1. SCHEDULE OF BENEFITS CHANGES

The following changes are being made to the Schedule of Benefits and are based on the input of advisory committees to the PSC:

  • Bone mineral density (BMD) testing

BMD screening of low risk patients for osteoporosis that was previously allowed annually will be limited to once in any 24-month period, based on current scientific evidence. For services on or after October 1, 1999, the 24-month period is determined from April 1, 1998 onwards. The diagnostic facility should verify eligibility for insured BMD testing with both the patient and the referring physician prior to rendering the service. Additional BMD tests of low risk patients beyond the annual limit are uninsured.

High-risk patients will continue to receive unrestricted access to medically necessary testing to assess fracture risk and monitor treatment. The relative value of technical fees for BMD will be adjusted by 35% to reflect the lower cost of the new technology.

Enclosed is a Patient Fact Sheet that explains the above changes regarding BMD benefits. This Fact Sheet may be reproduced by physicians for distribution to their patients.

  • Sleep studies

Patients with sleep disorders will be limited to 2 overnight sleep studies in any 12-month period. For services on or after October 1, 1999, the 12-month period is determined from October 1, 1998 onwards. The diagnostic facility should verify eligibility for insured sleep studies with both the patient and the referring physician prior to rendering the service. Medically necessary additional testing will require prior authorization from the Ministry of Health and Long-Term Care’s District Medical Consultant.

  • Flow volume loop tests

Definitions for spirometry and flow volume loop tests are clarified. Associated changes to pulmonary function tests include disallowing redundant tests and modernizing the Schedule by removing four obsolete services.

  • Acne therapy

Assessment and treatment of acne with prescribed medications remains an insured service. Surgical procedures for treatment of acne are either ineffective or cosmetic in nature and are therefore not insured services.

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Ontario Ministry of Health and Long-Term Care
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