QUESTIONS AND ANSWERS

  CLARIFICATION OF COMMENTARY REGARDING DIAGNOSTIC HEARING TESTS

  1. Is compliance with professional standards a condition of payment for insured services?
    Yes.  Section 18(1) 6. of the Health Insurance Act authorizes the ministry to refuse payment for an insured service if it has not been provided in accordance with accepted professional standards and practice.

  2. For OHIP payment purposes, is a physician permitted to delegate 'communicating a diagnosis' or 'prescribing a hearing aid' to non-physician employee?
    No. These controlled acts are normally performed as elements of an assessment. Insured assessments must be personally performed by the physician and, for payment purposes, cannot be delegated to a non-physician.

  3.  Is this a change of payment policy?
    No.   The revision to the Commentary pertaining to delegation and supervision of DHTs represents only clarification of existing policy but now explicitly acknowledges the distinction between controlled and uncontrolled acts.


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Ontario Ministry of Health and Long-Term Care
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