December 2016

Legislative authority

Sections 2 and 5 of the Act.
Sections 36, 41, 43, 44, and 57 of Regulation 134/98.
Regulation 564/05.

Audit requirements

A copy of the completed Application for Special Diet Allowance (Form 3111-English/3112-French) is on file.

A Special Diet Allowance for inadequate lactation to sustain breast-feeding or breast-feeding is contraindicated is not paid in combination with a Pregnancy/Breast-feeding Nutritional Allowance.

Only eligible applicants or recipients receive a Special Diet Allowance.

All required documentation (including letters) to support eligibility and/or ineligibility for a Special Diet Allowance is complete and on file.

Application of policy

A Special Diet Allowance (SDA) provides additional assistance to members of a benefit unit to assist with the cost of a special diet that is due to an approved medical condition for which the special diet:

  • is generally considered by the Ontario medical community to be an adjuvant to the treatment of the medical condition
  • results in additional costs above a normal diet

This includes applicants or recipients who rent or own their accommodation or who live in a board and lodging situation. The allowance is also available to children on whose behalf Temporary Care Assistance is being paid.

Applicants and recipients who reside in hospitals, domiciliary-type hostels, interval and transition homes for victims of family violence, emergency hostels and shelters – CMSMs and DSSABs, and residential programs for the treatment of substance abuse may also be eligible for this allowance if their budgetary requirements are determined under sections 41 or 44(1) of O. Reg 134/98.

Applicants or recipients receiving emergency hostels services by First Nations delivery agents or residing in long-term care homes are not eligible for an SDA as part of their budgetary requirements as their needs are met by the institution.

The maximum amount for an SDA is $250 per month, per benefit unit member.

The Application for Special Diet Allowance (Form 3111/3112) and the Special Diets Schedule are used to determine eligibility for, and the appropriate amount of, an SDA.

Products Covered under the Ontario Drug Benefit Program

Products covered under the Ontario Drug Benefit Program (ODB) shall not be considered for an SDA. An SDA will only be paid in relation to a medical condition(s) listed in the Special Diets Schedule.

Applying for a Special Diet Allowance

An Ontario Works applicant or recipient and any other member of the benefit unit may apply for an SDA.

An original copy of the Application for Special Diet Allowanceis issued for each member of the benefit unit upon request for an SDA.

Only the original, ministry-approved application form can be used. Photocopies, faxed copies, and forms that have been altered may not be issued or accepted.

An applicant or recipient who requests an SDA must have one of the following approved health care professionals complete the application form:

  • a Physician registered with the College of Physicians and Surgeons of Ontario
  • a Registered Nurse in the Extended Class registered with the College of Nurses of Ontario
  • a Registered Dietitian registered with the College of Dietitians of Ontario
  • a Registered Midwife registered with the College of Midwives of Ontario
  • a Traditional Aboriginal Midwife recognized and accredited by her or his Aboriginal community
  • Note: Midwives may only confirm that a special diet is required for inadequate lactation to sustain breast-feeding and/or breast-feeding is contraindicated

The applicant or recipient is responsible for submitting the completed application form to the local Ontario Works office.

Women who are pregnant or are breast-feeding may be eligible to receive support through the Pregnancy/Breast-feeding Nutritional Allowance instead of through the see Directive 6.5: Pregnancy/Breast-feeding Nutritional Allowance for more information).

Where breast-feeding is not possible (e.g., inadequate lactation or the infant is unable to tolerate breast milk, the mother’s breast milk is contaminated due to medical treatment, or the mother is not present, etc.), the infant is eligible to receive a Special Diet Allowance until the month in which he or she turns 12 months of age. (see Directive 6.5: Pregnancy/Breast-feeding Nutritional Allowance for more information).

The $20 fee for completion of the Application for Special Diet Allowance by a Physician is covered under OHIP. The assigned OHIP billing code is located on the top of the application form.

