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Alberta Aids to Daily Living (AADL) Primary Module B
General Policies and ProceduresPart 1
AADL General Policies and Procedures
Overview
Alberta Aids to Daily Living (AADL) Overview
Purpose:
• To provide an overview of the AADL program
• To provide information on the various AADL stakeholders, benefits, forms, processes and resources
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Alberta Aids to Daily Living (AADL) Overview
What is Alberta Aids to Daily Living?
The AADL program helps Albertans with long-term disability, chronic illness or terminal illness to maintain their independence in their residence and community by providing financial assistance to purchase medical equipment and supplies.
Alberta Aids to Daily Living (AADL) Overview
• All residents of Alberta with valid Alberta Health Care coverage are eligible
• AADL is a cost-sharing program
• Benefit year is from July 1 to June 30
AADL General Policies and Procedures
Stakeholders
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Stakeholders
There are three mainstakeholders involved in the AADL program.
Clients and their
representatives
Authorizers and
Specialty Assessors
Vendors and Specialty Suppliers
Stakeholders
Authorizer
• A health care professional who assesses a client's medical needs and eligibility for AADL benefits.
Vendor
• A business with an agreement with AADL to provide medical equipment and/or supplies to AADL clients.
Stakeholders
Specialty Assessor• A health care professional that is employed by a
Specialty Supplier.• Assess a client’s medical needs and eligibility for
AADL benefits
Specialty Supplier• A business with an agreement with AADL to provide
medical equipment and/or supplies to AADL clients.• Employs Specialty Assessors
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Stakeholders
Authorizer/Vendor
Client assessed by Authorizer
Client selects Vendor
Vendor provides benefit to Client
Vendor invoices AADL and Client
Specialty Supplier
Client selects Specialty Supplier
Client is assessed by a Specialty Assessor
Specialty Supplier provides benefit to Client
Specialty Supplier invoices AADL and Client
AADL General Policies and Procedures
General Eligibility Criteria
General Eligibility Criteria
Permanent resident of
Alberta
Valid Alberta Personal Health Number (PHN)
Authorization completed by an
Authorizer or Specialty Supplier
Sign the client declaration form
Authorization validated by
AADL
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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General Eligibility Criteria
Home Living
Independent Living
Eligible for all AADL benefits
Assisted/Supportive Living (1&2)
Seniors lodges, retirement
communities, personal care homes
Eligible for all AADL benefits
General Eligibility Criteria
Supportive Living levels 3 & 4
SL3, SL4 and SL4D
- Eligible for ostomy and incontinence supplies, walkers,
wheelchairs & compression garments
- Not eligible for bathing/toileting aids, beds, overlays, bed rails, lifters or
transfer pole aids
Long Term Care
Includes nursing homes, auxiliary and extended care
- Eligible for walkers, wheelchairs, compression
garments
- Not eligible for bathing/toileting aids, beds, overlays, bed rails,
lifters, transfer pole aids, ostomy or incontinence supplies.
AADL General Policies and Procedures
Benefit Overview
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Benefit Overview
• Primary product ranges assigned based on discipline– Included as part of today’s training
• Secondary product ranges requires separate application– Require specialized clinical skills
– Must already be an AADL Authorizer
– Criteria is listed in benefit specific manuals
Benefit OverviewPrimary Product Ranges
Occupational Therapists and Physiotherapists– Pediatric equipment
– Soft Supports
– Bathing and Toileting equipment (small)
– Walking aids
– Bathing and Toileting equipment (large)
– Transfer Aids and Overlays
– Homecare Beds and Lifters
Benefit OverviewPrimary Product Ranges
Registered Nurses– Ostomy
– Incontinence
– Catheters
– Soft supports
– Bathing & toileting equipment (small)
– Homecare beds and lifters
– Transfer aids and overlays
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Benefit OverviewSecondary Product Ranges
• Burn garments – OT, PT, RN
• Compression garments – OT, PT, RN
• Incontinence supplies – OT, PT
• Seating – OT, PT
• Speech generating communication devices –SLP, OT
• Wheelchairs – Manual and Power – OTs and PTs
Benefit Overview
Mobility & large equipment
Medical and surgical benefits
Hearing and augmentative
communication
Prosthetics, orthotics,
seating and footwear
Respiratory
Benefit Overview
Mobility and Large Equipment
Manual and Power
wheelchairs
Bathing and Toileting Aids
Wheelchair Accessories
Pediatric equipment
Patient lifters Walking AidsHomecare beds
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Benefit Overview
Medical and Surgical
Incontinence supplies
Ostomy Supplies
Compression garments
Soft supports
Burn garments
Breast prostheses &
Syringes
Benefit Overview
Hearing and Augmentative Communication
Hearing AidsAugmentative
speech & communication
Laryngectomy supplies
Benefit Overview
Prosthetics, Orthotics, Seating and Footwear
Prosthetics
Seating
Orthotics
Footwear
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Benefit Overview
Respiratory
Oxygen VentilatorsBPAP
Tracheostomy tubes
Suction & humidity therapy
Resuscitator & bagging
units
Benefit Overview
• Each benefit area has Policies and Procedures, and Approved Product Lists (APLs) .
• Only benefits listed on the Approved Product Lists are funded by AADL.
• Benefits have a maximum quantity, frequency, and price.
• Each benefit area have benefit clerks and a program manager.
