Introduction to this manual

Department of Indian Affairs and Northern Development Eligible Items
General Principle
Specified eligible items are provided to all non-status recipients and non-status dependants and children who are eligible for Medical Services Plan (MSP) coverage. Status Indians receive health benefits through the Medical Services Branch of Health Canada. For more information, visit the Health Canada web site at unity health representative or community health nurse. Note: This list is provided only as a general guide and is not to be considered all
inclusive. When in doubt regarding the eligibility for coverage of specific equipment and supplies, contact your Funding Services Officer for clarification. Hospital Insurance
Hospital insurance benefits in general hospitals for acute care may be provided. Payments for coinsurance charges, emergency services, and hospital charges for minor surgery may also be considered as part of the health care services. Benefits within the terms of MSP may be provided. Prescription Drugs
Eligible prescription drugs that are listed by PharmaCare. Prescription drugs shall be paid for directly by the administering authority. Recipients are responsible for having their physician apply to PharmaCare for a Special Authority for any non-covered prescription drugs. Social Development Policy and Procedures Manual Vol.1 (362816 v4) Non-drugs
With limitations on type, certain non-drugs prescribed by a qualified
medical practitioner may be provided where authorized. The
prescribed non-drugs include the items in the following paragraphs
of this section:
• Surgical supplies for chronic conditions if the amount required
is not large nor ongoing, nor in the nature of first aid supplies. • Surgical appliances that are personally applied to the body and
are not transferable. These include braces, prostheses and orthopedic shoes, including the cost of alterations, adjustments and repairs to the shoes, splints, elastic stockings, support devices, including trusses and surgical corsets, and ileostomy and colostomy supplies. • Wheelchairs or crutches may be provided.
• Hearing aids may be approved at the discretion of the Funding
Services Officer upon the recommendation of a medical specialist. Necessary repairs and batteries may also be provided with the approval of the Funding Services Officer. Private Hospital
Provision may be made for private hospital staff to order approved drugs and surgical supplies from the provincial pharmacy for patients in approved or licensed private hospitals who have an MSP card authorized by the administering authority. Other Health Benefits
The Funding Services Officer may authorize payment for necessary health benefits, other than those listed, to eligible recipients. Life-saving Situations In a life-saving or similar extreme medical situation where no other
resources are available, the administering authority may authorize payment for a recipient or for an indigent person to be transported to a hospital for medical treatment. Medical Exam
When necessary, a physician will be reimbursed for the cost of an examination of a recipient when such an examination is done at the request of the department to determine employability, provided the person cannot pay for the examination and the physician would not otherwise be reimbursed. Emergency
Prescription drugs may be supplied in emergency circumstances to Prescription Drugs
a recipient who is not otherwise eligible for health care benefits through the department. Each authorization form issued by the administering authority in such situations will be for a single supply of the drug prescribed for the patient. Tuberculosis
Payments for transportation for a person requiring hospitalization in an institution for tuberculosis may be provided if the person is indigent, whether in receipt of income assistance or not. Transportation to
Where an individual requires assistance for costs of transportation to Mental Health Facility
a mental health facility for the purpose of admission, such travel expenses may be authorized by the local administering authority. Chapter 10, Non-Status Health and Benefits (362816 v4) Supplies and Equipment
When prescribed by a licensed practitioner, consideration may be given to provision of the following medical supplies, equipment, supplies, and devices: Bandages and
Dressings (Medical
Supplies)
• protectors When such supplies are required on an ongoing basis, a public health nurse or other health care professional should be consulted regarding the monthly quantity requested. Bathroom Aids
(Medical Equipment
and Devices)
Includes a maximum of two hours installation time. Installation time beyond two hours is considered a home renovation and requires an alternate source of funding. Beds and Specialized
Only those items available through a medical supply company (e.g., Mattresses (Medical
hospital beds, flotation system) may be provided. Any other type of Equipment)
mattress or bed, including a waterbed, cannot be considered to be a medical item, and requires an alternate source of funding. Bowel Stimulants -
Medicated (Medical
Supplies)
Braces (Orthotics)
(Including parts and repairs) as long as the item or repair is not a Pharmacare benefit. Breast Pumps
(Medical Equipment)
Burn Treatment
Garments
Breathing Aids
(Medical Equipment
and Devices)
Catheters (Medical
Supplies)
Chapter 10, Non-Status Health and Benefits (362816 v4) Contraceptive Devices For contraception lubrication and disease prevention (including
and Supplies (Medical
male and female condoms). A prescription from a physician is not Supplies)
required for condoms. This does not include oral contraceptives, which are provided under the provisions of MSP. The Norplant birth control devices is not a benefit of MSP. Note: Birth control clinics may offer supplies at reduced prices. Diabetic Supplies and • glucometers (testing machine)
Equipment (Medical
Equipment/Supplies)
• sharp containers for needle disposal Electrotherapy
• basic TENS unit (costs should not exceed $250) (Medical Equipment)
Hearing Aid Supplies
Incontinent Supplies
(Medical Supplies)
Lumbar Supports
(Medical Equipment
and Devices)
Mobility Aids
Orthotics
Positioning Devices
Prostheses, Repairs,
Supplies and services may be considered if they are not a benefit and Adjustments
Rubber Gloves
(Medical Supplies)
When required as part of urinary or incontinence care by either the client or a non-employed caregiver. Scabicides,
Pediculicides
Chapter 10, Non-Status Health and Benefits (362816 v4) Scooter, Scooter
A scooter may be considered as a primary mobility device for an Repairs (Medical
eligible client not capable of basic mobility. Additional accessories Equipment)
may include a cane holder, a handi-dart kit, and one shopping basket, but not rear mirrors, red flags, light packages, sheepskins, or scooter totes. Shower Aids (Medical
Equipment and
Devices)
Stockings (Medical
Elastic, off-the-shelf obtained through a medical supplier. Supplies)
Urinary Drainage
(Medical Supplies)
Wheelchair Repairs
All medical equipment is purchased with a two-year, all-inclusive (Medical Equipment
warranty. Do not approve repairs during the warranty period. If and Devices)
uncertain, consult with your Funding Services Officer. Chapter 10, Non-Status Health and Benefits (362816 v4) Procedures

