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Home Oxygen Therapy Policy and Administration Manual
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Home Oxygen Therapy Policy and Administration Manual 1 May 2021
Home Oxygen Therapy
Po licy and AdministrationManual
Assistive Devices Program
Ministry of Health
ontario.ca/page/assistive-devices-program Home Oxygen Therapy Policy and Administration Manual 2May 2021
Table of Contents
Table of Amendments ........................................................................ ........................................... 9 Introduction ........................................................................ ............................................................. 11 Part 1: Introduction to Home Oxygen Therapy Policy and Administration Manual ...................................................................................... 12100 Purpose of the Manual ........................................................................
............................................. 12105 Protecting Personal Health Information ........................................................................
..... 13110 Definitions ........................................................................
.......................................................................... 13115 Roles and Responsibilities........................................................................
..................................... 19 Devices Covered ........................................................................ ................................................... 28 Part 2: Devices Covered ........................................................................ ..................................... 29200 Devices Covered ........................................................................
......................................................... 29205 Low Flow Oxygen Systems ........................................................................
................................. 30210 Oxygen Equipment and Services Not Funded by ADP ........................................... 31
215 Travel ........................................................................
................................................................................... 33220 Client Leaves Ontario ........................................................................
.............................................. 34 Home Oxygen Therapy Policy and Administration Manual 3May 2021
Applicant Eligibility Criteria for Home Oxygen Therapy 3 .......................................... 35
Part 3: Applicant Eligibility Criteria for Home Oxygen Therapy ............................... 36 300 Prescriber ........................................................................
.......................................................................... 36 305 Applicant Identified as Ineligible by ADP ........................................................................
... 37310 Medical Eligibility Criteria ........................................................................
....................................... 37315 Medical Eligibility Criteria for Long-Term Oxygen Therapy for Resting
Hypoxemia ........................................................................ ....................................................................................... 38320 Medical Eligibility Criteria for Long-Term Oxygen Therapy for Exertional
Hypoxemia ........................................................................ ...................................................................................... 39325 Medical Criteria for Long-Term Oxygen Therapy for Children ....................... 43
330 Medical Eligibility Criteria for Oxygen Therapy for Palliative Care .................... 44
335 Medical Eligibility Criteria for Short-Term Oxygen Therapy .............................. 46
340 Annual Re-assessment of Home Oxygen Therapy ................................................... 48
345 Discontinuation of Home Oxygen Therapy ...................................................................... 48
350 Ineligible Individuals ........................................................................
................................................. 48355 Procedure for Special Authorization ........................................................................
............. 49Confirmation of Eligibility for Equipment Required 4 ................................................... 51
Part 4: Confirmation of Eligibility for Equipment Required ........................................ 52
Home Oxygen Therapy Policy and Administration Manual 4May 2021
400Registered Respiratory Therapists ........................................................................
................ 52405 Acceptable Evidence of Medical Eligibility: Applicants 18 Years of Age or
Younger ........................................................................ ............................................................................................. 53410 Acceptable Evidence of Medical Eligibility: Applicants 19 Years of Age or
Older 54
415 Arterial Blood Gas (ABG) Test ........................................................................
.............................. 57420 Oximetry Studies ........................................................................
......................................................... 58Fundin
g Periods ........................................................................ .................................................... 62Part 5: Funding Periods
...................................... 63500 Funding Periods: Long-Term Oxygen Therapy ............................................................ 63
505 Funding Period: Long-Term Oxygen Therapy for Children ............................... 65
510 Funding Period: Oxygen Therapy for Palliative Care ..................................................... 66
515 Funding Periods: Short-Term Oxygen Therapy ............................................................ 67
520 Designated Re-assessment Period ........................................................................
.............. 68525 Discontinuation of Home Oxygen Therapy ...................................................................... 69
Funding and Payment 6 ........................................................................ .................................... 70 Part 6: Funding and Payment ........................................................................ .......................... 71600 Funding Amount for ADP Clients ........................................................................