AADL General Policies and Procedures
Authorizer Roles and Responsibilities
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Authorizer Roles and Responsibilities
Advocate
Role
Authorizer
Role
Authorizer Roles and Responsibilities
As an authorizer, you are accountable for the authorizations submitted to AADL and must:
1. Comply with AADL policies and procedures
2. Confirm client’s meet all eligibility criteria prior to authorizing benefits
3. Ensure the authorization form is accurate and complete
4. Advise AADL when you change facilities, name or no longer require authorizer status
Authorizer Roles and Responsibilities
Authorizers must not:
1. Profit from the sale or supply of benefits to clients
2. Discriminate or intentionally malign a vendor
3. Authorize benefits for themselves, family or friends
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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AADL General Policies and Procedures
Forms and Processes
Forms and Processes
Most commonly used forms for authorizing:
• General Authorization form (1250)
• Authorization form for wheelchairs (1251)
• Correction and Change form
• Cost-Share Exemption
• Temporary Cost-Share Exemption
• Quantity and Frequency Review (QFR) Request
Forms and Processes
Go to Datagroup.com and registerto obtain Authorization forms, Correction and Change forms, Brochures and AADL return envelopes.
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Forms and Processes
Authorization form (1250)
• Used for all benefits except wheelchairs
• Documents the assessment and authorize benefits
Forms and Processes
Wheelchair Authorization form (1251)
• Only used for manual and power wheelchairs
Forms and Processes
Authorization Correction and Change form
• Used for adding, deleting, changing benefits or extending authorizations
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Forms and Processes
Some benefits require additional documentation. These may include (but are not limited to):
• Wheelchair Adult-Tilt-in-Space Request form
• Manual Wheelchair Specification forms
• Assessment Summary for Incontinence Products
• Lower Leg Assessment Form
• Assessment Summary for Bathlift Benefit
Refer to the benefit manual to determine if additional forms are required.
Forms and Processes
Cost-Share • Clients are required to pay 25% of the approved
benefit amount up to a maximum of $500 per family per benefit year
• Benefit year is July 1 – June 30
• Respiratory is cost share exempt
• Prosthetics, Orthotics, Breast Prostheses and Ocular are cost share exempt for clients over 65 and their dependents
Forms and Processes
There are several ways a client can qualify for Cost-Share Exemption:
• Cost-Share Exemption
• Temporary Cost-Share Exemption
• Cost-share Appeal
• Hearing Aid Benefit Cost-Share Exemption
• Reached the yearly $500 maximum
• AISH
• Income Support Program
• Alberta Adult Health Benefits
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
14
Forms and Processes
Cost-Share Exemption• Explain cost-share policy to
client
• Provide client with cost-share exemption form– $20,970 or less for single coverage
– $33,240 or less for a family with no children
– $39,250 or less for a family with children
Forms and Processes
Temporary Cost-Share Exemption• Have experienced
significant income reduction for at least three months
• If client has not filed income tax return in past year
Forms and Processes
Complaints• AADL has a formal complaint process
• Submitted by:– Complaint form
– Letter
– Telephone
• Anyone can submit a complaint
• Cannot be anonymous
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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AADL General Policies and Procedures
Quantity and Frequency Review Process
Quantity and Frequency Review
Quantity and Frequency Review (QFR) Requests are submitted when a client’s clinical needs have changed
Quantity and Frequency Review
All Quantity and Frequency (QFR) requests require the following:
• An assessment identifying clinical need
• Rationale explaining why the existing benefit no longer meets the client’s clinical needs
• General and benefit specific eligibility criteria must be met
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
16
Quantity and Frequency Review
Request meets QFR criteria
Advise the client of the QFR
process
Complete and fax the QFR form and supporting documentation
Quantity and Frequency Review
QFR Approved
Complete authorization
form
QFR Denied
May appeal to QFR Appeal
Committee
Quantity and Frequency Review
Submit QFR Appeal to the
Director
If approved, submit
authorization
If denied, pursue
alternate funding
QFR Appeal to the Director Process
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
17
AADL General Policies and Procedures
AADL Resources
Interactive Voice Response
The Interactive Voice Response (IVR) is an automated telephone system that allows authorizers to check:
• Client’s cost-share status
• Benefits the client has received
• Status of an authorization
Interactive Voice Response
How to enter letters
Authorizer number NR123
N = 62
R = 73
62 73 123
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Brochures
General Brochure
• AADL benefits
• Client eligibility requirements
• Where to get equipment and supplies
• How to access AADL benefits
• Cost-share and how to apply for Cost-Share Exemption
• Contact Information
Website
• https://www.alberta.ca/alberta-aids-to-daily-living.aspx
• Policy and Procedures
• Program Manuals
• Vendor Lists
• Forms
• Bulletins
• Contact list for AADL staff
AADL has an e-mail subscription to receive notices of updates to the AADL website.
Questions?
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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Alberta Aids to Daily Living Program10th Floor, Milner Building10040 104 StreetEdmonton, Alberta T5J 0Z2
TelephoneEdmonton and area: 780-427-0731Toll-free in Alberta: 310-0000, then 780-427-0731
Deaf/hearing impaired callers within Alberta using a TTY can reach the provincial government by dialing 780-427-9999 in Edmonton or 1-800-232-7215 throughout Alberta.
Fax: 780-422-0968
https://www.alberta.ca/alberta-aids-to-daily-living.aspx
© 2019 Government of Alberta
Alberta Health - Pharmaceutical and Supplementary Benefits Alberta Aids to Daily Living Module B, Part 1 - General Policies and Procedures
© 2019 Government of Alberta Revised March 2019
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