Starting January 27, 2021, the Out-of-Country Health Services Regulation (otherwise known as the Regulation) has been updated to include changes aimed at improving efficiency. The new changes help clarify what criteria are actually needed for the application process.
If you’re applying for funding of medically required ‘out-of-country health services’ on behalf of any patients then the following changes will affect you:
- Out-of-Country Health Services Committee (OOCHSC) and Out-of-Country Health Services Appeal Panel (Appeal Panel) are now defining business days as Monday-Friday instead of calendar days. A business day is any day that is not a Saturday, Sunday, holiday, or a day when Government of Alberta offices are closed.
- Elective services, emergency services definitions, and program/application criteria are now clearly defined (see ‘Out-of-country health services funding requests‘ for all updated details).
- Your patient’s application can be denied if:
- it was submitted 365 days after the out-of-country health services were given
- if the patient is not a resident of Alberta or registered under the Alberta Health Care Insurance Plan, or if you are not registered to practice in Alberta.
- Only your patient or their representative can appeal the decision.
Overall, if you’re applying on behalf of your patient it’s best to familiarize yourself with the application process so you know how to respond to requests for any out-of-country health services. If you have any questions about this or a previous AHCIP Bulletin don’t hesitate to get in touch with our team.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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