Manitobans who are not financially eligible for income assistance are not to be considered.

The Disability and Health Supports Unit is responsible for the review and approval of CPAP prescription from the SDC for EIA participants as well as the administration of CPAP-related co-payment and ongoing consumable requirements for EIA participants found eligible for CPAP coverage.

22.4.2 Supplies and Services - Personal Care Home Residents

It is the responsibility of personal care homes to provide the following supplies and services to residents:

Personal Consumption Items

Minor mending of clothes (e.g., seam repairs, replacing buttons, etc.)
General laundering of clothing
Prescribed drugs and over-the-counter preparations approved by Manitoba Health
Food, including special and therapeutic diets, dietary supplies, thickeners and nutritional supplements.
Supplies required for general personal hygiene (e.g., soap, perineal cleanser, barrier products, shampoo, denture cups, toothettes) excluding over-the-counter products approved by an alternate provincial drug program.

Medical Supplies

Diabetic supplies
Medical nursing supplies (e.g., wound managements supplies and dressings, compression dressings, venous ulcer treatments, catheters, needles, syringes, diagnostic and testing materials, ostomy supplies and tube feeding supplies)
Disinfectant and antiseptic preparations
Incontinent care aids (as determined by individual resident PCH assessment)

Medical Equipment (note: for use by, or transferrable to, more than one resident)

Overhead trapeze bars
Mechanical lifts and slings sliders
Transfer belts
Basic walkers and crutches for short-term use
Therapeutic and pressure-reducing mattresses
Raised toilet seats
Commodes
Restraint devices
Transport wheelchairs
Oxygen, regulators and oxygen concentrators
Fall mats
Bed and chair alarm systems

Needs not provided by personal care homes and which are the responsibility of the individual include:

Personal Consumption Items

Major repairs and alterations to clothing
Purchasing and labelling of clothing
Dry cleaning of clothing and other privately-owned items such as rugs, drapes, bedspreads and blankets
Alcoholic beverages and tobacco products
Cosmetics and deodorants
Hairdressing and haircuts

Medical Equipment (for individual use)

Support hose
Hearing aids and batteries
Dentures and denture adhesives
Eyeglasses
The following items when they are purchases solely for one resident's use and remain the property of that resident: canes; walkers; crutches; wheelchairs and wheelchair repairs; pressure cushions; slings for mechanical lifts; specialized seating; and, transfer poles.
Repair and preventative maintenance cost associated with equipment owned by the individual

Medical Supplies (for individual use)

Incontinent care aids when the resident prefers a brand that is different from those care aids provided by the personal care home
Non-prescription biologics and related preparations such as skin care powders, lotions, creams, ointments, jells, cleansers, throat lozenges and non-prescription eye drops and when the resident prefers a biologic brand that is different than what is provided by the personal care home
Portable oxygen for outings other than approved recreation programs.

Other Personal Health-Related Services

Services performed by a chiropodist or podiatrist
Services performed by a chiropractor that are not covered by Manitoba Health Services
Acupuncture
Television and radio services
Insurance for personal belongings
Transportation costs when not covered as an insured benefit
Transportation and meal costs for medical escorts accompanying participants to essential medical appointments when not covered as an insured benefit by Manitoba Health, Seniors and Active Living.

22.4.3 Chiropody, Podiatry, Foot Care Services, Orthopaedic Footwear and Foot Orthotics

Policy

Orthopaedic Footwear and Foot Orthotics (PDF 294 KB)

Form

Orthotics Preauthorization / Claim (PDF 106 KB)

Podiatry, Chiropody or Foot Care Services

Podiatry, chiropody or foot care services are not an insured health service by Manitoba Health. As permitted under Schedule A, section 9 of the Regulation the parameters of the policy are as follows:

Approval of podiatry or chiropody and foot care services will only be authorized when:

Information from the physician or other health practitioner indicates that foot care service is essential in the management of the medical condition; or
Staff determine that information provided on the medical assessment form supports that foot care service is an essential health need in the management of the medical condition.

When one of the above criterion is met, staff can approve foot care services:

At a rate up to $32.00 each visit; and
To a maximum of nine visits per fiscal year.

