APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write
APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NOTES AB To be eligible for a travel allowance, a worker must: Policy (04-02 Part II, Application 2) • take the most reasonably direct route available to the place of examination or treatment, and • use the most economical means of transportation available. If regularly scheduled public transportation is unavailable or inconvenient, the worker may use a private vehicle and the WCB will reimburse the worker at the rate per kilometre ($0.49/km). The WCB usually considers the worker’s normal place of residence to be the point of origin when calculating the travel allowance amount. Unless required by medical or other special circumstances, a travel allowance is not paid when: • a worker’s place of residence and place of treatment are in the same locality, or • a worker chooses to travel to a distant location when adequate treatment is available in a local community. Except for incidental transportation, taxi-cab services will only be covered by the WCB if required by medical necessity or extraordinary circumstances. The WCB may limit the amount paid for travel when the travel is for a long-term course taken as part of a vocational plan. In these cases, the WCB will compare the travel costs with the cost of temporarily relocating the worker to the centre where the 1 Figures and policy current to June 14, 2011. December 5, 2011 Page 1 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NOTES course is held. The worker will still have the choice whether to relocate, even if relocation is more cost-effective. However, if relocation is a reasonable option and the worker prefers to travel to and from the course, the WCB will only pay travel costs up to the estimated cost of relocation. MB Policy Policy - reimburses actual reasonable expenses related to travelling to medical treatment which are in excess of costs normally incurred by the worker while traveling to and from work. - all travel reimbursements should be based on the most cost-effective alternative and take account of the injured worker's medical functioning level. 44.120.10 Medical Aid Administrative Guidelines - mileage will be reimbursed at the rate that a WCB employee would receive for travel within the province. The cost of necessary local transportation will be reimbursed but the WCB does not pay for the cost of personal trips. NB - (Policy No. 29220, 21-220) Workers are not compensated for travel within 22 km, a distance referred to as “the Exclusion Zone.” This Exclusion Zone corresponds to the distance a worker might typically travel in the course of day-to-day living. - Transportation costs = (Distance travelled – exclusion zone) x transportation rate. - This method is used to determine the amount payable, regardless of whether the injured worker chooses to travel by some other transportation method, unless the injured worker’s needs and condition warrants using an alternative mode of transportation. - For travel to appointments outside New Brunswick, WorkSafeNB arranges (or pre-approves) and pays for the injured worker’s transportation. When doing so, WorkSafeNB uses the most cost-effective and suitable means available. December 5, 2011 Page 2 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NOTES - When an injured worker chooses to travel by means other than that approved by WorkSafeNB, WorkSafeNB pays the lesser of: The transportation rate for the distance travelled minus the exclusion zone; or he cost of the most economical, suitable means of transportation available. - Expenses are paid at cost for ferries, road and bridge tolls and parking fees. Receipts are required. - Injured workers in short or long-term training programs away from their home area are eligible to have the following costs covered: a) a one way trip at the start of the program; b) a one way trip at its conclusion; and c) a round trip every month during the program, as long as it does not disrupt the worker’s participates in the program. If the program is outside NB, WorkSafeNB uses the most cost-effective and suitable means available. Additional trips home may be authorized if an injured worker’s needs justify the expense. - WorkSafeNB may pay additional transportation costs to injured workers who participate in WorkSafeNB approved return to work programs if attending the program causes the worker to have additional expenses that exceed pre-accident workrelated travel expenses (e.g. missing carpool). NF Policy (Policy HC-07, Procedure 60.00) - Public transportation to be used wherever possible. - Where public transportation is not available, private vehicles may be used and a km allowance will be provided. Procedure December 5, 2011 - Expenses will be covered based on the most economical and suitable means of travel available. Travel options may include bus/public transportation, private vehicle, taxi, air travel or ferry service. - The most cost-effective and suitable means of travel/accommodation available will be utilized for travel outside NF. - Actual costs for parking at a parking garage or lot will be paid, where a receipt is provided for the time of the worker’s appointment. Page 3 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NWT/Nunavut (Worker’s Compensation General Regulations R-080-2010, s. 4) NS Worker Travel Expenses for Health Care 2.1.1R7 NOTES - Parking meter charges are covered up to a maximum of $8 per day flat-rate. - Where a worker undergoes medical examination or treatment at the direction or with the approval of the Commission at a place other than that in which he or she resides, he or she shall take the most direct route and use the most economical means of transportation available. - Where regularly scheduled public transportation is unavailable or inconvenient, the worker may make use of a private motor vehicle and shall be reimbursed for its use at the rate of $0.58 per kilometre. - When a worker accesses commercial travel within the province, subject to pre-authorization by the case worker, coverage is: bus or train fare (actual fare, based on receipts); and/or air fare (actual fare, based on receipts). - Cost of travel in local areas for medical treatment and Board-arranged appointments, will be paid as follows: a) actual bus, train fares; b) private vehicle - mileage at 40.92 c/km and c) taxi fares will be paid if pre-authorized, or circumstances justify, and proper receipts are provided. - A client may use his/her own vehicle for transportation purposes to access services necessitated by the compensable injury, if this use has been pre-authorized by the Board. Authorized vehicle use will be reimbursed at the rate of 40.92 c/km. - Out-of-province travel must be pre-authorized by the case worker. The most appropriate mode of travel will be approved. Actual costs will be reimbursed based on receipts. Future travel rates will be adjusted, on a go-forward basis, following notification from the Director of Human Resources that the rates for Workers’ Compensation Board employees have increased. December 5, 2011 Page 4 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NOTES ON - Practicality, expedience, and clinical necessity are considered when determining the mode of transportation. The decisionmaker may consult with WSIB clinical staff regarding the nature and sufficiency of travel arrangements. Transportation expenses are paid based on the most direct route. - Use of public transportation is fully reimbursed. - If public transportation is available but an alternate mode is chosen, the equivalent of public transportation costs is paid When public transportation is not available and a personal vehicle is used, payment is made at the approved mileage rate ($0.38/km). - When the use of a personal vehicle is approved, actual parking fees are reimbursed. - Transportation costs will be reimbursed at the rate of 45.3 cents per kilometre (the same as WCB employees) when transportation is required for: o Medical treatments with attending physicians; o Physiotherapy, chiropractic, or any other treatment as deemed necessary or appropriate by the