Registered Nurses in the Extended Class, Dietitians and Midwives are to submit an invoice to the local office to be paid by Ontario Works. The invoice should indicate the recipient or applicant’s name and member ID, and the health care professional’s name, address, telephone number and college registration number. The local office is responsible for processing the invoice.

If the invoice is not complete or if it does not identify the recipient, the Letter to Health Care Professional re: Invoice for Completing Application Form may be sent to the identified health care professional.

Receiving an incomplete Application for Special Diet Allowance (Form 3111/3112)

Applications are to be considered incomplete if under Section 2, the health care professional has:

  • not identified the number of medical conditions indicated in Section 3 or has identified a different number of conditions than are indicated in Section 3
  • not signed the application form
  • under Section 3, the health care professional has not indicated at least one eligible medical condition or initialed each indicated medical condition
  • under Section 4, the recipient/applicant or someone lawfully authorized to sign on their behalf have not signed the applicant declaration and consent for release of information

Note: A photocopy of the application form is not a valid application form. If a recipient submits a completed photocopy of the application form it is to be considered incomplete.

If an incomplete application form is submitted, the Request for Allowance/Allowance under Review – Form Not Completed Correctly letter is sent to the recipient.

Determining the amount of a Special Diet Allowance

The Special Diets Schedule is used to determine the amount of an SDA. The schedule indicates the amount that may be provided for each medical condition identified on the Application for Special Diet Allowance by the approved health care professional.

In some cases, a benefit unit member may have more than one medical condition for which a special diet is required. In these cases, the member is eligible to receive multiple amounts equal to the amount for each condition with the following exceptions:

  • congenital heart defect – have had Ross procedure or arterial switch procedure or have coexisting coarctation of aorta, diabetes, gestational diabetes, hypertension, extreme obesity and hypercholesterolemia/hyperlipidemia and Pader-Willi syndrome
  • if more than one of the above conditions are listed on the application form, only one allowance, the highest, will be provided
  • allergy to milk/dairy and lactose intolerance
  • if both of the above conditions are listed on the application form only one allowance, the allowance for llergy to milk/dairy products, will be provided
  • allergy to Wheat and Celiac Disease
  • if both of the above conditions are listed on the application form, only one allowance will be provided (note: allowance amount for these conditions are the same)
  • chronic wounds (Stage 1 & 2) and burns (1-10% body surface area) and chronic wounds (Stage 3 & 4) and Burns (>10% body surface area)
  • if both of the above conditions are listed on the application form, only one allowance, the allowance for chronic wounds (Stage 3 & 4) and burns (>10% body surface area), will be provided
  • chronic hepatitis C (BMI <25) and chronic wounds and burns (any stage or percentage of body surface area)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest), will be provided
  • chronic hepatitis C (BMI <25) and unintended weight loss (any condition)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest), will be provided
  • chronic hepatitis C (BMI <25) and renal failure (pre-dialysis or peritoneal / haemodialysis)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest), will be provided
  • chronic hepatitis C (BMI <25) with interferon treatment and chronic hepatitis C (BMI < 25)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest), will be provided
  • chronic hepatitis C (BMI <25) with interferon treatment and chronic wounds or burns (any stage or percentage of body surface area)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest), will be provided
  • chronic hepatitis C (BMI <25) with interferon treatment and renal failure (pre-dialysis or peritoneal / haemodialysis)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest), will be provided
  • renal failure (pre-dialysis or peritoneal / haemodialysis) and renal failure (GFR <30) with unintended weight loss
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest) will be provided
  • Rett Syndrome (BMI <18.5) and chronic hepatitis C (BMI <25)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest) will be provided
  • Rett syndrome (BMI <18.5) and chronic wounds and burns (any stage or percentage of body surface area)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest) will be provided
  • Rett syndrome (BMI <18.5) and renal failure (pre-dialysis or peritoneal / haemodialysis)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest) will be provided
  • Rett syndrome (BMI <18.5) and unintended weight loss (any condition)
  • if more than one of the above conditions are listed on the application form, only one allowance (the highest), will be provided

Also note that an applicant/recipient is only eligible for one unintended weight loss special diet. The cumulative total SDA paid for the benefit unit member cannot exceed $250 per month.

