2.4 Protocolo de Señalización de Voz: H.323
2.4.2 Flujos de llamada H.323
GUIDELINES
1. A third party payer is an agency or program that is responsible for paying the costs of services provided to a client. The major third party payers in Saskatchewan are: a) Saskatchewan Government Insurance (SGI);
b) Workers Compensation Board (WCB); and, c) Veterans Affairs Canada (VAC);
2. These guidelines outline the key factors for determining eligibility and the benefits that may be provided for each of the major third party payers. The program descriptions are simplified to highlight aspects of interest to home care programs and are not
comprehensive.
3. The guidelines also recommend basic procedures for Regional Health Authorities to follow when dealing with each of the major third party agencies and provide contact information for other agencies.
Saskatchewan Government Insurance (SGI)
Eligibility Based on the insurance policy and, in liability cases, the judgment of a court. Benefits SGI will pay the Regional Health Authority the client fee portion of
providing the home care service.
Recommendations When a home care client has established a valid claim with SGI, the
Regional Health Authority should bill SGI directly for the client fee portion of providing the following home care service:
Home Management
Meals on Wheels; and,
Home Maintenance.
Notes The Regional Health Authority will continue to be the key agent in
Subject:
Third Party Payers
Workers’ Compensation Board (WCB)
Eligibility Workers injured on the job excluding teachers, domestics, out-workers, employees of farmers and ranchers, and workers exempted by regulations. Some of the above may be covered through voluntary action of their employer.
Benefits The WCB pays costs incurred as a direct result of a compensable injury. Each case is assessed by the WCB on its own merits, and a range of benefits may be available. Some types of benefits relevant to home care include:
costs of personal care services (for current payment rates contact WCB);
nursing services prescribed by a doctor; and,
other services, such as home modification, are sometimes approved. The level of benefits provided is based on individual circumstances. Normally payment is made directly to the care provider or care-providing agency. Prior approval of services is required.
Recommendations In the case of a service that is directly related to an injury incurred on the job, the Regional Health Authority should:
seek immediate approval from WCB;
begin providing the service; and,
charge unit costs, including administration and assessment and coordination costs, to the WCB if and when the service is approved. Notes Regional Health Authorities may have to subsidize the cost of services
provided before approval is received. Contact Workers’ Compensation Board
1881 Scarth Street REGINA SK S4P 4L1
Telephone: 306-787-4370 Toll Free: 1-800-667-7590
Home Care Policy
Home Care Client Fees and Charges
Date of Issue: September 2006 Revised September 2013 Subject:Third Party Payers
Veterans Affairs Canada (VAC)
Veterans Affairs Canada has three programs that may be of significance to Regional Health Authorities:
War Veterans Allowance
Recommendations Veterans Affairs covers costs to the client only (e.g. client fees). The Regional Health Authority should advise the client to contact the nearest Veterans Affairs district office (Regina or Saskatoon) directly.
Canadian Pension Commission
Recommendations This program does not generally cover home care services. The Regional Health Authority should advise the qualified individual requiring benefits to contact the nearest Veterans Affairs district office (Saskatoon or Regina) directly.
Veterans Independence Program
Recommendations Veterans Affairs covers costs to the client only (e.g. client fees). The Regional Health Authority should advise the client to contact the nearest Veterans Affairs district office (Saskatoon or Regina) directly.
In a case where an eligible client needs more services than the Regional Health Authority can provide, or services not offered by home care, the client may be able to obtain financial assistance from the Veterans
Independence Program. When a Regional Health Authority identifies such needs, it may be able to facilitate the coverage for the client by contacting the nearest Veterans Affairs district office directly.
Veterans Affairs may request home care assessment information to support the client’s application. Regional Health Authorities may provide this assessment information with the consent of the client.
Subject:
Third Party Payers
Veterans Affairs may also ask the Regional Health Authority to conduct an additional nursing assessment of the client using its own form. The Regional Health Authority may agree to do the requested nursing assessments but should charge for it. Veterans Affairs Canada has agreed to pay “the customary professional fee” for nursing assessments conducted on its behalf. Note that occasionally Veterans Affairs Canada may ask a Regional Health Authority to perform a nursing assessment (using its form) of a person who is not a home care client. Again, the Regional Health Authority may agree to perform the assessment, but should charge costs to Veterans Affairs Canada.
Chief of Client Services Veterans Affairs Canada 400 – 2055 Albert Street REGINA SK S4P 2T8
Telephone: 306-780-5237 Contacts
Chief of Client Services Veterans Affairs Canada Room 501, 5th Floor 101 – 22nd Street East
SASKATOON SK S7K 0E6 Telephone: 306-975-4972
Home Care Policy
Home Care Client Fees and Charges
Date of Issue: September 2006 Revised September 2013 Subject:Third Party Payers
Others Agencies
Indian and Northern Affairs Canada (INAC)
The INAC-Saskatchewan Region comprises of a regional office in Regina, a district office in Prince Albert (North Central District), and budget centers in Regina (North West Budget Centre) and Fort Qu’Appelle (South Budget Centre). These offices provide a variety of services to approximately 120,000 Registered First Nations people in Saskatchewan.
Regional Office
Room 200, 1 First Nations Way REGINA SK S4S 7K5
Telephone: 306-780-5945
306-780-5392 Fax: 306-780-5733
North Central District office 3601 – 5th Avenue East
PRINCE ALBERT SK S6V 7V6 Telephone: 306-953-8522 Fax: 306-953-8648 South Budget Centre
PO Box 760
2nd Floor, Room 210
Treaty Four Governance Centre, Sioux Avenue FORT QU’APPELLE SK S0G 1S0
Telephone: 306-332-8500 Fax: 306-332-6019 Contacts
Subject:
Third Party Payers
First Nations and Inuit Health Branch (FNIHB) - Health Canada
Regional Director
First Nations and Inuit Health Branch Health Canada
18th Floor - 1920 Broad Street REGINA SK S4P 3V2 Telephone: 306-780-5413 Fax: (306) 780-7733 Email:
Regional Home Care Coordinator Saskatchewan Region
First Nations and Inuit Health Branch 18th Floor - 1920 Broad Street
REGINA SK S4P 3V2 Telephone: 306-780-6559 Fax: 306-780-6026 Email:
Contacts
Home Care Policy