Workers Compensation Board; o Vocational rehabilitation programs to a maximum of $175.00 per week, except where the Workers Compensation Board determines it is more cost effective to pay room and board costs in lieu of transportation to and from the program; o Any other meeting arranged by the Workers Compensation Board pertaining to a worker’s claim. o In situations where personal use of a motor vehicle is not possible, workers are required to use the most appropriate and cost effective mode of transportation. - The payment of expenses must be pre-authorized by the WCB before the expenses are incurred by the worker. - A travel allowance may be given to the worker to cover reasonable travel expenditures, where the WCB arranges or approves out-of-province medical aid or assessment. - In situations where personal use of a motor vehicle is not possible, workers are required to use the most appropriate and Travel and Related Expenses 17-01-09 PEI (Policy POL-03) December 5, 2011 Page 5 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NOTES cost-effective mode of transportation (which must be pre-authorized by the WCB). Reimbursement of commercial transportation costs is based on receipts received. - Where transportation is provided for by means other than by commercial transportation, reimbursement is not to exceed the maximum km rate for the use of private motor vehicles. QUE - (Regulation Respecting Travel and Living Expenses, c.A-3.0001, r.8.) - The CSST shall reimburse, upon the production of supporting documents, to the worker and, if his physical condition requires it, to the person who must accompany him, the travel and accommodation expenses incurred to receive care, undergo examinations or take part in a personal rehabilitation program according to the amounts it determines and publishes in the Gazette. All expenses incurred for public transportation by bus, subway, train or boat are reimbursable. Rate reimbursed for using personal vehicles: $0.145/km per km (“unauthorized”); $0.43/km if “authorized” (i.e. a physician certifies that worker is unable to use public transportation). Parking and toll costs are paid for whether personal vehicle is authorized or not. SK - (Policy POL 12/2008, PRO 52/2011) The purpose of the travel and sustenance allowance is to ensure workers do not incur additional expenses when required to travel outside the resident community to attend WCB directed treatment, vocational programs or other appointments or hearings. - Subject to the following policy, travel will be reimbursed only for that portion of expense exceeding the normal employment expense. The exception will be attendance for appointments other than for the purpose of treatment or vocational training where appropriate travel and sustenance will be reimbursed without deduction of normal employment expense. - Wherever possible, workers must attend the closest available treatment facility or training centre. Where the worker chooses to by-pass the nearest available facility/centre, only travel to the closest available will be reimbursed. - Where workers reside and work in the same community, no additional expense will be paid. However, where parking is not a normal employment expense, receipts will be reimbursed. December 5, 2011 - Page 6 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NOTES - Mileage for private vehicle at PSC rates calculated between city centre and city centre, or the actual cost of public transportation (e.g., STC bus) plus return taxi from the terminal to treatment; - Parking receipts, where not considered a normal employment expense. - Vocational training programs: o For travel within a 75 km radius from the resident community (considered a reasonable commute), the worker will be provided PSC mileage rates up to a maximum of $190 per week for private vehicles; or if public transportation is used, actual costs as long as it. o At the discretion of the authorizing agent, where a worker’s individual circumstances make commuting a hardship, expenses (e.g., meals, accommodations, parking) will be reimbursed. This is normally restricted to short-term programs where relocation (below) is not considered. o Effective May 1, 2011, the rate for using one’s personal vehicle for WCB business are as follows: - Ordinary – 39.23 c/km - North of the 54th Parallel - 42.25.c/km Subject to minimum allowance of $5.00 per day, prorated for shorter periods at $1.50 per hour for actual usage to a maximum of $6.00 per day or 36.23¢km, whichever is the greater. YK - The YWCHSB covers the reasonable expenses of traveling. Reasonable travel expenses are the exceptional travel costs that exceed any regular pre-injury work-related travel costs that would not have been incurred without the requirement to travel. When deciding whether costs are exceptional or regular, the YWCHSB shall consider the traveler’s regular pre-injury work-related pattern of travel, such as the normal distance traveled, the mode of travel, and whether the travel was conducted alone or not. - The YWCHSB shall encourage the use of public transportation when it is available and practical. (Policy EN-11, BD-02) December 5, 2011 Page 7 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II TRAVEL ALLOWANCES (MILEAGE, EXCLUSION ZONE & PARKING) 1 JURISDICTION NOTES - December 5, 2011 The YWCHSB may allow an alternate mode of transportation on a discretionary basis. The decision to allow alternate transportation is based on the overall costs and on whether the mode of transportation would impede the recovery and return of an injured worker to the workforce. Page 8 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II MILEAGE Province Mileage 2 Method of Calculating Increase BC $0.37/km Policy #82.20 Policy #82.20 Effective June 30, 2002, the kilometer rate will be adjusted on January 1 of each year. The percentage change in the consumer price index determined under s.25.2 of the Act will be used. The result is rounded to the nearest cent. $0.49/km Policy 04-02 Part II Policy 04-02, addendum, Allowance Rates The mileage rate under the travel allowance is based on the average cost for operating a vehicle. Average costs for a wide range of vehicles are considered when the rate is set. $0.37/km Administrative Guidelines to Policy 44.120.10 Policy 21-10-40 Appendix A Mileage allowance is updated every quarter. Mileage will be reimbursed at the rate that a WCB employee would receive for travel within the province. $0.39/km Policy 29-220 Policy 21-220 WorkSafeNB pays for travel by personal vehicle according to actual distance travelled, minus the “exclusion zone” (Policy 21 -220 - 22km per day, as this is considered to be the distance a worker may travel for day-to-day living). Rates are same for workers and staff. AB MB NB 2 Worker Rate vs. Employee Rate Same Same Same Based on rates in policy as of June 13, 2011. December 5, 2011 Page 9 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II MILEAGE Province Mileage 3 Method of Calculating Increase Worker Rate vs. Employee Rate NF $0.30/km Policy HC-07 Same Procedure Number 60.00 – Healthcare Fees and Expenses When a claimant is required to travel outside his/her home community for purposes of medical treatment, other purposes connected with management of the claim, or for rehabilitation purposes, the Commission will cover the cost of reasonable travel and accommodation expenses. Allowances shall be as established from time to time by the Management Committee of the Commission; but at no time shall exceed the level of allowances provided to Commission staff. NWT/ Nunavut $0.58/km Workers’ Compensation General Regulation s. 4(3) – states rate but not method for setting it. NS $0.4092/km Policy 2.1.1R7 Policy 2.1.1R7 Future travel rates will be adjusted, on a go-forward basis, following notification from the Director of Human Resources that the rates for Workers’ Compensation Board employees have increased (rates are same for workers and staff) $0.38/km Policy 17-01-09 Policy 18-01-05 Every year, the WSIB reviews and sets the following rates after conducting an external survey of costs for each specific rate. ON 3 Same