When a Special Diet Allowance has been approved

The Application Approved - With or Without Review Date letter is sent to the recipient notifying him/her that an SDA has been approved, the amount of the SDA and the review date (if applicable).

The SDA is added to the benefit unit’s budgetary requirements, starting with the first day of the month in which the approved Application for Special Diet Allowance was received by the local office.

When a Special Diet Allowance has not been approved

Where application for an SDA is not approved, an Application Not Approved – Appealable Decision letter is sent to the recipient. The letter indicates that their request for SDA has not been approved, provides the reason why it has not been approved, and explains the right of the recipient to request an internal review of the decision (see Directive 10.1: Notice and internal review process for more information).

If an internal review does not result in a changed decision, the recipient may then appeal to the Social Benefits Tribunal (see Directive 10.2: Appeal process for more information).

Reviewing the Special Diet Allowance

A recipient’s ongoing eligibility for SDA for all medical conditions is subject to review. The timing of the review and the method of review is based on the length of time the approved health care professional confirms the special diet is required. For most conditions, health care professionals can choose one of the following three options on the application form when indicating the length of time a special diet is required: six months, 12 months or indefinite.

However, a recipient’s eligibility for SDA is reconfirmed at the time of the recipient’s eligibility review if the review precedes the expiry date of the SDA.

For SDA that expire in six months or 12 months, an eligibility review is initiated 90 days prior to the SDA review date. Recipients are notified of a review using the Notification of Review letter accompanied by a new Application for Special Diet Allowance.

A recipient may have more than one review date if more than one medical condition has been confirmed. If this occurs, a recipient will be required to submit a separate application form at the time of each review.

The review must take place prior to the cancellation of the recipient’s SDA. In instances where a special diet is required for less than 12 months, a review must still be completed prior to cancelling the SDA.

The recipient must be provided with adequate time to obtain re-confirmation from an approved health care professional. The Administrator should consider the impact of limited access to approved health care professionals in remote or under-serviced areas when determining the date of review.

Where a recipient fails to provide the required re-confirmation within the identified time period, or where an approved health care professional indicates that a special diet is no longer required as a result of a medical condition set out in the Special Diets Schedule, the Administrator will reduce the budgetary requirements of the benefit unit by the amount of the SDA.

If an approved health care professional confirms that a recipient’s special dietary needs are indefinite, the SDA is reviewed periodically at the time of the recipient’s eligibility review.

In addition, the Administrator may request a review of a recipient’s special dietary needs at anytime, even in cases where the health care professional has confirmed that the special diet is required on an indefinite basis. The Administrator may request for a new application form to be completed by a health care professional other than the one that completed the original form.

Consent to release medical information

SDA applicants are required to sign a consent to the release of relevant medical information to support their application for SDA (Section 4 of Form 3111/3112). Medical records requested by the Administrator will be reviewed by medical experts. Caseworkers should not request access to or review recipients’ medical records, beyond the information contained on the SDA application form.

Decisions related to Special Diet Allowance may be appealed

Decisions related to the SDA may be appealed. Prior to an appeal to the Social Benefits Tribunal, an internal review must be requested.

Recipients Transferring from Ontario Works to the Ontario Disability Support Program (ODSP)

Some Ontario Works participants will be granted ODSP while receiving an Ontario Works Special Diet Allowance. Eligible amounts should continue to be paid without interruption until the review date of the current (Ontario Works) Special Diet Allowance, if applicable.

If the Application for Special Diet Allowance (Form 3111/3112) has expired, eligible amounts can be paid but recipients transferring from Ontario Works are required to have a new Form 3111/3112 completed and submitted for review within 90 days.

Special Diets Schedule

Medical condition that requires a special diet

Wasting/weight-loss due to one or more of the following medical conditions:

Notes:

Only one unintended weight loss special diet will be provided per applicant/recipient.

If unintended weight loss due to renal failure is indicated together with renal failure (pre-dialysis or peritoneal / haemodialysis), only one allowance (the highest) will be provided.

