Manitoba Wheelchair Program Policy and Procedure Manual

Wheelchair Services

1111 Winnipeg Ave. Winnipeg, MB R3E 0S2 Toll Free

Revised January 2013

POLICIES AND PROCEDURE MANUAL

Society for Manitobans with Disabilities (SMD) Wheelchair Services

1857 Notre Dame Avenue Winnipeg, Manitoba R3E 3E7

Telephone: (204) 975-3250 Fax: (204) 975-3240

Toll Free: 1-800-836-5551

Wheelchair Services 1857 Notre Dame Avenue. Winnipeg, MB Ph: (204) 975-3250 Fax: (204) 975-3240 Toll Free: 1-800-836-5551

Revised January 2013

Table of Contents 1. SMD Services Mission statement………………………………………………………… 1

2. MWP Purpose and scope………………………………………………………………… 1

3. MWP General Client eligibility criteria………………………………………………….. 2

4. SMD Wheelchair Services Responsibilities……………………………………………. 2

5. SMD Wheelchair Services Accountability……………………………………………… 3

6. SMD Wheelchair Services Service management…………………………………….. 3

7. Responsibilities of the Prescriber………………………………………………………. 6

8. Responsibilities of the Client …………………………………………………………….. 7

9. Manual Wheelchairs……………………..……………………………………………….. 8

a. Definition of terms b. Eligibility criteria c. Procedure for requesting manual wheelchairs d. Procedure for exchanging manual wheelchairs

10. Power wheelchairs……………………………………………………………………… 13

a. Eligibility criteria b. Procedure for requesting power wheelchairs c. Procedure for exchanging power wheelchairs d. Conditional Approval of power wheelchairs e. Repairs to own power wheelchair f. Follow up for power wheelchair issued to clients g. MWP provides only one basic mobility device h. Mid-wheel drive

11. Power dynamic positioning devices (PDPD)………………………………………. 17

a. Eligibility criteria b. Procedure for requesting PDPD c. Procedure for exchanging PDPD d. Follow up for PDPD issued to clients

12. Returning equipment to wheelchair services……………………………………… 19

13. Option to purchase upcharge / upgrade …………………………………………. 20

14. Client refusal of wheelchair………………………………………………………….. 20

15. Ownership of the wheelchair ……………………………………………………….. 21

16. Modifications to the wheelchair……………………………………………………... 21

17. Parts Change………………………………………………………………..……….. 22

18. Assessment wheelchairs……………………………………………………………. 22

19. Services to clients who are quarantined or in isolation…………………………... 22

20. Lap Belts………………………………………………………………………………. 22

21. Clients in hospital ……………………………………………………………………. 23

22. Clients coming to SMD for fitting of assigned wheelchair………………………… 23

23. Clients in personal care homes and institutions………………………………….. 23

24. Appeals……………………………………………………………………………….. 23

25. Wheelchair sizing guidelines………………………………………………………… 24

26. Appendix 1 – Equipment/Accessory listing………………………………………… 24

27. Appendix 2 – Equipment for consumers covered by NIHB………………………… 29

28. Appendix 3 – Equipment for consumers covered by EIA………………………. 30

Wheelchair Services 1857 Notre Dame Ave. Winnipeg, MB Ph: (204) 975-3250 Fax: (204) 975-3240 Toll Free: 1-800-836-5551

Revised January 2013 1

1. SMD SERVICES MISSION STATEMENT

To continually develop, maintain and deliver relevant services that assist in the development of individual independence and community support for persons with disabilities.

2. MANITOBA WHEELCHAIR PROGRAM (MWP) PURPOSE AND SCOPE

The MWP equipment pool provides equipment for “basic mobility” to individuals living in the community who have a long term disability which restricts their mobility, or those who are end stage palliative. Long term disability defined as being 6 months or longer. Enhancement of mobility is expected to promote independence and health, delay institutionalization and enable increased participation by persons with disabilities in their communities. The basic mobility definition is satisfied through the provision of mobility equipment and some accessories with fundamental features necessary for safe functional mobility in ones living environment. For those who are independently mobile, functional mobility is achieved only if the task of propelling a wheelchair does not impede their ability to carry out their activities of daily living once reaching their desired destination. The services provided by the agency include the long-term loan, maintenance and repair of manual wheelchairs, power wheelchairs and some accessories. The program serves over 10,000 Manitobans, through reconditioned equipment pools. The program is one of many offered by the Society for Manitobans with Disabilities, a non-profit organization that promotes the full participation and equality of people with disabilities. For the MWP equipment pool, wheelchair contracts are tendered through the WRHA. With input from Wheelchair Services, the WRHA provides direction regarding the type of loan equipment and accessories that are available from the equipment pool. A limited number of primary vendors for the equipment are utilized in order to minimize costs, facilitate repairs and ensure service can be provided to consumers on a timely basis. A computerized database provides access to current information on consumers and equipment. All service requests are entered onto the database, which allows us at any time to call up a work history on any of our wheelchairs.

SMD Wheelchair Services manages 3 reconditioned wheelchair pools on behalf of:

a. The Winnipeg Regional Health Authority (WRHA) – Manitoba Wheelchair Program (MWP)

b. The Government of Canada – Non Insured Health Benefits (NIHB) c. Employment and Income Assistance (EIA)

Specifics regarding the NIHB and EIA pools will be addressed in Appendix 2 and 3 respectively.



3. GENERAL CLIENT ELIGIBILITY CRITERIA

a. Full time resident of the Province of Manitoba, AND

b. Have a valid Manitoba Personal Health Identification Number (PHIN), AND

c. Have a physical disability affecting their mobility and require a wheelchair for a

minimum of 6 months, AND

d. Are without entitlement to receipt of a wheelchair through a third party (i.e. EIA, DVA, WCB, NIHB, MPI, etc), AND

e. Are not in the process of being paneled for a personal care home, OR

f. Are at the end stage of a life-limiting illness and are considered to be palliative., AND

g. Are prescribed a wheelchair by an Occupational Therapist, Physiotherapist,

Physician or Registered Nurse licensed to practice in Manitoba.

NOTE: Since the program’s mandate is to issue wheelchairs to persons requiring a wheelchair for community use greater than six months, should a wheelchair be approved for or issued to a client and he/she is subsequently paneled, the client will no longer be eligible for the wheelchair.

4. SMD WHEELCHAIR SERVICES RESPONSIBILITIES

The development and maintenance of a MWP Policies and Procedures Manual.

The monitoring of and compliance of MWP policies and procedures by clients and prescribers.

The determination of MWP eligibility criteria.

The ongoing evaluation and approval of MWP products.

The management of MWP resources effectively and efficiently.

The provision of MWP information to various stakeholders including clients and authorizers through bulletins, manual updates, revisions etc.

The establishment of associated MWP committees and terms of reference.