Based on rates in policy as of June 13, 2011. December 5, 2011 Page 10 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II MILEAGE Province Mileage 3 Method of Calculating Increase PEI $0.453/km Policy POL-03 – refers to “maximum kilometer rate in place for the use of a private vehicle” but does not state the rate or the method by which it is changed. POL-03 (Current rates not listed) SK Ordinary: $0.3923/km North of the 54 Parallel: th $0.4225/km PRO 52/2011 QUE $0.145/km per km (“unauthorized”); $0.43/km if “authorized” (i.e. a physician certifies that worker is unable to use public transportation). Policy 07/2003 Worker Rate vs. Employee Rate Same Mileage for private vehicle is payable at Public Service Commission (PSC) rates. Subject to minimum allowance of $5.00 per day, prorated for shorter periods at $1.50 per hour for actual usage to a maximum of $6.00 per day or 36.23¢km, whichever is the greater (see PRO 52/2011) Section 21 of the Regulations: reimbursement amounts for meals, travel, and accommodation are revalued in accordance with the amendments that the Treasury Board make to the regulations respecting the travel expenses of civil servants (Règles sur les frais de déplacement des fonctionnaires) Same (Regulation Respecting Travel and Living Expenses, c.A-3.0001, r.8,s.5) December 5, 2011 Page 11 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II MILEAGE Province Mileage 4 Method of Calculating Increase YK $0.61/km. Minimum daily rate for mileage is $2.35. Rates of travel expenses are listed in App. A of BD-02. Worker Rate vs. Employee Rate Policy EN-11 Appendix A of BD-02. 4 Based on rates in policy as of June 13, 2011. December 5, 2011 Page 12 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION NOTES AB - WCB will pay workers a subsistence allowance (amounts for travel, accommodation, and meals) for each 24 hour period away from home. - WCB may pay a subsistence allowance when a worker is required to be away from home for less than 24 hrs. and does not need lodging or overnight accommodation. - WCB may pay the actual cost of meals for workers in exceptional circumstances when a worker is required to travel to a location where the meal allowance is not enough to cover the cost of an average meal. For payment of the actual cost, receipts must be supplied by the worker and include taxes and gratuities, but not alcoholic beverages. - Fixed meal allowance is $44 per day: $13 for breakfast, $13 for lunch, and $22 for dinner. - The nightly accommodation allowance is $114, or, for private residences, $15. The WCB may authorize a higher amount when required (e.g. special medical requirements, accommodation availability, other relevant conditions). - No mention is made of traveling companions in the policy. Forms for “personal escorts,” however, are available and the WCB advises that meals could be approved for personal escorts on a case-by-case basis. Meal allowances would be the same rate as for the worker. (Policy 04-02) MB Policy (Policy 44.120.10) - WCB reimburses actual reasonable expenses related to travelling to medical treatment which are in excess of costs normally incurred by the worker while traveling to and from work. - All travel reimbursements should be based, however, on the most cost-effective alternative and take account of the injured worker's medical functioning level. - Arrangements should be made at a moderately priced hotel. The WCB will approve hotels approved by the Province of Manitoba for its employees. If a worker chooses to make arrangements at a hotel not approved by the WCB, the 5 Figures current to Aug 28, 2009 December 5, 2011 Page 13 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION NOTES reimbursement will not exceed what would have been paid at an approved hotel. If an eligible individual chooses to make arrangements to stay in non-commercial lodgings such as with a relative, a payment may be made that would not exceed 50% of the cost of an appropriate hotel. NB - Additional costs to cover the care of dependents during travel will be paid on receipt of detailed invoice showing at least the date of care of dependents, the cost of care of dependents, and the name and address of the care provider. - The WCB may provide escorts for medical appointments if the WCB determines that the injured worker’s functioning level requires it. An escort may also be provided if it is unsafe for the injured worker to travel alone. The WCB will cover the escort’s travel, accommodation, meals and wage loss. - Fixed meal allowances are provided for “workers who travel to appointments or Appeals Tribunal hearings and are not at home over meal hours.” No receipts are required. Policy Transportation Expenses (29-220) Claim related travel expenses – 21-220, 29224 December 5, 2011 - o w/in NB: $37.50 for the day ($7.50 for breakfast, $10.50 for lunch, and $19.50 for dinner). o outside NB: $46.00 for the day ($10.00 for breakfast, $12.00 for lunch, and $24.00 for dinner). Individual meal allowances are payable if: o For breakfast, the duration of the reason for travel exceeds four hours, and the out-going departure time is before 8 a.m.; o For lunch, the duration of the reason for travel exceeds four hours, either side of noon; o For supper, the duration of the reason exceeds four hours, and the arrival time home is after 7 p.m. - Injured workers attending long-term training programs away from their home area have specific per diem allowance and meal per diem rates. - WorkSafeNB authorizes a companion or attendant to travel with an injured worker if the injured worker’s needs and individual circumstances justify this expense. Page 14 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION NF (Policy HC-07, Procedure December 5, 2011 NOTES - WorkSafeNB pays authorized attendants/companions’ travel expenses under this policy, in the same manner as it pays injured workers’ expenses. - WorkSafeNB pays for accommodations for an injured worker who stays away from home overnight to attend an appointment or Appeals Tribunal when making the round trip is not safe or cost-effective OR the injured worker’s needs and individual circumstances justify the overnight stay. - For claim-related travel within NB, workers are expected to use hotels that have negotiated rates with WorkSafeNB. Expenses incurred will be reimbursed by WorkSafeNB up to the negotiated rates. If workers use a non-negotiated rate hotel, only the negotiated rate is reimbursed. When a negotiated rate is not established in hotels in the area, WorkSafeNB reimburses for the cost of accommodation. For claim-related travel outside NB, WorkSafeNB pays the full cost of accommodation. - When WorkSafeNB authorizes an attendant or companion to share an injured worker’s room, the double-occupancy surcharge on the room is paid in full. - Receipts are required for reimbursement for accommodation expenses. When no receipts are provided, WorkSafeNB pays a daily allowance of $40. - Injured workers who have dependants requiring supervision during an absence for claim-related reasons are eligible for payment. Payment for child/dependent care is based on the period of service regardless of the number of children involved. Expenses are paid only for those costs above what would normally be incurred when the worker was working. Receipts are required. WorkSafeNB provides a meal allowance that is equal to 50% of the meal per diem listed above to injured workers attending a long-term training program. - when a worker must travel outside his or her own home community o overnight: per diem allowance of $25 per night including meals is paid if staying with relatives or friends (no receipts required); OR per diem allowance of $79, not including meals, is paid when staying at a commercial establishment (receipts required). A higher nightly rate may be authorized if vacancy is limited and a room is not available for the Page 15 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION NOTES 60.00) NWT/Nunavut NT (Policy 04.02, rates set out in the General Regulations). approved maximum amount or where the accommodations available for the maximum do not meet the functional