If chronic hepatitis C (BMI <25) with interferon treatment is indicated together with one or more of the following conditions: Chronic Hepatitis C (BMI <25), chronic wounds or burns (any stage or percentage of body surface area), renal failure (pre-dialysis or peritoneal / haemodialysis), only one allowance (the highest) will be provided.

  • anorexia nervosa
  • cystic fibrosis
  • amyotrophic lateral sclerosis
  • congestive heart failure
  • chronic hepatitis C (BMI <25) with interferon treatment
  • Crohn’s disease
  • cirrhosis (Stage 3 and 4)
  • HIV/AIDS
  • Huntington disease
  • lupus
  • malignancy
  • multiple sclerosis
  • muscular dystrophy
  • ostomies
  • pancreatic insufficiency
  • Parkinson disease
  • short bowel syndrome
  • ulcerative colitis
  • renal failure (GFR <30)
    • wasting/weight-loss of > 5% and ≤ 10% of usual body weight - $191
    • wasting/weight-loss of > 10% of usual body weight - $242
  • Allergy to wheat - $97
  • Celiac disease - $97

Note: Where both of the above conditions are indicated, only one allowance amount (the highest) will be provided.

  • Chronic wounds (Stage 1 & 2) or burns (1-10% body surface area) - $88
  • Chronic wounds (Stage 3 & 4) or burns (>10% body surface area) - $191
  • Chronic Hepatitis C (BMI <25) - $88

Notes:

Where more than one of the above three conditions are indicated, only one allowance amount (the highest) will be provided.

Where chronic hepatitis C (BMI <25) is indicated together with unintended weight loss (any condition), only one allowance amount (the highest) will be provided.

Where chronic hepatitis C (BMI <25) is indicated together with renal failure (pre-dialysis or peritoneal / haemodialysis), only one allowance amount (the highest) will be provided.

Congenital heart defect - Have had Ross procedure or arterial switch procedure or have coexisting coarctation of aorta - $86

  • Diabetes - $81
  • Extreme obesity BMI > 40 - $51
  • Gestational diabetes - $102

Note: provided during pregnancy and for 3 months post partum

  • Hyperlipidemia or hypercholesterolemia - $51
  • Hypertension - $86
  • Prader-Willi syndrome - $200

Note: Where more than one of the above 7 conditions are indicated, only one allowance (the highest) will be provided.

Dysphagia requiring thickened fluids - $125

Food allergy - milk/dairy

  • 1-8 years of age - $32
  • 9-18 years of age - $63
  • 19-50 years of age - $32
  • 51 years of age or older - $47

Lactose intolerance

  • 1-8 years of age - $30
  • 9-18 years of age - $59
  • 19-50 years of age - $30
  • 51 years of age or older - $45

Note: Where both of the above conditions are indicated, the allowance amount for allergy to milk/dairy will be provided

Inadequate lactation to sustain breast-feeding or breast-feeding is contraindicated during the first 12 months of infant’s life

A Special Diet Allowance will be paid during the first 12 months of an infant’s life, if formula is necessary due to inadequate quantity of breast milk or if breast-feeding is contraindicated (e.g., infant is unable to tolerate breast milk; mother’s milk is contaminated due to other conditions or medical treatments such as HIV/AIDS, chemotherapy; infant has galactosemia; mother is not present, etc.) and the infant requires supplementation to maintain weight.

  • lactose tolerant - $145
  • lactose intolerant - $162

Osteoporosis - $38

Renal failure - pre-dialysis (GFR<30) - $52

Renal failure - peritoneal/haemodialysis - $88

Rett syndrome (BMI <18.5) - $88

Note: Where Rett syndrome (BMI <18.5) is indicated together with one or more of the following conditions: chronic hepatitis C (BMI <25), chronic wounds or burns (any stage or percentage of body surface area), renal failure (pre-dialysis or peritoneal / haemodialysis), or any unintended weight loss conditions, only one allowance (the highest) will be provided.