O. Reg. 169/02: GENERAL
filed June 13, 2002 under Health Insurance Act, R.S.O. 1990, c. H.6
Skip to contentONTARIO regulation 169/02
made under the
health insurance act
Made: June 12, 2002
Filed: June 13, 2002
Printed in The Ontario Gazette: June 29, 2002
Amending Reg. 552 of R.R.O. 1990
(General)
Note: Since the end of 2001, Regulation 552 has been amended by Ontario Regulations 23/02, 56/02, 57/02 and 61/02. Previous amendments are listed in the Table of Regulations published in The Ontario Gazette dated January 19, 2002.
1. (1) The definition of “schedule of benefits” in subsection 1 (1) of Regulation 552 of the Revised Regulations of Ontario, 1990 is revoked and the following substituted:
“schedule of benefits” means the document published by the Ministry of Health and Long-Term Care titled “Schedule of Benefits — Physician Services under the Health Insurance Act (April 1, 2002)” including the following amendments but not the portions of the document described in subsection (4):
1. Amendments dated June 15, 2002.
(2) Subsection 1 (4) of the Regulation is amended by adding “and including the amendments dated June 15, 2002” after “(April 1, 2002)”.
2. Section 8 of the Regulation is amended by adding the following subsection:
(2.1) Despite subparagraph 5 ii of subsection (1), the provision of verteporfin to an out-patient on or after June 15, 2002, for use in the home, is an out-patient service to which an insured person is entitled without charge if the verteporfin is provided in the following circumstances:
1. The verteporfin is provided in the course of ocular photodynamic therapy for the treatment of predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration or pathologic myopia.
2. The area of classic subfoveal choroidal neovascularization is equal to or greater than 50 per cent of the total lesion, as determined by fluorescein angiography.
3. The first treatment is commenced within 30 months after the initial diagnosis of predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration or pathologic myopia.
4. The patient’s visual acuity is 20/40 or worse.
3. Section 24 of the Regulation is amended by adding the following subsection:
(1.0.1) Subparagraph 4 i of subsection (1) does not apply with respect to the preparation or provision of verteporfin on or after June 15, 2002 if all of the following conditions exist:
1. The verteporfin is provided in the course of ocular photodynamic therapy for the treatment of predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration or pathologic myopia.
2. The area of classic subfoveal choroidal neovascularization is equal to or greater than 50 per cent of the total lesion, as determined by fluorescein angiography.
3. The first treatment is commenced within 30 months after the initial diagnosis of predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration or pathologic myopia.
4. The patient’s visual acuity is 20/40 or worse.
4. The Regulation is amended by adding the following section:
37.1.1 (1) Despite subsection 37.1 (1), the following services rendered by an opthalmologist in Ontario on or after April 1, 2002 and before June 15, 2002 are insured services if all of the conditions listed in subsection (2) are met:
1. Ocular photodynamic therapy, including establishment of intravenous access.
2. The provision of verteporfin.
3. The supervision of drug infusion and application of non-thermal diode laser for the activation of verteporfin.
(2) These are the conditions that must be met:
1. The service is provided for the treatment of predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration or pathologic myopia.
2. The area of classic subfoveal choroidal neovascularization is equal to or greater than 50 per cent of the total lesion, as determined by fluorescein angiography.
3. The first treatment is commenced within 30 months after the initial diagnosis of predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration or pathologic myopia.
4. The patient’s visual acuity is 20/40 or worse.
(3) Despite subsection 37.1 (2), the basic fee payable by the Plan for an insured service described in subsection (1) is the lesser of,
(a) the amount actually paid by the insured person for the service; and
(b) the usual amount charged for the service in Ontario for similar treatment provided in similar circumstances.
5. (1) Subject to subsection (2), this Regulation comes into force on the day it is filed.
(2) Section 1 comes into force on June 15, 2002.
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