Laboratory and Medical Imaging Tests
Funding will not be provided for experimental or developmental laboratory and medical imaging tests where the efficacy of such services is not known.
In order for proven laboratory and medical imaging tests to be funded out of country, all diagnostic avenues in BC and Canada must have been exhausted.
If laboratory and medical imaging tests are not available in Canada, but are of proven value, the appropriate specialist may request coverage for out of country tests. Funding will be approved only when the test information is expected to significantly alter the management of the beneficiary's condition. In limited circumstances, US Food and Drug Administration (FDA) approved laboratory and medical imaging processes may be deemed medically necessary if promising outcomes have been substantiated by reputable clinical trials, beyond Phase III published in peer reviewed medical literature.
It is the responsibility of the appropriate medical specialist to provide peer reviewed medical literature, with the application for out of country laboratory or medical imaging tests
Genetic testing performed within BC is not funded by MSP, but it is funded through health authority* funding when it is medically necessary to the medical management of the beneficiary’s condition.
If out of country genetic testing is medically necessary to create a new medical treatment plan for the beneficiary or to significantly alter current medical treatment for the beneficiary, funding may be approved by MSB, subject to these Guidelines.
Any service that is considered the responsibility of the British Columbia Cancer Agency (BCCA), because the modality of treatment is delivered by the BCCA or its programs, requires a written recommendation by the Medical Director of the BCCA. The attending specialist must include the BCCA recommendation with the application for pre-approval of funding for out of country medical treatment. Such treatments include chemotherapy, radiation or surgery.
It is the responsibility of the attending medical specialist to provide written documentation of a review and recommendation from the appropriate conference or team review of the BCCA regarding the referral for out of country treatment.
If medically necessary cancer treatment is not available in Canada, a negotiated U&C* rate will apply for out of country treatment.
Stereotactic Radiotherapy/Radiosurgery by Gamma Knife
Prior authorization must be sought by the attending specialist, with expert knowledge of the proposed treatment
Referrals for treatment of trigeminal neuralgia (tic doloureux) must include medical documentation to confirm severe disability and medical/surgical treatment has not proven successful or is not indicated in the clinical circumstances
Authorization for treatment of movement disorders will not be granted.
Terms with an asterisk are defined in Appendix 1
Medical Services Commission Out of Country Funding Guidelines January 19, 2011