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Appendix 2

APPLICATION AND REVIEW PROCESS FOR FUNDING OF OUT OF COUNTRY MEDICAL CARE

A. INTRODUCTION

Prior approval of provincial coverage for elective out of country medical care is the responsibility of Out of Country Claims Branch, HIBC, and the Medical Services Branch, Ministry of Health Services, in accordance with Guidelines established by the Medical Services Commission. These Guidelines are established under the authority of the Medicare Protection Act and the Hospital Insurance Act.

In order to consider provincial coverage for elective out of country medical care, an application for prior approval must be received by HIBC. In cases where out of country funding is appropriate, the pre- approval process enables the province to negotiate a reasonable and fair compensation rate from out of country service providers prior to the provision of the service.

B.

APPLICATION BY APPROPRIATE SPECIALIST

Applications for prior approval of funding for medically necessary out of country services must be submitted to HIBC by an appropriate specialist actively involved in the beneficiary's care in BC. An appropriate specialist is one with the most knowledge in the proposed service and/or specialty that will be provided out of country.

C. DOCUMENTATION

It is the responsibility of the appropriate medical specialist making application on behalf of the beneficiary to submit all supporting documentation, including, when appropriate or required, a written recommendation from the tertiary care centre or appropriate agency responsible for standards of care in BC regarding the proposed out of country medical care.

D. APPLICATIONS

Only complete applications will be considered. Incomplete or abandoned applications are not eligible for review by an authority delegated by the MSC.

An incomplete application is one that does not include a recommendation from the appropriate attending medical specialist and/or does not include the required documentation or written recommendation from a tertiary care centre or the appropriate agency responsible for the medical standard of care in BC.

If additional information is requested during the course of reviewing an application, the information must be received within 45 days of the request, or on an agreed date. If the information is not received, the application for out of country funding will be considered abandoned.

E.

SUMMARY OF THE DECISION PROCESS

Stage 1 - Consideration and decision by Medical Services Branch

The completed application for funding approval and any supporting documentation is considered by MSB or its designate, Health Insurance BC, and a decision is made as to whether or not funding for out of country care will be provided. The beneficiary will be notified of the decision in writing.

_________________________________________________________________________________________________________

Medical Services Commission Out of Country Funding Guidelines January 19, 2011

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