needs of the worker. - A meal allowance is provided when a worker is required to travel over a period when a meal would generally be consumed and, travel in excess of 200 km round trip; or attends an approved program that is 5 hours minimum, regardless of the distance from home. - Fixed allowance amounts for meals: $6.00 for breakfast, $8.00 for lunch, and $11.00 for dinner. No receipts required. - There is an out-of-province per diem of $32.00 per day (no receipt required). - Costs for an attendant or companion to travel with the worker will be covered (at the same rates as the injured worker) where the attendant or companion is medically necessary. The most cost effective appropriate means of transportation must be used. Only one person in a car pool will be covered for personal vehicle expenses when traveling to approved appointments. For non-emergency travel, prior approval for an attendant or companion is encouraged so that the injured worker is aware whether the costs will be covered. - The WSCC pays a subsistence allowance to workers when the workers must be away from their home community to obtain medical aid for a work-related injury. The subsistence allowance is only paid when workers maintain a connection to a place other than where the WSCC directs them to be. Maintaining a connection means paying a significant amount of rent, mortgage or other fee or cost that guarantees a place for the worker to live upon return. No subsistence allowance is payable where: - • • a worker chooses to travel to a major or other centre for treatment or to await recovery; or the WSCC provides a worker with board and lodging in a hospital or other place of treatment. Where the WSCC arranges and pays for meals and accommodation for workers or other approved travellers, they are paid incidentals according to the Workers’ Compensation General Regulations: • December 5, 2011 Breakfast for $20.95; lunch for $20,30; and dinner for $52.30. Incidental expenses can be reimbursed up to $17.30. Page 16 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION NOTES - For overnight commercial accommodation, where the Commission has pre-approved it and a receipt is provided to the Commission, the amount charged will be reimbursed; for overnight, non-commercial accommodation, $50.00 will be reimbursed. - If a worker who received transportation and subsidence allowances fails to attend a required appointment without a valid reason, the WSCC considers the expenses to be an overpayment and recovers them. - The Commission will pay a person escorting an injured worker a subsidence allowance equal to the worker’s allowance if the Commission is satisfied that: • • NS - A fixed meal allowance may be provided to workers who must be away from home over a meal period, where preauthorized. - per diem amount of $38.00 - $6 breakfast, $12 lunch, $20 dinner. - Workers will be provided with overnight accommodations when the need arises, pre-authorized by the Board. Where possible, costs will be charged directly to the Board; otherwise, reimbursement will be based on receipts. - Expenses related to escorts may be paid. Each claim must be reviewed on individual merit. - Fixed meal allowances are paid at approved rates if workers are required by the WSIB to lodge away from home, attend scheduled appointments, out-patient health care programs, etc.: $10 for breakfast, $16 for lunch, and $23 dinner. - Travel expenses for escorts are paid when there is a clinical necessity, or for compassionate or practical reasons. If the worker is unable to travel due to the work-related medical condition, payment of travel and related expenses is extended to enable one family member to visit the worker (consideration for payment is according to the same criteria used for workers returning to their residences). Travel expenses are paid when a family member is required to travel to a treatment centre to Policy 2.1.1R7 ON Policy 17-01-09 December 5, 2011 the worker should, for medical or other reasons, be escorted by another person; and the person who escorts the worker is a suitable escort. Page 17 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION NOTES receive instruction in the care and treatment of the worker’s condition. PEI - When required to lodge away from home while keeping an appointment or participating in a program authorized by the WSIB, accommodation expenses (hotel, or room and board) are paid at approved rates (which are not listed). - Fixed meal allowances are paid when worker required to be away from home for a for a period exceeding 4 hours from the time the worker leaves his or her residence until the completion of the medical treatment or meeting. Before reimbursement of expenses can occur, confirmation of attendance at the treatment/program must be received by the Workers Compensation Board. - Meal allowance: $7.50 for breakfast, $8.50 for lunch, and $19.50 dinner. - Receipts for all expenses, other than kilometer reimbursement and meal allowances, must be attached to the applicable Worker’s Expense Claim (CL-08) form. - In circumstances that are medically necessary and where prior approval is given by the Workers Compensation Board, appropriate travel costs for an attendant to travel with a worker will be reimbursed by the Workers Compensation Board. Attendant fees will be paid only when the attendant is a health professional and the services of a health professional are medically required to accompany the worker to the medical appointment. Prior approval for an attendant to travel with the worker may be waived in situations where the injury is life-threatening. - In situations where overnight accommodations are required, other than for vocational rehabilitation programs, workers will be reimbursed to a maximum rate of $120 per night (inclusive of taxes). Receipts are required for reimbursement. Accommodations in private residences are reimbursed at a rate of $10 per night (and no receipt is required for reimbursement). - Only expenses for meals taken during a trip where the destination is more than 16km from the worker’s residence, by the shortest route, are reimbursable in the following cases: a) where the worker had to leave his home before 7:30 a.m, breakfast expenses; b) where the worker had to leave his residence before 11:30 a.m. and where he had to return after 1:30 p.m., lunch expenses; or c) where the worker had to leave his residence before 5:30 p.m. and where he had to return (Policy POL-03) QUE (Regulation Respecting December 5, 2011 Page 18 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION Travel and Living Expenses, c.A3.0001, r.8.) NOTES after 6:30 p.m., dinner expenses. - Lunch expenses are also reimbursable where the worker has to travel 16 km or less from his residence to receive care or to undergo medical examinations and where he has to stay at the destination between 8:30 a.m. and 11:30 a.m. or between 11:30 a.m. and 1:30 p.m. - Meals may be reimbursed up to: Breakfast $10.40; Lunch $14.30; Dinner $21.55. - Living expenses incurred in staying at a hotel or at the home of a relative or friend are reimbursable where the Commission has given prior authorization for the stay. - Hotel accommodation may be reimbursed up to: Island of Montreal: $126 to $138/night; Communaute metropolitaine de Quebec: $106/night; Cities of Laval, Gatineau and Longueui;: $102 to $110 /night; elsewhere in Quebec: $83 to $87/night; Plus an allowance of $5.85 for each day of travel with hotel accommodation. - Lodging at the home of a friend or relative is reimbursed $22.25/night. - A nurse, a nursing assistant or a nurse’s aide providing home care to a worker in accordance with the Act is entitled to reimbursement of travel and living expenses equal to the amounts listed above for an injured worker. The nurse, nursing assistant or nurses’ aide becomes entitled to meals under the same conditions where they travel by the shortest route more than 16 km from the establishment of their employer. The Commission may authorize a nurse, a nursing assistant or a nurse’s aide to use a personal vehicle or a taxi. SK - (Policy PRO 52/2011) Entitlement will be determined