12.0 Communication equipment and supplies benefits list

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12.1 General information

12.1.1 Benefit policies

General information common to all medical supplies and equipment (MS&E) can be found in the general policies.

12.1.2 Prescriber and provider requirements

Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of the item under the NIHB program. Items that are prescribed by prescribers/recommenders not recognized by NIHB will lead to denials or reversals of claims.

NIHB recognized prescribers/recommenders include:

  • MD — Physician
  • NP — Nurse Practitioner
  • SLP — Speech-language Pathologist
  • OT — Occupational Therapist

Some augmentative and alternative communication (AAC) benefits require a prescription or recommendation from an Speech-language Pathologist or Occupational Therapist who are part of an augmentative and alternative communication clinic. See augmentative and alternative communication benefit listing in section 12.3 for details and a list of clinics.

NIHB recognized providers include:

  • GEN — Enrolled general medical supplies and equipment or pharmacy provider

12.1.3 Prior approval requirements

General prior approval requirements can be found in the general policies.

To initiate the prior approval process, complete the NIHB Communication the Prior Approval Form, found on the Express Scripts Canada website and submit to the NIHB regional office along with the following supporting documentation:

  • the prescription/recommendation or referral form signed by an NIHB recognized prescriber for the requested benefit
  • assessment within the last 6 months for voice prosthesis and speaking valve:
    • assessment must be by a specialized speech-language pathologist (SLP) which provides a diagnosis and describes the client's current condition in relation to his/her laryngectomy or tracheostomy, and which indicates that the client is a good candidate and would benefit from these devices
  • additional relevant information the provider, physician, nurse practitioner, or speech-language pathologist may have to support the request
  • an explanation of benefits from any third-party coverage available to the client (for example: provincial plan, workers' compensation board, private insurance, education plan, etc.)

12.1.4 Exclusions

The general exclusion policy is listed in the general policies.

12.1.5 Warranties

Providers must honour the manufacturer's warranty.

12.1.6 Repairs

Repairs that are not covered under the warranty are eligible for coverage when supported by proper documentation.

The following rules apply:

  • prior approval is required
  • request must include detailed cost breakdown of parts, labour time and rates
  • repairs must have a minimum warranty of 90 days

A description of all repairs with dates, detailed cost breakdown of parts, labour time and rates must be kept on file for each client.

Note: The NIHB program will not cover the labour cost for repairs that are covered under the warranty.

12.1.7 Replacement requirements

To be eligible for replacement the item must meet ONE of the following conditions:

  • be outside the recommended replacement guideline
  • not working, outside of warranty and the cost of repair exceeds the cost of a new item
  • the item no longer meets the client's needs due to a change in medical condition

All requests for replacement require a new prescription. If an item is required before the recommended replacement guidelines, documentation supporting the need for early replacement must be provided.

12.1.8 Services included in the price

The following services must be included in the cost of the item to be considered for coverage:

  • product and parts ordering and delivery from manufacturer to provider (including delivery costs, exchange rate)
  • dispensing of the benefit, which includes any required adjustments or fittings
  • a markup to the price of AAC equipment and accessories is not accepted

12.1.9 Terminology

Item code

The item code is an 8-digit code that identifies the benefit being requested and is submitted to Express Scripts Canada for billing purposes.

Prior approval

A program coverage confirmation is issued by a FNIHB regional office to a provider to ensure that the client is eligible for specific medical supplies and equipment benefits. The approval is issued primarily for items identified as requiring prior approval before being billed to the program.

Recommended replacement guidelines

The recommended replacement guidelines set a maximum number of each item a client may receive over a given period of time (frequency). Coverage of additional items may be considered on a case-by-case basis. For requests exceeding the recommended replacement guidelines, a prior approval is required.

Maximum price

The NIHB program has established a maximum price for specific items. Maximum price information may be found on the price files located on the Express Script Canada website.

