July 2017
Section 44(1)1 ii of the ODSP Regulation
The items and services that are covered under the Hearing Aid Benefit are outlined in the MCSS Schedule of Services and Fees for Hearing Aids, Devices and Services (“the Schedule”), along with approved amounts.
The Schedule also sets out the process for making a request under the Exceptional Circumstances Policy. A request may be made for an item/service not listed in the Schedule under the Exceptional Circumstances Policy where a medical indication for the requested item/service exists. A request may also be made for an items or service listed in the Schedule where it is specified that approval under the Exceptional Circumstances Policy is required.
The Hearing Aid Benefit also covers the cost of Alerting Systems for ODSP recipients and eligible members of the benefit unit who are deaf and hearing impaired.
To provide assistance to ODSP recipients and eligible dependants with the purchase of hearing aids and hearing related items and services.
The Hearing Aid Benefit is available to:
Recipients must be determined eligible for the Hearing Aid Benefit by the local ODSP office.
Assistive Devices Program (ADP) under Ministry of Health and Long-Term Care (MOHLTC)
The MOHLTC is responsible for the delivery of ADP. ADP provides funding to all eligible Ontario residents to help them purchase assistive devices such as hearing devices.
Applicants for ADP must have a documented hearing loss and require the hearing device(s) for use as part of his/her daily living activities at home, school, recreation, sports or work.
Hearing devices approved by ADP for funding are:
In addition to ADP funding, the ODSP Hearing Aid Benefit will provide assistance, as outlined in the Schedule, with:
The ODSP Hearing Aid Benefit aligns with ADP’s policies for the replacement and return of devices.
For more information on ADP, refer to the ADP Policy and Administration Manual on the MOHLTC web site.
There may be situations where an ODSP recipient, who is a refugee claimant under the Immigration and Refugee Protection Act may not be eligible for ADP. Staff should verify that the recipient is not eligible for these benefits through the Interim Federal Health Program prior to issuing the benefit. In these cases, ODSP will pay an amount up to:
the MCSS maximum allowable amount, as set out in the Schedule; plus
the ADP allowable amount, as set out in the Schedule.
Coverage of Alerting Systems
An Alerting System picks up sounds from fire alarms, smoke detectors, carbon monoxide monitors, baby monitors, telephones, doorbells and building security systems and transmits a signal to a light flasher, bed shaker or other appropriate alerting mechanism. In addition, there are also smoke and carbon monoxide detectors for people who are deaf and hearing impaired that provide a visual strobe alert.
ADP does not cover the costs of alerting systems. ODSP provides coverage for alerting systems and installation of the alerting system for ODSP recipients, their spouses and dependent children (0-17 years) who are deaf and hearing impaired.
Note: Aerting systems are not included in the Schedule. Alerting systems are covered as a mandatory benefit and should be processed accordingly.
Accessing the Benefit for eligible ADP items and services on the Schedule
ODSP recipients must meet with their ODSP caseworker to determine eligibility for the Hearing Aid Benefit, and must complete the recipient’s section of the ODSP Hearing Aid Benefit Authorization Form. The form will indicate what products/services are approved by the ODSP caseworker.
Once the ODSP caseworker determines that a recipient is eligible for the benefit, the recipient must go to a service provider that is registered with the Ministry of Health and Long-Term Care's (MOHLTC) Assistive Devices Program (ADP) to complete the rest of the process.
The service provider will determine eligibility for ADP and complete the ODSP Hearing Aid Benefit Authorization Form.
Once device(s) are dispensed according to the Schedule, the recipient must sign the ODSP Hearing Aid Benefit Authorization Form verifying that the services were performed and/or the goods were received in good working order. The service provider must then send the completed Hearing Aid Benefit Authorization Form to the local office along with a copy of the recipient’s completed ADP form and any relevant additional documents (e.g. audiograms).
The ministry will review the forms to ensure that the device(s) and/or service(s) provided are among those authorized by the Schedule. The ministry can authorize payment of the invoices once verification is complete. If a discrepancy exists, the claim will be automatically rejected and returned to the service provider for appropriate action.
Please note the service provider must provide the services and counselling necessary for the proper and effective use, operation, care and maintenance of the hearing aid, ear mold and other related devices.
The Schedule sets outs the approved items, services and amounts. The Schedule is used in parallel with the ADP policies and processes.
The Schedule is available to ODSP staff, participating service providers, municipal Ontario Works Administrators, and Regional Offices.
The following are available for funding through the ODSP Hearing Aid Benefit and will be funded in accordance with the amounts set out in the Schedule.
The Schedule is available to service providers on the Ontario Shared Service Forms repository web portal (search for MCSS Schedule Services of Fees for Hearing Aids, Devices and Services)
Assessments
The ODSP Hearing Aid Benefit provides funding for the cost of an assessment required to determine eligibility for a hearing aid device under ADP. Funding is provided in accordance with the amounts set out in the Schedule.
