ODSP and hearing aids: Ministry responds

In yesterday's blog post, I presented complaints about the Ontario Disability Support Program's two quote policy, which both audiologists and some patients are calling unfair. Here is what the Ministry of Community and Social Services had to say:

Q: The Minister indicated in a letter to OSLA that there is no two quote policy unless the original cost is deemed unreasonable. Yet audiologists and patients I've interviewed say it does. In one case, a disabled man in Petawawa is being forced to travel return 100 k at his own expense to get a second quote. He is very agitated about having to lose his audiologist of 13 years.

A: For clarity, the Minister indicated in this letter that there was no change in the policy. The policy has always provided caseworkers with the authority to request a second quote, where it was considered necessary.

Clients may not be required to obtain two quotes in every circumstance, for example, where;

- Emergency and weekend repairs are needed (also exempt from prior authorization requirement)

- limited number of vendors in a geographical area

- using another vendor would void the warranty on a device

- repair costs are reasonable and or minor in nature

- addressing the specialized accommodation needs of a client (eg. client requiring the services of an audiologist with sign language expertise)

- device is a high technology mobility device as Shoppers Home Care is the vendor for Centralized Equipment Pool (CEP) mobility devices

* (list is not exhaustive)

The ministry has been in contact with the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA). The intent of the discussion was to reach an understanding of the issue from both sides and come away with a mutual appreciation of the challenges each party faces with respect to this matter. The ministry also provided further information to the OSLA that offered additional insight into the measures being taken to improve customer service for ODSP clients while continuing to be accountable to the taxpayers of Ontario. The discussion was positive and ended with an agreement that the ministry will work collaboratively with the OSLA.

Q: What is considered an unreasonable cost? Are there guidelines that audiologists/clinics can follow to ensure they operate within the guidelines?

A: At this time, there are no fee guidelines set out in the ODSP policy, however, options are currently being explored by the ministry to address both service and costs associated with the delivery of the Hearing Aid policy to ODSP clients.

Q: What is the appeal process? One caregiver was told by her MPP that "the rules are the rules".

ODSP clients have the right to request an internal review of any decision that affects their eligibility for or the amount of income support that they receive. This includes whether they are granted or denied a hearing aid benefit. Once an internal review decision has been rendered, clients who disagree with the result may appeal to the Social Benefits Tribunal.

Q: What is the Ministry's position on the fact that disabled Ontarians are refused the right to choose their caregivers, that privacy laws are being breached and caseworkers are choosing health providers for patients?

A: Clients may obtain quotes from any vendor, including their preferred vendors. While there is an importance placed on ensuring value for money, cost is not the only consideration when a quote is approved. In order to make sure that we are meeting ODSP clients’ needs while still being accountable to taxpayers, Caseworkers will review both quotes based on a number of factors, including the client's circumstances and individual needs. If the client needs a better model, this may be approved over a lower priced/inferior hearing device. In some cases, it may be necessary to follow up with vendors for an explanation of the quote.

To ensure fairness and protect the privacy of individuals in the 2 quote process, each quote should be provided independently. Caseworkers have been directed that the 1st quote should not be shared with the 2nd vendor. Further, Caseworkers have been advised that they must not forward a quote that includes a client's health information which was provided to a health professional as this violates the Personal Health Information Privacy and Access Act (PHIPA).

Q: How does the ODSP compensate audiology clinics for spending time in performing their own test and the HAE for the purpose of providing a quote? Does the ODSP reimburse the first clinic if their quote is not successful or let them know why they have not been selected?

Local ODSP offices may pay the costs if a fee is charged to obtain a second quote for hearing or mobility devices or for a test/assessment related to obtaining a second quote.

Under ODSP, the Hearing Aid benefit will cover:

· the portion of the cost for a hearing aid/appliance not covered by ADP

· the cost of the dispensing fee when it is not covered by ADP, based on the dispensing fee rate approved and listed by ADP

· the cost of a hearing test if the person does not have access to an appropriately qualified physician(hearing tests are covered by OHIP when performed or supervised by appropriately qualified physicians or administered by qualified persons they employ, including audiologists)

· the cost of the hearing aid evaluation (or re-evaluation if one is necessary) is not covered by OHIP and can be covered by ODSP if it is not covered under another resource (a hearing aid evaluation is necessary to determine the most suitable hearing aid where a hearing aid or hearing appliance is recommended)

Only the selected vendor is contacted. Audiology clinics should contact their local ODSP office to discuss reimbursement.

How does the ODSP evaluate the quote if an audiologist quotes for more expensive hearing devices if they determine that is what is needed to meet the patient's needs? I'm thinking pocket talkers or FMs or digital versus analog? Isn't this comparing apples and oranges?

There are a range of hearing devices and the decision regarding the appropriate make and model of hearing device for the client must be left up to the ADP registered authorizer, as they have the required expertise to make such a determination.

While there is an importance placed on ensuring value for money, cost is not the only consideration when a quote is approved. In order to make sure that we are meeting ODSP clients’ needs while still being accountable to taxpayers, ODSP caseworkers will review both quotes based on a number of factors, including the client's circumstances and individual needs.

If the client needs a better model, this may be approved over a lower priced/inferior hearing device.Each situation is reviewed on its own merits and in some cases, it may be necessary to follow up with vendors for an explanation of the quote.

Q: Also, do you know how many clients the CSS serves in terms of hearing loss patients who need rehabilitation services and devices?

In fiscal year 2011-12, there were about 8,000 ODSP cases in receipt of the hearing aids/batteries. It’s important to note that our database cannot separate the number individuals in receipt of hearing aids devices, or individuals who have received funding for repairs or replacement batteries. The number above is a combined total of the number of individuals who have received funding for hearing aids devices, repairs or replacement batteries.