Health Insurance Act - General

Regulation Number(s):
Instrument Type:
Bill or Act:
Health Insurance Act
Summary of Decision:
Approval for amendments under the Health Insurance Act which implement evidence-based payments to physicians under OHIP for the following medical services:
1. Limit payment for sleep studies to one per 12-month period for diagnostic studies, and one per 24-month period for therapeutic studies. Conditions that link payment for these services to College of Physician and Surgeons of Ontario’s clinical practice guidelines would also b e included.
2. Limit payment for bone mineral density testing for low-risk patients (current limit is one per 36-month period) to: A second test 36 months after baseline and one subsequent test every 60 months thereafter for low-risk patients.
3. Restrict payment for routine pre-operative testing, specifically electrocardiograms and chest x-rays, before cataract surgery (currently unrestricted payment).
4. Permit payment for certain laboratory tests that physicians may perform in their offices. These tests would be necessary to support immediate clinical decision-making. This would ensure that quality standards are met.
Further Information:
Proposal Number:
Posting Date:
October 25, 2010
Summary of Proposal:
Amendments will help the government to control expenditures while protecting delivery of health care services and focus on the key priority of ensuring the appropriateness of care through provision of evidence-based services.
Contact Address:
Effective Date:
July 1, 2010