Under ADP, in order to determine what device(s) is clinically required for ADP funding purposes, the ADP Authorizer must complete a thorough assessment. The assessment must include an audiogram for both ears.
Hearing Aid Assessments - Adults and Children
Teletypewriter/Flashing Signal Device Assessments - Adults and Children
Devices
The following are available through the ODSP Hearing Aid Benefit and will be funded in accordance with the amounts set out in the Schedule.
Adults
Children (0-17 years)
Adults and Children
Service Bundles
Service bundles are intended to cover necessary services over the life of the hearing instrument. Service bundles will be funded in accordance with the amounts and time periods outlined in the Schedule.
Service bundles are differentiated by age group:
Service bundles are organized in two types of bundles: (1) Initial Care and (2) Ongoing Care.
The Initial Care bundle is the first bundle to be used for adults and children receiving funding for a new hearing instrument. The duration of the Initial Care bundle is 1 year.
This Ongoing Care bundle is to be used after the Initial Care bundle has expired. The Ongoing Care bundles will be triggered by patient request for services after the previous bundle has ended. The duration of the Ongoing Care bundle is renewable each year over the remaining life of the hearing instrument.
The bundles are to be funded per instrument.
Service Bundles consist of the following services:
Replacement
Adults
If a replacement hearing instrument is approved, the Initial Care Bundle applies. For more information on ADP, please refer to the ADP Policy and Administration Manual on the MOHLTC web site.
Children
In the case of children, replacement may be approved by a caseworker. In these cases, funding is in accordance with the amounts set out in the Schedule. Where the child is not eligible for ADP coverage, MCSS will also pay the ADP maximum allowable amount, as set out in the Schedule.
Return
The ODSP Hearing Aid Benefit aligns with ADP’s policies for a return of the device.
For more information on ADP, please refer to the ADP Policy and Administration Manual on the MOHLTC web site.
Shipping Fees:
Administration of the items/services under the Schedule
For items under the Schedule, service providers should mail the completed ODSP Hearing Aid Benefit Authorization/Invoice forms to the Local Office for processing.
Exceptional Circumstances
A request under the Exceptional Circumstances Policy may be made where a medical indication for the requested item/service exists.
Requests under the Exceptional Circumstances Policy fall into two categories:
Service providers must obtain pre-authorization from the Ministry before dispensing or providing item(s)/service(s) requiring approval under the Exceptional Circumstances Policy. Service providers should advise recipients about the pre-authorization requirement for item(s)/service(s) outside of the Schedule.
Examples of medical indications that may be considered under the Exceptional Circumstances Policy include:
Decisions for Exceptional Circumstances requests will be made by the Director and managers of the Social Assistance Centralized Services Branch (SACSB).
If an item/service is approved under the Exceptional Circumstances Policy for an item/service on the Schedule, payment will be in accordance with the Schedule (i.e. advanced hearing aids required due to medical indication).
If an item/service is approved under the Exceptional Circumstances Policy and the approved item/service is not set out in the Schedule, the amount payable will be determined by the Director based on the particular circumstances.
1. Submission of Exceptional Circumstances Requests
All Exceptional Circumstances Requests are handled and reviewed by MCSS.
The Hearing Aid Benefit (Exceptional Circumstances) form is available to service providers on the Ontario Shared Service Forms repository web portal (search for ODSP Hearing Aid Benefit).
The service provider must provide the following information with an Exceptional Circumstances request:
Service providers must send the request to:
Ministry of Community and Social Services
ODSP Hearing Aid Benefit Program (Exceptional Circumstances)
77 Wellesley Street West
Box 460
Toronto, ON M7A 1N3
Once received, the Ministry will review the information and issue a decision to the recipient and the service provider. Internal reviews and appeal provisions apply.
The Ministry will notify both recipient and the service provider of the decision within 30 business days.
If the information provided is not sufficient to make a decision or if a second estimate is required, a letter will be sent to the service provider requesting additional information.
The service provider will have 10 business days to respond to the request for additional information. If a response is not received within 10 business days, a follow-up call will be made by the Ministry to the service provider.
2. Payment of Approved Exceptional Circumstances Requests
Once an Exceptional Circumstances request is approved by the Ministry, service providers must provide the following to receive payment:
The Ministry approval letter and the Hearing Aid Benefit Authorization form should be sent to the address below to receive payment. All sections of the form must be complete to receive payment.
ODSP Hearing Aid Benefit Payment Processing,
77 Wellesley St. W.,
Box 333, Toronto, ON M7A 1N3,
Or Fax: 647-723-0343
9.6 Assistive Devices
9.12 Mandatory Special Necessities
13.1 - Notice of Decision and Internal Review Process
13.2 - Appeals