August 23, 2017
Note: This article was originally posted in our August 2017 newsletter, and has not been updated.
Midwives have the authority to order pregnancy diagnostic ultrasounds and pelvic diagnostic ultrasounds under the Controlled Acts Regulation of the RHPA. However, the Schedule of Facility Fees for Independent Health Facilities (IHF Schedule) states “Ultrasound for normal, complicated or high risk pregnancy (but not for the postpartum period) rendered in an Independent Health Facility is insured when referred by a midwife who is a member of the College of Midwives of Ontario.” This has been interpreted by IHFs to mean that postpartum ultrasounds are uninsured. A restriction on payment in the IHF setting presents a barrier to optimal care, and would be arbitrary, as midwives can order these ultrasounds in the hospital setting.
In our mandate of protecting the public, and ensuring quality midwifery care, we wrote to the Ministry of Health for some clarification on this matter. The Ministry advised that this interpretation of the IHF Schedule was incorrect, and that midwives are able to order ultrasounds in the postpartum period, even in an IHF.
According the Ministry of Health, this language in the IHF Schedule is meant to indicate that postpartum ultrasounds cannot be claimed as pregnancy ultrasounds. In the postpartum period, midwives are able to order insured pelvic ultrasounds. There are no OHIP payment rules that block payment to a physician for a pelvic ultrasound when the service is ordered by a midwife.
In order to clarify this situation, the Ministry of Health’s Health Services Branch is going to send a bulletin to IHFs, and will propose amendments to the IHF Schedule and to the section 9 of the Diagnostic Ultrasound Preamble in the Schedule of Benefits for Physician Services. We will share these documents with you when we have them.