5. SMD WHEELCHAIR SERVICES ACCOUNTABILITY

Details of the Agency’s accountability to the WRHA are outlined in a Service Purchase Agreement (SPA). The Agency demonstrates accountability to consumers through the delivery of equipment and services to consumers in a timely manner and in compliance with Program policies and procedures

Consumers who are not satisfied with the services or equipment provided can contact the Manager of Wheelchair Services at (204) 975-3250.

6. SMD WHEELCHAIR SERVICES SERVICE MANAGEMENT

The importance to the consumer of retaining their mobility and independence is clearly understood by Wheelchair Services. Due to the number of consumers registered with the program, the limited work force, and the service demand, a priority of service has been developed. In order to meet the most urgent needs of safety and mobility first, the service priorities are as follows:

a. Equipment Provision

Wheelchair Timeframe

Category 1 A & B Category 2 A & B

Winnipeg Rural Manitoba

Regular requests Within 7-14 days Within 8-15 days

Urgent requests apply to category 2A and 2B and palliative only. Client is a full time user and has no other means of mobility and /or will be discharged from hospital in 2-6 days.

Within 2-6 business days

Within 7 business days

Category 2C, Category 3 Category 4

Within a maximum of 30 working days from the time the application is approved by the SMD Occupational Therapist. Wheelchairs in the pool will be issued within 20 days, special orders within 30 days.

Power Wheelchairs Within a maximum of 30 working days of approval by the SMD Occupational Therapist.



Criteria for ensuring service: Time frame for category 1A, 1B, 2A & 2B does not begin until the

program has received a fully completed requisition from a prescriber. Meeting targets are based upon the availability of the manufacturer to

supply ordered product or reconditioned product is available from the loaner pool.

The availability of spare parts from the manufacturer That someone is available to accept delivery of the wheelchair Technician capacity to respond to demand beyond service targets is

provided through adequate funding.

b. Repair/Maintenance Service

Service to the loan equipment will be performed in the consumer’s residence, place of employment or education, the Notre Dame Avenue depot or at an emergency location. As with the priorities for provision of equipment, service to equipment will follow the same level of priority to meet the needs of safety and mobility:

1) Urgent: response time for service is within 2-6 working days.

Requests are considered “urgent” when a consumer is completely dependent on a wheelchair for mobility. In this situation consumers are full time wheelchair users and/or have no other means of mobility within their home environment. This might include those who’s equipment is unsafe and should not be in operation.

2) Regular: response time for service is within 7-14 working days. These

requests might include those who require service where safety of current equipment is not an immediate concern.

3) Other: response time for service is greater than 14 working days. These

requests might include exchange of wheels, arm pads, upholstery, etc.

All requests for service/maintenance/adjustments made by an occupational therapist or physiotherapist must be submitted either by phone or fax with the following information:

Client’s first and last name

Current address

PHIN # (9 digits)

Description of request and reason for request

For parts exchange, therapist must submit a completed SMD-012. Consumers using manual wheelchairs are encouraged to come to the depot at 1857 Notre Dame Avenue for repairs. Appointments for service are suggested,



particularly for major repairs, as consumers are seen on a first come first served basis. Appointments for manual wheelchair can be coordinated through the Receptionist at (204)-975-3250. Consumers using power wheelchairs must call to make an appointment prior to coming to the SMD WCS depot. Appointments for power wheelchair repair can be coordinated through the Service Clerk, at (204) 975-3242. Consumers who are knowledgeable and able to manage repairs to their chair can request the parts required and they will be mailed out with the exception of electronic components and batteries that have been replaced within 12 months. When service is requested, it is difficult to give consumers specific times as to when the technician will attend due to the degree of work involved with some service calls. Technicians will call the client the morning of the day the service call has been scheduled. It is expected the consumer will understand and be available on the appointed day for service as requested.

c. Extended Hours – Emergency Only

SMD Wheelchair Services clients will be able to access emergency repairs in Winnipeg. City of Winnipeg boundaries are defined as within the perimeter highway, but including St. Norbert and MiddleChurch. All other areas are considered rural Manitoba. A repair is considered an emergency when a full time user is without mobility away from home (i.e. in the community) due to an unsafe or unusable wheelchair. The technician on call will use their judgment to determine if the consumer is in a safe environment and prioritize accordingly. In this case the consumer will be seen the next business day. If the need is emergent, call (204) 975-3250 Monday to Friday from 4pm - 8pm. Saturday, Sunday and holidays from 9am - 4pm.

d. Maintenance Inspections

Maintenance inspections are performed to insure the consumers’ loan equipment is operating efficiently and safely. Through regular maintenance, major repair resulting in a loss of mobility to the consumer is reduced. It also allows us to update consumer files for future contact purposes and to improve the potential for returning equipment to the recyclable pool. Maintenance inspection includes a thorough check of the equipment for:

Broken, cracked or twisted frames/wheels.

Peeling chrome

Torn or unsafe upholstery

Security of all nuts, screws, brakes and tires.

Condition of bearings, brakes and tires

Drive assembly and power source

Suitability of equipment to consumer needs and environment (e.g. change in medical condition)



Consumers are responsible for general maintenance as outlined in the brochure which is provided with each new loan request. This means that the consumer must keep their wheelchair clean and in good repair. Maintenance service is offered as needed. General inspection and maintenance are offered every 12 months for power chairs and 24 months for manual. Rural maintenance clinics are scheduled annually as per schedule A in Steinbach, Portage La Prairie, Brandon and Thompson. City of Winnipeg maintenance inspections will occur year round.

7. RESPONSIBILITIES OF THE PRESCRIBER

Recommend equipment only for individuals whom he/she has assessed in person and who meet eligibility criteria.

Complete the wheelchair application form in a timely fashion following assessment.

Inform applicant about Wheelchair Services policies, eligibility criteria, procedures so that the applicant can make a well informed decision regarding submitting an application to the program.

Follow up with the client once the wheelchair has been delivered.

Maintain an understanding of program policies and procedures.

Maintain good working knowledge of available products in the program.

Prescriber is defined as a professional health care provider licensed to practice in Manitoba. Occupational therapists, physiotherapists, physicians and registered nurses shall prescribe category 1 wheelchairs. Occupational therapists and physiotherapists shall prescribe category 2, 3, 4 manual wheelchair, power wheelchairs and power dynamic positioning device.

The health professional and the Wheelchair Services program together play a very important role in meeting the needs of Manitobans who are mobility disadvantaged. Through this partnership the consumer is better served.



8. RESPONSIBILITIES OF THE CLIENT

Participate in the assessment of their mobility needs.

Provide necessary documentation to prescriber / MWP.

Inform the program of change of name, address, phone #, etc

Sign an “equipment loan agreement”. The request will not be processed without this signature. The therapist/prescriber may sign as a witness, and if they feel the applicant does not understand the loan agreement, the client’s legal representative must sign on the client’s behalf.

Responsibilities regarding loaned equipment

Cleanliness of equipment

Safe, warm and dry storage of equipment.

Reasonable respect in the use and handling of the equipment.

The client (their family, trustee/guardian) is responsible to ensure there is reasonable care and maintenance of the MWP owned wheelchairs. The program recommends that the wheelchair be added to the Client’s homeowner’s/tenant’s insurance policy.