Eligibility
• Health Benefits Request & Authorization (SA 205) • Detailed prescription by a medical physician • Budget and Decision Form (901-25) • Social Development Financial and Statistical Report Recipients must provide a written prescription and diagnosis from a physician. If the cost is more than $200 but less than $500, the recipient must provide at least two estimates. Details of the exceptional medical need and the financial assessment are to be recorded on the client’s file. See Chapter 10.10, Non-eligible Items to determine if the requested medical supplies are an eligible item, and ensure the requested item does not fall under other policy. Funding services officer should be contacted if unsure about this policy. Health Benefits Request & Authorization (SA 205)
Requests for medical supplies and equipment shall be made with a Health Benefits Request & Authorization (SA 205) form, which is to be completed as follows: 1) The band social development worker (BSDW) shall complete Section A: Client Information before providing the form to the client. 2) The client shall provide the form to the medical physician, who shall complete Section B: Service Information before returning the form to the client. 3) The client shall provide the form to the BSDW, who shall complete Section C: Recommendation information before authorizing service. 4) The BSDW or the funding services officer (FSO) shall complete Section D:
Authorization – amounts up to $500 are to be authorized by the BSDW, and amounts exceeding $500 are to be authorized by the FSO). All required documentation (i.e., invoices, lab slips, and/or prescriptions) are to be attached to the form. The BSDW shall date-stamp the Health Benefits Request & Authorization (SA 205) form and accompanying documentation at the time they were received. This will ensure time lines are maintained. Note: Claims must be submitted within one year of the date of service.
Chapter 10, Non-Status Health and Benefits (362816 v4) The BSDW must verify satisfactory provision of services to the patient before paying the supplier. Payment must never be made directly to the client. Budget and Decision Form (901-25)
The Budget and Decision Form (901-25) is to document the expenditure of the approved medical supplies and equipment for the client as follows: • Comment section – indicate “Health Benefit (Non-Status)”, • Basic Needs section – amount of expenditure, • Temporary Allowance section – month in which the expenditure is paid, and • Signatures of both the recipient and administering authority. All required documentation (i.e., invoices, lab slips, and/or prescriptions) are to be attached to the form. Health benefits allowances are charged to the basic needs budget.
Social Development Financial and Statistical Report
The administering authority is to include the number of people and expenditures on the monthly Social Development Financial and Statistical Report (SDFSR) under the Health Benefits (Non-Status) section (see the BC First Nations Program Guide). Chapter 10, Non-Status Health and Benefits (362816 v4) Chapter 10, Non-Status Health and Benefits (362816 v4)

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