.......................71 Home Oxygen Therapy Policy and Administration Manual 5May 2021
605Eligibility for 100 Percent Funding........................................................................
....................71610 Eligibility for 75 Percent Funding ........................................................................
.......................71615 Re-assessment Carried Out After the Designated Re-assessment Period
72620 Hospitalization........................................................................
................................................................ 74625 Prescriber Discontinues Home Oxygen Therapy ......................................................... 75
630 Stale-dated Policy ........................................................................
....................................................... 76635 Change in Vendor ........................................................................
....................................................... 76640 Request for a Change in Oxygen Delivery System .................................................... 77
645 Update of Client Data ........................................................................
................................................ 77 Invoicing Procedures ........................................................................ .......................................... 79Part 7: Invoicing Procedures ........................................................................
........................... 80700 Invoice Processing ........................................................................
..................................................... 80705 ADP Processing Errors ........................................................................
............................................ 80710 Long-Term Oxygen Therapy / Children Funding Invoicing Procedures . 80
715 Palliative Care Invoicing Procedures ........................................................................
............. 81 720 Short-Term Oxygen Therapy Invoicing Procedures ................................................ 82
725 Northern and Southern Designation ........................................................................
............. 83 Home Oxygen Therapy Policy and Administration Manual 6May 2021
Vendors for Home Oxygen Therapy 8 ........................................................................
....... 84Part 8: Vendors
...................................................... 85800 Vendor Status ........................................................................
................................................................ 85805 Joint Ventures: Vendors Sharing Proceeds with Hospitals ................................ 86
810 Preferred Vendor Agreement ........................................................................
............................ 87815 General Vendor Policies ........................................................................
........................................ 88820 Client Safety and Education ........................................................................
................................ 89825 Staff Training and Education Program ........................................................................
......... 90830 Infection Prevention and Control ........................................................................
..................... 91835 Client Record Keeping ........................................................................
............................................. 91840 Staff Screening ........................................................................
.............................................................. 93845 Accountability ........................................................................
............................................................... 93850 Sub-Contracting ........................................................................
.......................................................... 94 Home Oxygen Therapy During The COVID-19 Pandemic 9 ......................................... 95 Part 9: Home Oxygen Therapy During The COVID-19 Pandemic ............................. 96900 Policy Changes Due to COVID-19 ........................................................................
.................. 96905 First Time Applicants ........................................................................
............................................... 97910 Extended Funding ........................................................................
...................................................... 97 Home Oxygen Therapy Policy and Administration Manual 1May 2021
Home Oxygen Therapy
Po licy and AdministrationManual
Assistive Devices Program
Ministry of Health
ontario.ca/page/assistive-devices-program Home Oxygen Therapy Policy and Administration Manual 2May 2021
Table of Contents
Table of Amendments ........................................................................ ........................................... 9 Introduction ........................................................................ ............................................................. 11 Part 1: Introduction to Home Oxygen Therapy Policy and Administration Manual ...................................................................................... 12100 Purpose of the Manual ........................................................................
............................................. 12105 Protecting Personal Health Information ........................................................................
..... 13110 Definitions ........................................................................
.......................................................................... 13115 Roles and Responsibilities........................................................................
..................................... 19 Devices Covered ........................................................................ ................................................... 28 Part 2: Devices Covered ........................................................................ ..................................... 29200 Devices Covered ........................................................................
......................................................... 29205 Low Flow Oxygen Systems ........................................................................
................................. 30210 Oxygen Equipment and Services Not Funded by ADP ........................................... 31
215 Travel ........................................................................
................................................................................... 33220 Client Leaves Ontario ........................................................................
.............................................. 34 Home Oxygen Therapy Policy and Administration Manual 3May 2021
Applicant Eligibility Criteria for Home Oxygen Therapy 3 .......................................... 35
Part 3: Applicant Eligibility Criteria for Home Oxygen Therapy ............................... 36 300 Prescriber ........................................................................
