A-3.001, r. 1 - Regulation respecting medical aid

Full text
chapter A-3.001, r. 1
Regulation respecting medical aid
INDUSTRIAL ACCIDENTS — MEDICAL AID
Act respecting industrial accidents and occupational diseases
(chapter A-3.001, ss. 189 and 454)
A-3.001
September 1 2012
DIVISION I
INTERPRETATION
1. In this Regulation,
border region means a part of the territory of Québec comprised within 80 km of any point along the border with Ontario, New Brunswick or Newfoundland; (région frontalière)
health worker means a natural person, other than a health professional within the meaning of the Act respecting industrial accidents and occupational diseases (chapter A-3.001), entered on the roll of a professional order governed by the Professional Code (chapter C-26) and working in the field of health care, including the holder of a psychotherapist’s permit issued by the Ordre professionnel des psychologues du Québec; (intervenant de la santé)
statutory holiday means a statutory public holiday referred to in the National Holiday Act (chapter F-1.1) or a statutory general holiday referred to in the Act respecting labour standards (chapter N-1.1). (jour férié)
O.C. 288-93, s. 1; O.C. 888-2007, s. 1; 185-2017O.C. 185-2017, s. 1.
DIVISION II
GENERAL
2. The care, treatment, technical aids and costs provided for in this Regulation form part of the medical aid to which a worker may be entitled where his condition requires such aid as a result of an employment injury.
O.C. 288-93, s. 2.
3. The Commission des normes, de l’équité, de la santé et de la sécurité du travail shall assume, in accordance with the amounts provided for in this Regulation, the cost of care, treatment and technical aids received in Québec where such care, treatment or technical aids was or were prescribed by the physician in charge of the worker before the care or treatment was received or before the expenditures for technical aids were made. Barring provisions to the contrary, the amounts include the supplies and costs related to the care, treatment or technical aids.
Every claim submitted to the Commission concerning the care, treatment or technical aids shall be accompanied by a copy of the prescription from the physician in charge of the worker, a copy of the health worker’s recommendation, where applicable, and copies of vouchers detailing their cost.
O.C. 288-93, s. 3; O.C. 888-2007, s. 2.
4. Where the employment injury occurs in a border region of Québec, the Commission shall assume the cost of the following care, provided that the Commission had first given authorization to the worker:
(1)  the cost of care, treatment and technical aids received outside Québec and described in this Regulation, including, where applicable, supplies and expenses related thereto, up to the amounts provided for in this Regulation;
(2)  the cost of care and treatment received in a hospital centre and the services of physicians, dentists, optometrists or pharmacists received outside Québec, including, where applicable, the cost of supplies and expenses related thereto, on the basis of what similar care, treatment and services would cost under a public hospital insurance or health insurance plan in force in Québec.
O.C. 288-93, s. 4.
5. Notwithstanding section 3, where the worker sustains an employment injury outside Québec, the Commission shall assume the actual cost of the care and treatment listed in Schedule I, received outside Québec, including the supplies and expenses related thereto, upon presentation of vouchers and of a physician’s attestation as to necessity.
The Commission shall also assume the charges for technical aids and costs up to the amounts and under the conditions provided for in Division IV.
O.C. 288-93, s. 5.
DIVISION III
CARE AND TREATMENT
§ 1.  — General rules
6. The Commission shall assume the cost of the care and treatment determined in Schedule I up to the amounts provided for therein, where such care and treatment are furnished personally by a health worker to whom the worker was referred by the physician in charge of him.
The Commission shall also assume the cost of laboratory examinations carried out in a medical biology laboratory within the meaning of the Act respecting medical laboratories, organ and tissue conservation and the disposal of human bodies (chapter L-0.2) and of the regulations made thereunder, up to the amounts provided for in Schedule I.
O.C. 288-93, s. 6; O.C. 888-2007, s. 3.
7. The Commission shall assume the cost of nursing care and of chiropractic, physiotherapy and occupational therapy treatment provided in the home by a health worker at the rates listed in Schedule I, where the physician in charge of the worker observes that it is impossible for him to leave his home because of his employment injury and where the physician previously prescribed such home care.
O.C. 288-93, s. 7.
8. An amount indicated for a type of care or for a treatment includes the cost of the health worker’s travel expenses, x-rays, the supplies used by the health worker, and ancillary costs.