Inform the program when repairs are required.

Return the loan equipment to MWP when it is no longer required, or if the client is no longer a resident of Manitoba.

Maintain batteries on power wheelchairs (i.e. regular charging of batteries).

Financial responsibility for the following:

1) Pneumatic tires and tubes. Wheelchair services will supply the

parts at no cost, however the client will be charged for labor if service is requested. This is an in house service only for a flat fee of $20.00 per wheel. Fee subject to change.

2) Maintenance and repair of spoke wheels. Replacement of spokes.

3) Maintenance, repair and replacement of upcharges or upgrades that the consumer purchased.

NOTE: Clients whose frequency of repair requests suggests that they are not complying with the loan agreement and client responsibility will have their service request reviewed by Wheelchair Services management.



9. MANUAL WHEELCHAIRS

a. Definition of terms

1) Occasional user - Consumers who need the wheelchair for outings where there will be excessive walking OR those who walk some of the time and use the wheelchair for fatigue, long outings. Usage is more than once per week, but less than 3 hours per day.

2) Part time user- requires the use of the wheelchair 3-5 hours a day.

3) Full time user – requires the use of the wheelchair a minimum of 6 hours/day.

4) Attendant assist – does not propel wheelchair. Is pushed all the time.

5) Partially independent propeller– Propels wheelchair independently but requires assist some of the time.

6) Independent propeller – Propels wheelchair independently. Does not require assist at all.

b. Eligibility criteria for manual wheelchairs

1) Consumers eligible for category 1A (basic) wheelchair

Are occasional users.

May or may not be able to self propel.

Can walk more than 25 meters without aid but requires the use of a

wheelchair for fatigue or long outings.

Require little or no adjustability in a wheelchair.

Do not have a body weight in excess of 250 lbs

Palliative

2) Consumers eligible for category 1B (basic heavy duty) wheelchair

As per category 1A but have a body weight in excess of 250 lbs.

3) Consumers eligible for category 2A (lightweight) wheelchair are

Part time user, attendant assist, or

Part time user, partially independent propeller, or

Part time user, independent propeller, or

Full time user, attendant assist, or

Full time user, partially independent propeller or

Might be able to walk up to 25 meters with or without aid.

Do not have a body weight in excess of 250 lbs.

NOTE: This category will not be supplied for ease of caregiver.



4) Consumers eligible for category 2B wheelchair

As per category 2a but have a body weight in excess of 250 lbs.

5) Consumers eligible for category 2C (lightweight) wheelchair are those who

Full time user, independent propeller indoors and immediate surrounding

outdoors, or

Full time user, partially independent propeller indoors and immediate

surrounding outdoors and have physical limitations that preclude the use

of category 2A and whose functional performance will be increased with

the use of category 2C. or

Part time user, independent propeller indoors and immediate surrounding

outdoors and have physical limitations that preclude the use of category

2A and whose functional performance will be increased with the use of

category 2C.


Does not have a weight in excess of 275 lbs.

Note: This category will not be supplied for ease of caregiver.

6) Consumers eligible for category 3A (tilt / tilt and recline) wheelchair are those who

Full time user.

Assessment findings and equipment trial indicate that the category

prescribed is the minimum essential to achieve one or more of the

following goals:

a. Maintain skin integrity where there is a history or present tissue trauma, inability to independently shift weight, and fixed seating alone is not an adequate solution.

b. Increase sitting tolerance where there is a risk of tissue trauma

due to unrelieved pressure and inability to shift weight

independently and / or there is an inability to maintain a

functional seated position where abnormal tone is a factor. It

must be demonstrated that in both of these situations, fixed

seating alone is not an adequate solution

Note: Goals will be achieved only where there is an attendant available to regularly alter the

angle of tilt in space.

Note: Applications will not be considered where purpose is solely for non mobility related activities but not limited to



pain management, facilitation of transfers, feeding, toileting activities and or rest.

Note: Prior to considering prescription of a category 3a

wheelchair, it is advisable for clinicians to consider interfacing commercial seating products that can provide static tilt and/or recline into the client’s current wheelchair. Obviously this is not suitable for clients who need to be able to have regular adjustments made to their back/seat angles, but could potentially meet many clients’ needs without the inconvenience of being unable to transport the chair.

Note: Category 3A wheelchairs do not collapse for transport.

Please be sure to advise your clients of this before requesting the chair. Also, program policy dictates that a second collapsible chair will not be provided to clients who are issued a category 3 wheelchair.

Note: Category 3A chairs can come with a solid seat and a

basic headrest but not a back nor a seat cushion. Note: Health professionals and consumers are welcome to

make an appointment to see and/or trial Category 3 (adult) wheelchairs at 1857 Notre Dame.

7) Consumers eligible for category 3B (recline) wheelchair are those who

Full time or part time users and

Have ROM restrictions that require an open back to seat angle or

Have bladder management issues that can be improved with the use of a

recline or

Have decreased postural control of their head and trunk or

Have respiratory issues that can be improved with the use of a recline or

Have orthostatic hypotension that can be improved with the use of a

recline.

8) Consumers eligible for category 4A (ultra-lightweight) wheelchair are those

who

Full time user, fully independent very active propeller (indoors and

outdoors) who frequently propels in the community alone or

Full time user, fully independent propeller indoors and immediate

outdoors but have physical/functional limitations that preclude the use of

a category 2C wheelchair, and



Functional performance will be increased as a result of utilizing features

of category 4A.


Wheelchair accessible home to allow safe independent entry / exit to the

home.

Note: priority will be given to those applicants who require the wheelchair for school and/or work.

Note: Health professionals and consumers are welcome to make an appointment to see and/or trial Category 4 wheelchairs at 1857 Notre Dame.

Note: Category 4 wheelchairs will not be provided for ease of

caregiver.

9) Pediatric chairs (category 3A and category 4) wheelchairs. In an attempt to limit the number of exchanges required for children due to growth, the MWP offers the pediatric chairs with growth features for all children regardless of their usage profile. All requests for pediatric wheelchairs will need to be reviewed or completed by a therapist from the Rehab Center for children (RCC).

c. Procedure for requesting manual wheelchairs

In order to determine what equipment is required and basic for MWP application purposes, the prescriber must complete a wheelchair/seating assessment. Therapists may use SMD -010 Wheelchair and Seating Assessment form if they don’t have their own. There is no need to submit SMD-010 with the application unless requested.

Equipment should be considered from the most basic to the more complex, taking into consideration the applicant’s medical condition, physical and functional status, as well as environmental and safety issues. Specifications of manual wheelchair and options that are available through the program as well as options for purchase may be downloaded from the SMD website. Once the assessment has been completed and the prescriber confirms client’s eligibility to access wheelchair through the program, the appropriate application form may be completed. An application must not be submitted to Wheelchair Services if, after assessing the client’s mobility requirements, the prescriber confirms the client does not meet eligibility criteria. Application forms may be downloaded from the SMD website.

