Expected to Work/Barriers to Full Employment Policy & Procedures

Published Date: April 17, 2014
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10 Supplementary Health Benefits

Special Diets

AUTHORITY

ISTHB Regulation, Schedule 4, Section 21
BFE/ETW & Full-Time Learners Ministerial Order: Section 24, Schedules 1, 2, and 4

Special diets are regulated as the difference between the amounts set out in Schedule 5 for food and the cost of the special diet as determined by the Minister. The amount set out for food per ISTHB Regulation, Schedule 4, Section 21 and Delegation of Minister’s Authority to Directors/Staff Ministerial Order is $83 for each dependent child in a household unit.

INTENT

This benefit provides additional funds to those individuals requiring special diets for specific health reasons.

POLICY

Individuals who require a special diet for health reasons are provided an allowance to cover the difference between the regulated food rate and the cost of the food required for a special diet. The Minister has authority to establish special diet rates, and this authority is delegated to the Executive Director, Alberta Works Programs. Rates for special diets are not subject to appeal to an Income and Employment Supports Appeal Panel.

For special diets, not shown in the table below, approval is required by the Executive Director, Alberta Works Programs.

Rates
These rates are the difference between the regulated food rate and the cost of the specific established special diets. For more information on nutritional requirements of these diets, see Special Diets Helpful Information.

    Special Diets

    Monthly Rate Per
    Adult or Child

    Low Sodium

    $20

    Low Cholesterol or Low Fat
    • Both have similar nutritional requirements
    • Do not issue for both

      $20

      High Fibre

      $20

      High Calcium

      $20

      High Protein

      $20

      Lactose Free
      • Either lactose free or milk free would be issued, not both

      $20

      Low or High Potassium

      $20

      Baby’s needs – Pregnancy

      • All women who are pregnant or become pregnant must be issued these special diet funds
      • A woman pregnant with twins is issued two times the pregnancy special diet rate

      $25

      Baby’s needs – Breast feeding mother (of baby up to 12 months old)

      • Funds must be issued for breastfeeding and/or infant formula
      • A breastfeeding mother of twins may be issued two times the breastfeeding special diet 
      • In cases where the baby is being breast fed and on infant formula, both special diets should be considered

      $30

      Baby’s needs – Infant formula

      It is recommended that, whenever possible, infant formula is issued as a Health Benefit. Alternatively, infant formula may be issued as a Special Diet.

      • Funds must be issued for infant formula and/or for breastfeeding (Baby’s needs – Breastfeeding mother).
      • Workers should review the continued need for the infant formula benefit when the child is approximately one year old.

      Infant formula as a Health Benefit:

      • Several formulas are included on the Interactive Drug Benefit List and are covered benefits on the Health Benefits Card with a prescription by an authorized prescriber.
      • Requests for any other infant formula may be authorized by HBEC
      • Clients eligible for health benefits may access these infant formulas with the Health Benefits Card.

      Infant formula as a Special Diet:

      • When infant formula is funded as a special diet, the worker may issue the difference between the food rate ($83) and the cost of the formula, up to $200/month.
      • Director Approval is required if the cost is over $200/mth 
      • An estimate of the monthly cost from a health care professional (nurse, dietician, nurse practitioner, etc) is required.

      As First Nations clients are not eligible for Health Benefits Cards, they may receive special diet funding to cover the cost of infant formula.

      Up to $200

      High Calorie (over 2,500 calories)

      • If Boost, Ensure or similar high calorie supplements are prescribed, then do not issue funds for a high calorie diet

      $36

      HIV/AIDS or Hepatitis C

      • These are different medical conditions, but have the same nutritional requirements
      • Even if a person has both conditions, only $36 is issued

      $36

      Diabetic or Heart Healthy

      • These are different medical conditions, but have the same nutritional requirements
      • Even if a person has both conditions, only $40 is issued
      • This diet also contains the nutritional elements covered in low cholesterol, low fat, and low sodium diets. Those diet amounts are not to be duplicated

      $40

      Milk Free

      • Either milk free or lactose free would be issued, not both

      $50

      Celiac/Gluten Free

      $80

      Renal Failure/Insufficiency

      • Contains the nutritional elements covered in high calorie, high protein, low sodium, low potassium, low phosphorous, low fat, diabetic and heart healthy. Those diet amounts are not to be duplicated.