In exceptional circumstances where the participant cannot attend a medical clinic due to mobility restrictions, the director or designate may approve to a maximum of $40.00 for a home visit. All other requests for payment not described in this policy must be referred to the Program Specialist for review and consideration.

Orthopaedic Footwear and Foot Orthotics

EIA participants who have a medical need that requires orthopaedic footwear or modifications to footwear are eligible for assistance with the cost of these items.

To receive benefits, participants submit their prescription, which must include a diagnosis by a physician, podiatrist, nurse practitioner or physician assistant, to Health Services – Orthotic Program. Participants can also see a service provider, indicate they are receiving income assistance and present their Health Services card if they have one. Service providers will work directly with Health Services staff to coordinate benefits. Service providers are aware of the products, services and fees covered.

If participants or service providers need more information, they are to contact Health Services – Orthotic Program staff directly.

Field staff should not authorize orthopaedic footwear or foot orthotic benefits.

Health Services – Orthotic Program

Provincial Services

102 – 114 Garry Street

Winnipeg, MB R3C 1G1

Telephone (Winnipeg): (204) 948 – 3666

Toll-free: 1 (877) 587 – 6224

Fax: (204) 945 – 3930

Email: provservic@gov.mb.ca

22.4.4 (deleted)

22.4.5 Radioisotope Material for Nuclear Medicine Examinations

Nuclear medicine examinations are paid for by Manitoba Health as an insured benefit. However, the radioisotope material used in the examination does not form part of the insured service, therefore, the cost of such materials must be borne by the patient. The payment of account due to materials used is in turn a claimable item under the Health Services program.

22.4.6 Hearing Aids

Form

Hearing Preapproval (PDF 63 KB)

For EIA participants of any age, the actual cost of hearing aids and related services will be paid according to the schedule of rates negotiated with the Hearing Aid Dealers Association of Manitoba listed below.

The type of hearing aid approved for payment should be consistent with the recommendation of the audiologist or otolaryngologist. For example, if the audiologist recommends that a participant receive a digital/programmable hearing aid, then the costs for this type of hearing aid should be covered to the maximums prescribed (see hearing aid rates payable for rate maximums).

Staff must not direct participants to any particular agency or dealer for the purchase of hearing aids. The choice of dealer must be left entirely to the participant with Family Services meeting the cost in accordance with the negotiated agreement.

Hearing aid services to children under 18 years, not in receipt of income assistance are insured services through the Hearing Aid Program with Manitoba Health, to view the specifics of this program please view the Manitoba Health Internet site address:

www.gov.mb.ca/health/mhsip/hearingaid.html

Any person applying for "single grant" assistance from EIA because of the need for a child's hearing aid should be advised of the insured service, which should be considered when calculating any possible eligibility for such a single grant.

Hearing Aid Rates Payable

The maximum amounts to be paid for hearing aids are the usual and customary prices up to the amounts listed when provided by a licensed hearing aid dealer. (These rates, negotiated with the Hearing Aid Dealers Association of Manitoba, are effective April 1, 1999):

hearing aid: landed invoice cost to a maximum of $500.00 per hearing aid; $1,800 per digital/programmable hearing aid
dispensing fee: $250.00 (in the case of binaural hearing aids the dispensing fee for the second hearing aid is $150.00)
taking ear impressions: $20.00
ear mould: landed invoice cost to a maximum of $48.00 per ear mould (includes checking the fit and efficacy of the ear mould)
hearing examination, if requested by an audiologist or otolaryngologist
air and bone conduction audiogram: $7.45

speech tests (including air and bone): $11.80

supra threshold test: add $1.80
impedance audiometry: $14.85
hearing aid selection if requested by an audiologist or otolaryngologist (includes testing and recommendation for amplification, electroacoustical modification, etc.)
monaural: $14.85

binaural: $22.40
hearing aid orientation visit (includes instructions on the proper use and maintenance of the hearing aid, adapting to amplification and the provision of informational brochures and other printed material): $14.85
follow-up visits for fitting checks, etc. (up to two visits per hearing aid within 90 days of purchase of hearing aid): $7.45 per visit per hearing aid
validation testing where appropriate sound field test equipment or other accepted means are available: $29.85
electroacoustic test

monaural:	$14.85
binaural:	$28.75

Regular servicing and cleaning, instrument warranty, the provision of a suitable hearing aid while a hearing aid is away for repair, and CROS or by-CROS aids are included in the amounts set out above.