1) Fax or mail completed manual wheelchair application form including signed

loan agreement to Wheelchair Services. If incomplete it may be returned to



the originator for completion. If the required information is not submitted within 30 days, the request may be closed.

a) SMD – 001 Category 1 & 2 Application Form b) SMD – 002 Palliative Application Form c) SMD – 003 Category 3 Application Form d) SMD – 004 Category 4 Application Form e) SMD – 011 Pediatric Application Form

2) Information from the application and description of the equipment to be loaned

is entered into the consumer’s record (client data base). 3) Requests for categories 2C, 3 and 4 are reviewed by the SMD –OT. 4) In the case of purchasing upcharge, see Section 13 Option to Purchase

Upcharge/Upgrade 5) Request is approved if application is deemed eligible for the category being

requested. When application is approved, the equipment pool is examined first to see if an appropriate wheelchair is available and cost effective to recondition and assign to the client. If requested wheelchair is not available in the pool, a new wheelchair will be ordered. An application may be deemed not eligible if the criteria for the applicant to access the category being requested is not met and or insufficient, incomplete and or inaccurate information is provided in the application.

6) SMD-occupational therapist will inform the prescriber when the application for category 2C, 3 and 4 is approved.

7) Equipment is assigned and information entered in consumer record 8) Equipment is delivered or consumer arranges for pick up.

d. Procedure for exchanging manual wheelchairs

The program does not automatically exchange nor replace wheelchairs after a period of time has elapsed. Request for wheelchair exchange may be submitted if:

There was a change in client’s body size and/or weight. Client no longer fits the chair and it cannot be grown or shrunk to fit.

The client has had a major change in medical condition and current wheelchair no longer meets client’s need. Prescriber indicates what measures were taken to make the current wheelchair work.

Wheelchair is damaged beyond repair. Prescriber or client must arrange to have the wheelchair assessed by Wheelchair Services technician. Program will advise the prescriber of the outcome of the assessment.

Procedure for exchanging manual wheelchairs is the same as procedure for requesting manual wheelchair. The following forms are downloadable from the SMD website.

a) SMD – 001 Category 1 & 2 Application Form b) SMD – 002 Palliative Application Form c) SMD – 003 Category 3 Application Form d) SMD – 004 Category 4 Application Form e) SMD – 011 Pediatric Application Form



Clients will not automatically be qualified for the same category of wheelchair as what they currently have. Decision on client’s eligibility for requested wheelchair will be based on information provided in the exchange application form. In the case of pediatric wheelchairs, a growth kit will be ordered for the child’s current chair where appropriate. Please be aware, without reasonable justification, exchanges will not be considered if the request comes within 6 months of the original request. Without reasonable justification, exchange will not be considered for 1” difference in width, depth or seat height.

10. POWER WHEELCHAIRS

a. Eligibility Criteria for Power Wheelchairs

Applicants must meet general program eligibility criteria. In order to qualify for a

power wheelchair, applicants must:

Individual cannot propel a manual wheelchair independently to meet his/her basic and essential mobility requirements.

Require a power wheelchair for more than 6 hours per day for work, school, recreation, ADL’s and IADL’s. (This criteria will exclude seasonable applicants who request the power wheelchair for summer use only)

Priority will be given to those requiring the power chair for ADL’s, work and school

The applicant must have wheelchair accessible housing. Power wheelchair will not be issued until a ramp according to code is built or modifications to the home are completed to allow entry and exit to the home as well as to areas identified as essential for client to perform identified activities of daily living.

Have suitable storage i.e. indoor, locked, heated and well ventilated area

Be able to care for a power chair and keep batteries properly charged

Be able to safely, independently and with good judgment operate a power wheelchair

If wheelchair is for use in the community only, application must show that applicant cannot utilize a scooter. i.e. unable to transfer, and/or operate steering column.

NOTE: Applications for power wheelchair will not be considered within two years of receipt of a category 4 wheelchair.



NOTE: Children under 18 must meet general program eligibility criteria. In order to qualify for their first power wheelchair the child must demonstrate a need for powered mobility and demonstrate the potential to learn the skills necessary to safely operate a power wheelchair. In addition there must be a supervised environment in which to learn these skills. The child must demonstrate the potential to drive the chair after extensive trialing. NOTE: Requests for replacement power chairs for children must provide evidence that the child is able to safely and independently operate a power wheelchair (i.e. the same criteria as adult users). The child must be using the power chair as their primary method of mobility at home, school and in the community. The child’s home must be fully wheelchair accessible. In addition, plans to transport the power chair must be in place.

b. Procedure for requesting power wheelchairs

In order to determine what equipment is required and basic for MWP application purposes, the prescriber must complete a wheelchair/seating assessment. Therapists may use SMD -010 Wheelchair and Seating Assessment form if they don’t have their own. There is no need to submit SMD-010 with the application unless requested.

Equipment should be considered from the most basic to the more complex, taking into consideration the applicant’s medical condition, physical and functional status, as well as environmental and safety issues. Specifications of power wheelchair and options available through the program as well as options for purchase may be downloaded from the SMD website.

Once the assessment has been completed and the prescriber confirms client’s eligibility to access wheelchair through the program, the appropriate application form may be completed. Application forms may be downloaded from the SMD website.

1) Fax or mail completed SMD-005 Power Wheelchair Application Form,

including signed loan agreement to Wheelchair Services. If incomplete it may be returned to the originator for completion. If the required information is not submitted within 30 days, the request may be closed.

2) Information from the application and description of the equipment to be loaned is entered into the consumer’s record (client data base).

3) The application is reviewed by the SMD-WCS Occupational Therapist 4) Request is approved if application is deemed eligible for power

wheelchair. An application is denied if the criteria for power wheelchair is not met.

5) SMD-occupational therapist will inform the prescriber when the application for power chair is approved or denied.

6) A letter will be sent to the client and prescriber to inform them of the outcome of the application. Reason (s) for denial will be provided if the application is denied. Clients can appeal this decision. See section 24 on page 23.



7) When application is approved, the equipment pool is examined first to see if an appropriate wheelchair is available and cost effective to recondition and assign to the client. If requested wheelchair is not available in the equipment pool, a new chair will be ordered.

8) In the case of a conditional approval (e.g. requires ramp, more training) selection of power chair will not be initiated until receipt of written confirmation from prescriber that condition of approval is satisfied.

9) In the case of purchasing upcharge, see section on Option to Purchase Upcharge/Upgrades.

10) Equipment is assigned and information entered into the consumer record.

11) Equipment is delivered to address specified in the application.

c. Procedure for Exchanging Power Wheelchairs

The program does not automatically exchange nor replace power wheelchairs after a period of time has elapsed. Request for wheelchair exchange may be submitted if:

The client has had a major change in medical condition and current power wheelchair no longer meets client’s need.

Wheelchair is damaged beyond repair. Prescriber or client must arrange to have the wheelchair assessed by Wheelchair Services technician. Program will advise the prescriber of the outcome of the assessment.