O.C. 288-93, s. 8; O.C. 888-2007, s. 4.
9. The first visit to a health worker’s office, even for an initial evaluation, shall be paid for, up to the amounts provided for in Schedule I for a treatment session, except in the case of care or treatment in audiology or speech therapy.
O.C. 288-93, s. 9.
10. Where health workers practise their profession as a group on the same premises, they shall indicate on their statements of fees the group number assigned to them by the Commission.
Those health workers shall send to the Commission, in writing, the name of each person in the group, the address to which payment must be sent, the name of the person designated to receive payment from the Commission, as well as any change in such information.
O.C. 288-93, s. 10.
11. A health worker who practises his profession alone shall indicate on his statements of fees the services supplier number assigned to him by the Commission.
O.C. 288-93, s. 11; O.C. 757-2011, s. 1.
12. (Revoked).
O.C. 288-93, s. 12; O.C. 888-2007, s. 5.
§ 2.  — Special rules for physiotherapy and occupational therapy
13. The Commission shall assume the cost of physiotherapy and occupational therapy treatment administered by a member entered on the roll of the Ordre professionnel de la physiothérapie du Québec or by an occupational therapist entered on the roll of the Ordre professionnel des ergothérapeutes du Québec.
O.C. 288-93, s. 13; O.C. 888-2007, s. 6.
14. The Commission shall pay the amounts in Schedule I for physiotherapy and occupational therapy treatment if the Commission and the physician in charge of the worker have received from the member of the Ordre professionnel de la physiothérapie du Québec or from the occupational therapist, for each worker, an initial report, a treatment termination report or, where required, a progress report for each 21-day period of treatment.
O.C. 288-93, s. 14; O.C. 888-2007, s. 7.
15. A report referred to in section 14 must contain the information prescribed in Schedule III and be signed by the member of the Ordre professionnel de la physiothérapie du Québec or by the occupational therapist who personally administered the treatment.
O.C. 288-93, s. 15; O.C. 888-2007, s. 8.
16. Despite section 14, no treatment administered shall be paid after the end of the following periods, whichever ends earlier:
(1)  a period of 8 weeks from the date of taking charge by the health worker referred to in section 13, unless the health worker obtains from the physician in charge of the worker a reasoned opinion in writing to continue the treatment, giving an assessment of the worker’s functional status, and the opinion is sent by the health worker to the Commission;
(2)  a treatment period in which 30 physiotherapy treatments or 30 occupational therapy treatments are administered after the taking charge, unless the health worker obtains the reasoned opinion in writing referred to in subparagraph 1 and the opinion is sent by the health worker to the Commission.
For the purposes of this section, a subsequent prescription from the same or another physician and the taking charge by another health worker of the same professional order to which section 13 refers does not operate to extend the periods referred to in this section, unless the health worker obtains the reasoned opinion in writing required by subparagraph 1 and the opinion is sent by the health worker to the Commission. A single reasoned opinion in writing, duly completed for the treatment administered by the members of the same professional order, must be obtained and sent in accordance with this section within the abovementioned periods, in which case no other opinion is required.
O.C. 288-93, s. 16; O.C. 888-2007, s. 9.
17. Where the worker receives treatment administered simultaneously to other persons as part of a program in physiotherapy or occupational therapy, the Commission shall assume the cost of the treatment sessions at the group rate provided for in Schedule I.
O.C. 288-93, s. 17.
§ 3.  — Special rules for psychology, psychotherapy and neuropsychology
O.C. 757-2011, s. 2; 185-2017O.C. 185-2017, s. 2.
17.1. The Commission assumes the cost of psychological, psychotherapeutic and neuropsychological care administered by a psychologist entered on the roll of the Ordre professionnel des psychologues du Québec.
It also assumes the cost of psychotherapeutic care administered by the holder of a psychotherapist’s permit.
O.C. 757-2011, s. 2; 185-2017O.C. 185-2017, s. 3.
17.2. The Commission pays the amount in Schedule I for psychological, psychotherapeutic and neuropsychological care if the Commission and the physician in charge of the worker have received, for each worker, an evaluation report and, if treatment is provided, a progress report, where required, and a final treatment report.
A progress report must be prepared for each 10-hour period of treatment. If treatment is completed within or at the end of a 10-hour period, only a final report must be prepared.
The reports must be sent within 15 days of the date of the last meeting giving rise to the report.
