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Independent Health Facilities Act
Loi sur les établissements de santé autonomes

R.R.O. 1990, REGULATION 650

FACILITY FEES

Consolidation Period: From July 1, 2010 to the e-Laws currency date.

Last amendment: O. Reg. 98/10.

This Regulation is made in English only.

1. (1) The following services and operating costs are prescribed as services and operating costs that are not part of an insured service and that do not support, assist and are not a necessary adjunct, or any of them, to an insured service:

1. Costs and charges for travelling to visit an insured person outside the usual geographical area of practice of the person making the visit.

2. Toll charges for long distance telephone calls.

3. Costs of a device that is not implanted by means of an incision and that is used for therapeutic purposes unless,

i. the device is used to permit or facilitate a procedure or examination, or

ii. the device is a cast for which there is a fee listed in the schedule of benefits as defined in Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act.

4. Costs of,

i. a drug, antigen, antiserum or other substance used for treatment that is not used to facilitate a procedure or examination, or

ii. a drug to promote ovulation.

5. Advice given by telephone to an insured person at the request of the person or the person’s representative unless advice by telephone is specifically listed as an insured service or part of an insured service in the schedule of benefits as defined in Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act.

6. An interview or case conference in respect of an insured person that,

i. lasts more than twenty minutes, and

ii. includes a professional none of whose services are insured services.

7. The preparation and transfer of an insured person’s health records when this is done because the care of the person is being transferred at the request of the person or the person’s representative.

8. A service, including an annual health or annual physical examination, received wholly or partly for the production or completion of a document or the transmission of information to which paragraph 8.1 or 8.2 applies regardless of whether the document or information was requested before, at the same time as or after the service was received.

8.1 The production or completion of a document, or the transmission of information to any person other than the insured person, if the document or transmission of information is required by legislation of any government or is to be used to receive anything under, or to satisfy a condition under, any legislation or program of a government.

8.2 The production or completion of a document, or the transmission of information to a person other than the insured person, if the document or the transmission of the information relates to,

i. admission to or continued attendance in a daycare or pre-school program or a school, community college, university or other educational institution or program,

ii. admission to or continued attendance in a recreational or athletic club, association or program or a camp,

iii. an application for, or the continuation of, insurance,

iv. an application for, or the continuation of, a licence,

v. entering or maintaining a contract,

vi. an entitlement to benefits, including insurance benefits or benefits under a pension plan,

vii. obtaining or continuing employment,

viii. an absence from or return to work,

ix. legal proceedings.

9. The providing of a prescription to an insured person if the person or the person’s personal representative requests the prescription and no concomitant insured service is provided.

10. A service that is solely for the purpose of altering the appearance of an insured person except for otoplasty for the correction of outstanding ears of a person under the age of eighteen years.

11. An anaesthetic service rendered by a physician in connection with a dental service that is not an insured service that,

i. is provided outside a hospital as defined in Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act, or

ii. is provided in a hospital as defined in Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act and involves only the removal of impacted teeth.

12. The fitting of contact lenses other than for,

i. aphakia,

ii. myopia greater than 9 diopters,

iii. irregular astigmatism resulting from post corneal grafting or corneal scarring from disease, or

iv. keratoconus.

13. An acupuncture procedure.

14. Psychological testing.

15. A service that is part of a group screening program.

16. An examination or procedure for the purpose of a research or survey program other than an assessment that is necessary to determine if an insured person is suitable for the program.

17. Treatment for a medical condition that is generally accepted within Ontario as experimental.

18. A laboratory service except a laboratory service,

i. that is an insured service under section 52 of Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act, or

ii. that is carried out by a physician only for the purpose of diagnosing or treating one of his or her patients.

19. Psychotherapy that is a requirement for the patient to obtain a diploma or degree or to fulfil a course of study.

20. A service or operating cost that supports a service that is prescribed under paragraph 8, 8.1, 8.2, 10, 13, 15, 16, 17 or 18.

21. A service provided by a laboratory and ordered by a dentist, osteopath, chiropractor or chiropodist.

22. A missed appointment or procedure.

23. A service or cost that supports, assists and is a necessary adjunct, or any of them, to oocyte retrieval or embryo transfer.