The client has had a major change in condition and current power chair is not able to be retrofitted with approved Power Dynamic Positioning Device.

Parts are no longer available for outdated models.

For exchange request for power wheelchairs, the therapist will be required to submit completed SMD-006 Power Wheelchair Exchange Application. This will ensure that the client still meets program criteria for a power wheelchair, as well as take into account any changes in function, or size requirements. The prescriber will be notified of the outcome of the request.

d. Conditional Approval of power wheelchair

Conditions to the power wheelchair approval must be met within the first 6 months after the client and the prescribing therapist were notified of the outcome of the application. If more time is required to satisfy the conditions of approval, the prescriber must notify the SMD – WCS OT before the 6 months is up in order to keep the application active and the deadline can be extended for another 3 months.



If no communication is received from the prescribing therapist within the first six months regarding the status of the condition, the application will be closed and the client will have to submit a new application. Application will only proceed to power chair selection after the condition of approval is satisfied.

e. Repairs to own power wheelchair

A consumer who owns their power wheelchair may be eligible for maintenance and repairs provided it is a model that the Program supplies. Pre-inspection of the applicant’s privately owned power wheelchair is required and this can be arranged by calling (204) 975-3242. If it is determined that SMD-WCS can service the client’s power wheelchair, the prescriber may proceed with the application process by submitting a completed SMD- 005 Power Wheelchair Application or SMD-006 Power Wheelchair Exchange Application, whichever is applicable.

f. Follow-up of power wheelchairs issued to clients

Within 6 months that a power chair is issued to a client, SMD will do a follow up call using SMD-009 to determine if use of the power chair is consistent with program criteria.

Information will be reviewed and if it shows that the wheelchair is not used according to program criteria, therapist will be notified and every effort will be taken to assist the client with successful use of the equipment. If after appropriate intervention by SMD and the therapist, use of the power chair is not consistent with program criteria, appropriate action will be taken, including possible recall of the equipment. This form will also be used at any time when there are questions on the use of the power wheelchair consistent with program criteria are brought to the attention of SMD-WCS.

g. MWP provides only one basic mobility device

Effective December 1, 2011 the MWP provides only one basic mobility device. The manual wheelchair previously assigned to a client must be returned when they receive the power wheelchair. For rural clients, a bill of lading will be shipped with the power wheelchair for the client to use to ship the manual wheelchair back to SMD. Clients living in Winnipeg can either drop off the manual chair to 1857 Notre Dame or they can call SMD at 204-975-3250 to arrange for pick up.



For those who were already issued a power wheelchair and back up manual wheelchair prior to December 1, 2011:

1) They may keep both wheelchairs. The program will continue to

provide maintenance and repair service. 2) The chair will not be exchanged for width requirements. 3) If the chair is deemed not longer repairable by SMD, the client will be

provided with a used category 1 wheelchair of the same specification as the irreparable wheelchair. If this wheelchair is not available in the pool, the client will be put on a wait list until a chair becomes available. The program will not purchase a new wheelchair for this purpose.

h. Mid-Wheel Drive

If a mid-wheel drive is requested, an assessment using this drive wheel (both indoors and outdoors) is strongly recommended prior to application. If upon receiving the mid-wheel drive the client is not satisfied, the MWP cannot exchange for rear-wheel drive. Loan of a mid-wheel drive power chair can be arranged to help with this assessment. See section 18 page 22.

11. POWER DYNAMIC POSITIONING DEVICE

a. Eligibility criteria for power dynamic positioning devices

Provision of power tilt, power recline, power elevating leg rests will be considered for clients who have no ongoing caregiver support that effectively achieves the goals below, and whose assessment findings and equipment trial indicate that the equipment is the minimum essential to achieve one or more of the following goals:

1) For power tilt OR power recline

a) Maintain skin integrity where there is a high risk of tissue

trauma and a loss of ability to effectively weight shift independently, and fixed seating alone is not an adequate solution.

b) Maximize respiratory function where there are measureable limitations and objective data can be provided to show improvements with use of tilt /recline.

c) Maintain independent mobility through increased sitting tolerance, where there is an inability to maintain a functional sitting position due to abnormal tone / reflex activity, postural instability, and/or joint spinal contractures/deformities and fixed seating alone is not an adequate solution.

2) For power tilt AND power recline

Clinical assessment results demonstrate that power tilt or power recline alone is not an adequate solution to achieve goals above.



3) For power elevating leg rests

a) Decrease in lower extremity swelling due to chronic edema in

the lower extremities, where power tilt and / or recline is prescribed. Objective trial data must be provided.

NOTE: Request for power tilt, power recline, or power elevating leg

rests should not be considered where the purpose is solely for pain management, to facilitate transfers, toilet activities, swallowing, and/or rest.

b. Procedure for requesting power dynamic positioning devices

Based on your assessment findings, you will note that some clients may do well with fixed changes to the wheelchair seat angle or back/seat angle and do not require a dynamic positioning device. Begin by considering alternative seating components for use with client’s current wheelchair. Some adjustments to the power wheelchair seat angle as well as back/seat angle are possible to achieve some degree of static tilt or static recline. An assessment should be done to determine which seat/back angle and seat angle are most functional.

1) Applications for power dynamic positioning devices must be

completed by an occupational therapist or a physiotherapist.

2) Complete a request for power dynamic positioning device If assessment results indicate that fixed seating alone is not adequate to meet client’s needs. Application forms may be downloaded from the SMD website.

a) Complete SMD-007 If applicant already has an Invacare

power wheelchair supplied by Wheelchair Services.

b) Complete SMD-005 in addition to SMD-007 If applicant does not have a power wheelchair supplied by Wheelchair Services or if applicant’s current SMD power wheelchair is not an Invacare power chair.

3) Fax or mail completed application forms, including signed loan

agreement to Wheelchair Services. If incomplete it may be returned to the originator for completion. If the required information is not submitted within 30 days, the request may be closed.

4) Information from the application is entered into the consumer’s record (client data base).

5) Application is reviewed by the SMD-WCS Occupational Therapist



6) The therapist and the client will be informed of the outcome of the request for power dynamic positioning device. If approved, installation of the device will be done at 1857 Notre Dame Avenue.

c. Procedure for Exchanging Power Dynamic Positioning Device

For exchange request for power dynamic positioning device, the therapist will be required to complete the SMD – 008 Power Dynamic Positioning Device Exchange application form. This will ensure that the consumer still meets program criteria for a power dynamic positioning system/power wheelchair, as well as take into account any changes in function or size requirements. This form will be reviewed and the prescriber will be notified of the outcome.

d. Follow-up of PDPD issued to clients

Within 6 months that a PDPD is issued to a client, SMD will do a follow up call using SMD-009 to determine if use of the PDPD is consistent with program criteria.

Information will be reviewed and if it shows that the power dynamic positioning device is not used according to program criteria, therapist will be notified and every effort will be taken to assist the client with successful use of the equipment. If after appropriate intervention by SMD and the therapist, use of the power dynamic positioning device is not consistent with program criteria, appropriate action will be taken, including possible recall of the equipment. This form will also be used at any time when there are questions on the use of the power wheelchair consistent with program criteria are brought to the attention of SMD-WCS.

