Para Transpo information session and workshop: application and renewal

Questions, comments or suggestions received

Session # 1 – Tuesday, January 9, 2018

Q1. People with permanent physical disability should be exempt from 3 years of application & renewal. The more number of increased, based on easy approval, it would cause problems, on one hand. You are increasing the number of people to get eligible for Para Transpo on the other hand.

Q2. Why does a person with a permanent condition need to renew information?

Q3. Many of the clients have lifetime disabilities such as Cerebral Palsy, etc. Why not consider that they have no need to renew applications every 3 years or have Life Mark simply ask them if any changes.

Q4. If someone’s in a wheelchair, they should be exempt from having to renew.

Q5. I found the presentation unclear about the motivation for the new renewal process. Is there a valid concern about misuse of the system? What is the basis for this change? Some disabilities are genuinely permanent – why waste medical and other resources on re-assessment?

A1 – A5. The feedback is very helpful. It will be considered as we prepare for the start of renewals. There are several reasons why a 3-year eligibility renewal period is being implemented.

Additionally, many customers’ conditions may have changed and a 3-year renewal period allows OC Transpo to make adjustments to customer files to match changing needs. Customer information and files have never been updated. This is not a sound practice. Older applications (when Para Transpo administration was still a contracted service) may no longer be on file or only be available in hard copy. This means we don’t have up-to-date medical information for all our customers and that it would be difficult for Lifemark to access them (we’re talking about 17,000 files over 3 years). We need to look at everyone’s file on a case-by-case basis, and then decide on full or conditional services. We’re looking at how we can do this as simply as possible, and if we do or do not need medical information to make a decision.

On the one hand, accessibility of the OC Transpo system has changed over time. Many people were approved when buses were still not accessible (i.e., you had to climb up 2 or 3 steps to get on the bus). Now that our entire fleet is accessible (there are no more steps), some people who previously relied on Para Transpo service may now be able to take regular buses / trains at least some of the time.

It’s worth noting that the process for renewal of eligibility will not be as long as the process for new applications. The good news is you may only need to give us the medical information the first time you renew. When you renew again 3 years later, if Lifemark has your updated medical information and feels nothing would have changed in your status, they’ll just send you a short form to make sure we have your proper contact information (address, next of kin, etc.). If Lifemark feels they need to get a better update / more information, they may still ask for some medical information.

The question of a renewal period was raised at the 2015 consultations, and 53% of respondents agreed, and also “expressed that professionally qualified medical practitioners should provide reassessments”.

Q6. I would suggest a doctor and an occupational therapist have the final say regarding service provided to all individuals.

A6. Lifemark will be reviewing all applications, and will be making decisions based on the information provided by the applicant. Occupational therapists are assigned to each application and responsible for the approval process, with support from other healthcare specialists as needed.

Q7. How long will the renewal process allow for processing? Will the renewal process be time sensitive?

A7. While the renewal process is still being finalized, it is anticipated that applicants will have between 2 to 3 months to complete and return their renewal application. This timeline takes into consideration the fact that for some people who need it, it can sometimes take several weeks to get an appointment with a doctor or therapist.

Q8. The doctor’s fee for completing a form is problematic. Doctors charge up to $50 - $100 to fill out forms. This is cost prohibitive for most Para Transpo clients.

Q9. What about the doctor fees to renew? We are all on old age or disability. They all charge.

Q10. I think it should be clarified. The cost and the inconvenience of having to deal with an appeal will be difficult for us.

A8 – A10. We fully understand the issue and can appreciate these difficulties.

The renewal process is still being finalized and at this time, we are exploring what updated medical information is required when you renew the first and second time. Depending on the condition, we may only need your medical information once. As mentioned in the response for Q1, the medical information contained in the application form is required to make an informed decision on an applicant’s eligibility.

Q11. Why is the Medical Officer of Health the medical representative in the appeal panel? His or her sphere of practice is public health – it seems to me that a family physician would be a more appropriate practitioner to assess eligibility.

A11. The Medical Officer of Health position is held by a doctor who has experience either in clinical or scientific practice. The Medical Officer of Health will delegate a public health representative who possesses the medical experience to be able to properly understand and evaluate appeals decisions.

Q12. Why is there no doctor on the appeals panel?

There will be a trained medical professional on the panel. Please also see response to Q11 above.

Q13. Renewal application – consider longer renewal period or exemption for permanent disability (note: ‘Federal Disability Tax Credit’ application eliminated renewal for permanent disability – worth investigating why and learn from it).

A13. We will look at how this criteria may assist in the renewal process. See Q8 as well. During the 2015 consultations, 53% of respondents agreed with the recommendation of implementing a renewal process. When asked, the majority of respondents in agreement with implementing a renewal process recommended doing so every 3 years. The new renewal process is based on this feedback.

Q14. Applicants may use different devices – the system should allow for it (i.e. customer may use wheelchair on day vs. a walker on another day).

A14. We can work with customers on a case by case basis. Currently, our software only allows us to input one item at a time. We are in talks with the software provider to explore making modifications to the software to allow for multiple items at once.

Q15. The Lifemark Health Services reps are all occupational therapists. How do they assess mental disabilities?

A15. They also have access to other medical professionals as required. Occupational therapists receive formal training in developmental, cognitive and mental disabilities. In addition, Lifemark ensures their staff receive additional training if needed to fulfill their duties.

Q16. Will you send us out the renewal form by mail? E-mail? Will you be calling us? And how can we fill it out?

