QUESTIONS AND ANSWERS High Intensity Needs Fund Program Updated December 2, 2010 1. Q: Is there a toll-free line? A: The Central HINF Team can be reached both by the free number: 1-877-353-HINF (4463) as well the email address: highintensityneeds@ontario.ca 2. Q: For residents with multiple HINF categories e.g. food and wound supplies, the form only has one line for assessors name and one line for date. What if assessment happens at different times? Also, can one resident have more that one open claim? A. A resident can only have one workbook for each quarterly reporting period. The rule is one claim per resident. All categories can be claimed on one workbook. For the assessors, no date is requested only the names and titles of assessors. There is room for many names and titles of assessors if required. 3. Q: Identification based on a RAI number is difficult to track. Can a new ID system be implemented: A. Identification by RAI number is necessary in order to maintain residents privacy, as per the law. We understand this is cumbersome and we understand it creates a bit more work if a resident leaves and then comes back, but at this time, without an automated system to assist us, it s the best we can do while maintaining PHI. 4. Do you need to submit a new form when you have already obtained a pre-approval? A. THE SAME FORM CAN BE USED. Simply change line 15 to Approval for Payment. Check that the name on the bottom of the form states who pre-approved the claim, and re-send. 5. Q: How do we avoid forms being sent back regarding information required regarding wound care surfaces? A. Claims must indicate that it is a surface not a mattress. Therapeutic surfaces are covered under HINF while mattresses are covered by the resident s nursing and personal care. The Central HINF team is accountable to ensure that information is 1
documented correctly, just as homes are accountable for ensuring that they are submitting information correctly. Also, please check the Quick Reference, How-To Guide for instructions on what information is required for each category. ***Please note: all surfaces require pre-approval regardless of cost. 6. Q: Do we need to separate wages and benefits in 1:1 staffing claims? A. No there is no reason to separate wages and benefits. 7. Q: Can we obtain preapproval for end of life cases prior to or after submitting the correct form? A. If it is urgent, the Central HINF Team can be called (1-877-353-HINF (4463)), and will approve it as long as paperwork follows within 24 hours. Please note that the Central HINF team requires the workbook to follow, even if the approval is verbal. SAO managers should NOT be called; the Central HINF team should be called. All Preapprovals must be done prior to the use of the product. 8. Q: Submitting ostomy supplies once per year is difficult to track; it would be easier if submission could be quarterly. A. The ADP grants are paid to the homes 2x/yr so by doing the process annually, the full amount has been received by the home. It provides better tracking for HINF. 8. Q: If equipment (INCLUDING IV EQUIPMENT) or a surface has been purchased for a resident through the HINF, and the resident moves to another nursing home, what happens to that equipment or surface? A: All surfaces and equipment including IV equipment that is purchased through the HINF is purchased for the resident, not the home. Therefore, any piece of equipment or surface purchased for the resident through HINF stays with the resident and would be transferred with that resident to another home. HINF does not cover equipment purchased while in the hospital. We strongly encourage homes to explain as many details as possible in the description of need field, in order to help the Central HINF team understand the claim. 9. Q: Some homes have commented that the lack of feedback as to why items are denied is confusing. 2
A: The Central HINF team is very diligent about describing why a HINF claim was sent back. If the answer is not clear, the home can always call the Central HINF line. Additionally, a lot of claims are sent back because of slight deviations in the subject line of the email. We need the subject line accurate because this is what allows Outlook to sort the emails into the correct inbox by LHIN for the Central HINF Team. If the subject line is not filled out in the exact format description as per the manual, this will cause delays in homes reimbursement. 10. Q: Why is the approval signature from the MOHLTC not always being included in the approval back to the home? A: If this has happened, it was an oversight on our part. The signature field should be filled in. 11. Q: Batched reimbursement makes it difficult for homes to reconcile, and there is not feedback as to which items are not being reimburses. Can you provide more details when reimbursing, and not batch them? A: Once the Central HINF Team approves the individual claims, they get put on a spreadsheet and are signed by a Director. The claims then go to the Ministry s Financial Management Branch (FMB). FMB has internal processes they must follow that are Ministry-wide, and that includes batching reimbursements. We do not have the ability to influence how FMB makes its payments. 12. Q: If a product is no longer needed but has been purchased in bulk, what should a home do? A. If the item is something that could be put aside for the next resident that might need it, it can be claimed for the next resident. If that can t happen, we will accept claims for the rest of the order provided it is not excessive and that an explanation is given in the description of needs. It is expected, though that this product would then be used for another resident who would meet the criteria for HINF. If more of a particular product is needed, just make another claim for the product for that resident. 13. Q: How do we know if our application has been received? A. All approved workbooks are returned to the homes as their record as to what they will be reimbursed for. Homes can also send their claims with a read receipt message which will indicated when the email has been opened. This is a simple setting in your email program. 3
