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Prosthetic Devices Tariffs Regulations

made under subsections 13(1) and 17(2) of the

Health Services and Insurance Act

R.S.N.S. 1989 c. 197

O.I.C. 1999-146 (April 7, 1999), N.S. Reg. 32/99

as amended to O.I.C. 2013-289 (August 20, 2013), N.S. Reg. 287/2013


Citation

1     These regulations may be cited as the Prosthetic Devices Tariffs Regulations.


Arm and leg prostheses tariff

2     (1)    The tariff of fees for arm and leg prostheses is as set out in Schedule “A”.

 

       (2)    The tariff of fees for arm and leg prostheses is in effect from April 1, 1999, to March 31, 2008.

Subsection 2(2) amended: O.I.C. 2003-16, N.S. Reg. 8/2003; O.I.C. 2005-122, N.S. Reg. 83/2005.


Mastectomy prosthesis tariff

3     (1)    The tariff of fees for mastectomy prostheses is as set out in Schedule “B”.

 

       (2)    The tariff of fees for mastectomy prostheses is in effect from November 1, 1997, to March 31, 2008.

Subsection 3(2) amended: O.I.C. 2003-16, N.S. Reg. 8/2003; O.I.C. 2005-122, N.S. Reg. 83/2005.


Ocular prosthesis tariff

4     (1)    The tariff of fees for ocular prostheses is as set out in Schedule “C”.

 

       (2)    The tariff of fees for ocular prostheses is in effect on and after the date this subsection comes into force to March 31, 2015.

Subsection 4(2) replaced: O.I.C. 2013-289, N.S. Reg. 287/2013.


Authorization of payments

5     The Minister may authorize payments in respect of the tariffs prescribed by these regulations.



Schedule “A”

Arm and Leg Prostheses Tariff

(effective April 1, 1999, to March 31, 2008)


Tariff

1     This tariff is subject to the following increases:

 

                (a)    effective April 1, 1999, an increase of 2%;

 

                (b)    effective April 1, 2000, an additional increase of 2%; and

 

                (c)    effective April 1, 2001, an additional increase of 2%.

Numbered Section 1 and heading added: O.I.C. 2003-16, N.S. Reg. 8/2003.


Definitions

2     In this Schedule,

 

                (a)    “prosthetist” means an individual who is certified as a prosthetist by the Canadian Board for Certification of Prosthetists and Orthotists;

 

                (b)    “qualified supplier” means

 

                         (i)     a prosthetist who is located in the Province,

 

                         (ii)    a company that is located in the Province and that employs a prosthetist; or

 

                         (iii)   a company that is not located in the Province and that employs a prosthetist;

 

                (c)    “resident” has the same meaning as defined in the regulations respecting hospital insurance made pursuant to the Health Services and Insurance Act.

Section 2 added: O.I.C. 2003-16, N.S. Reg. 8/2003.


Insured services

3     A resident who is missing part or all of a limb will be provided with the following insured services, if, in a physician’s opinion, they are required:

 

                (a)    for all residents,

 

                         (i)     the initial fitting and provision of a prosthesis, including initial stump shrinkers, and

 

                         (ii)    repairs to a prosthesis;

 

                (b)    for a resident 17 years of age or younger, a replacement prosthesis once every 2 years; and

 

                (c)    for a resident 18 years of age or older, a replacement prosthesis once every 4 years.

Section 3 added: O.I.C. 2003-16, N.S. Reg. 8/2003.


Payments

4     (1)    Subject to subsection (2), an invoice submitted by a qualified supplier for an insured service under this tariff will be paid directly to the qualified supplier from the M.S.I. Plan on behalf of the resident.

 

       (2)    An invoice submitted by a qualified supplier as defined in subclause 2(b)(iii) will not be paid unless there has been pre-approval under the M.S.I. Plan for the insured service specified in the invoice.

 

       (3)    A qualified supplier will not be paid for an invoice not submitted within 12 months of the date of the insured service specified in the invoice.

Section 4 added: O.I.C. 2003-16, N.S. Reg. 8/2003.

Schedule “A” title amended: O.I.C. 2005-122, N.S. Reg. 83/2005.



Schedule “B”

Mastectomy Prosthesis Tariff

(effective November 1, 1997, to March 31, 2008)


Assistance to resident

1     A resident, as defined in the regulations respecting medical services insurance made pursuant to the Health Services and Insurance Act, who

 

                (a)    has undergone a mastectomy or lumpectomy; and

 

                (b)    in the opinion of a physician requires the use of a conventional mastectomy prosthesis,

 

will receive financial assistance up to a maximum of $150 per prosthesis once every two years.


Canadian Cancer Society

2     (1)    Special approval may be granted by the Canadian Cancer Society for the payment of up to a maximum of $300 per prosthesis and up to a maximum of $40 for the purchase of a supporting bra.

 

       (2)    This Section applies only to those eligible beneficiaries who are registered with the Canadian Cancer Society and who qualify under that Society’s Income Dependent Assistance Program.

 

       (3)    Payments shall be paid by the M.S.I. Plan on behalf of the Department of Health.


Payments

3     (1)    Payments made under this tariff will be made directly to the qualified supplier, on behalf of the resident, by the M.S.I. Plan or, if so desired, payment may be made directly to the qualified supplier by the resident who will seek reimbursement from the M.S.I. Plan.

 

       (2)    A “qualified supplier” in this Section means an individual or company that has received a certificate of training from a prosthetics distributor.

Schedule “B” title amended: O.I.C. 2005-122, N.S. Reg. 83/2005.




Schedule “C”

Ocular Prosthesis Tariff

(effective on and after the date this Schedule comes into force to March 31, 2015)

 

The tariff of fees for ocular prostheses is as set out in the following table:


Services

Present MSI Fee

MSI Fee 2012-13

MSI Fee 2013-14

MSI Fee

2014-15

Scleral pros

$1529.04

$1544.33

$1559.77

$1575.37

Conventional

$1287.30

$1313.05

$1339.31

$1366.09

Build-ups

$389.76

$395.61

$401.54

$407.56

Adjustments

$130.57

$133.18

$135.85

$138.56

Reglazings/rechecks

$53.00

$53.00

$53.00

$53.00

Conformers

$272.25

$277.70

$283.25

$288.91

House calls

$62.00/hour

$66.00/hour

$68.00/hour

$70.00/hour

Schedule “C” replaced: O.I.C. 2013-289, N.S. Reg. 287/2013.