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ontario regulation 144/23

made under the

Health Insurance Act

Made: June 22, 2023
Filed: June 23, 2023
Published on e-Laws: June 23, 2023
Published in The Ontario Gazette: July 8, 2023

Amending Reg. 552 of R.R.O. 1990

(GENERAL)

1. (1) The definition of “schedule of benefits” in subsection 1 (1) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by adding the following paragraph:

43. Amendments dated May 25, 2023 (effective as of November 1, 2021).

(2) The definition of “schedule of benefits” in subsection 1 (1) of the Regulation is amended by adding the following paragraph:

44. Amendments dated May 26, 2023 (effective as of July 1, 2023);

2. Subsections 8 (1.1) and (1.2) of the Regulation are revoked.

3. Section 8.1 of the Regulation is revoked and the following substituted:

8.1 Despite paragraph 3 of section 7 and paragraph 1 of subsection 8 (1), a laboratory, radiological or other diagnostic procedure ordered by an oral and maxillofacial surgeon and rendered in a hospital is not an in-patient or out-patient service to which an insured person is entitled without charge unless it is rendered,

(a) in connection with a dental surgical procedure provided by an oral and maxillofacial surgeon in a hospital and it is medically necessary for the person to receive the dental surgical procedure in a hospital; or

(b) on the order of an oral and maxillofacial surgeon who has reasonable grounds to believe that a dental surgical procedure, performed by an oral and maxillofacial surgeon, will be required in connection with the laboratory, radiological or other diagnostic procedure and that it will be medically necessary for the person to receive the dental surgical procedure in a hospital.

4. Paragraphs 7, 8 and 8.1 of subsection 38.4 (1) of the Regulation are revoked and the following substituted:

7. If the service is a diagnostic radiology procedure in accordance with the schedule of benefits, the Ontario Health Insurance Plan identification number of the referring physician, registered nurse in the extended class or oral and maxillofacial surgeon.

8. If the service is a laboratory or other diagnostic procedure listed under “Nuclear Medicine”, “Magnetic Resonance Imaging”, “Diagnostic Ultrasound” or “Pulmonary Function Studies” in the schedule of benefits, the Ontario Health Insurance Plan identification number of the referring physician, midwife, aboriginal midwife, registered nurse in the extended class, oral and maxillofacial surgeon or laboratory.

8.1 If the service is a diagnostic procedure that is listed under “Diagnostic and Therapeutic Procedures” in the schedule of benefits with both a professional and technical component, the Ontario Health Insurance Plan identification number of the referring physician or registered nurse in the extended class.

Commencement

5. (1) Except as otherwise provided in this section, this Regulation comes into force on the day it is filed.

(2) Subsection 1 (1) is deemed to have come into force on November 1, 2021.

(3) Subsection 1 (2) and sections 2, 3 and 4 come into force on July 1, 2023, or, if this Regulation is filed after that date, are deemed to have come into force on that date.