12.2 Voice restoration

12.2.1 Voice restoration device

Coverage criteria:

Voice prosthesis and electrolarynx:

  • the client has undergone a total laryngectomy
  • the special order indwelling voice prosthesis must meet the following additional criteria:
    • a speech-language pathologist must provide a medical rationale indicating why a standard indwelling voice prosthesis is not appropriate
    • indication from the speech-language pathologist that a standard prosthesis was trialed but was found to be insufficient/ineffective or caused medical issues that interfered with voice production
Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400993 Electrolarynx MD, NP, SLP GEN Yes 1 every 4 years  
99401254 Hands free speaking valve MD, NP, SLP GEN Yes 1 set of 3 valves per year Client has undergone a laryngectomy
99400193 Speaking valve MD, NP, SLP GEN Yes 4 per year Client has undergone a tracheostomy
99400994 Voice amplifier MD, NP, SLP GEN Yes 1 every 4 years Client presents with a neurological or structural problems that reduces speech volume
99400985 Voice prosthesis, indwelling, regular MD, NP, SLP GEN Yes 4 per year  
99400986 Voice prosthesis, indwelling, special order MD, NP, SLP GEN Yes 4 per year  
99400984 Voice prosthesis non-indwelling MD, NP, SLP GEN Yes 10 per year  

12.2.2 Voice prosthesis supplies

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400989 Cleaning brush MD, NP, SLP GEN Yes 2 boxes per year  
99400990 Flushing device MD, NP, SLP GEN Yes 1 box per year Client has undergone a laryngectomy
99400988 Gel cap insertion system MD, NP, SLP GEN Yes 1 per year Client has undergone a tracheostomy
99400992 Gel cap replacement MD, NP, SLP GEN Yes 1 box per year Client presents with a neurological or structural problems that reduces speech volume
99400991 Plug insert MD, NP, SLP GEN Yes 2 per year  
99400987 Puncture dilator MD, NP, SLP GEN Yes 1 per year  

12.3 Augmentative and alternative communication (AAC)

Coverage criteria for all augmentative and alternative communication devices and accessories

  • client has a moderate to severe communication impairment and communication needs (as determined by a Speech-Language Pathologist) which cannot be met by using speech alone
  • client has a long-term disability (speech or otherwise) and requires an augmentative and alternative communication device for personal use for a minimum of 6 months, or client is identified as palliative
  • devices cannot be prescribed for the purpose of acquiring new communication skills and therefore not prescribed as a therapy tool
  • in the Province of Ontario, clinician must first apply to the Assistive Devices Program (ADP) for coverage of the augmentative and alternative communication item prior to the application to the NIHB program. NIHB will cover the portion of the cost not covered by the Assistive Devices Program

Required information

  • In Ontario (items covered through ADP)
    • for both open and limited use benefits, clinician are required to submit the completed NIHB AAC Requisition and Prior Approval Form as well as the completed ADP submission Form
  • in all other provinces and territories (and for Ontario where items not covered by ADP)
    • for open benefits, clinician must submit the completed NIHB AAC Requisition and Prior Approval Form
    • for limited use benefits, clinician must submit the completed NIHB AAC Requisition and Prior Approval Form and the NIHB AAC Application Form

Integrated/Complex System

  • a rationale must be provided stating why client requires a highly complex device
  • device must be trialed successfully
  • client must have access to clinical follow-up by an speech-language pathologist for training purposes

List of augmentative and alternative communication clinics across Canada

Alberta

  1. Alberta Health Services: Children's Allied Health Services
  2. Alberta Health Services: Chinook Regional Hospital
  3. Alberta Health Services: Medicine Hat Regional Hospital
  4. Alberta Health Services: Alberta Children's Hospital – Augmentative Communication and Educational Technology Services (ACETS)
  5. Alberta Health Services: Access to Communication & Technology (ACT) Service Centre
  6. Alberta Health Services: I CAN centre, Glenrose Rehabilitation Hospital
  7. Getting Ready for Inclusion Today (GRIT), Edmonton
  8. Alberta Health Services: Eastern Edge Regional Collaborative Service Delivery (RCSD)
  9. Peace Collaborative Services
  10. Renfrew Educational Services, Assistive Technology (AT)
  11. Calgary Board of Education, Support Services for Inclusive Learning (SSIL)
  12. Rocky View School District
  13. Edmonton Public School Board, Inclusive learning Centre for Education
  14. Edmonton Catholic School Board, Genesis Early Learning Centre
  15. Elk Island Public School Board, Assistive Technology (AT)
  16. Peace Collaborative Services

Saskatchewan

  1. Adult Speech and Language Centre at Saskatoon City Hospital
  2. Rehabilitation Centre - Regina
  3. The Alvin Buckwold Child Developmental Program

Manitoba

  1. Communication Devices Program (CDP) - Deer Lodge Centre
  2. Specialized Services for Children and Youth (SSCY)
  3. Open Access Resource Centre (OARC) - Winnipeg