These rates are the same as those used by Manitoba Health in its subsidization of services provided by licensed hearing aid dealers to children under 18 years of age.

Replacement of Hearing Aid

One device is allowed per ear every four years, unless there is a medically diagnosed change in the participant's condition.

22.4.7 Family Support Program

In Winnipeg, the Family Support Program operated by the Family Centre of Winnipeg, provides supports to families through child care, respite services, parental guidance, and household assistance to families that are in crisis, where special needs exist, or where a family member is ill or has a disability. For participants who may require family support services in Winnipeg, referrals should be made directly to the Family Support Program, which will assess the need for services and the length of service required. Approval for the provision of services is not required from the Department of Family Services. The Family Centre of Winnipeg provides services through a service purchase agreement with Child and Family Services.

The Family Support Program may be contacted at 204-947-1401 (Fax 204-947-2128).

22.4.8 Winter Boots

EIA participants can receive assistance for the cost of winter boots if required for a medical condition. Approval will be based on the written recommendation of a health care professional. The recommendation must include a diagnosis of the participant’s condition as it relates to the need for winter boots.

For participants in receipt of custom orthotics, custom orthopaedic footwear and/or custom modifications to footwear, requests for winter boots must be referred to Health Services – Orthotic Program for review.

For participants not in receipt of custom orthotics, custom orthopaedic footwear and/or custom modifications to footwear who have a medical condition that requires winter boots, field staff can approve and issue up to $100.00 to assist with the cost of winter boots required for a medical condition. The replacement guideline is one approval every three years unless the winter boot is beyond repair, or is no longer suitable due to growth or a change in medical condition.

22.4.9 Supports for Participants Enrolled in an Approved Program to Address Addictions

Policy

Payment of Unlicensed Child Care (PDF 138 KB)

The Employment and Income Assistance (EIA) program recognizes that addictions often negatively impact a person's life by infringing on the person's own well-being, and that of his/her family, and by limiting full participation in society, including, restricting a person's ability to obtain and retain employment. EIA supports and encourages a participant's desire and efforts to address or reduce the harm from an addiction.

Accordingly, the following policy outlines the supports available to EIA participants when the participant, a service provider, and EIA are in agreement with a rehabilitation plan to address concerns related to an addiction. The supports available are sensitive to the varying needs of differing participant groups, and the different types of programs available.

Single Parents and Persons with Disabilities

Residential Programs

When the participant is enrolled in, and is attending a residential program, the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 3 months:

shelter costs: - to maintain stable accommodations for the family. If the accommodations are a contributing factor to the addiction, and the participant expresses a desire to move, storage and moving costs would be provided instead of shelter costs. Both shelter and moving costs may be required where other members of the household remain in the community (children, and/or the spouse of a person with a disability) pending the return of the person from the residential program;
basic needs/residential fee: - where required, (and not otherwise covered) in accordance with EIA's established per diem for the service provider. The personal allowance is also payable to or on behalf of the participant in the residential facility. Basic needs are payable for family members remaining in the community;
child care costs: - where required, without the participant contributing the $1.00 per day. The approval should take into consideration the availability of family member(s)/friend(s), subsidized care and private care;
transportation: - where required, to enter and return from the residential program, and any transportation costs required while in attendance at the program, in accordance with the most reasonably priced and appropriate means of transportation. In some cases these costs may be covered by the service provider or another program or agency (for example Manitoba Health).

Day Programs

When the participant is enrolled in and is attending a day program (day programs are usually all day, daily sessions) the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 3 months:

child care costs: - where required, without the participant contributing the first $1.00 per day. The approval should take into consideration the availability of family member(s)/friend(s), subsidized care and private care;
transportation: - to and from the program, in accordance with the most reasonably priced and appropriate means of transportation.

Self-Help Groups

When the participant is participating in a self-help group or a community based program (not usually daily, or all day) the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 6 months:

child care costs: - where required, without the participant contributing the first $1.00 per day. The approval should take into consideration the availability of family member(s)/friend(s), subsidized care and private care;
transportation: - where it is not practical or feasible for the participant to attend a group within close proximity to his/her home, or where required for medical reasons, in accordance with the most reasonably priced and appropriate means of transportation.

