Amendments to Regulation (Reg.) 552 (General) under the Health Insurance Act (HIA) and the Schedule of Benefits for Laboratory Services (SOB-LS) under Regulation 552 of the HIA
Regulation - LGIC
Bill or Act:
Health Insurance Act
Summary of Decision:
The Ministry of Health and Long-Term Care's Community Laboratory Modernization Strategy (Strategy) supports the goals of better value, ensures the sustainability of Ontario's health care system and improves quality and access for laboratory services.
To support the implementation of the Strategy, Bill 87, the Protecting Patients Act (PPA) which received Royal Assent on May 30, 2017 (Schedule 3), amended the Laboratory and Specimen Collection Centre Licensing Act (LSCCLA), the HIA and the Public Hospitals Act (PHA).
Amendments to the HIA which came into force on May 30, 2017, enabled the ministry to pay for insured laboratory services through an agreement rather than a fee-for-service.
O. Reg. 519/2017 amends sections 1 and 22(1) - 22.11 of Reg. 552 under the HIA to support implementation of the Strategy and a new funding model for community laboratory services. The amendments include:
• a new definition for "schedule of laboratory benefits", by incorporating a reference to the new Schedule of Benefits for Laboratory Services (SOB-LS) which contains revised preambles, new fee codes, new commentary, as necessary, and obsolete codes have been deleted. The new SOB-LS is retroactively effective to April 1, 2017;
• new provisions to reflect the new funding model, including the requirement that a community laboratory must enter into an agreement with the ministry for payment of insured laboratory services as of April 1, 2018. Therefore, the funding formulas in Reg. 552 will be revoked effective April 1, 2018;
• new provisions that would support, at a future date, paying hospitals designated under section 22 of the PHA for incremental volumes of community laboratory services which would be proclaimed when amendments to the PHA under Schedule 3 of the Protecting Patients Act, 2017 are proclaimed.
August 28, 2017
Summary of Proposal:
To support the Strategy, Bill 87, the Protecting Patients Act (PPA) received Royal Assent on May 30, 2017. Schedule 3 of the PPA amends the Laboratory and Specimen Collection Centre Licensing Act (LSCCLA), the HIA and the Public Hospitals Act (PHA).
An amendment to the HIA came into force on Royal Assent of Bill 87, allowing the ministry to pay for insured laboratory services through an agreement rather than a fee-for-service.
The ministry is proposing amendments to the SOB-LS. The SOB-LS has not had a comprehensive update in 17 years. The SOB-LS lists the fee codes associated with each test and includes other fee codes associated with specimen collection and patient documentation. Under Reg. 552, the amount payable for an insured service rendered by a medical laboratory is 51.7 cents (the value for labour, materials, supplies) multiplied by the applicable individual unit value for such service as set out in the SOB-LS. The ministry is proposing changes to the SOB-LS to achieve better value for money. Changes to the SOB-LS would align the prices of tests with current technologies and techniques.
The ministry is proposing amendments to Regulation 552 (General) under the HIA as follows:
-Update the definition of "schedule of laboratory" benefits in section 1
-Amend sections 22(1) - 22(10) to either repeal a section or update with new language.
-Amend sections 22.1 - 22.11 by revoking and replacing with new sections, as necessary, with provisions to reflect payment for insured laboratory services rendered by a medical laboratory in a time period.
-Introduce new provisions that would support, at a future date, paying hospitals designated under section 22 of the PHA for incremental volumes of community laboratory services.
-Amend the SOB-LS by updating fee codes and deleting obsolete fee codes; revising the preambles and adding new commentary, if necessary.
Laboratories and Genetics Branch
1075 Bay Street, 9th Floor
Toronto ON M7A 0A5
December 15, 2017