24. Destruction of hair follicles. R.R.O. 1990, Reg. 650, s. 1; O. Reg. 173/91, s. 1 (1); O. Reg. 618/91, s. 1; O. Reg. 298/93, s. 1 (1-3).

(2) Ultrasound and radiological procedures and their costs are not included in the services and costs set out in paragraph 23 of subsection(1). O. Reg. 173/91, s. 1 (2).

(3) Paragraphs 8, 8.1 and 8.2 of subsection (1) do not apply to:

1. Keeping or maintaining appropriate physician or practitioner records.

2. Conferring with or providing advice, direction, information or records to physicians or other professionals concerned with the health of the insured person.

3. Producing or completing documents or transmitting information,

i. required to satisfy a condition of being admitted to, or receiving health services in, a hospital, a home for retarded persons as defined in the Homes for Retarded Persons Act or a long-term care home as defined in the Long-Term Care Homes Act, 2007,

ii. required in relation to an annual health or annual physical examination of a patient or resident of any facility mentioned in subparagraph i,

iii. required to receive anything under a program administered by the Minister of Health,

iv. required to receive welfare or social assistance benefits provided by a government or vocational rehabilitation services under the Vocational Rehabilitation Services Act,

v. required by or for a health facility,

vi. respecting the health status of a child who,

A. is in the supervision, or under the care, custody or control of a children’s aid society,

B. resides in a place of secure custody, a place of open custody or a place of temporary detention, within the meaning of Part IV of the Child and Family Services Act, or

C. resides in a children’s residence licensed under Part IX of the Child and Family Services Act,

vii. required, as evidence of immunization status, for admission to or continued attendance in a daycare or pre-school program or a school, community college, university or other educational institution or program,

viii. required as evidence of disability, for the purposes of eligibility for a benefit, related to transportation, under any legislation or program of a government, or

ix. to obtain consents to the performance of insured services.

4. A service received wholly or partly for the production or completion of a document or the transmission of information to which paragraph 3 applies.

5. An examination rendered and documents produced or completed or information transmitted under the Mental Health Act.

6. An examination rendered and documents produced or completed or information transmitted for the purpose of an investigation or confirmation of an alleged sexual assault in accordance with the requirements of the Ministry of the Attorney General and the Ministry of the Solicitor General. O. Reg. 298/93, s. 1 (4); O. Reg. 98/10, s. 1.

(4) Paragraph 8 of subsection (1) does not apply to a service that is, in the opinion of the physician or practitioner, medically necessary and that is received wholly or partly for the production or completion of a document or the transmission of information that relates to any of the following:

1. The receipt of disability or sickness benefits or the satisfaction of a condition relating to disability or sickness benefits.

2. A return to a daycare or pre-school program after a temporary absence.

3. A condition relating to fitness to continue employment other than a condition that requires an examination or assessment to be conducted on an annual or other periodic basis.

4. An absence from or return to work.

5. Legal proceedings. O. Reg. 298/93, s. 1 (4).

2. (1) In this section,

“technical component of an insured service” means the part of an insured service rendered in Ontario for which a fee is payable by the Ontario Health Insurance Plan only if the service is rendered in a hospital as defined in Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act. R.R.O. 1990, Reg. 650, s. 2 (1).

(2) The technical component of an insured service set out in the schedule of benefits as defined in Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act that is rendered in Ontario outside a hospital as defined in Regulation 552 (General) of the Revised Regulations of Ontario, 1990 made under the Health Insurance Act is prescribed as a service that is not part of the insured service and that supports, assists and is a necessary adjunct, or any of them, to the insured service. R.R.O. 1990, Reg. 650, s. 2 (2).

3., 4. Revoked: O. Reg. 58/92, s. 2.

5. Subject to Regulation 649 of the Revised Regulations of Ontario, 1990, this Regulation applies to independent health facilities operated under subsection 7 (3) of the Act and to persons who operate the facilities. R.R.O. 1990, Reg. 650, s. 5.