on the basis of whether the client has been put to additional expense (beyond normal employment expenses) when travelling for medical treatment or vocational rehabilitation programming. - fixed meal allowances are paid when workers are required to travel outside their resident community and are required to be December 5, 2011 Page 19 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION NOTES away from home over meal times. - YK o w/in province: $41 per day - $8 for breakfast, $14 for lunch, and $19 for dinner. o outside province: $51 per day - $11 for breakfast, $16 for lunch, and $24 for dinner. - Reasonable and actual reimbursement for hotel accommodation will be authorized when supported by receipts for clients requiring accommodation in order to attend WCB authorized medical treatment or vocational programming. The PSC rate ($35/night) will be reimbursed for staying at a private home. - WCB may pre-approve travel and sustenance for attendants other than qualified Medical Personnel where it is considered essential by reason of the worker’s injury and confirmed by the treating physician and/or a WCB Medical Consultant. - For days in which workers are on “travel status” for the full day, injured workers can claim varying maximum amounts depending on which jurisdiction they eat in. The following amounts cover meals and incidentals for full day travel: C$99.60 (Yukon), C$112.50 (NWT), C$129.15 (NV), C$86.35 (Rest of Canada), US$99.60 (Alaska), US$86.35 (Rest of US). - For days in which workers are on travel status for partial days, injured workers can claim varying maximum amounts for each meal, depending on which jurisdiction they eat in: (Policy EN-11, BD-02) December 5, 2011 rates paid are Public Service Commission rates: Yukon NWT NV Rest of Canada Alaska Rest of US Breakfast C$15.60 C$21.35 C$21.05 C$15.05 US$15.60 US$15.05 Lunch C$18.45 $C20.65 C$28.60 C$14.15 US$18.45 US$14.15 Dinner C$48.25 $53.20 C$62.20 C$39.85 US$48.25 US$39.85 Page 20 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II SUBSISTENCE ALLOWANCES (INCLUDING TRAVELING COMPANION) 5 JURISDICTION December 5, 2011 NOTES - For days in which workers are on travel status for partial days, they can also claim up to $17.30 for incidentals in Canada (in Canadian dollars) and the U.S. (in American dollars). - The YWCHSB shall only pay travel expenses for a traveling companion when it is determined an injured worker or a witness who is required to travel is either medically or legally unable to travel alone. - YWCHSB reimburse’s for actual expenses for lodging at a commercial establishment as pre-authorized prior to travel. Lodging at a private accommodation will be reimbursed at a rate of $50.00 per night. No claim shall be paid by the Board for free accommodation from a private business or government. Page 21 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II OPIOID PRESCRIPTION INFORMATION JURISDIC -TION POLICY POLICY EFFECTIVE DATE British Columbia Policy item #77.30, The Prescription of Narcotics and Other Drugs of Addiction. October 12, 1989 AB Health Care 04.06, Part II, Application 4: Prescribed Opioid Analgesics (Narcotics) May 1, 2006 December 5, 2011 PRESCRIPTION TIMELINE 8 weeks post injury/post surgery. PHARMACY REQUIREMENTS None An extension of this 8-week period may be considered where there are extenuating circumstances (e.g. worker will receive permanent disability award and requires regular intermittent and limited narcotic preparation for the relief of pain). 12 weeks following injury. Payment for prescribed opioid analgesics (narcotics) may be authorized when: • An injured worker is in the early, acute stage of treatment for a compensable injury (generally the first 12 weeks following injury); • An injured worker is being treated in the later stages of a terminal disease which generally means a life expectancy of 12 months or less; or • An injured worker is being treated for severe injuries with recognized, organically based pain. • There is a requirement that there be only one dispensing pharmacy. Page 22 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II OPIOID PRESCRIPTION INFORMATION JURISDIC -TION NB NF POLICY 25.012: Medical Aid, Opioids HC-14: Use of Opioid Medication for Compensable Injuries POLICY EFFECTIVE DATE October 25, 2007 PRESCRIPTION TIMELINE First 6 weeks following an injury (acute stages). • Requires opioids be dispensed by an individual approved by the New Brunswick Pharmacists’ Association to dispense opioids. • There is a requirement that payment of opioids be to one licensed dispenser. • Opioids must be dispensed by a licensed pharmacist. • The dosage, frequency of use, and total amount prescribed must be clearly indicated in reports WorkSafeNB typically includes opioids on a formulary when the injured worker is: May 1, 2004 • In the acute stages of treatment for a compensable injury (generally the first six weeks following an injury); • Being treated for severe injuries with recognized, objective biological pain; • Diagnosed and being treated for cancer as a compensable disease; or • Being treated in the later stages of a compensable terminal disease, which generally means a life expectancy of 12 months or less. 2 weeks for acute pain, 2-12 weeks for subacute pain. The policy considers opioid prescription timelines based on pain type: • December 5, 2011 PHARMACY REQUIREMENTS Acute Pain (moderate to severe), 2 weeks. The use of opioids for minor injury (e.g. soft Page 23 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II OPIOID PRESCRIPTION INFORMATION JURISDIC -TION POLICY POLICY EFFECTIVE DATE PRESCRIPTION TIMELINE PHARMACY REQUIREMENTS submitted to the Commission using the Canadian Pharmacists’ Association Compendium of Pharmaceuticals and Specialities, or Managing Pain: The Canadian Health Care Professionals’ Reference (the guidelines endorsed by the Canadian Pain Society) as the references for establishing dosage recommendations. tissue sprain/strain) is not appropriate beyond the acute phase and will not be covered beyond two weeks post injury; December 5, 2011 • Acute pain (severe), 2+ weeks; • Subacute Pain (moderate to severe), 2-12 weeks. Generally, opioids will not be covered beyond 12 weeks, in exceptional cases an extension may be granted for 4 weeks. An extension beyond 16 weeks will not be granted for opioids based on subacute organic pain; • Chronic Non-Malignant Pain, policy provides parameters for opioid treatment of chronic non-malignant pain; or • Chronic Malignant Pain, policy provides little restriction on opioid use for chronic malignant pain. • All health care providers who prescribe and/or dispense opioid medication for the treatment of compensable pain are expected to have prerequisite knowledge, skills and experience necessary to appropriately administer and monitor such treatment. Page 24 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II OPIOID PRESCRIPTION INFORMATION JURISDIC -TION PEI POLICY POL-120 Medications December 5, 2011 POLICY EFFECTIVE DATE March 31, 2004 (updated February 11, 2011) PRESCRIPTION TIMELINE 2 weeks post injury/post surgery. • The WCB will authorize the payment of prescriptions of opioids for two weeks when all legal and regulation requirements have been met and use conforms to current medical practice standards. • The WCB may authorize opioid prescriptions beyond two weeks when numerous criteria are met, including (but not limited to): • the prescription is prescribed by a single licenced physician or dentist at any one point in time; • the route of prescription is oral; • there is a signed copy of a therapeutic agreement between the worker and physician, such as the Patient Agreement of Conditions Governing Treatment with Opioids, Appendix 4 of the College of Physicians and Surgeons of Prince Edward Island Guidelines, and a Narcotic Management Form signed by the prescribing physician, provided to PHARMACY REQUIREMENTS • For prescriptions longer than two weeks, the route of prescription must be oral and prescribed by one licensed physician or dentist at any one point in time. Page 25 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II