The Financial Services Regulatory Authority of Ontario (FSRA) announced Sept. 27 that it is conducting a review of the health service provider guidelines and frameworks in the province. To that end, it has published three consultation papers that set out options FSRA has the authority to implement “to support government auto insurance reforms,” they state.
The three papers include The Health Service Provider (HSP) Framework Review, The Health Claims for Auto Insurance (HCAI) System Review and The Statutory Accident Benefits Schedule (SABS) Guideline Review. The last paper encompasses a review of the Professional Services Guideline (PSG), the Attendant Care Hourly Rate Guideline (ACHRG) and the Minor Injury Guideline (MIG), as well. The consultation period for providing feedback on the documents and their proposed courses of action closes November 29, 2024.
“In its 2024 Ontario Budget, the government committed to move forward with auto insurance reforms and it included a request that FSRA conduct a review,” they write in the HCAI system review paper, “to find administrative and cost efficiencies to contribute to having a more modern and efficient system.”
Each paper discusses previous stakeholder feedback regarding each guideline discussed, proposes initiatives, their rationale and items for consideration.
Data integrity issues
In the HCAI report, for example, they say the electronic platform which enables insurers and health professionals to communicate about claims approvals and payment decisions could be improved to make claims processing more efficient. Stakeholder feedback also indicates that the HCAI has technical issues which need to be addressed, along with data integrity issues (stakeholders have asked for the system’s administrators to add gender options so providers with non-binary clients can accurately record claimant’s identification data, for example). They also say complexities in the system contribute to errors that can result in findings of non-compliance among HSPs.
The initiatives the regulator is seeking feedback on include making the number of forms available for transmission through HCAI a priority. Revising forms and data-related initiatives are also discussed as potential priorities.
A multi-step process
The SABS guidelines review paper, meanwhile, they say is the first step of a multi-step process being undertaken to review all three SABS guidelines. It discusses the purpose of each guideline, current maximum hourly rates prescribed by the guidelines and proposes priorities for the future. Among those priorities, they discuss indexing the maximum hourly rates, a move to flat rate fees, an initiative where the PSG does not prescribe rates and another initiative which maintains existing hourly rates. In attendant care and minor injury guideline considerations, stakeholders are asked to discuss indexation of hourly rates alongside options which maintain the current status quo.
Finally, the HSP framework review considers past improvements to HSP regulation which occurred between 2019 and 2023. They say stakeholder feedback indicates that “the current requirement for HSPs to obtain a licence in order to bill electronically does not appear to be achieving the intended objectives of controlling costs and ensuring effective provisions of benefits by reducing fraud,” they state. “HSP stakeholders have raised concerns that FSRA’s regulatory approach is redundant with oversight of Ontario’s regulated health professionals by the regulatory health colleges.”
They add that the following opportunities can provide administrative and cost efficiencies: The first proposal is to modernize HSP licensing, the second is to modernize FSRA’s supervisory approach. The paper also discusses enhancing cooperation and collaboration with regulatory health colleges.
