Supplementary Services
8.1 Home Oxygen Program
The Assistive Devices Program (ADP) of the Ministry of Health and Long-Term Care (MOHLTC) administers the Home Oxygen Program (HOP). Oxygen is not included as a benefit under the Ontario Drug Benefit (ODB) Program.
The Community Care Access Centre (CCAC) is not responsible for the provision of oxygen and related equipment.
8.1.1 Role of the CCAC Case Manager
The CCAC case manager may help CCAC clients to access information about HOP, may assist clients to obtain the application forms and to complete necessary documentation to apply for the program.
8.1.2 Eligibility
The HOP pays for oxygen and related equipment for eligible Ontario residents. Residents who have an illness resulting in the need for oxygen therapy may apply. Applicants must have a valid Ontario health card and meet the medical criteria (see subsection #8.1.4 in this manual).
Eligibility for Long-Term Oxygen Funding
The person’s medical condition must be stabilized and treatment regimen optimized before long-term oxygen therapy is considered. The person must have chronic hypoxemia on room air at rest – PaO2 of 55mmHg or less or SaO2 of 88% or less.
Some applicants with a persistent PaO2 in the range of 56 to 60mmHg may be considered candidates for long-term oxygen therapy if the following medical conditions are present:
• cor pulmonale;
• pulmonary hypertension; or
• persistent erthrocytosis.
Also some persons with a persistent PaO2 in the range of 56 to 60mmHg may be candidates for long-term oxygen if the following occurs:
• exercise limited by hypoxemia and documented to improve with supplemental oxygen; or
• nocturnal hypoxemia.
Eligibility for Funding for Oxygen for Palliative Care
Special consideration is given to persons at the end stage of a terminal disease receiving palliative care who do not meet the medical criteria. Persons who are identified as receiving palliative care may receive funding assistance for a maximum of 90 days. If oxygen is required after the 90-day period, the medical criteria must be met. In this instance, oximetry tests are acceptable.
The vendor bills the MOHLTC.
8.1.3 Persons Not Eligible
The following are not eligible for funding assistance from the HOP:
• people who require oxygen due to work related injuries; or
• people who are eligible for benefits through the Department of Veteran Affairs (DVA) Group “A”; or
• people who are in acute, chronic or rehabilitation hospitals.
8.1.4 Funding
For eligible Ontario residents, the HOP may fund 100% of the monthly cost of a basic oxygen system. Vendors can supply a liquid system or concentrator and/or cylinders. The ADP pays a flat monthly rate regardless of the system supplied except for cylinders which get a per cylinder rate according to the person’s oxygen needs. To qualify for 100% coverage, a person must meet the medical criteria and be:
• receiving in-home professional services through the CCAC; or
• 65 years or older; or
• a social assistance recipient; or
• a resident in a long-term care (LTC) home.
The HOP may fund 75% of the monthly cost of a basic oxygen system according to the
person’s oxygen needs. To qualify for 75% coverage a person must be 64 years or younger and must meet the medical criteria, and should not fall into any of the categories listed immediately above.
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8.1.5 Application Procedure for Home Oxygen Program Funding
The HOP application form is available from oxygen vendors and must be completed by the physician and a registered oxygen vendor. New HOP applicants must submit arterial blood gas results with the first application. Applicants who meet medical eligibility criteria receive approval for 90 days. To continue HOP funding, an oximetry test must be submitted at the end of the 90-day period. HOP clients who continue to meet the medical eligibility criteria receive funding for an additional 12 months. A final oximetry test must be submitted at the end of the 12-month period confirming eligibility. At that time, ongoing funding is approved and
continues until HOP is notified that oxygen therapy has been discontinued.
8.1.6 Registered Vendor
A registered oxygen vendor supplies and monitors the oxygen equipment. A list of registered vendors can be obtained from the HOP. Registered vendors agree to follow HOP policies and must not charge more than the program-approved price for oxygen and approved equipment.
They may charge less if they choose.
8.1.7 Hospital Replacement Program Pilot Project – Short Term Oxygen Therapy
Effective August 1, 2005, the ADP introduced the Hospital Replacement Program (HRP) Pilot Project, which will be part of the HOP. The pilot project will run for two years, beginning in 2005 and concluding in 2007.The intent of the HRP is to prevent a person with an acute respiratory condition from being admitted to hospital or, in the case of hospitalization, allows the individual to be discharged earlier by providing funding assistance for short term oxygen therapy.
To receive funding assistance through the HRP, the individual’s condition must be such that early discharge from hospital or avoiding hospitalization with short-term home oxygen therapy and other appropriate support services is recommended by the prescribing physician.
An applicant with an acute respiratory condition such as, but not restricted to, an acute exacerbation of COPD, pneumonia, pulmonary emboli or post-operative lung surgery is eligible to apply for funding assistance if the individual exhibits hypoxemia at rest. For the HRP, hypoxemia at rest is defined as PaO2 less than or equal to 60mmHg. If the individual meets the general and medical eligibility criteria funding assistance is provided for up to 60 days.
Access to the HRP occurs through one of four methods:
1. Emergency room physicians, who have diagnosed their patient with an acute respiratory condition and have determined that the use of short-term home oxygen therapy, along with appropriate support services, will result in an early discharge from the hospital or avoid hospitalization.
2. Attending physicians, who have diagnosed their patient with an acute respiratory condition and have determined that the use of short-term home oxygen therapy, along with
appropriate support services, will result in an early discharge from the hospital.
3. CCAC case managers, located in the hospital or discharge planners who have identified a patient with an acute respiratory condition that could potentially be discharged from the hospital. The attending physician would then determine if short-term home oxygen therapy, along with appropriate support services, would result in an early discharge from the
hospital.
4. Family physicians, who have diagnosed their patient with an acute respiratory condition and have determined that the use of short-term oxygen therapy, along with appropriate support services, will avoid hospitalization.
8.1.8 HRP Application Process
1. Applicants to the HRP use the regular HOP application form that is used by all HOP clients.
2. The prescribing physician must complete section 2 of the HOP application form, clearly indicating in section 2, that the applicant is applying to the HRP. The physician can do this by recording the phrase “Hospital Replacement Program” directly on the application form.
The home oxygen service provider cannot complete this section.
3. When applying to the HRP, arterial blood gas results must be provided. The arterial blood gas results must be within one day of the physician’s prescription date.
4. A separate HRP questionnaire must be completed for all applicants to the HRP. The questionnaire can be completed by the health care professional from the home oxygen service provider. Data collected from the questionnaire will be used to evaluate the program at the end of the two-year period. Copies of the Hospital Replacement Program
Questionnaire have been provided to all ADP registered home oxygen service providers and can be printed from the MOHLTC website at:
[http://www.health.gov.on.ca/english/providers/program/adp/hrp/questionnaire.pdf].
5. The completed questionnaire should be attached to the application and submitted to the ADP.
6. Funding assistance is provided for up to 60 days. If funding assistance is required beyond the 60-day funding period, the client must apply to the regular HOP and must meet the general and medical eligibility criteria and submit arterial blood gases.
CCACs will be notified when the pilot project is completed.
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