OPIOID PRESCRIPTION INFORMATION JURISDIC -TION POLICY POLICY EFFECTIVE DATE PRESCRIPTION TIMELINE PHARMACY REQUIREMENTS the Workers Compensation Board. YK HC-02, Health Care Assistance; Safe Use of Medications January 1, 2010 4 weeks following the workplace injury. • When determined appropriate by the YWCHSB, payment may be authorized for opioids, tranquilizers and hypnotics for: • A period of hospitalization for the workrelated injury; • Up to one month following the workplace injury; or • Related subsequent surgery or recurrence of injury. With respect to medication generally (not just opioids), the worker is expected to purchase their prescription from their usual pharmacy. Where the use of medication is extended by the medical practitioner for a period greater than one month, he or she must provide a satisfactory medical explanation of special or extenuating circumstances in writing to the YWCHSB. NWT/ Nunavut 04.06: Prescription Drug Use December 5, 2011 March 16, 2011 4 weeks None Instances in which the WSCC would compensate for opioid prescriptions are: Page 26 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II OPIOID PRESCRIPTION INFORMATION JURISDIC -TION POLICY POLICY EFFECTIVE DATE PRESCRIPTION TIMELINE • For a limited period after surgery; • During the acute phase of a worker’s injury; • Where a worker is released from the hospital early, but still needs pain medication; or • During a medical evacuation. PHARMACY REQUIREMENTS Although opioids will generally not be covered beyond 4 weeks, there may be cases of more severe injury where an extension may be granted. The worker must show functional improvement, supported by objective medical evidence, to continue use of opioid medication. December 5, 2011 Page 27 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE AB 9 levels of self-managed personal care. Policy 04-07 The WCB may pay a personal care allowance when, in order to live at home, a worker needs assistance with communication, mobility, self-care, or supervision due to the compensable injury. A worker who is confined to a hospital, nursing home, or other institution is normally not eligible, however, if the worker is temporarily hospitalized, the WCB may continue to pay a personal care allowance during hospital stays up to 30 days from the date of admission. The amount of the allowance depends on the level of personal care required. Payment of self-managed care is based on an individual living with at least one other adult and the principle that they shared housekeeping and transportation responsibilities before the accident. HOME MAINTENANCE ALLOWANCE To off-set the additional home maintenance costs that result from the compensable injury. SUMMARY OF PCA AND HMA COSTS • Self-managed, personal care: AB pays the actual and reasonable costs for care, set on a case-by-case basis. • Home maintenance allowances range from approximately $210 to $2,000 per month. 2 levels: Level 1 (paid monthly, $209.54 in 2011): permanent compensable disability preventing them doing such things as lawn maintenance, snow removal, painting themselves. Level 2 (paid annually, $1917.73 in 2011): Has a permanent compensable disability requiring the use of a wheelchair or mobility device all or most of the time; and owns their home and is responsible for the maintenance costs. Therefore the allowance includes 50% of the required care for housekeeping and transportation responsibilities, to reflect the portion that was the worker’s responsibility December 5, 2011 Page 28 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS before the accident. The WCB will pay actual and reasonable costs for the care provided. When a family member is the primary care-provider, the WCB will base the allowance on competitive rates for equivalent care. MB 44.120.30 Attendants provide personal care services to assist injured or severely injured workers in dealing with the following tasks: hygiene, safety and security, grooming, attendant/proctor care, feeding, food preparation, transfer assistance, toilet, medical treatments, provision of medical and non-medical equipment and professional care (e.g., nursing and healthcare aid services). The WCB may pay support for personal care when a worker needs assistance to live at home and the amount is determined on a case-by-case basis. Family member attendants must be able to provide care at a skill level equivalent to private attendants in order to qualify for financial support. The WCB will provide an allowance for day-to-day maintenance and housekeeping at the worker's residence (e.g., snow removal, lawn care, general home repair, housekeeping, laundry, etc.). • Personal Care Services: Family members providing care for workers receive $10.72/hour at a maximum 56 hours a week (totaling approximately $2,400 per month).WCB reimburses actual billed rates for private care. • The maintenance allowance for day-to-day maintenance and housekeeping is $269/month. Rate is $269/month as of October 2011. Support for family member attendants will be December 5, 2011 Page 29 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS paid at a rate determined by the WCB and indexed annually by one of the three methods specified earlier. If care is provided by a family member, the 2011 rate of payment is $10.72/hr up to a max of 56 hrs/week (for approximately $2,400.00 per month) If care is provided by a private attendant, the WCB pays actual billed rates. The WCB does not have any negotiated contracts with preferred providers. NB 25-003, 29-550 and 29-555 Rates for professional services are paid directly to the agency. In addition to professional services to address a worker’s home care needs, NB also provides an informal care allowance to enable a worker to remain at home and receive assistance from a family member or friend. The allowance for informal care is paid directly to the injured worker on a monthly basis and is intended to offset some of the costs for services provided by an informal December 5, 2011 The Home Maintenance allowance is intended to offset some of the costs for activities related to: • The “informal care allowance” is an additional allowance provided to workers who receive care from an informal caregiver such as a family member or friend. This allowance varies from $75.00/month to $1,712.00/month. • No set limits are published for the home maintenance allowance, which is added to the “informal care allowance” • Lawn care; • Snow removal; • Minor home repairs; and • Other seasonal activities such as woodpiling. This allowance is assessed and paid as part of the informal care allowance. Page 30 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE caregiver. This allowance is structured into seven levels that are based on a combination of specific care needs (such as activities of daily living, home maintenance, and physical care, as assessed by WorkSafeNB) and the number of hours required to provide this care for the injured worker. December 5, 2011 • Level 1 – 30 minutes or more, but less than one hour of care per day. $73.40/month • Level 2 – one hour or more, but less than two hours of care per day. $146.79/month • Level 3 – two hours or more, but less than five hours of care per day. Level 3 - $293.58/month • Level 4 – five hours or more, but less than seven hours of care per day. $529.08/month • Level 5 – seven hours or more, but less than ten hours of care per day. $696.17/month HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS above. • There is also a quality of life allowance that provides money for items, services or activities that improve the quality of life for seriously injured workers. This grant is up to $2,000 the first year, then an additional $1,000 every five years thereafter. Page 31 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION NF HC-06 and PRO-19 PERSONAL CARE ALLOWANCE • Level 6 – ten hours or more, but less than thirteen hours of care per day. $974.63/month • Level 7 – thirteen hours or more care per day. $1,670.79/month Essential personal care coverage will be considered where, as a result of the compensable condition, an injured worker has very limited