12. RETURNING EQUIPMENT TO WHEELCHAIR SERVICES

For clients living in Winnipeg, arrangements can either be made with family/friends to have the equipment dropped off at 1857 Notre Dame Avenue or arrangements can be made to have Wheelchair Services technician pick-up the wheelchair.

For those clients living in rural Manitoba the following procedure can be followed:

Contact Wheelchair Services with the information regarding manual wheelchair to be returned. Consumer will be sent a package of information containing instructions and Bill of Lading. The equipment must then be taken to the local post office.

In the case of power wheelchairs that have been cleared for return by the SMD OT, the client can contact Gardewine North Transportation company at 1-800-282-8000 to have the power chair picked up and shipped to SMD.



13. OPTION TO PURCHASE UPCHARGE / UPGRADE

Not all wheelchair components and parts are provided through the program. Some are available for purchase should the client choose to. If this is the case, the prescribing therapist may request SMD –WCS to send the client a quote. If the client decides to purchase, a cheque or money order must be mailed or delivered to the SMD office prior to ordering the upcharge. If the client chooses to not proceed with the purchase, SMD –WCS must be informed immediately. Option to purchase parts are readily available on new order wheelchairs. They will be available in reconditioned pool wheelchairs only if those parts can be added after market. Purchased upcharge is the property of the client. When the wheelchair is no longer needed and returned to the program, client may either decide to donate it to the program or have it uninstalled by SMD and returned to client.

Replacement or repair of purchased upcharges is a cost to the client. For options/ accessories that clients decide to purchase through the program, the following process is followed:

Invoice is sent to client and must be paid in full prior to the wheelchair being ordered.

The purchased part/accessory will be listed in the consumer’s file as owned by the client.

If the add on item/accessory needs repair and is under warranty, the client must pay for labor cost only.

If the add on item/accessory needs repair and is no longer under warranty, the client must pay for parts and labor.

If the add on item/accessory needs replacement, the client is responsible for payment for the full price of replacement plus labor.

Labor rates range between $49.00 (in house) and $54.00 (field call) per hour. (rates subject to change).

14. CLIENT REFUSAL OF WHEELCHAIR

The program has an ongoing problem with client refusal of delivered wheelchair or returning the wheelchair following delivery. Some of the reasons for refusal include but are not limited to caregiver not wanting to use the wheelchair, there is no space in the home for the wheelchair, client not aware that the wheelchair was ordered.



There are financial implications to the refusal as well as time wasted on the part of Wheelchair Services and the prescriber. In the event of client refusal either at the time of delivery or after:

The program will advice the prescriber of the refusal and reason (s) given. The program will hold the chair for 30 days to allow time for the prescriber to clarify the refusal with their client.

The program will not re-supply a wheelchair at least 6 months, at which time, a new application will have to be submitted.

15. OWNERSHIP OF THE WHEELCHAIR

The program retains full ownership of all wheelchairs issued to clients. These wheelchairs are given on loan to the client and they are not for re-sale. The wheelchair must be returned to the program recycle pool when:

When client no longer needs it, or

When it has been replaced by another program wheelchair, or

When client moves out of Manitoba, or

If for any other reason the client becomes ineligible for the wheelchair

Exception: Upcharges that was purchased by the client

16. MODIFICATIONS TO THE WHEELCHAIR

In order to maintain accurate record of program wheelchairs and its configurations as well as to ensure that the wheelchair remains structurally and electronically safe, therapist must get prior approval from the SMD-WCS occupational therapist and supply the following information:

Details of required modification

Reason(s) for modifications

Who is doing the modifications

Replacing parts damaged during modification is not the responsibility of SMD. Prescriber must confirm with the SMD-WCS occupational therapist when the modifications have been completed and client’s equipment information will be updated.



17. PARTS CHANGE

Parts change applies when change in configuration or the addition or exchange of a program approved part is required to accommodate a change in the client’s physical, medical or functional status. Client must be stable. Without reasonable justification, parts change will not be considered if the request comes within 6 months of receipt of a newly assigned wheelchair. Client may opt to purchase new part.

Request for parts change will not be met if request comes within 6 months of parts change approval for the same part.

To request for parts change, prescriber must submit a completed SMD-012.

18. ASESSMENT WHEELCHAIRS

The SMD-WCS assessment area is equipped with a number of manual and power wheelchairs that are available for assessment either at 1857 Notre Dame or client’s home. To set up an appointment, call 975-3250. Contact the Occupational Therapist at 204-975-3253 for specific requirements. Cost of transporting the wheelchair to the client’s home is the responsibility of the client. Assessment is for fitting and assessing functionality. It may not be the exact size and may not have all the options required by the client.

19. SERVICES TO CLIENTS WHO ARE QUARANTINED OR IN ISOLATION

When a client’s wheelchair requires repairs while the client is being quarantined or in isolation, the facility staff or client should inform SMD staff when requesting a service call. The work order will indicate “quarantine” in the “alternative address” section. The client’s wheelchair should be removed from the quarantined area and cleaned (using facility guideline) by facility staff prior to the technician working on the wheelchair. The technician should not go into the quarantine area to get the equipment.

20. LAP BELTS

SMD will provide an auto style lap belt to all wheelchairs. These lap belts are not intended to be used as restraint and should not be used as such when client is being transported in a vehicle while seated in the wheelchair. Approved and tested occupant and wheelchair restraints must be used at all times when a client who is seated in the wheelchair is in a moving vehicle.



21. CLIENTS IN HOSPITAL

Discharge date is required prior to issuance of equipment when a client is in hospital. For clients with complex seating requirements who are expected to have an extended inpatient stay and discharge into the community is planned, equipment may be provided and issued to the therapist for set up and training as required prior to discharge. If there is a change in discharge location, SMD must be notified.

22. CLIENTS COMING TO SMD FOR FITTING OF ASSIGNED WHEELCHAIR

If therapist or client chooses to come to SMD for fitting of their newly assigned wheelchair, an appointment must be made in advance and prescribing therapist must be present.

23. CLIENTS IN PERSONAL CARE HOME (PCH) HOSPICE & INSTITUTIONS

If a client is being considered for paneling for the PCH process or if they have already been paneled, they are not eligible for a MWP wheelchair. If a consumer has been living in the community and has been in possession of a loan wheelchair for a period exceeding six months prior to entering the PCH/institution, they are entitled to retain the wheelchair and are eligible for on going maintenance. Should the wheelchair be deemed irreparable by wheelchair services, the wheelchair will not be exchanged nor replaced. If consumer becomes a resident of a PCH/institution within six months of receipt of a loan wheelchair, the wheelchair must be returned to the SMD-WCS.

