Health Care Equipment and Supplies

Effective March 3, 2008,the WSIB requirespurchases of approved health care equipment and supplies on behalf of workers to be made from one of the WSIB’s three preferred suppliers: Medical Mart, Motion Specialties, andShoppers HomeHealthCare.

Health care equipment and suppliesare items used as a treatment or functional aid during the worker’s recovery, or to improve or maintain their independent living. This includes items such as canes, crutches, back rests and supports, walkers, and Transcutaneous Electrical Nerve Stimulator (TENS) units.

We have developed twoOperational Policies to support this initiative. Additional details, including cases where health care equipment and supplies can be purchased from a non-preferred supplier on an exceptional basis, are contained in this Q & A.

• 17-01-07 Preferred Supplier of Health Care Products/Services
• 17-07-06 Health Care Equipment and Supplies

Please direct general inquiries about this initiative to our dedicated toll-free hotline at 1-877-434-3443. It will be in operation Monday through Friday from 8:30 a.m. to 4:30 p.m.

Calls regarding specific claims issues should be directed to the adjudicator or nurse case manager assigned to your claim. If you do not know who is assigned to the claim, call the our toll-free general inquiry line at 1-800-387-0750 and have the name and claim number of the worker handy.

We have developed a separate Q & A about this initiative for suppliers.

• Walkers (e.g. standard folding, rollator)
• Canes, Crutches and Accessories
• Bathroom Equipment (e.g. tub stools, bath benches, commodes, toilet seats, grab bars, handrails)
• Reaching Aids
• TENS / NMES and Supplies (e.g. electrodes, lead wires, conductive gel, lotion, adhesive tape)
• Rental of Walkers, Standard Commodes or TENS

Off-the Shelf* Supports

• Abdominal Supports (e.g. abdominal binder)
• Ankle Supports (e.g. soft support or neoprene sleeve)
• Cervical Supports (e.g. cervical pillow, soft foam collar)
• Elbow Supports (e.g. elbow sleeve, splint)
• Foot Orthotics (e.g. thermal or gel insoles, rigid arch support insoles)
• Hand Supports (e.g. soft support, metacarpal splint)
• Knee Supports (e.g. soft support or neoprene sleeve for knee)
• Leg Supports (e.g. shin support, splint)
• Shoulder Supports (e.g. sling, shoulder immobilizer, splint)
• Torso Supports (e.g. lumbar supports, lumbosacral or dorsolumbar)
• Wrist Supports (e.g. soft support, neoprene)
  

*Over the counter does not include products that require customization.
Medical Supplies

• Catheters (all types – e.g. Foley, indwelling, external, intermittent)
• Incontinence Supplies (e.g. incontinence pads, tubing, urinary protective underwear)
• Ostomy Supplies
• Pressurized Stockings
• Skin Care Supplies (e.g. moisturizer or skin cream, ointment, vinyl gloves)
• Tensor Bandages
• Urinary Supplies (e.g. leg bag, cleaning products, drainage bag)
• Wound Care Supplies (e.g. adhesive remover, adhesive tape, disinfectant, dressing, gauze, skin prep, sponges)

Q&A for Health Care Equipment and Supplies initiative

Q-1: What items are included in this initiative?

A: Items covered under this initiative include walkers, crutches, off-the-shelf back supports and orthotics, bandages, and catheters. For a more detailed list, please see the Health Care Practitioners Page on our website at www.wsib.on.ca.

Prescription medication and custom-made orthotics are not included as part of this initiative and injured workers will still require local expertise to meet these needs.

Q-2: How are injured workers being informed about this initiative?

A: In November 2007, the WSIB mailed letters to all workers who had received health care equipment and supplies over the past year. The letter informed them that beginning on March 3, 2008 the WSIB will require all approved purchases of health care equipment and supplies to be made from one of its three preferred suppliers: Medical Mart, Motion Specialties and Shoppers HomeHealthCare.

A second letter was sent out by the WSIB in March 2008 to injured workers, reminding them of the effective date of this new requirement. As in the first letter, workers were encouraged to visit the WSIB’s website for more information, or call a toll-free number (1-877-434-3443) that has been established for this initiative.

Q-3: What if a storefront location for one of the preferred suppliers is not located near a worker's home or the worker is unable to go to the storefront location?

A: All three preferred suppliers offer home delivery for workers who are unable to access a storefront location. This option is available to all injured workers, including those who live in a remote area or who are unable to travel.

WSIB staff can provide contact information and product details for each of the preferred suppliers and can assist in finding the nearest storefront location.

Q-4: What happens if the injured worker is not at home to receive the next day home delivery?

A: All of the preferred suppliers use the same delivery service standards for the area, which means that the worker would have a choice of options.

If a worker is not available for the courier delivery, the worker can call the courier company to reschedule the delivery for a suitable time. If the delivery is made by Canada Post, then the worker may go to the local post office for pick up (as they would with any other Canada Post deliveries).

The worker can also elect to have the package left at the door

Q-5: How can workers ensure that their purchase of health care equipment and supplies will be covered by the WSIB?

A:According to Operational Policies 17-01-07 Preferred Supplier of Health Care Products/Servicesand 17-07-06 Health Care Equipment and Supplies,workers will be covered by the WSIB for purchases of health care equipment and supplies when entitlement exists and when purchased from a preferred supplier. Only on an exceptional basis will workers be reimbursed for purchases made from non-preferred suppliers.

Whenever possible, prior to making a purchase of health care equipment and supplies, injured workers should contact their adjudicators or nurse case managers to ensure compliance with these policies.

Q-6: Can you provide some examples of when payment of health care equipment and supplies to non-preferred suppliers can be made on an exception basis?

A:Examples of exceptions include:

• Purchases that are made prior to the allowance of a WSIB claim, or before they were made aware of the requirement to purchase from one of the three preferred suppliers
• Instances when there is an urgent need by a worker for a product that has either broken or is out of stock from a preferred supplier
• If a product is not available through the preferred suppliers and a suitable substitute product is not available
• If a worker does not have a preferred supplier in close proximity and must travel to select a cane for the first time
• Purchases that are made for Out-of-Province claims.

Any questions regarding exceptions should be discussed with the adjudicator or nurse case manager prior to purchase. If you do not know who is assigned to the claim, call 1-800-387-0750 and provide the claim number.

Q-7: What if a worker requires health care equipment or supplies through treatment received at a hospital or clinic. Would this qualify as an exception?

A:Yes,this represents an exception and would be a situation when the WSIB would consider a payment to a non-preferred supplier. Examples include:

• A worker who is treated through a hospital emergency room and is discharged with equipment or supplies provided by a hospital, or
• A worker who is an in-patient at a fracture clinic

The WSIB would notauthorize a payment to a non-preferred supplier that is located within a hospital, such as an independent pharmacy or health care store.

Q-8: Will there be any change in the approval process before health care equipment and supplies are purchased?

A:No.Before purchasing any health care equipment and supplies, workers require a prescription and muststill get approval from the WSIB for:

• the health care equipment/supplies
• the cost, and
• the supplier/provider.