Access to local Community Care Access Centres (CCACs) after a motor vehicle accident- who pays for what?

When a person is injured in a motor vehicle accident and is transitioning from hospital to home and community, the question often gets asked who is responsible for setting up (paying for) services upon discharge. It seems that discharge planning often is transformed into a game of “tag” in that no one seems to want to be “it”. With hospital pressures for quick bed turnover, funding constraints of the local Community Care Access Centres (CCACs) and challenges accessing Accident Benefits, obtaining follow-up care has become challenging.

According to the Ministry of Health and Long-Term Care (2012), “When a person is injured in a motor vehicle accident, the Statutory Accident Benefit Schedule requires the automobile insurer to pay for nonprofessional health care services (such as personal support and homemaking services, attendant care services, and community support services).” Other professional services (such as nursing, occupational therapy, physiotherapy, social work, speech language pathology, etc.) can be provided through local CCACs according to the Ministry of Health and Long-Term Care (see Table 1). Conversely, and in practice, the eligibility of clients for CCAC professional services, supplies and equipment is tenuous at best, in that the approach of the agency is one whereby if clients have access to alternative supports (i.e. automobile insurance) to meet their care needs, they are not necessarily viewed as a priority.

Table 1.

The Ministry of Health and Long-Term Care pays for:Automobile Insurers’ pay for:
  • Medical costs (all physician services)
  • Hospital services
  • Mental health facilities
  • Air ambulance
  • Several professional in-home health services such as nursing, occupational therapy, physiotherapy, speech-language pathology, social work and nutritional services provided in a range of setting including the home, school or community
  • Any other ministry-funded services not covered under the Long-Term Care Act, 1994
  • Community Support Services, such as; Meals and transportation:
    • Caregiver support
    • Home maintenance and repair
    • Social or recreational services
  • Attendant Care/Personal Support/Homemaking Services, such as; Assistance with activities of daily living
  • Assistance with personal hygiene
  • House cleaning, laundry
  • Preparing meals

*up to specified maximum limits

The Ministry of Health and Long-Term Care. (June 28, 2012). Who pays for Health Care: Injuries from Motor Vehicle Accidents. Retrieved from: http://www.health.gov.on.ca/en/public/publications/ohip/motorvehicle.aspx

When CCAC services are offered to injured parties subsequent to a motor vehicle accident, it is important to understand that CCAC utilizes specific service ordering guidelines governed by budgetary restrictions and fiscal considerations. For instance, CCAC is most often focused on short-term, goal oriented assistance and will not generally provide professional services for long-term monitoring of chronic conditions, medication administration or intensive/on-going rehabilitation. Most professional services will be offered through a consultative approach, in that they rely on the client and or their caregivers to become independent in the implementation of treatment. Ambulatory and transportable clients will not automatically be allocated services in their home and may be asked to visit community clinics to receive their post-acute care. There may be wait times for professional services such as physiotherapy and occupational therapy and often such professional services will not be offered at the same time but rather in a staggered manner. Finally, CCACs are serving more clients with increasingly complex health-care needs, leaving clients with less complex injuries (who may still benefit from professional services) not necessarily qualifying for support. In this respect CCAC service provision is variable and unpredictable.

While injured clients do have access to professional services through CCAC (subject to eligibility) this approach cannot necessarily be relied on as an alternative source of support following a motor vehicle accident. It is important that clients align themselves with informed and knowledgeable healthcare professionals to help them maximize their access to auto insurance benefits and private pay services following a motor vehicle accident.

References:
The Ministry of Health and Long-Term Care. (June 28, 2012). Who pays for Health Care: Injuries from Motor Vehicle Accidents. Retrieved from: http://www.health.gov.on.ca/en/public/publications/ohip/motorvehicle.aspx

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