Ontario

  1. Assistive Technology Clinic (Sunnybrook/Baycrest sites)
  2. Bridgepoint Health - Toronto
  3. Thrive Child Development Centre - Sault Ste Marie
  4. Children's Treatment Centre - Chatham
  5. Children's Treatment Centre - York/Simcoe
  6. Erinoak Kids - Mississauga
  7. Five Counties Children's Centre - Peterborough
  8. George Jeffrey Children's Centre - Thunder Bay
  9. Grand River Hospital - Kitchener
  10. Hamilton Health Sciences - Hamilton
  11. Health Sciences North - Sudbury
  12. Holland Bloorview Kids Rehab Hospital - Toronto
  13. KidsInclusive, Hotel Dieu Hospital – Kingston
  14. Hotel Dieu Shaver Hospital - St. Catherines
  15. John McGivney's Children Centre - Windsor
  16. KidsAbility - Kitchener
  17. Niagara Children's Centre - St. Catherines
  18. One Kids Place - North Bay
  19. CHEO (Ottawa Children's Treatment Centre) - Ottawa
  20. Pathways Centre For Children - Sarnia
  21. Saint-Vincent Hospital- Ottawa
  22. Surrey Place Healthcare and Rehabilitation - Toronto
  23. Thames Valley Children's Centre - London
  24. Ottawa Hospital Rehab Centre - Ottawa
  25. Toronto Rehabilitation Institute - Toronto
  26. West Park Healthcare Centre - Toronto

Québec

  1. Integrated Health and Social Services Centre of Bas-Saint-Laurent:
    • Rimouski-Neigette Rehabilitation Center
    • Technological Aid Access Program
  2. Integrated Health and Social Services Centre of Saguenay-Lac St. Jean:
    • Le Parcours Rehabilitation Centre
  3. Integrated Health and Social Services Centre of the National Capital:
    • Québec Rehabilitation Institution for Physical Impairment
  4. Integrated Health and Social Services Centre of Mauricie - Québec Centre:
    • Environmental Control and Communication Assistance Program
  5. Integrated Health and Social Services Centre of Estrie-CHUS:
    • Estrie Rehabilitation Centre
    • Sherbrooke University Hospital Centre
  6. Integrated Health and Social Services Centre of Montréal Island South:
    • Lucie-Bruneau Rehabilitation Centre
    • Rehabilitation Institute of Gingras-Lindsay-Montréal (IRGLM)
    • Technology Aid Access clinic
  7. Integrated Health and Social Services Centre of Montréal Island West:
    • Constance-Lethbridge Rehabilitation Centre
    • MAB-Mackay Rehabilitation Centre (Mackay site)
  8. Marie Enfant du CHU Ste. Justine Rehabilitation Centre
  9. Integrated Health and Social Services Centre of Outaouais:
    • La Ressource Regional Rehabilitation Centre
    • Rehabilitation and Integration Centre for Motor Impairment for Adults and Communication Aid Services
  10. Integrated Health and Social Services Centre of l'Abitibi–Témiscamingue:
    • Intellectual Disability, Autism Spectrum Disorder and Physical Disability Program
  11. Integrated Health and Social Services Centre of the North Coast:
    • Intellectual Disability, Autism Spectrum Disorder and Physical Disability Program
  12. Integrated Health and Social Services Centre of Gaspésie
  13. Integrated Health and Social Services Centre of Chaudière-Appalaches:
    • Rehabilitation Centre for Physical Impairment of Chaudière-Appalaches
  14. Integrated Health and Social Services Centre of Laval:
    • Services for Technical Aids and Communication Aids Program, Jewish Rehabilitation Hospital
  15. Integrated Health and Social Services Centre of Laurentides-Lanaudière:
    • Communication Aids and Assistance Program Blainville Rehabilitaiton Centre
  16. Integrated Health and Social Services Centre of Montérégie-Ouest:
    • Montérégien Rehabilitation Centre - St. Hubert

New Brunswick

  1. Stan Cassidy Centre for Rehabilitation, Augmentative Communication Services

Nova Scotia

  1. APSEA (Atlantic Provinces Special Education Authority)
  2. Nova Scotia Rehabilitation Centre in Halifax at QEII Health Sciences Centre
  3. Nova Scotia Hearing and Speech Centre at IWK Centre
  4. Hearing and Speech Nova Scotia – Augmentative Communication Consultative Services

Newfoundland and Labrador

  1. The Miller Centre
  2. Janeway Children's Health and Rehabilitation Centre

12.3.1 Quick messaging device

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401296 Quick messaging device SLP, OT GEN No 1 every 2 years Examples include: Big Mac, Step by Step, etc.