O.C. 757-2011, s. 2; 185-2017O.C. 185-2017, s. 4.
17.3. A report referred to in section 17.2 must contain the information prescribed in Schedule IV and be signed by the psychologist or by the holder of a psychotherapist’s permit who administered the care.
O.C. 757-2011, s. 2; 185-2017O.C. 185-2017, s. 5.
DIVISION IV
TECHNICAL AIDS AND COSTS
§ 1.  — General rules
18. The Commission shall assume the cost of leasing, purchasing and renewing a technical aid provided for in Schedule II, under the conditions and in accordance with the amounts set out in this Division and in that Schedule, where the technical aid is used in treating an employment injury or is necessary to compensate for temporary functional disabilities resulting from such injury.
The Commission shall also assume the costs set out in Schedule II, under the conditions and in accordance with the amounts indicated therein, upon presentation of vouchers detailing such costs.
O.C. 288-93, s. 18.
19. The Commission shall, in the cases provided for in Schedule II, assume the cost of a technical aid recommended by a health worker to whom the worker was referred by the physician in charge of him.
O.C. 288-93, s. 19.
20. Notwithstanding section 18, where the Health Insurance Act (chapter A-29), the Act respecting the Régie de l’assurance maladie du Québec (chapter R-5) or a regulation made under those Acts provides for a cost for purchasing or renewing a technical aid having the same characteristics as a technical aid provided for in this Regulation, the Commission shall assume only the cost provided for in those Acts or regulations.
O.C. 288-93, s. 20.
21. Where a technical aid estimated to cost $300 or more is purchased or renewed, the worker shall also furnish the Commission with 2 estimates, except in the cases referred to in sections 20 and 27.
O.C. 288-93, s. 21.
22. Every adjustment, purchase or renewal of a technical aid estimated to cost $150 or more must be previously authorized by the Commission, except in the case of the adjustment, purchase or renewal of an aid referred to in sections 20 and 27.
O.C. 288-93, s. 22.
23. The Commission shall assume only the cost of leasing a technical aid where Schedule II provides only for the leasing thereof.
O.C. 288-93, s. 23.
24. In the case of canes, crutches, walkers and accessories therefor listed in Schedule II, the Commission shall assume the estimated leasing cost for the foreseeable consolidation period or the purchase cost if such cost is lower.
O.C. 288-93, s. 24.
25. The Commission shall assume the cost of adjusting, repairing or renewing a technical aid except during the guarantee period, insofar as the aid is used in accordance with the manufacturer’s instructions.
O.C. 288-93, s. 25.
26. Where the estimated cost of repairing a technical aid exceeds 80% of the renewal cost, the Commission shall assume only the renewal cost.
O.C. 288-93, s. 26.
§ 2.  — Special rules for certain therapeutic aids
27. The Commission shall assume the cost of a transcutaneous nerve stimulator having the following characteristics:
(1)  2 channels;
(2)  direct current;
(3)  biphasic square waves;
(4)  variable frequencies adjustable from 2 to 80 cycles per second;
(5)  impulses adjustable between 50 and 250 micro-seconds;
(6)  frequency modulator.
O.C. 288-93, s. 27.
28. The Commission shall assume the cost of leasing a transcutaneous nerve stimulator only for the first 3 months of its use.
At the end of that period, the Commission shall assume the cost of purchasing such device, less the initial leasing cost where the medical prescription for the use of the device is renewed.
The cost of purchasing and renewing a transcutaneous nerve stimulator may not exceed $590.
O.C. 288-93, s. 28.
29. Except where provided for in the third paragraph, the cost of leasing, purchasing or renewing a transcutaneous nerve stimulator includes the following accessories required to use the device:
(1)  4 electrodes;
(2)  2 pairs of wires;
(3)  gel;
(4)  hypoallergenic adhesive tape;
(5)  batteries and battery charger.
The Commission shall also assume the cost of renewing such accessories, up to a maximum of $300 per year.
The Commission shall assume, where the physician in charge of the worker prescribes the use thereof, the cost of self-adhesive rigid or flexible electrodes, up to $400 per year, and an additional maximum of $120 per year for wires and batteries.
O.C. 288-93, s. 29.
30. The Commission shall assume the cost of leasing a tinnitus masker during the first month of use where the worker sends the Commission a specific evaluation by an audiologist.
At the end of that period, the Commission shall assume the cost of purchasing that device, less the initial leasing cost, where the worker sends the Commission a purchase recommendation from an audiologist and from the physician in charge of the worker.
O.C. 288-93, s. 30.
31. (Omitted).
O.C. 288-93, s. 31.
SCHEDULE I
(ss. 5, 6, 7, 9, 14, 16 and 17)
CARE AND TREATMENTS ADMINISTERED BY HEALTH WORKERS
Rate