A participant may require the supports from all three types of programs over the course of time.

No sanctions will apply for a single parent or a person with a disability if he/she chooses not to participate in a program respecting addictions.

General Assistance Participants

Residential Programs

shelter costs: - to maintain stable accommodations for a family with children, if the accommodations are not a contributing factor to the addiction, in which case moving costs may be approved. Shelter costs may also be approved for a childless couple and a single person, if the living arrangement is stable and not a contributing factor to the addiction;
basic needs/residential fee: - where required, (and not otherwise covered) in accordance with EIA's established per diem for the service provider. The personal allowance is also payable to or on behalf of the participant in the residential facility. Basic needs are payable for family members remaining in the community;
child care costs: - the spouse would normally provide child care, unless he/she is in treatment, employed or otherwise unable to provide the care, in which case costs may be approved without the participant contributing the $1.00 per day;
transportation: - where required, to enter and return from the residential program, and any transportation costs required while in attendance at the program, in accordance with the most reasonably priced and appropriate means of transportation. In some cases these costs may be covered by the service provider or another program or agency (for example Manitoba Health).

Day Programs

child care costs: - the spouse would normally provide child care, unless he/she is in treatment, employed or otherwise unable to provide the care, in which case costs may be approved without the participant contributing the $1.00 per day;
transportation: - to and from the program, in accordance with the most reasonably priced and appropriate means of transportation.

Self-Help Groups

child care costs: - the spouse would normally provide child care, unless he/she is in treatment, employed or otherwise unable to provide the care, in which case costs may be approved without the participant contributing the $1.00 per day;
transportation: - where it is not practical or feasible for the participant to attend a group within close proximity of his/her home, in accordance with the most reasonably priced and appropriate means of transportation.

A participant may require the supports from all three types of programs over the course of time.

In some situations, the rehabilitation plan may be a step to independence as outlined in the action plan developed by the participant and the Case Coordinator or Counsellor. In these situations, where employment expectations apply, participation in the approved rehabilitation plan should be considered as meeting the expectation of the action plan. Should the participant fail to follow through with the program she/he is subject to the same sanctions as any other participant who fails to meet her/his employment expectations. When considering imposing sanctions to promote participation, consideration should be given to the reasons why the participant may have failed to meet her/his obligation. Staff should consult with the service provider, where possible, to ensure that the participant has been given every opportunity to comply. If sanctions are imposed, all policies relating to imposing sanctions apply, including denying benefits and reducing the budget.

All Participant Groups

Requests for funding for expenses other than those identified above, including extending the specified timeframes, must be reviewed with the Director, for his/her approval or that of his/her designate.

Circumstances under which the Director or designate may extend transportation benefits for self-help groups beyond the established timeframes may include, but are not limited to:

treatment appropriate for an individual’s needs not available in local community;
participant’s privacy is in jeopardy as a result of the location of the group;
participants’ sponsor or other support unable to attend programming in the participant’s local area; and
participant is experiencing a crisis that is impacting on the progress of his or her recovery.

The Director or Designate may approve extensions for storage fees beyond the established three-month timeframe for residential programs that are longer than three months, provided that storage is the most economical and appropriate option for a participant.

Approval should be based on confirmation of the participant's attendance. It is acknowledged that in some cases with self-help programs, such confirmation may not be available. All approved costs should be coded using the appropriate SAMIN health needs codes.

Methadone Maintenance Treatment

Methadone Maintenance Treatment (MMT) is a harm reduction protocol for individuals dependent on opiates. Participants who stabilize in MMT programs can earn methadone carrying privileges or "carries". A carry is a participant’s dosage of methadone dispensed to them in advance so they do not have to attend the clinic or pharmacy for a supervised dose.

Employment and Income Assistance will provide supports for MMT until a participant is granted carrying privileges that reduce the number of visits to the clinic or pharmacy to once per week to a maximum of eight months.

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air and bone conduction audiogram:	$7.45
speech tests (including air and bone):	$11.80
supra threshold test:	add $1.80