12.3.2 Speech generating device

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401300 Simple speech generating device SLP GEN Yes 1 every 3 years Devices with static display, digitized speech and simple programming options. Messages are simple with limited vocabulary, primarily word or phrase based. Examples include: Go Talk, Quick Talker or Simple Speech Generating System (up to three quick messaging devices) ,
99401302 Speech generating device, lease SLP GEN Yes Voice output communication aids used to supplement or replace speech or writing.  They may allow for support of alternative access and integrated capabilities that could allow the device to be more complex. . Examples include: Lightwriter, Allora 2, NovaChat, Accent (800, 1000 or 1400), etc.
99401301 Speech generating device, purchase SLP GEN Yes 1 every 5 years Voice output communication aids used to supplement or replace speech or writing.  They may allow for support of alternative access and integrated capabilities that could allow the device to be more complex. Examples include: Lightwriter, Allora 2, NovaChat, Vibe, Accent (800, 1000 or 1400) etc.
99401315 Speech tablet package SLP GEN Yes 1 every 4 years Example of speech tablet: the Indi tablet package or the Via Pro

Package includes:
  • tablet
  • case

12.3.3 Software

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401297 Communication display making software SLP GEN No 1 every 3 years Examples include: Boardmaker, SymWriter, etc.
99401299 Software for speech generating device, lease SLP GEN Yes Examples include: Proloquo, WordPower, Mind Express, Essence, etc.
99401298 Software for speech generating device, purchase SLP GEN Yes 1 every 3 years Examples include: Proloquo, WordPower, Mind Express, Essence, etc.

12.3.4 Communication display board

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401293 Communication display board SLP GEN No 1 every 6 months Static based communication system. Examples include: Paper-based communication boards, eye gaze board, etc.

12.3.5 Integrated and complex systems

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401295 Integrated and complex systems, lease SLP GEN Yes

Communicators must be able to combine words and phrases to create a unique message. Examples include: Grid pad, Tellus 5, Tobii I-13, I-16, I-110, Accent 1000 or 1400 with Look module, Tobii 15, etc.

Prescription from an augmentative and alternative communication clinic is required

99401294 Integrated and complex systems, purchase SLP GEN Yes 1 every 5 years

Communicators must be able to combine words and phrases to create a unique message. Examples include: Grid pad, Tellus 5, Tobii I-13, I-16, I-110,  Accent 1000 or 1400 with Look module, Tobii 15, etc.

Prescription from an augmentative and alternative communication clinic is required

12.3.6 Switches and mounting systems

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401312 Complex mounting system for access hardware, lease OT GEN Yes

Complex mounting system to mount an access device to a wheelchair, or other vehicle.

Prescription must come from an Occupational Therapist at an augmentative and alternative communication clinic.

99401311 Complex mounting system for access hardware, purchase OT GEN Yes 1 every 3 years

Complex mounting system to mount an access device to a wheelchair, or other vehicle.

Prescription must come from an Occupational Therapist at an augmentative and alternative communication clinic.

99401310 Complex mounting system for device, lease OT GEN Yes

Complex system for mounting a communication device to a wheelchair, or other vehicle.

Prescription must come from an Occupational Therapist at an augmentative and alternative communication clinic.

99401309 Complex mounting system for device, purchase OT GEN Yes 1 every 3 years

Complex system for mounting a communication device to a wheelchair, or other vehicle.

Prescription must come from an Occupational Therapist at an augmentative and alternative communication clinic.

99401306 Complex switch, lease OT GEN Yes

May include switch interface.

Prescription must come from an Occupational Therapist at an augmentative and alternative communication clinic.

99401305 Complex switch, purchase OT GEN Yes 1 every 2 years

May include switch interface.

Prescription must come from an Occupational Therapist at an augmentative and alternative communication clinic.

99401308 Simple mounting system access OT GEN No 1 every 5 years For output (for example, switch, head pointer, etc.)
99401307 Simple mounting system device OT GEN No 1 every 5 years For speech generating devices, IPad, etc.
99401304 Simple switch OT, SLP GEN No 5 per year Examples include:
Aero/Freedom, Big buddy switch, Big Red, Buddy Button, etc.

