O. Reg. 345/01: GENERAL

 

ONTARIO regulation 345/01

made under the

health insurance act

Made: August 29, 2001
Filed: August 30, 2001
Printed in The Ontario Gazette: September 15, 2001

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

(General)

Note: Since the end of 2000, Regulation 552 has been amended by Ontario Regulations 14/01, 66/01, 183/01, 250/01, 272/01, 306/01, 322/01 and 344/01.  Previous amendments are listed in the Table of Regulations published in The Ontario Gazette dated January 20, 2001.

1. (1) Subsection 1 (1) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by adding the following definitions:

“dental surgeon” means a person entitled to practise dentistry in the place where dental services are rendered by the surgeon;

“oral and maxillofacial surgeon” means,

(a) with respect to dental services rendered in Ontario, a dental surgeon who holds a specialty certificate of registration from the Royal College of Dental Surgeons of Ontario authorizing the surgeon to practise oral and maxillofacial surgery in Ontario,

(b) with respect to dental services rendered elsewhere in Canada, a person who holds a designation from a professional regulatory body in the Canadian province or territory outside of Ontario where the services are rendered that, in the opinion of the General Manager, is equivalent to the designation referred to in clause (a), or

(c) with respect to dental services rendered outside Canada, a person who is authorized to practise oral and maxillofacial surgery in the jurisdiction outside Canada where the services are rendered and holds, in the opinion of the General Manager, a designation equivalent to the designation referred to in clause (a);

(2) The definition of “schedule of benefits” in subsection 1 (1) of the Regulation is revoked and the following substituted:

“schedule of benefits” means the Ministry of Health and Long-Term Care document titled “Schedule of Benefits — Physician Services under the Health Insurance Act (April 1, 2001)” and including the following amendments:

1. Amendments dated July 1, 2001.

2. Amendments dated August 13, 2001.

3. Amendments dated September 1, 2001.

2. Paragraph 4 of section 7 of the Regulation is amended by striking out “attending physician or midwife” and substituting “attending physician, oral and maxillofacial surgeon or midwife”.

3. (1) Paragraph 3 of subsection 8 (1) of the Regulation is amended by adding “or by an oral and maxillofacial surgeon” at the end.

(2) Paragraph 5 of subsection 8 (1) of the Regulation is amended by striking out “by a physician on the medical staff or a midwife on the midwifery staff” in the portion before subparagraph i and substituting “by a physician on the medical staff, a midwife on the midwifery staff or an oral and maxillofacial surgeon on the dental staff”.

4. The Regulation is amended by adding the following section:

8.1 (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,

(a) in the case of a radiological or diagnostic procedure, it is a procedure described in subsection (2); and

(b) the laboratory, radiological or other diagnostic procedure is rendered,

(i) 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

(ii) 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.

(2) The following radiological and diagnostic procedures are the procedures to which an insured person is entitled without charge for the purposes of clause (1) (a):

1. Nuclear medicine bone and labeled leukocyte scintigraphy.

2. Plain X-ray of the head, neck, chest, pelvis and tibia.

3. Computed tomography of the head.

4. Fistula or sinus radiology examination.

5. Radiology sialograms.

6. Ultrasound of the face and sinuses.

7. Pulmonary function studies.

8. Electrocardiograms.

5. Subsection 9 (3) of the Regulation is amended by striking out “attending physician or midwife” wherever it occurs and substituting in each case “attending physician, oral and maxillofacial surgeon or midwife”.

6. (1) Clause 11 (1) (a) of the Regulation is amended by striking out “legally qualified medical practitioner” at the end and substituting “physician”.

(2) Clause 11 (1) (b) of the Regulation is amended by striking out “legally qualified medical practitioner” and substituting “physician”.

(3) Clause 11 (1) (c) of the Regulation is amended by striking out “or” at the end of subclause (i), by adding “or” at the end of subclause (ii) and by adding the following subclause:

(iii) an oral and maxillofacial surgeon, for any laboratory, radiological or diagnostic procedure described in section 8.1.

(4) Subsection 11 (1) of the Regulation is amended by adding the following clause:

(c.1) admitted as an in-patient or registered as an out-patient on the order or under the authority of an oral and maxillofacial surgeon;

7. (1) Subsection 16 (1) of the Regulation is amended by striking out “The services rendered by dentists” at the beginning and substituting “The services rendered by dental surgeons”.

(2) Subsection 16 (2) of the Regulation is amended by striking out “that they be performed in a hospital by a dentist” and substituting “that they be performed in a hospital by a dental surgeon”.

(3) Subsection 16 (5) of the Regulation is amended by striking out “where the service is performed by an oral surgeon” at the end and substituting “where the service is performed by an oral and maxillofacial surgeon”.

8. Paragraph 3 of subsection 24 (2) of the Regulation is amended by striking out “ordered by a dentist” and substituting “ordered by a dental surgeon”.

9. (1) Clause 28.2 (1) (b) of the Regulation is amended by striking out “dentists” and substituting “dental surgeons”.

(2) Subsection 28.2 (4) of the Regulation is amended by striking out “dentists” and substituting “dental surgeons”.

10. (1) Clause 37 (2) (a) of the Regulation is amended by striking out “be prepared by the physician” at the beginning and substituting “be prepared by the physician, oral and maxillofacial surgeon”.

(2) Subsection 37 (3) of the Regulation is amended by striking out “attending physician” wherever it occurs and substituting in each case “attending physician or oral and maxillofacial surgeon”.

11. Subsection 38.3 (2.1) of the Regulation is amended by striking out “by a dentist” at the end and substituting “by a dental surgeon”.

12. Section 38.4 of the Regulation is amended by adding the following subsection:

(2.2) Claims for X-ray procedures and for laboratory and other diagnostic procedures that were provided in a hospital must include the Ontario Health Insurance Plan identification number of the referring oral and maxillofacial surgeon.

13. (1) Paragraph 1 of the Preamble to Schedule 13 to the Regulation is amended by striking out “dental surgeon/oral surgeon” and substituting “dental surgeon or oral and maxillofacial surgeon”.

(2) Subparagraphs 5A and 5D of the Preamble to Schedule 13 to the Regulation are amended by striking out “dental/oral surgeon” and substituting in each case “dental surgeon or oral and maxillofacial surgeon”.

(3) Items T631 and T632 under the heading “Emergency Procedures” in Schedule 13 to the Regulation are revoked and the following substituted:

T631	79603	Post-surgical care, minor, by other than treating dental surgeon……………………...	13.00	15.70
T632	79604	Post-surgical care, major, by other than treating dental surgeon……………...………	29.00	34.80

 

14. (1) Paragraph 1 of the Preamble to Schedule 14 to the Regulation is amended by striking out “dental surgeon/oral surgeon” and substituting “dental surgeon or oral and maxillofacial surgeon”.

(2) Subparagraphs 5A and 5D of the Preamble to Schedule 14 to the Regulation are amended by striking out “dental/oral surgeon” and substituting in each case “dental surgeon or oral and maxillofacial surgeon”.

15. (1) Paragraph 1 of the Preamble to Schedule 15 to the Regulation is amended by striking out “dental surgeon/oral surgeon” and substituting “dental surgeon or oral and maxillofacial surgeon”.

(2) Subparagraphs 5A and 5D of the Preamble to Schedule 15 to the Regulation are amended by striking out “dental/oral surgeon” and substituting in each case “dental surgeon or oral and maxillofacial surgeon”.

16. This Regulation comes into force on September 1, 2001.