O. Reg. 565/07: GENERAL

 

ontario regulation 565/07

made under the

health insurance act

Made: August 22, 2007
Filed: December 20, 2007
Published on e-Laws: December 21, 2007
Printed in The Ontario Gazette: January 5, 2008

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

(General)

1. (1) Subsection 37.1 (4) of Regulation 552 of the Revised Regulations of Ontario, 1990 is amended by striking out “The basic fee” at the beginning and substituting “Subject to subsections (5) to (11), the basic fee”.

(2) Section 37.1 of the Regulation is amended by adding the following subsections:

(9) The basic fee payable by the Plan for the following laboratory services set out in the schedule of laboratory benefits and rendered by a physician in the circumstances referred to in clause (3) (a) is nil:

1. Alcohol, ethyl - quantitative (code L006).

2. Chloride (code L053).

3. Potassium (code L204).

4. pH (code L034).

5. Sodium (code L226).

(10) The following additional rules apply with respect to the following laboratory services set out in the schedule of laboratory benefits and rendered by a physician in the circumstances referred to in clause (3) (a):

1. For target drug testing, urine, qualitative or quantitative (code L073), the basic fee payable with respect to one insured person for tests rendered in a single day is nil for each test after the fourth test.

2. Where tests for any combination of target drug testing, urine, qualitative or quantitative (code L073), for drugs of abuse screen, urine (code L078) or for broad spectrum toxicology screen, urine (code L079) are rendered for one insured person in a single day, the basic fee payable is the fee for the service for which the greatest number of LMS units is payable under the schedule of laboratory benefits, and the basic fee payable for the other service or services is nil.

3. Where tests are rendered for one insured person in any period of seven consecutive days for target drug testing, urine, qualitative or quantitative (code L073), for drugs of abuse screen, urine (code L078), for broad spectrum toxicology screen, urine (code L079) or for any combination of them, the basic fee payable is nil for each test after the second test. However, for the purposes of determining whether or not the second test in the seven day period has been attained, the first group of four or fewer code L073 tests rendered for one insured person in one day is deemed to be one test.

4. For creatinine (code L067), the basic fee payable with respect to tests rendered for one insured person in any period of seven consecutive days is nil for each test after the second test.

(11) For the purpose of subsection (10),

“target drug testing” includes qualitative or quantitative measurement of alcohol, performed by any method.

2. This Regulation comes into force on the later of October 1, 2007 and the day it is filed.