12.3.7 Batteries

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401282 Batteries for switch or pointer SLP, OT GEN No 4 batteries every 6 months Batteries could be double A or triple A.

12.3.8 Accessories

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401283 Carrying case for speech generating device SLP GEN No 1 every 5 years
99401289 Keyguard for speech generating device, lease SLP, OT No Example: Touch guide, etc.
99401288 Keyguard for speech generating device, purchase SLP, OT GEN No 1 every 5 years Example: Touch guide, etc.
99401314 Mouse alternative, lease OT GEN Yes Circuitry to provide alternate mouse control. For example, a head mouse which is controlled through head movements. It provides reliable hands-free mouse control for individuals who are unable to use a traditional manual computer mouse to control their communication device. Examples include: Tracker Pro,  Irisbond Duo Camera, PC Eye plus, NuPoint, etc.
99401313 Mouse alternative, purchase OT GEN Yes 1 every 3 years Circuitry to provide alternate mouse control. For example, a head mouse which is controlled through head movements. It provides reliable hands-free mouse control for individuals who are unable to use a traditional manual computer mouse to control their communication device. Examples include: Tracker Pro, Irisbond Duo Camera, PC Eye Plus, NuPoint, etc.
99401285 Pointer, lease OT GEN No Non-computerized
99401284 Pointer, purchase OT GEN No 1 every 5 years Non-computerized
99401291 Power converter, wheelchair accessory, lease OT No This is a converter for a power wheelchair. This converter uses the power of the wheelchair to power the communication device.
99401290 Power converter, wheelchair accessory, purchase OT GEN No 1 every 3 years This is a converter for a power wheelchair. This converter uses the power of the wheelchair to power the communication device.
99401287 Speech generating device access hardware, lease OT GEN Yes

Enhanced switch circuitry: This equipment is an alternative method used by a client with a disability for operating their speech device if they are unable to use a keyboard or other standard input method. Examples include: Eye gaze tracking systems, the Look module, Eye module for Tobii 15, etc.

Prescription from an Occupational Therapist at an augmentative and alternative communication clinic

99401286 Speech generating device access hardware, purchase OT GEN Yes 1 every 5 years

Enhanced switch circuitry:This equipment is an alternative method used by a client with a disability for operating their speech device if they are unable to use a keyboard or other standard input method. Examples include: Eye gaze tracking systems, Look module, Eye module for Tobii 15, etc.

Prescription from an Occupational Therapist at an augmentative and alternative communication clinic

99401292 Wheelchair control unit (input/output module) OT GEN Yes 1 every 3 years This is a converter for a power wheelchair. This converter uses the drive controls (for example, joy stick) of the wheelchair to control a communication device. It allows the drive control to talk to another circuitry such as the Mouse alternative. For example, the joystick of the wheelchair can be used as a joystick mouse to control the communication device.

12.4 Laryngectomy Supplies

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400476 Adhesive removers MD, NP, SLP NSWOC, WOCC (C) GEN Yes 6 boxes per year  
99401241 Cleaning towels MD, NP, SLP GEN No 2 boxes per year  
99401233 Heat & moisture exchanger (HME), specialized MD, NP, SLP GEN No 1 per day  
99401232 Heat & moisture exchanger (HME), standard MD, NP, SLP GEN No 1 per day  
99401235 Heat & moisture exchanger, housing/baseplate, specialized MD, NP, SLP GEN No 1 per day  
99401234 Heat & moisture exchanger, housing/baseplate, standard
MD, NP, SLP GEN No 1 per day  
99401243 Laryclip MD, NP, SLP GEN No 12 per year  
99401237 Laryngectomy button MD, NP, SLP GEN No 2 per year  
99401236 Laryngectomy tube MD, NP, SLP GEN No 2 per year  
99401238 Laryngectomy tube holder MD, NP, SLP GEN No 12 per year  
99401240 Shower cover MD, NP, SLP GEN No 1 per year  
99401253 Skin barrier wipes MD, NP, SLP GEN No 7 boxes per year  
99401242 Skin Tac wipes MD, NP, SLP GEN No 7 boxes per year  
99401239 Stoma cover MD, NP, SLP GEN No 4 per year  

12.5 Servicing

12.5.1 Delivery

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401268 Delivery, communication   GEN Yes   Delivery of equipment to the client

12.5.2 Repairs

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401281 Repairs, augmentative and alternate communication Yes Minimum of 12 months warranty on repairs.
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