24. APPEALS

Client can appeal a decision of denial of request for a manual or power wheelchair by submitting a letter to SMD occupational therapist describing the reason(s) for the appeal and additional information to support their need of requested wheelchair. The application will be reviewed again and client and therapist will be informed of the decision. If client disagrees with outcome of the appeal, client can submit their request/concern in writing to:

Program Consultant Home Care Supplies & Equipment and Manitoba Wheelchair Program Winnipeg Regional Health Authority 330-496 Hargrave Wpg, MB R3K 0X7 Ph: (204)940-2523 Fax: (204)940-2009 e-mail: [email protected]

mailto:[email protected]



25. WHEELCHAIR SIZING GUIDELINES

Wheelchair services utilize the following criteria as a guideline for meeting the needs of the client. The health professional’s input is a necessary contribution in meeting the needs of the consumer. Requests for clients whose weight is over 250 pounds, an assessment by a therapist is mandatory.

HEIGHT WEIGHT WIDTH

4’9 - 5’11 80 -130 lbs 16” 4’9 - 5’3 131 - 170 lbs 18” 4’9 - 5’3 171 - 200 lbs 20”

5’3 - 6’0 100 - 170 lbs 16” 5’3 - 6’0 171 - 210 lbs 18” 5’3 - 6’0 211 - 250 lbs 20” 5’3 - 6’0 250 lbs and up** 20”

26. APPENDIX 1 – Program Loan Equipment and Accessory Listing

a. Wheelchair Specifications Forms may be downloaded from the SMD website. b. Anti tippers are automatically supplied where the axle plate is adjustable in the

horizontal position or if the client has bilateral lower limb amputations. c. Power chairs may be retrofitted with tie down brackets if requested by the client

or therapist for the sole purpose of providing securement location during wheelchair transport. These add on brackets are not crash tested.

Wheelchair Model Options and Accessories provided through the MWP

Accessory options for purchase

MANUAL WHEELCHAIRS

Category 1A Breezy EC 2000 16” 18” 20” seat width

16 “ seat depth

16” fixed backrest height

17.75” and 19.75” floor to seat height on 16” 18” and 20” wide

Fixed height, removable full and desk length arm rests

Removable leg rests, standard and ELR

Composite foot plates

24” rear wheels

solid urethane or low profile polyurethane (same)

8” casters

Dual vertical axle position

24.5 overall width for 16” w

None



26.5 overall width for 18” wide

29.5 overall width for 20” wide

Weight from 41 lbs.

250 lb. weight capacity for 16” 18” wide

300 lb. weight capacity for 20” wide

Category 1B Breezy EC 2000 HD 20, 22, 24” seat width

16” seat depth on 20” wide

18” seat depth on 22” and 24”

16” fixed back height

17.75” & 19.75” seat height on 20” w

21” seat height on 22 and 24” w

Fixed height, removable full and desk length arm rests

Removable leg rests, standard and elevating

Aluminum foot plates

24” rear wheels

Solid urethane or low profile polyurethane (same)

8” casters (solid or low poly)

Single position axle

30.5” overall width on 22” wide

32.5” overall width on 24” wide

300 lb. weight capacity on 20” wide

450 lb. weight capacity on 22” & 24”

Weight from 41 lbs. on 20” wide

Weight from 57 lbs. on 22” & 24”

None

Category 2A Breezy EC 4000 16”, 18”, and 20” seat width

16” and 18” seat depth for 16” 18” wide

Only 18” seat depth on 20” width

16” and 18” adjustable back rest

17.75”, 18.75” and 19.75” seat height 16 and 18” wide chairs with 24” wheels & 8” casters

16.75” and 18.75 seat height on 16” and 18” wide chair with 22” wheels and 8” casters

18.75” and 19.75 seat height on 20” wide chair with 24” wheels and 8” casters.

20” wide chairs do not come with 22” wheels and 6” casters

Flip back, height adjustable full and desk length arm rests

Removable leg rests – standard and elevating

Composite footplate

Dual position axle plate

22” and 24” mag wheels

Solid urethane and full polyurethane tires

Aluminum hand rims

6” and 8” solid urethane casters

Amputee axle kit available only on 16” and 18” wide chairs

Anti-tippers



Brake extensions

Weighs 33.5 lbs. (without leg rests)

23” overall width on 16” wide



250 lb. weight capacity

Maple Leaf Swift 14, 16, 18, 20” seat width

16 and 18” seat depth

15.5, 16.5, 17.5, 18.5, 19.5 and 21” seat heights

18” fixed height backrest

Variety of armrests and leg rests/footplate options as per order form (with the exception of articulating leg rests)

22” and 24” solid urethane tires and full profile polyurethane tires

Mag wheels

Polycomp, plastic coated, chrome, and projection hand rims


Amputee adaptor kit

Dual Vertical axle position t

horizontal adjustable axle plate on some

Brake extensions

Anti tippers

Weight from 36 lbs

None as this is a discontinued item

Category 2B Breezy Rubix HD See Sunrise/MWP Manual Wheelchair Specification

form for Breezy Rubix HD for options provided through the program and options for purchase.

Maple Leaf Swift Heavy Duty

18, 20, 22 and 24” seat width

18” seat depth (16” by upholstery available, but frame depth remains 18”)

16 ½”-19 ½” floor to seat height

Fixed height backrest


22” and 24” solid urethane and full profile polyurethane tires

Mag wheels

Polycomp, plastic coated, chrome, and projection hand rims

6 and 8” solid urethane casters

Vertical and horizontal adjustable axle plate

Amputee adaptor kit

Brake extensions

Anti tippers

Weight from 41 lbs

None as this is a discontinued product.



Category 2C Breezy Rubix See Sunrise/MWP Manual wheelchair

specification form for Breezy Rubix for options provided through the program and options for purchase.

Category 3 Quickie SR45 See Sunrise/MWP Manual wheelchair

specification form for SR45 for options provided through the program and options for purchase.

Maple Leaf Supertilt 22”, 24” solid urethane or full profile polyurethane rear tires

Mag wheels

Polycomb, plastic coated or chrome handrims

5”, 6”, 8” solid urethane casters

14”, 15”, 16”, 17”, 18”, 19”, 20” seat width (21”-24” are special orders)

15”, 16”, 17”, 18” seat depth

20” backrest (non-folding), with 5, 10, 15 degree angle adjustment

14 ½”, 15 ½”, 16”, 17 ½” 18 ¼” 19 ¾”, floor to seat heights


3 rear axle positions

20” backrest (non-folding), with 5, 10, 15 degree angle adjustment

Reclining back rest (with justification)

Brake extension

Anti-tippers

0-45 degrees of tilt

Single trigger operation for tilt

Contoured foam headrest, back insert and seat cushion

Weight from 48 lbs

None as this is a discontinued item

Quickie Iris See Sunrise/MWP Manual wheelchair specifications for Quickie Iris for options provided through the program and options for purchase

Zippie TS See Sunrise/MWP Manual wheelchair specifications for Zippie TS for options provided through the program and options for purchase.

Zippie Iris See Sunrise/MWP Manual wheelchair specifications for Zippie Iris for options provided through the program and options for purchase.

