With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing a revised Assessment of Attendant Care Needs form (Form 1) effective October 1, 2016. The Form 1 Pilot Project (pilot project) in the Health Claims for Auto Insurance (HCAI) system is also being announced.
Revised Assessment of Attendant Care Needs (Form 1)
A revised Form 1 has been approved by the Superintendent for attendant care benefit claims. It is to be used for new and existing claims submitted to the insurer on or after October 1, 2016. The changes to Form 1 facilitate its implementation into HCAI on a voluntary pilot basis, also beginning October 1, 2016.
Highlights of Changes to Form 1
The changes to Form 1 are administrative in nature and will not alter the existing application and adjudication processes. The changes are limited to the applicant, insurance company and customer information sections of the form; Part 1 through Part 4 remain the same.
Changes to the form include:
- Amending unused or duplicate fields;
- Clarifying delivery instructions such as identifying the correct insurance company, adjuster and claimant;
- Amendments that will make certain fields consistent with other automobile insurance forms that are currently automated through HCAI (e.g., OCF 18, OCF 21 and OCF 23).
General Processing Rules:
- Claims for attendant care that were initiated prior to October 1, 2016 can continue to be submitted using the revised Form 1, in paper format, or may be submitted electronically through HCAI.
- Adjudication responses to Form 1 submissions by insurers will correspond to the format of submission.
- As set out in section 42 of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (SABS), only occupational therapists and registered nurses are able to prepare and submit the Form 1.
The Form 1 HCAI Pilot Project
Commencing October 1, 2016, FSCO and HCAI will be conducting a voluntary Form 1 pilot project. Facilities that are enrolled with HCAI will be able to submit the form to insurers electronically using either a Practice Management System (PMS) that is integrated with HCAI, or the HCAI web channel.
The following rules apply to the pilot project:
- Facilities wishing to submit electronically via HCAI must be enrolled with the HCAI system. Once they begin submitting in that format they should continue electronic submission for the duration of the pilot. Electronic and paper submission methods cannot be used by facilities simultaneously.
- Invoices for attendant care services will continue to be submitted and processed outside of the HCAI system.
The pilot project is expected to run for one year and will apply to all claims for attendant care under the SABS.
Following the pilot project and after addressing any findings, it is anticipated that the Form 1 will be made mandatory for submission through the HCAI system.
On or after October 1, 2016, the attached revised Form 1 is to be used for new and existing claims for attendant care whether submitted in paper or electronically through HCAI.
How to Obtain the Revised Form
A copy of the revised Form 1 is included as an attachment to this Bulletin, and is also available on FSCO’s website at: www.fsco.gov.on.ca
Support resources and educational material concerning Form 1 and its submission in HCAI will be available closer to the implementation date at: www.hcaiinfo.ca
Further, facilities and regulated health professionals not enrolled in HCAI but wishing to use the system now that Form 1 is becoming available are encouraged to enrol with HCAI. Additional information on the HCAI enrolment process can be found on the HCAI website provided above.
Chief Executive Officer and
Superintendent of Financial Services
June 20, 2016