Amendments to the Schedule of Benefits for Physician Services and Regulation 552 of the Health Insurance Act.
Regulation - Other
Bill or Act:
Health Insurance Act
Summary of Decision:
Changes to Regulation 552 were approved as follows:
The Across the Board Fee Reduction is effective October 1, 2015.
The additional targeted changes to fee for service (FFS) physician payments are effective October 1, 2015 and April 1, 2016.
The payment reduction on FFS professional fee payments of $1M or more is effective retroactive to April 1, 2015.
Summary of Proposal:
Under the Health Insurance Act (HIA), the Ontario Health Insurance Plan (OHIP) provides payments for prescribed hospital services, medically necessary physician services, certain dental services that are required to be performed in a hospital, and prescribed therapeutically necessary services provided by practitioners and health facilities. Regulation 552 and the Schedule of Benefits for Physician Services (Schedule) list the physician services that are insured under Ontario's HIA. In order to make changes to the funding of these services, regulatory amendments are required.
The amendments will support the fiscal sustainability of Ontario's health care system and include an increase to the existing Across the Board Fee Reduction, additional targeted changes to fee for service (FFS) physician payments, and a payment reduction on FFS professional fee payments of $1M or more.
Health Services Branch
1055 Princess Street, 2nd Floor
PO Box 168 Stn Main
Kingston, ON K7L 5V1
April 1, 2015