Regulation - LGIC

OHIP Amendments under the 2012 Physician Services Agreement

Regulation Number(s):
Instrument Type:
Regulation - LGIC
Bill or Act:
Health Insurance Act
Summary of Decision:
The 2012 PSA amendments to physician services effective October 1, 2013, and one change retroactive to April 1, 2013.

Changes to colonoscopy services to support community-based specialty clinics are effective January 1, 2014.

The OOC and OOP changes to genetic testing are effective October 1, 2013 and April 1, 2014.

Further Information:
Proposal Number:
Posting Date:
Summary of Proposal:
In December 2012 the Ministry of Health and Long-Term Care and the Ontario Medical Association (OMA) entered into a two year 2012 Physician Services Agreement (PSA).

This regulatory change introduces amendments which fulfill obligations under the 2012 PSA and introduces additional changes to physician services resulting from bilateral negotiations with the OMA. These changes to physician services will be effective October 1, 2013, with one exception which will be effective retroactive to April 1, 2013.

Additionally, the Ministry is shifting low-risk services out of hospitals and into community-based specialty clinics in a two-phased approach. Amendments have been introduced to support phase one of this approach by making changes to the Schedule of Benefits for Physician Services to permit payment of facility fees for non-hospital insured colonoscopy services. These changes will be effective January 1, 2014.

This regulatory change also includes changes to OHIP funding for out-of-country and out-of-province (OOC/OOP) genetic testing. The changes remove the requirement for a recommendation from Health Quality Ontario for OOC/OOP genetic testing, and broaden the requirement for a recommendation from a medical geneticist to include other specialists. These changes to OOC/OOP genetic testing will be effective October 1, 2013 and April 1, 2014, respectively.
Contact Address:
Jody Hill
Health Services Branch
Negotiations and Accountability Management Division
370 Select Drive, Kingston ON K7M 8T4
Effective Date:
October 1, 2013