Extended Medical Therapies

Overview

Essential extended medical therapies consisting of acupuncture, chiropractic, massage therapy, naturopathy, podiatry and physical therapy may be provided to specific recipients who are eligible for general health supplements. A medical practitioner or nurse practitioner must confirm an acute need and there must be no other resources available.

This supplement is available under the Employment and Assistance Regulation and Employment and Assistance for Persons with Disabilities Regulation.

Policy

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Coverage under MSP Supplementary Benefits

Effective:  January 1, 2020

Medical Services Plan (MSP) supplementary benefits covers extended medical therapies consisting of acupuncture, chiropractic, massage therapy, naturopathy, non-surgical podiatry and physical therapy to a combined limit of up to 10 visits per calendar year. Recipients of income assistance, disability assistance and hardship assistance receive access to MSP supplementary benefits under their Plan C MSP coverage.

[For more information, see Related Links – Medical Services Plan & Medical Coverage.]

MSP contributes $23 per visit. Recipients may be required to pay an additional amount if the practitioner has opted out of MSP or charges above the MSP fee schedule. The ministry does not pay for any extra billing charges.

[For more information on MSP supplementary benefits, see Contacts]

 

Eligibility for Extended Medical Therapies

Effective:  January 1, 2020

The ministry may consider extensions of extended medical therapies for recipients eligible for general health supplements when:

  • recipients have exhausted their 10 visits for the year authorized under the Medical Services Plan (MSP) supplementary benefits
  • a medical practitioner or nurse practitioner has confirmed an acute need, not chronic (acute means severe and immediate, whereas chronic refers to ongoing conditions)
  • no other resources, including local hospital out-patient facilities, are available 

Extensions are limited to a maximum of 12 visits per year. The ministry contributes $23 per visit. Recipients may be required to pay an additional amount if the practitioner has opted out of MSP or charges above the MSP fee schedule. The ministry does not pay for any extra billing charges.

Note:  The 12-visit extension applies to any combination of services included under extended medical therapies after the 10 MSP visits have been exhausted. 

[see Related Links - Health Supplement Summary]

Procedures

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Assessing Eligibility for Extended Medical Therapies

Effective:  January 1, 2020

To assess a recipient’s eligibility for extended medical therapies consisting of acupuncture, chiropractic, massage therapy, naturopathy, non-surgical podiatry and physical therapy beyond the 10 visits covered by Medical Services Plan (MSP) supplementary benefits, follow these steps:

Employment and Assistance Office (EAO) 1. Confirm no other resources, including local hospital out-patient facilities, are available
 

2.

Ensure that the recipient has provided a written request from a medical practitioner or nurse practitioner and therapist that includes all of the following:

  • name and address of therapist diagnosis of the condition (specifically whether the condition is acute or chronic) from a medical practitioner or nurse practitioner
  • frequency and number of visits required for each type of therapy
  • medical  justification why further treatment is required
  • date on which the 10 MSP visits were exhausted
  3. Forward all documentation to Health Assistance (HA) [see Contacts].

HA

4.

Recipient will be notified of decision by letter. If HA approves a service included under extended medical therapies, the service provider will be notified via Purchase Authorization generated at HA.

  • The ministry does not reimburse clients.
  • All therapies funded by HA must be pre-approved.

Authorities and Responsibilities

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Responsibilities

Effective: January 1, 2020

Employment and Assistance Worker and Community Integration Specialist are responsible for:

  • gathering documentation required to determine eligibility for extended medical therapies
  • forwarding all relevant documentation to Health Assistance 

Health Assistance is responsible for:

  • approving extensions to extended medical therapies