Mandatory use of HCAI for the Assessment of Attendant Care Needs Form (Form 1)

With this Bulletin, the Financial Services Commission of Ontario (FSCO) is informing all automobile insurance companies and healthcare providers that effective October 1, 2018, all facilities must submit the Assessment of Attendant Care Needs Form (Form 1) through the Health Claims for Auto Insurance (HCAI) system. Furthermore, all insurers must communicate the approval or rejection of the Form 1 through HCAI.

On October 1, 2016, a revised Assessment of Attendant Care Needs Form (Form 1) was released and the voluntary pilot project in the HCAI system was launched.

Form 1 was amended in order to facilitate its automation into the HCAI system. Submission of Form 1 through HCAI began on a voluntary basis on October 1, 2016.

Form 1 is a Superintendent-approved form required when an injured claimant applies for attendant care benefits in accordance with the Statutory Accident Benefits Schedule (SABS) section 42(1). It is used for automobile accidents that occur on or after March 31, 2008.

An occupational therapist or registered nurse must complete the form. It sets out the claimant’s specific attendant care needs and the associated monthly cost following an accident. The completed Form 1 is submitted to an auto insurance company.

Prior to the pilot project, the completed Form 1 was submitted in paper format to auto insurance companies.

Automation of Form 1 into the HCAI system on a pilot basis allowed healthcare providers the option to submit it electronically rather than by fax or mail. The objective of the change and pilot was to make it easier for healthcare providers to submit and track the document. In addition, insurers would be better able to monitor and adjudicate claims. Existing application and adjudication processes remained unchanged.

The pilot tested the success of submitting Form 1 electronically both through the HCAI portal and through third-party software systems. It demonstrated that benefit amounts could be proposed, approved and tracked with ease.

Mandatory use of HCAI for Form 1

Starting October 1, 2018, all facilities enrolled with HCAI must submit Form 1 to insurers electronically, using either a practice management system (PMS) that is integrated with HCAI, or the HCAI web channel.

Invoices for attendant care services will continue to be submitted and processed outside of the HCAI system.

The HCAI guideline will be updated close to the mandatory implementation date to reflect this change.

In the interim period between the release of this bulletin and October 1, 2018, submitting Form 1 electronically remains optional.

Facilities that wish to begin submitting Form 1 electronically via HCAI must be enrolled with the HCAI system. Once a facility begins to submit Form 1 electronically, and for those who have already begun, electronic submission should continue. Electronic and paper submission methods cannot be used by facilities simultaneously.

Support resources and educational material concerning Form 1 and its submission in HCAI are available at www.hcaiinfo.ca 

Facilities and regulated health professionals that are not enrolled in HCAI must enrol with HCAI for the electronic submission of Form 1. Additional information on the HCAI enrolment process can be found on the HCAI website provided above.

Brian Mills
Chief Executive Officer and
Superintendent of Financial Services

January 4, 2018