.......................................................................... 36 305 Applicant Identified as Ineligible by ADP ........................................................................
... 37310 Medical Eligibility Criteria ........................................................................
....................................... 37315 Medical Eligibility Criteria for Long-Term Oxygen Therapy for Resting
Hypoxemia ........................................................................ ....................................................................................... 38320 Medical Eligibility Criteria for Long-Term Oxygen Therapy for Exertional
Hypoxemia ........................................................................ ...................................................................................... 39325 Medical Criteria for Long-Term Oxygen Therapy for Children ....................... 43
330 Medical Eligibility Criteria for Oxygen Therapy for Palliative Care .................... 44
335 Medical Eligibility Criteria for Short-Term Oxygen Therapy .............................. 46
340 Annual Re-assessment of Home Oxygen Therapy ................................................... 48
345 Discontinuation of Home Oxygen Therapy ...................................................................... 48
350 Ineligible Individuals ........................................................................
................................................. 48355 Procedure for Special Authorization ........................................................................
............. 49Confirmation of Eligibility for Equipment Required 4 ................................................... 51
Part 4: Confirmation of Eligibility for Equipment Required ........................................ 52
Home Oxygen Therapy Policy and Administration Manual 4May 2021
400Registered Respiratory Therapists ........................................................................
................ 52405 Acceptable Evidence of Medical Eligibility: Applicants 18 Years of Age or
Younger ........................................................................ ............................................................................................. 53410 Acceptable Evidence of Medical Eligibility: Applicants 19 Years of Age or
Older 54
415 Arterial Blood Gas (ABG) Test ........................................................................
.............................. 57420 Oximetry Studies ........................................................................
......................................................... 58Fundin
g Periods ........................................................................ .................................................... 62Part 5: Funding Periods
...................................... 63500 Funding Periods: Long-Term Oxygen Therapy ............................................................ 63
505 Funding Period: Long-Term Oxygen Therapy for Children ............................... 65
510 Funding Period: Oxygen Therapy for Palliative Care ..................................................... 66
515 Funding Periods: Short-Term Oxygen Therapy ............................................................ 67
520 Designated Re-assessment Period ........................................................................
.............. 68525 Discontinuation of Home Oxygen Therapy ...................................................................... 69
Funding and Payment 6 ........................................................................ .................................... 70 Part 6: Funding and Payment ........................................................................ .......................... 71600 Funding Amount for ADP Clients ........................................................................
.......................71 Home Oxygen Therapy Policy and Administration Manual 5May 2021
605Eligibility for 100 Percent Funding........................................................................
....................71610 Eligibility for 75 Percent Funding ........................................................................
.......................71615 Re-assessment Carried Out After the Designated Re-assessment Period
72620 Hospitalization........................................................................
................................................................ 74625 Prescriber Discontinues Home Oxygen Therapy ......................................................... 75
630 Stale-dated Policy ........................................................................
....................................................... 76635 Change in Vendor ........................................................................
....................................................... 76640 Request for a Change in Oxygen Delivery System .................................................... 77
645 Update of Client Data ........................................................................
................................................ 77 Invoicing Procedures ........................................................................ .......................................... 79Part 7: Invoicing Procedures ........................................................................
........................... 80700 Invoice Processing ........................................................................
..................................................... 80705 ADP Processing Errors ........................................................................
............................................ 80710 Long-Term Oxygen Therapy / Children Funding Invoicing Procedures . 80
715 Palliative Care Invoicing Procedures ........................................................................
............. 81 720 Short-Term Oxygen Therapy Invoicing Procedures ................................................ 82
725 Northern and Southern Designation ........................................................................
............. 83 Home Oxygen Therapy Policy and Administration Manual 6May 2021
Vendors for Home Oxygen Therapy 8 ........................................................................
....... 84