mobility, or for other reasons, requires assistance with supervisory care, nursing care, and daily living needs (Daily Living Needs: includes feeding, bathing, toileting, grooming, and laundry. This does not include general property maintenance which will not be covered by the Commission.). HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS • NFL bases its personal care allowance on the type of care and the number of hours of care required. The Board pays the same rate as the province does for nonprofessional home care attendants. As of July, 2010, the rate is $11.75 per hour. • There is no home maintenance allowance. Essential personal care may be provided by a health care professional, a personal care service provider, or a family member, as appropriate depending on the needs of the worker and the availability of care. Where professional care is required, the Commission will pay the actual costs of approved care directly to the service December 5, 2011 Page 32 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS provider, within the limits of any relevant service provision agreements in effect at the time. Where a family member, friend or other nonprofessional care giver is approved to provide essential personal care to the worker, the care provider will be awarded an amount equivalent to the number of hours required to meet the worker’s documented needs, in accordance with Provincial Government Home Support Worker agreements ($11.75 per hour). NWT/Nunavut 03.11 An allowance will be provided for attendant care by a professional or a family member. In circumstances where an injured worker requires eight or more hours per day of attendant care, provided by a family member, respite care may be considered to provide primary care while the family care giver is off duty or on vacation. Respite care may be given for a maximum of four weeks per year without financial penalty. Three levels of attendant allowance range from $1,000 to $4,000 per month, depending December 5, 2011 The Manager of Claims Services, NWT or Nunavut Operations, may approve a Home Maintenance And Independent Living allowance of $240 per month to an injured worker who has a permanent disability or severe temporary injury, for services to assist with home maintenance and independent living. HMILA is intended to cover services including yard maintenance and housekeeping. • Attendant care allowances range from a maximum of $1,000 to $4,000/month, depending on the number of hours and type of care provided. • A home maintenance allowance of $240 per month may also be paid. • NWT/Nunavut also provides independent living devices to assist an injured worker’s Page 33 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE on the number of hours and type of care provided. Level 1: One to four hours per day, to a maximum of $1,000 per month. This allowance is provided to workers with restricted mobility who can feed, partly clean and otherwise care for themselves but need assistance in acts of daily living. HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS ability to communicate, be mobile, attend to personal hygiene. Examples of items covered include automatic page turners, motorized carts, telephone typewriters for the deaf. • Level 2: Four to eight hours per day, to a maximum of $2,000 per month. This allowance is provided to workers with restricted mobility who require assistance in feeding, dressing and washing themselves as well as in other aspects of personal care and acts of daily living. • Level 3: Eight to twelve hours per day, to a maximum of $4,000 per month. This allowance is provided to workers with restricted or no mobility who require extensive assistance in maintaining personal hygiene and in all acts of daily living. NS 2.1.6 December 5, 2011 Attendant allowance is usually paid where a worker suffers 100% Permanent Medical • The Attendance Allowance is based on the type of care Page 34 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE Impairment, but in some instances may be payable in other cases where a worker is, either temporarily or permanently, unable to perform necessary personal care as a result of a work injury. SUMMARY OF PCA AND HMA COSTS required. • There is no home maintenance allowance. • For Personal care, agency attendants such as nurses are paid directly at negotiated rates. In general, the allowance is based upon the severity of the compensable medical impairment of the worker. Basically, the allowance is to assist claimants regarding mobility, self-care and any "in house" treatment that is required for the compensable condition. ON 17-06-05 Severely impaired workers may hire one or more attendants to provide the assistance they require. An attendant could be • a non-agency attendant such as a spouse, family member, or friend, or • an agency attendant, such as a nurse. Level of care may range from skilled (handling complex healthcare and hygiene), personal (handling routine personal care) December 5, 2011 An independent living allowance may be granted to an injured worker, up to a maximum of $3,631.53 annually (or approximately $300 per month). No receipts are required. The allowance is intended to off-set the cost of services (regardless of cost) and devices and other items (less than $250), in order to improve a worker's ability to live independently and the quality of his or her life. Payment for non-agency attendants for personal care is based on the WSIB rates for each of the three levels of care: Workers can spend the allowance as they Page 35 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE and general (handling basic supervision). HOME MAINTENANCE ALLOWANCE wish and are not required to provide receipts. Agency attendants such as nurses are paid directly at negotiated rates. Workers may use the allowance to pay for independent living services, such as: Unless specially authorized by the WSIB, the combined hours of care provided by multiple attendants must not exceed 24 hours per day. Payment for non-agency attendants is based on the WSIB rates for each of the three levels of care. Indoor/outdoor maintenance (principal residence only) General Attendant Rate Personal Attendant Rate Skilled Attendant Rate Bookkeeping Fee • snow shoveling • lawn and yard maintenance • cleaning (including the cleaning of eaves, pools, etc.) • housekeeping $10.25/hr* $13.40/hr • painting $19.66/hr • house repair, and $720.00 annually • general maintenance. SUMMARY OF PCA AND HMA COSTS General Attendant Rate Personal Attendant Rate Skilled Attendant Rate Bookkeeping Fee • $10.25/hr* $13.40/hr $19.66/hr $720.00 annually An independent living allowance may also be paid annually, at an equivalent rate of approximately $300/month. No receipts are required. Other services December 5, 2011 • taxi service to participate in social or community activities • supportive therapy, physical fitness, or recreational programs (e.g., art/music therapy, fitness Page 36 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS centre membership) PEI POL-82 “Personal care” means aspects of care such as hygiene, eating, dressing, toileting, and supervision of activities. “Home care” means services provided to make it possible for workers to remain in their own homes. These services help workers achieve and maintain health, wellbeing, and independence through a process of assessment, coordination and/or provision of services. Home care services include: • health care services such as nursing care and occupational therapy; • personal care; • meal preparation; • laundry and essential household tasks; • non-vocational instruction such as "help line" support for computer programs • internet access. Severely injured workers may require home maintenance services as a result of a workplace injury. To assist, the Workers Compensation Board may reimburse the worker for the labour costs related to the following types of expenses: • A personal care allowance is paid as well as an amount for home maintenance services. • yard maintenance such as snow removal and lawn care; • interior house cleaning; and • additional wear and tear to flooring and walls, caused by wheelchairs