14. Q: Will the Ministry continue to fund Dri-Flow products that are used in conjunction with wound care surfaces? A: Although this has been a practice in the past, the Ministry will no longer be supporting the costs of Dri-Flow products used in conjunction with surfaces to treat/prevent pressure ulcers effective March 31, 2010. These items are not included or referenced in the HINF Policy Manual. These products are used in place of continence products, and thus should not be funded from the HINF. Please do not include the cost of these items when claiming for reimbursement of surfaces after March 31, 2010. 15. Q: What is the process for completing the new Workbook? A: The entire process for completing the HINF Workbook can be found in the Quick Reference How-To Guide for the High Intensity Needs fund quarterly Workbook, Version 2.1. This guide outlines general and detailed instructions for completing both the HINF Notification Form and the HINF Claim Form. As outlined in the Guide, one Notification Form and one Claim Form are to be used for each resident on the HINF Program. These forms are to be submitted to the Ministry on a quarterly basis. 16. Q: After October 1, 2009 how will the ET s assessment be put into the HINF Notification Form? A: It is the LTCH staff responsibility to request approval for HINF funding. When a resident assessment is completed by an external clinician, LTCH staff must enter relevant information from the assessment into the designated area on the HINF Notification Form. 17. Q: Where is a cost benefit analysis done and what is required? A: Cost benefit analysis is explained in Section 4.3 on page 23 in the HINF Manual. While there is not a required formal process, it should be completed by the LTCH in order to estimate savings and time frame for the equipment to pay for itself. There may be a need for the equipment to be used by more than one resident with similar conditions or care needs in order to justify the cost effectiveness of the purchase. 18. Q: How does one enter a credit on the new system? A: Enter the appropriate information on the HINF Summary form, then enter a negative dollar amount (e.g. - 600) and the workbook will automatically calculate the credit. See Section 2 on page 36 of the HINF User Guide 19. Q: Is it acceptable to submit claims on a cash basis rather than an accrual basis? A: The claims must be submitted on an accrual basis. For example, if a resident needs transportation for dialysis today (October 2), it is an October expense, and should be set up and submitted as an expense for October, regardless of when it is paid. 4
20. Q: Do we need a pre-approval for every surface or for all wound care supplies? A: As per Section 4.3 (page 23) in the HINF Manual, only equipment or surfaces over $2000 will require pre-approval. This includes the total purchase cost of a rent- to - own surface. If wound products meet the wound care requirements in Section 3.5 of your HINF Manual, they do not need pre-approval and will be deemed eligible for reimbursement. 21. Q: Can you explain further the $100 threshold? Does the home pay the first $100? A: A $100 threshold (or minimum) is being applied to wound care costs (excluding assessments) for eligible residents as outlined in Section 3.5 of the HINF Manual. Many products such as bandages, cleansers, dressing trays and topical medications should continue to be purchased from the Levels of Care per diem. Where specialized supplies and equipment for wound care treatment of an eligible resident exceeds $100 per month, then the total cost of the claim or full amount is eligible for reimbursement. If the cost for an individual resident does not exceed a total of $100 per resident per month, then the ministry s per diem funding is expected to cover these costs. For example, if the total cost for one resident for one month was $75, this resident s wound costs would not be eligible, but if the total cost for that eligible resident for the month was $250, then the full amount of $250 would be paid, since it is over the $100 threshold. Note: Charging a resident for wound care costs that are less than $100 and so not eligible for funding under the HINF is not permitted. These costs are to be managed by the home and not transferred to the resident. 22. Q: The new wound timelines indicate 3 months with an additional 3 months only if the wound is actively healing. What happens with the nonhealing and palliative wounds? A: While the wound timelines are not new to this manual or to the High Intensity Needs funding, it is recognized that there are some types of wounds that may not heal. This type of wound will require discussion with the Central HINF Team and the LTCH care team. The Central HINF Team will then make a decision on a case-by-case basis regarding whether or not the case qualifies as an exception. 23. Q. When are protective supplies funded under the HINF program? A: Personal Protective Supplies (PPE) are standard issue and should be covered by the homes regular operating costs. When an official outbreak is declared by Public Health, then the HINF would cover supplies required to implement additional precautions, over and above basic routine practices. 5
For example, if the home staff regularly uses gloves to bathe residents, then even in an outbreak those would not be covered since they are basic routine practices. However if the resident required extra gloves due to his being affected by the organism that is causing the outbreak, then those extra supplies would be covered. 24. Q: If Supplementary Staffing (1:1), has been approved for 72 hours and these hours have been used over a 3-4 week period, when is a weekly update needed?. A: As stated in Section 3.12 (page 20), in the HINF Manual, weekly reports must be received by the Central HINF Team if Supplementary Staffing is required beyond a period of two weeks. 25. Q: Is there a qualifying number for oxygen saturation in order for it to be eligible for funding? A: The need for oxygen under High Intensity Needs Fund must be demonstrated by oximetry testing with a Saturation Level of less than 88%. This requirement has not changed; other qualifying conditions for oxygen funding are outlined in Section 3.6 (page 14), of the HINF Manual. 6