Acupuncture

Acupuncture care administered
by an acupunctor, per session $27.00

Audiology

Audiology (interview,
consultation of record),
per session $20.25

Pure-Tone audiometry $54.25

Speech audiometry (threshold
and discrimination tests) $20.25

Acoustic impedance tests
(tympanogram, acoustic
reflex, adaptation of
acoustic reflex, Metz test) $20.25

Acoustic impedance screening $3.50

Special tests (A.B.L.B.,
S.I.S.I., adaptation,
Békésy, etc.), per test $15.00

Electrophysiological tests
(Echo G; evoked potentials)

— without anesthetic $54.25

— under anesthetic $114.00

Issue of an audiological
evaluation report and,
where applicable, of a
hearing aid certificate $30.50

Analysis of needs and
determination of
appropriate treatment $33.00

Psychoacoustic testing of
hearing aid $40.00

Electroacoustic testing
of hearing aid $33.00

Chiropractic

Chiropractic treatment, per session,
including cost of x-rays $32.00

Occupational therapy

Individual treatment, per session $36.00

Group treatment, per session $21.00

Speech therapy

Speech therapy (interview,
record consultation), per session $32.00

Tests for speech reading due
to deafness $32.00

Voice parameter tests $48.00

Expressive language tests $32.00

Receptive language tests $32.00

Phonetic inventory tests $16.00

Written language tests $64.00

Prosody tests $47.50

Complementary tests (such
as praxia, math), per test $16.00

Issue of a speech therapy
evaluation report $30.50

Physiotherapy

Individual treatment, per session $36.00

Group treatment, per session $21.00

Podiatry

Per session $32.00

Psychology

Psychological, psychotherapeutic and
neuropsychological care, hourly rate $86.60

Home care

Chiropractic treatment,
per session $50.00

Occupational therapy treatment,
per session $50.00

Physiotherapy treatment,
per session $50.00

Nursing care, per session $44.00
Laboratory examinations
The cost of the examinations is reimbursed according to the amounts set out in the agreement made under section 195 of the Act.
O.C. 288-93, Sch. I; O.C. 561-94, s. 1; O.C. 888-2007, s. 10; O.C. 368-2009, s. 1; O.C. 757-2011, s. 3; 185-2017O.C. 185-2017, s. 6.
SCHEDULE II
(ss. 18, 19, 23 and 24)
TECHNICAL AIDS AND COSTS
TECHNICAL AIDS
1. Locomotive apparatus:
(1) the cost of acquiring, renewing or leasing canes, crutches, walkers and their accessories;
(2) the cost of leasing a manually propelled wheelchair;
(3) the cost of leasing a motorized wheelchair where the worker is unable to use his upper limbs to move the wheelchair or where the physician in charge of him attests that it is contraindicated for him to use a manually propelled wheelchair.
2. Daily life aids:
The use of daily life aids may be recommended by the occupational therapist or physiotherapist to whom the physician in charge of the worker referred him.
(1) Adapted objects:
The cost of purchasing aids for eating, dressing, personal hygiene care or household activities, made or modified for use by a worker having sustained an employment injury; such aids include jar openers, stocking-pullers, long-handled combs or brushes, buttoners or other similar objects;
(2) Transfer aids:
The cost of leasing the following transfer aids:
(a) hydraulic, electrical or mechanical patient lifters;
(b) seat lifters for the bathtub;
(c) armchairs for the bath and shower;
(3) Bathroom apparatus:
(a) The cost of purchasing the following bathroom apparatus:
i. bedpans;
ii. urinals;
iii. elevated toilet seats;
iv. safety handles and grabs;
(b) The cost of leasing the following apparatus:
i. commodes and their accessories;
ii. shower chairs;
(4) Hospital beds and accessories:
The cost of leasing a hospital bed and its accessories, namely, bedboards, a bed table, a bed cradle, a trapeze and a footstool.
The cost of leasing an electrical hospital bed is assumed only where the worker has no-one to position his bed for him and he is capable of positioning an electric bed by himself.
3. Therapeutic aids:
(1) Transcutaneous nerve stimulators (T.E.N.S.);
(2) Epidural and intra-thalamic nerve stimulators:
The cost of purchasing those apparatus;
(3) Other therapeutic aids:
The cost of purchasing the following therapeutic aids:
(a) accessories for the prevention and treatment of bed sores such as a sheepskin, a mattress and a cushion, an elbow pad, a foot-drop splint, a heel pad and a donut;
(b) corsets, collars and splints;