      $110

       

      If a client requests a special diet not on the list, the worker may issue $20 pending approval by the Executive Director, Alberta Works Programs. If an individual requires more than one special diet the rates for both diets are issued, except in the circumstances noted above.

      Nutritional Products and Supplements
      The special diet allowance is intended for the purchase of food items. Many nutritional products such as Boost or Ensure, vitamins or special non-food products such as Thicken Up, are listed on the Interactive Drug Benefit List and can be provided through the Health Benefits Card (HBC). Products not listed must be authorized by the Health Benefits Exception Committee.

      Substantiation
      Pregnancy:

      • Confirmation from a health care professional or a verbal or written statement from the client.

      Breast feeding:

      • Verbal or written statement from the client that she is breast feeding and for how long.

      Infant formula:

      • Letter from a health care professional, and
      • Estimate of the cost.

      All other special diets:

      • Confirmation from a registered dietician or other health care professional indicating:

         

        • The type of diet required and/or medical condition, and
        • The length of time the condition requiring the diet is expected to last if it is not permanent.

      Note
      If documentation exists (e.g., a Medical Report) to show that a client has a specific health condition which is likely to require a special diet listed in the table (e.g., Hep C) then further substantiation from a health professional is not required to verify the need for a special diet.

      If it is obvious that a health condition is permanent (e.g., diabetes) then confirmation of the length of time the special diet is needed is not required.

      Since special diet rates are set in policy, cost is not required to substantiate a special diet need. The exception is for infant formula as there is no cost set in policy. Also, if a request is being sent to the Executive Director, Alberta Works Programs for approval of a special diet not listed in policy then the cost may be required.

      PROCEDURES

      When the need for a special diet has been established, the worker:

      • Issues the table rate for one or more diets.

         

      • Records in Mobius Notes:

         

        • Type of special diet (e.g. low cholesterol)
        • Related medical condition (e.g. heart condition)
        • Length of time the special diet is likely to be required (if the condition is not permanent) 
           
      • Establishes the time period for confirmation of continuing need if the medical condition is not permanent. Enters a Task in Mobius if applicable.

      Need Code
      1701  Special Diet

      Procedure for Special Diet Rates That Have Not Been Established
      If there is no rate for a client’s specific special diet the worker forwards a request for Director Approval of a special diet rate by sending information to the Income Support Unit. The request must include:

      • Description of type of diet required
      • Medical condition being treated
      • Copy of medical documentation submitted (ideally a letter from a registered dietician)
      • Estimate of costs
      • Worker comments
      • Worksite contact (if different from worker)
      • Client File Number

      In consultation with a Registered Dietician, the Director determines an appropriate rate. The worker is advised of the Director’s decision.

      Need Code
      1701  Special Diet

      Workers do not issue funds as a Special Diet for nutritional products or vitamins. When a request is received for Special Diet funds for a nutritional product or vitamins, the worker:

      • Checks the Interactive Drug Benefit List to determine if the requested nutritional product or vitamin is covered by the Health Benefits Card.

         

      • If the item is listed on the DBL or DBS, informs the client they can get the needed nutritional product or vitamin with their Health Benefits Card and a prescription at their pharmacy.

         

      • If the item is listed on the DBL or DBS but covered only through Special Authorization, informs the client their doctor must apply to ABC for Special Authorization.

         

      • If the item is not listed on the DBL or DBS, or the client submits substantiation that ABC has denied Special Authorization, submits a request to the HBEC for authorization of the requested nutritional product or vitamin.