Q16. Lifemark is a very progressive company, and they like having different ways to communicate with you. As we currently don’t have a complete list of customer e-mails to share with them, we’ll be sending a letter and the renewal form for the first renewal by mail to all our current customers. You can complete the renewal form online (a link will be provided in the renewal letter) or you can mail the hard copy back to Lifemark.

Q17. I have concerns about conflict of interest for Lifemark, from all medical records. That is, current Lifemark patients being assessed for Para Transpo.

A17. This was a component of this contract and is addressed. Lifemark has made sure that “conflict of interest” policies are in place and will be followed. In other words, if you’re a patient with Lifemark and apply for Para Transpo services, the person who processes your application must be someone who has never worked with you before.

Session # 2 – Saturday, January 13, 2018

Q18. Do renewals like they are done for parking passes.

A18. This response is similar to Q1 and Q8 above. Please see the responses previously provided.

Q19. If someone’s medical situation will never change for their entire life, is this not a waste of time and money for both OC Transpo and the members. With budgets tighter and tighter, does it make sense to waste money?

Q19. We understand this point – however renewal is not just about medical information. It is equally about accurate customer records with up to date information in all areas. Please see the responses to the similar questions Q1 and Q8 above.

Q20. 3-year assessment for those with Para the longest – I am permanently in a wheel chair, not accessed physical. Can we see our family physician? There is a cost to this.

Q20. This is similar to questions Q1 and Q8 above. Please see the responses previously provided.

Q21. How will psychiatry customers be evaluated?

A21. Customers will be evaluated against established practices that include the ability to ride on any part of our system. The evaluation process takes into account many different customer situations.

Q22. Will the Para Transpo customer on the review panel be matched to the disability type of the person who is applying?

A22. No. The customer representative on the panel will not change from case to case. Rather, the representative will be a member of the public and will be assigned to the committee for a pre-determined period of time (generally, for the same time as the four year term of City Council). We will ensure that the role is assigned to someone who uses both Para Transpo and OC Transpo, so that they have a clear view of both systems.

Q23. Can renewals be done over the phone? I am in a wheelchair and blind, can you arrange someone to help? How do I get to you?

A23. We can help you fill out your part of the application by phone if you need help. There is a medical portion, but we could fill it out then send to you to bring to your medical specialist. Our OC Transpo Transit Accessibility Specialist, and Lifemark are available to assist anyone who may need it. We want to note that there are 36 Lifemark clinics across the city, which means it’s easier to get in to see them if you need to. They are here to help.

Received to date by e-mail or other methods

Q24. Regarding Para Transpo users to renew their qualification every 3 years seems a little too harsh for people who have a permanent condition. I have had polio since I was 2 years old. The only change I have noticed over the years is that things have gotten worse. Many of Para Transpo users have such permanent disability. It seems rather unfair to have to prove the permanent disability every so often. Not to mention the added burden of paying doctor's fees on people on limited income.

Q25. I think, after the first upcoming renewal the duration can be made a little longer for people with permanent disability, if exclusion is not an option, like 5 years or even 10 years similar to what is required to qualify for Disability Tax Credit. 3 years seems like an awfully short time short time.

Q26. Many clients are permanently disabled for life (multiple sclerosis, cerebral palsy, Downs syndrome, Parkinson Disease, osteoarthritis, traumatic brain injuries and many others). Reassessment implies another physician visit and an extra administrative fee of $25 to $50 incurred by the client, not to mention the added anxiety, stress and uncertainty of the approval process.

Q27. Does renewal imply updating, or reassessment or reapplying? There are noted differences in the terminology. Given this comment, is it fair to require that permanently disabled people be reassessed or reapply every three years?

Q28. How much lead-time would clients have to renew their files?

Q24 – Q28. These questions are similar to Q Q1 and Q8 and Q19 above. Please see the response previously provided.

Q29. Is a client suspended from the service until renewal approval is received?

A29. Customers will be given lots of time to return their application, and we’ll even remind you if required. That said, you may be suspended if you don’t return your renewal application within the generous time periods allowed. Timelines will be clearly communicated to you in advance to minimize the chances of this happening.

Q30. Can the approval and renewal process be online?

A30. The application forms (new and renewals) are available to print online, and will be available to complete entirely online in the future. Lifemark is currently looking to develop an online application that will be available to customers in the future.

Q31. Will the renewal application include a clause safeguarding the privacy of personal and medical information, in accordance with the laws in place?

A31. Yes, all applications will be reviewed by City of Ottawa Legal Services, and will include any clauses required by law.

Q32. In terms of Lifemark, should not the assessment criteria be transparent and open?

A32. The new application is easy to follow, and Lifemark will make a decision based on the information that they receive. There will be a type of “scorecard” that sets out the criteria that meets the level where service is required.

Q33. Is each Lifemark employee given an upper limit of the number of files they are allowed to approve?

A33. No. Occupational therapists are not required to approve or deny a certain number of applications. Applications are processed on an individual basis and each decision is made based on the information provided in the application form.

Q34. If there is an appeal, how long does that appeal process take? And is a client suspended until then?

A34. There are several stages to the appeals process, with the first stage consisting of a manager review. At this point, it is anticipated that the appeal board will meet monthly on an as-needed basis. We estimate that the process can take up to 6 to 8 weeks if the appeal is escalated to the appeal board.

Assuming a new application is refused and there’s an appeal, the customer would be granted temporary access until the appeal is completed. In the case of a renewal application, the customer’s status would remain the same until the appeal is resolved.

Q35. I would be interested in participating on that Appeal Board. How should I apply?

A35. The process for the recruitment of the customer representative for the appeal board is being finalized. Details regarding the recruitment will be posted online at octranspo.com. Members of this distribution list will also be advised when the recruitment period is launched.

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