(c) exercise equipment such as the following, used in the home as part of an active occupational therapy or physiotherapy program: exercise balls, plasticine, a system of pulleys for shoulder ankylosis, weights for the wrist or ankle, a sandbag with a velcro fastener, a fixed resistance exercise apparatus, and a set of light weights under 5 kg;
(d) compressive clothing;
(e) lumbar belts and hernia bandages;
(f) cervical traction devices with dead weights;
The cost of leasing the following aids:
(a) muscular nerve stimulators;
(b) osteosynthesis apparatus;
(c) continuous passive motion machines (C.P.M.).
4. Communication aids:
(1) The use of the following communication aids must be recommended by a speech therapist to whom the physician in charge of the worker referred him:
(a) the cost of purchasing imagers;
(b) the cost of purchasing communication boards.
(2) The cost of leasing the following auditive aids in the case of temporary bilateral deafness, if the worker sends the Commission a recommendation for use by an audiologist to whom the physician in charge of the worker referred him:
(a) telephone amplifiers;
(b) an environmental sound control system.
(3) Any other technical communication aid on prior authorization by the Commission.
COSTS
5. Extricating equipment:
The cost of using extricating equipment where the worker’s condition so requires because of an employment injury sustained outside his employer’s establishment or away from a construction site.
The costs incurred for the use of extricating equipment are refundable, up a maximum of $360. Where the distance to be travelled is more than 50 km, the refund is increased by a maximum of $1,75 per kilometre travelled to transport the extricating equipment to the site of the accident.
6. Long distance calls:
The long distance calls made by a worker admitted to and sheltered in an institution within the meaning of the Act respecting health services and social services (chapter S-4.2) or the Act respecting health services and social services for Cree Native persons (chapter S-5), because of an employment injury, up to a maximum of $10 per week insofar as the worker is sheltered.
O.C. 288-93, Sch. II.
CONTENT OF PHYSIOTHERAPY AND OCCUPATIONAL THERAPY REPORTS
1. An initial report, a progress report and a treatment termination report must contain
(1) the worker’s name, health insurance number, telephone number and address;
(2) the name and number of the member of the professional order;
(3) the name, telephone number and services supplier number or, where applicable, the group number;
(4) the signature of the member of the professional order who personally administered the treatment and the date of the signature;
(5) the name of the physician in charge of the worker and number assigned to the physician by the professional order or, if there is a change of physician, the name of the new physician and number assigned to the new physician by the professional order;
(6) the date of the employment injury and, where applicable, the date of any relapse, reoccurrence or aggravation;
(7) the diagnosis by the physician in charge of the worker;
(8) the date of the prescription for treatment;
(9) an indication of any former referral or treatment in physiotherapy or occupational therapy in the case of the initial report;
(10) the date of the beginning of treatment;
(11) the frequency of treatment;
(12) an indication, where applicable, as to whether the treatment is for maintenance, for verification or for a special approach or whether there is a contraindication for the continuation of treatment; and
(13) the worker’s attendance record stating the dates of treatment administered and the dates of the worker’s absences for treatment, where applicable, except in the case of an initial report.
2. An initial report and a treatment termination report must contain, in addition,
(1) the date of taking charge and initial evaluation in the case of an initial report;
(2) the problems, goals and treatment plan in the case of an initial report; and
(3) in the case of a treatment termination report, the date of completion of treatment and, where applicable, the date of release from the physician in charge of the worker, as well as an evaluation of the worker’s condition upon the termination of treatment.
3. A progress report must contain, in addition to the information required by section 1,
(1) an evaluation of the worker’s subjective and objective signs;
(2) an analysis of the worker’s problems and the treatment plan;
(3) the changes in the worker’s condition;
(4) the reasons for and the date of any suspension of treatment; and