Breezy EC 4000 Recliner

16”, 18” 20” seat width

17” seat depth

22” back height with 10” removable headrest

See seat heights available in Breezy EC 4000

Flip back, height adjustable full and desk length

none



arm rests

Removable leg rests – standard and elevating

Composite footplate

Dual position axle plate

22” and 24” mag wheels with solid urethane and full profile polyurethane tires

Aluminum hand rims


Brake extensions

Anti tippers

Weighs 43 lbs (without leg rests)

250 lb. weight capacity

Maple Leaf NRG + Recliner

22 and 24” solid urethane and full profile polyurethane rear tires

Mag wheels

Polycomp, plastic coated or chrome handrims,

6 or 8” solid urethane casters

14, 15, 16, 17 and 18” seat widths

16, 17 and 18” seat depth

17 ½, 18 ½, and 19 ½” floor to seat height


Brake extension

Head rest extension

Anti tippers

Weight 55 lbs

None as this is a discontinued item.

Category 4 Quickie LXI See Sunrise/MWP Manual wheelchair specification

form for Quickie LXI for options provided through the program and options for purchase.

Quickie QXi See Sunrise/MWP Manual Wheelchair specification form for Quickie QXi for options provided through the program and options for purchase.

Quickie 2 See Sunrise/MWP Manual wheelchair specification form for Quickie 2 for options provided through the program and options for purchase.

Quickie GPV See Sunrise/MWP Manual wheelchair specification form for Quickie GPV for options provided through the program and options for purchase.

Quickie GPSA See Sunrise/MWP Manual wheelchair specification form for Quickie GPSA for options provided through the program and options for purchase.

Quickie Q7 Adjustable

See Sunrise/MWP Manual wheelchair specification form for Quickie Q7 Adjustable for options provided through the program and options for purchase.



Quickie M6 See Sunrise/MWP Manual wheelchair specification form for Quickie M6 for options provided through the program and options for purchase.

POWER WHEELCHAIRS The program will supply only one drive control on a power wheelchair. Should client wish to have more than one drive control,

the program will supply the primary one only and the client will need to purchase the secondary one.

Invacare TDX SC See Invacare/MWP Power wheelchair specification form for Invacare TDX SC for options provided through the program and options for purchase.

Invacare TDX SP See Invacare/MWP Power wheelchair specification form for Invacare TDX SP for options provided through the program and options for purchase.

Invacare Torque SP See Invacare/MWP Power wheelchair specification form for Invacare Torque SP for options provided through the program and options for purchase.

Invacare TDX Spree See Invacare/MWP Power wheelchair specification form for Invacare TDX Spree for options provided through the program and options for purchase. NOTE – Power elevating seat will be activated if requested

by the prescribing therapist. Repair and replacement will be a cost for the client.

POWER DYNAMIC POSITIONING DEVICE Power Tilt Power Recline Power ELR

27. APPENDIX 2 - Medical Services (Non-Insured Health Benefits – NIHB)

Medical Services has an arrangement with Wheelchair Services in which a separate pool of recyclable equipment is maintained. Prior to issuing equipment/accessories, Wheelchair Services must obtain approval from NIHB. Prior approval is required for repairs costing over $500.00. Prescribers may assist in the process by ensuring all necessary information e.g. treaty number, signature and registration number are present on the request form. Equipment is available for short term use for clients by NIHB. NIHB funds one primary mobility every 5 years. Eligibility criteria for manual and power wheelchair as well as power dynamic positioning device are determined by NIHB.



Procedure for requesting manual or power wheelchair is the same as Manitoba Health except that all applications are submitted to NIHB for approval. When Wheelchair Services is made aware of the outcome of the application, a faxed letter will be sent to the referring prescriber, who will notify client of the status of their application. For more information, refer to the following links:

http://www.provider.esicanada.ca/pdf/Medical_Supplies_and_Equipment_English/

NIHB_MSE_Claims_Submission_Kit.pdf

http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/pdf/pubs/nihb-ssna/yhb-vss/nihb-

ssna-yhb-vss-eng.pdf

http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/fnihb-

dgspni/pdf/pubs/medequip/2009-prov-fourn-guide-eng.pdf 28. APPENDIX 3 - Employment and Income Assistance (EIA)

EIA clients living in the community

Clients covered by Employment and Income Assistance and living in the community are entitled to the same equipment as those who are provided equipment by the Manitoba Wheelchair Program. Eligibility criteria and process for new or exchange application for equipment are the same as that for the program. If approved, the equipment is provided from the MWP pool or recycled equipment. If a client requires a wheelchair that is not available through the program or parts/ accessories listed as upcharges, prescriber must attach a letter to the application form outlining:

Justification for the part/accessory requested to meet the client’s basic mobility OR

Justification for prescribing the wheelchair that is outside of what is available in the MWP or EIA pool of equipment to meet client’s basic mobility.

SMD occupational therapist will review the application and forward recommendation to EIA for approval. If approved, SMD occupational therapist will contact prescriber and approved vendor.

http://www.provider.esicanada.ca/pdf/Medical_Supplies_and_Equipment_English/NIHB_MSE_Claims_Submission_Kit.pdf

http://www.provider.esicanada.ca/pdf/Medical_Supplies_and_Equipment_English/NIHB_MSE_Claims_Submission_Kit.pdf

http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/pdf/pubs/nihb-ssna/yhb-vss/nihb-ssna-yhb-vss-eng.pdf

http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/pdf/pubs/nihb-ssna/yhb-vss/nihb-ssna-yhb-vss-eng.pdf

http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/fnihb-dgspni/pdf/pubs/medequip/2009-prov-fourn-guide-eng.pdf

http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/fnihb-dgspni/pdf/pubs/medequip/2009-prov-fourn-guide-eng.pdf



EIA clients living in an institution

Clients covered by EIA and residing in an institution are eligible for the same equipment as those consumers who are provided equipment by the MWP. Eligibility criteria and process for new or exchange application for equipment are the same as that for the MWP. If approved, the equipment will be supplied from the EIA recycled pool of equipment managed by Wheelchair Services. If a client requires a wheelchair that is not available through the program or parts/ accessories listed as upcharges, prescriber must attach a letter to the application form outlining:

Justification for the part/accessory requested to meet the client’s basic mobility or

Justification for prescribing the wheelchair that is outside of what is available in the MWP or EIA pool of equipment to meet client’s basic mobility.

SMD occupational therapist will review the application and forward recommendation to EIA for approval. If approved, SMD occupational therapist will contact prescriber and approved vendor. Use appropriate SMD Wheelchair Services Application form when requesting a wheelchair through EIA and fax to 975-3240.

Return of EIA Equipment

When equipment is no longer needed, recycling of these items is encouraged. The process for returning a wheelchair/accessory is the same as that for the program and will be returned to the EIA equipment pool.

Manitoba Wheelchair Program Policy and Procedure Manual

Documents

Transcript of Manitoba Wheelchair Program Policy and Procedure Manual