or similar mobility aids which are required because of the compensable injury. Eligible costs do not include major projects or renovations (i.e. roof repairs). • assistance with daily activities (e.g. banking December 5, 2011 Page 37 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS and grocery shopping); and • travel accompaniment (e.g. medical appointments). Where home care services are authorized by the Workers Compensation Board, the request for services will be referred to a firm(s), contracted by the Workers Compensation Board, for those services. The Workers Compensation Board will procure services through standing offers. SK Personal Care Allowance Temporary Additional Expense • 4.2.1, 4.2.3 and 4.2.6 “Personal care” refers to the need of a client with a work injury for assistance with various aspects of the care of his or her person; e.g. hygiene, dressing, mobility challenges, supervision, etc. Additional expense is that portion of expense which is over and above what a client incurred while working (pre-injury) and is not covered elsewhere by WCB policy. Personal Care Allowance ranges from approximately $400/month to $2000/month. • The allowance is based on the needs of the worker and the level of assistance required. These expenses may include the following: child-care, care of a family member incapacitated by injury or illness, transportation costs, meal preparation, housecleaning or other general day-to-day home maintenance (e.g., lawn care or snow removal). Home maintenance does not include major renovations to a property The Independent Living Allowance is 5% of total Permanent Functional Impairment maximum award for a maximum annual payment of $2,260 for a worker with a PFI of 40% or higher. Level I ($405 per month) The client: i. December 5, 2011 requires help limited to specific times, once or twice daily, which Page 38 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE may consist of assistance in putting on an appliance or clothing. ii. has cleaning or laundry needs as a result of incontinence caused by the injury. iii. uses a wheelchair. iv. has loss of vision in both eyes, and requires assistance only occasionally. v. requires overseeing, as for a child. Level II ($813 per month) The client: i. requires help with regard to bowel or bladder malfunction. ii. is confined to a wheelchair and requires assistance such as help in and out of bathtub or bed. iii. has below the elbow double arm amputations requiring additional help due to limited use of prostheses. iv. has loss of vision in both eyes, and due to another disability (e.g. loss of December 5, 2011 HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS or home. Only expense(s) that exceed what a worker paid pre-injury is eligible and only to maintain the current standard of living. While there is no maximum, the amount and duration or reimbursement will not exceed what is reasonable in the circumstances and determined by medical evidence. Reimbursement under this policy will be discontinued if the additional expense items identified under this policy are covered by the Personal Care Allowance or the Independence Allowance (e.g. the rate paid to remove snow is about $10 per hour). The purpose of the Independence Allowance is to assist the injured worker to pay for additional costs of maintaining a home and/or travel costs that will allow the client to maintain a reasonable degree of independence Eligible home costs refer to a principal residence, e.g. hiring someone to cut Page 39 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE hearing, amputation, etc.), requires more assistance than would otherwise be the case. Level III ($1,618 per month) The client: i. ii. has quadriplegia with limited mobility and impairment of bowel and bladder function. requires custodial care due to a cognitive disability, cannot be left alone at any time, and needs assistance with washing, shaving, dressing and feeding. iii. has above the elbow double arm amputations. HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS grass, remove snow, or perform interior cleaning; including a condominium or other accommodation where specific fees are charged for basic maintenance of the property. This includes routine maintenance, and not major projects or renovations or home costs like roof repairs or house painting. Eligible travel costs include hiring of taxis or other transport services. Annual allowance appears to be 5% of total Permanent Functional Impairment maximum award. The maximum annual payment, therefore, is approximately $2,250. iv. is confined to a wheelchair and requires assistance such as help in and out of bathtub or bed, with the additional need of care required due to pressure sores, severe spasticity, or other complications. Level IV ($2,032 / month) December 5, 2011 Page 40 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS The client: YK HC-06 i. can be in a wheelchair with help, but requires assistance for dressing, feeding, enemas, and bladder care, and cannot be left alone. A common example would be a client with high lesion quadriplegia. ii. is completely bedridden requiring constant attendance and nursing care. Activities of Daily Living services (in addition to the allowance, described in the next column) includes: • Personal care attendants; • Respite Care, • Homemaker services; and • Additional childcare costs There is no set limit on the amounts to be paid to workers. Rates will be set and negotiated with providers, but nothing has been negotiated as of June, 2011. December 5, 2011 Assisted Living ADL Allowance An assisted living allowance is a monthly sum of money paid to offset the additional costs of miscellaneous expenditures incurred for services that an injured worker performed on their own prior to the workrelated injury (e.g. shoveling snow), but now requires assistance as a result of their work-related injury. It also covers the cost of other devices up to the maximum monthly allowance ($250), as well as qualifying social or fitness activities. An assisted living allowance must be recommended as part of an ADL plan. • The ADL allowance cannot exceed $250/month. Page 41 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE The level of personal care is determined through an ADL assessment and will consider the number of care hours required; the complexity of the care; the worker’s functional level; and the short- and long-term care needs of the worker. The amount of respite care provided will be identified in the ADL Assessment and will consider the amount of care hours being provided to the injured worker and the amount of leave that a personal care attendant normally takes on an annual basis. Homemaker services may be provided when an ADL Assessment determines that the worker requires assistance with household activities such as shopping, laundry, cleaning, or cooking meals. Additional child care costs may be paid after an ADL assessment. The costs covered will take into consideration the number of hours required for childcare and competitive market rates. HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS The ADL assisted living Allowance is meant to cover miscellaneous expenditures that include, but are not limited to, the following types of services and devices: • home maintenance; • yard maintenance; • firewood; • transportation costs; • communications; • fitness or social activities that are therapeutic for the work-related injury; or • other devices identified in the ADL Assessment as being required to support daily living. This allowance cannot exceed $250 per month, with receipts. The YWCHSB will enter into contracts with service providers who provide homemaker services, childcare services, and personal December 5, 2011 Page 42 of 43 APPENDIX I INTERJURISDICTIONAL RESEARCH for Chapter 10 Re-Write Rehabilitation Services & Claims Manual, Volume II PERSONAL CARE ALLOWANCE (“PCA”) AND HOME MAINTENANCE ALLOWANCE (“HMA”) JURISDICTION PERSONAL CARE ALLOWANCE HOME MAINTENANCE ALLOWANCE SUMMARY OF PCA AND HMA COSTS care services. December 5, 2011 Page 43 of 43
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