Emergency procedure medical devices assistance pALS
The Special Assistance Commission
REIMBURSEMENT of Special medical devices or adaptations
In order to reduce or eliminate the limitations of a person with limited functionality, the “Vlaams Agentschap voor Personen met een Handicap” (VAPH) (Flemish Agency for Disabled People) previously called “Vlaams Fonds” may intervene financially under certain conditions for the purchase of medical devices. If a medical device is used that doesn’t appear on the reference list of reimbursed medical devices, you can request approval from the Bijzondere Bijstands Commissie (BBC) (Special Assistance Commission). They will determine whether the medical devices used will be refunded or not. You can read in the article below how that independent Commission decides on its rulings.
The Special Assistance Commission has 5 members and holds monthly meetings. Its members are chosen because of their medical, technical and/or other expertise as a user. “Some are doctors, some are representatives of health insurers and some are representatives of organizations of people with disabilities. The big advantage of its composition is that the dossiers are not treated as paper exercise only, but these dossiers are looked at by dedicated specialists who decide on a case by case basis whether the request for assistance is a valid request or not”. In 2006, 1,490 requests for assistance were handled of which 1,120 were approved for a total value of just over 2 million Euros. The Commission has access to 10% of the money that has been budgeted to financial assistance. Because that budget holds thirty million Euros, the Commission had three million Euros available.
To be able to request for assistance, some conditions need to be met: “The request has to be about an unregistered medical device. The register or reference list is a list with the most common medical devices and the amount that is refunded for them. Also, the medical device or adaptation requested needs to cost at least €250. Medical devices that are on the reference list but cost more than what the reference list shows for it, are eligible for a request for assistance on the condition that there is a proven need for that medical device”.
“I do not understand why, in case of ALS, one still has to submit a request”
Of course, the requestor has to be member of the “het Vlaams Agentschap voor Personen met een Handicap (VAPH)”. (Flemish Agency for Disabled People)
Via multidisciplinary teams
Each dossier has to be submitted via the "multidisciplinary teams” (MDT), those are services that assist disabled people with the registration with the VAPH. Most health insurers are recognised by the Vlaams Agentschap (Flemish Agency)
“Often one can also apply for assistance with the NMRC where you are a pALS member. “
The dossiers are prepared and motivated by the multidisciplinary teams. “The reason for the request of course, has to be more than: “we request reimbursement of…” It isn’t just because something costs more, the Bijzondere Bijstands Comissie (Special Assistance Commission) will give its permission.”
“You best provide a valid reason that shows that the requested medical device is of vital importance for you. In case of ALS the necessity of the requested device is usually already proven.”
It is important that the request for a medical device has been submitted before you purchase the device. ”Only those medical devices, purchased after submitting a request will, after a positive decision, be refunded. When a negative decision has been made, there will be no refund. If you want to be sure that a refund will be provided, then it is best to wait with the purchase until after the decision has been made. The crucial problem with waiting is that it may take up to 6 to 7 months before the request is answered depending on the complexity of the request. Some requests require a lot more research, and that takes time. Usually though, things move forward quite swiftly.”
The Vlaams Agentschap voor Personen met een Handicap applies the highest priority to ALS cases. This means that the VAPH will do anything within its power to work on requests for medical devices for people with ALS.
The VAPH is active on 2 levels:
On the one hand: An effort is made to change regulations so to create a real emergency procedure within their book of regulations.
Last year the VAPH has developed an emergency procedure for people with a quickly progressive degenerative disorder. This emergency procedure is of obvious use for people with ALS. During the course of this year, the VAPH wants to create a similar emergency procedure for the request for assistance.
On the other hand: The VAPH is making this effort within the current regulations. Practically this means that when a request for assistance arrives at the provincial division, within the framework of the procedure for the Provinciale Evaluatie Commissie (regional evaluation commission), or it arrives at the Executive Committee, in the framework of a procedure to request financial assistance for a medical device, the request is prepared immediately for the next meeting. The request does not need to be in the meeting’s agenda, but can be discussed “at the table”. This increases the workload for the meeting organizer and the members of the commission, but it shortens the procedure considerably.
The Bijzondere Bijstands Commissie was created as a result of heavy protest from the disabled community because of the savings measures of Wivina De Meester in relation to financial assistance to persons with limited mobility. As a token of compensation the BBC was founded within the Vlaams Agentschap. The Bijzondere Bijstands Commissie is an advising committee that has full independent decisive powers. It is a separate entity that is independent from the Vlaams Agentschap voor Personen met een handicap (VAPH). “The great majority of the decisions are taken by consensus, but if it has to be made by a vote for majority against minority, it will be done so. As long as a decision by the Bijzondere Bijstands Commissie is not illegal, it will be executed. That decision – like all decisions of the Vlaams Agentschap itself - can be brought before the Labour Court. For those who don’t agree with the decision that could be a possible next move.”
“This has to be within 1 month after you received the decision from the VAPH!”
The commission is run as a prudent man does. She handles the maxima for certain tools, then for others she doesn’t. Sometimes it is impossible to apply limits, like for adaptations of a car. Because of car electronics an adaptation can quickly become very expensive and run up to tens of thousands of Euro’s. She also checks what the requestor already has. Not every “new gadget” is refunded. At the moment, there are no renewal periods in use but the requestor has to show that an adaptation is really needed. “He, who already has a car adaptation and puts in a new request after a year, will not receive any refund.”
In 2006 most requests from ALS patients related to car adaptations, environmental controls, communication devices, shower seats and elevators. Also stair lifts, eat aid devices, and many requests for adaptation for a new house building and home remodelings.
ALS Mobility & Digitalk, Mahy Mia en BBC
Source Framework: VAPH