(5) the planned duration of any further treatment.
O.C. 288-93, Sch. III; O.C. 888-2007, s. 11; O.C. 757-2011, s. 4.
SCHEDULE IV
(s. 17.3)
CONTENT OF PSYCHOLOGY, PSYCHOTHERAPY AND NEUROPSYCHOLOGY REPORTS
(1) An evaluation report, a progress report and a final treatment report must contain
(1) the worker’s name, health insurance number, telephone number and address, and the Commission’s record number;
(2) the psychologist’s name and permit number, the telephone number and services supplier number or, where applicable, the group number;
(3) the signature of the psychologist who administered the care and the date of the signature;
(4) the name of the physician in charge of the worker and the number of the physician’s permit to practise;
(5) the date of the employment injury and, where applicable, the date of any relapse, reoccurrence or aggravation; and
(6) the diagnosis by the physician in charge of the worker giving rise to the referral or, where applicable, the reason for the referral.
(2) An evaluation report must also contain
(1) the dates of the evaluation meetings;
(2) the history of the case and the relevant antecedents that may have an impact on the treatment plan;
(3) the factors intrinsic and extrinsic to the employment injury that could have an impact on the worker’s psychological and social functioning and his or her return to work;
(4) the worker’s perception of his or her situation in relation to the employment injury and his or her capacity to return to work;
(5) the problems associated with the employment injury and their impact on the return to work;
(6) the nature, dates and frequency of the activities carried out, including, where applicable, the tests carried out;
(7) an analysis of all the data and observations and, where applicable, of the tests carried out;
(8) the findings of the evaluation and the recommendations;
(9) in the case of a neuropsychological evaluation, the observations on the worker’s behaviour during the meetings and when taking the tests, and the evaluation of the worker’s behaviour in the following areas: cognitive, motor, somesthetic, affective, personality and perception; and
(10) in the case of treatment, an individualized treatment plan containing, among others things,
(i) the clinical approach and the therapeutic methods being considered;
ii. the objectives sought by the treatment;
iii. the therapeutic activities to be implemented;
iv. the participation expected from the worker;
v. the means used to measure the progress made under the individualized treatment plan;
vi. the prognosis regarding the attainment of results;
vii. the date set for the beginning of treatment;
viii. the number and frequency of the meetings scheduled.
(3) A progress report must contain, in addition to the information required by section 1,
(1) the dates of the meetings for each 10-hour period of treatment;
(2) a reminder of the objectives sought by the treatment;
(3) the therapeutic activities implemented in relation to the objectives sought;
(4) the evaluation of the worker’s progress in relation to the objectives sought;
(5) the worker’s perception of his or her progress in relation to the objectives sought;
(6) where applicable, the changes to be made to the individualized treatment plan and the recommendations; and
(7) the number and frequency of the meetings scheduled.
(4) A final treatment report must contain, in addition to the information required by section 1,
(1) the dates of the meetings since the previous report;
(2) the problems associated with the employment injury identified in the initial evaluation;
(3) the therapeutic activities implemented in relation to the objectives sought;
(4) the worker’s perception in relation to the attainment of the objectives;
(5) an analysis and an evaluation of the results in relation to the objectives sought, including the intrinsic and extrinsic factors having contributed to or hindered the attainment of the objectives; and
(6) the grounds for terminating treatment.
(5) Subject to the acts a psychotherapist is authorized to perform under his or her permit, sections 1 to 4 apply, with the necessary modifications, to the holder of a psychotherapist’s permit.
O.C. 757-2011, s. 5; 185-2017O.C. 185-2017, s. 7.
REFERENCES
O.C. 288-93, 1993 G.O. 2, 963
O.C. 561-94, 1994 G.O. 2, 1502
S.Q. 1994, c. 40, s. 457
O.C. 888-2007, 2007 G.O. 2, 2925
O.C. 368-2009, 2009 G.O. 2, 1276
O.C. 757-2011, 2011 G. O. 2, 1633
S.Q. 2015, c. 15, s. 237
O.C. 185-2017, 2017 G.O. 2, 631