VETERANS AFFAIRS CANADA PAGE 1 PRINT DATE: AUGUST 13, 2018 BENEFIT GRID
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1 ************************************************************************************************************************************************************************************************* * CUSTOMER...VAC/ACC * PROVINCE...ON * POC...12 * LANGUAGE...E *************************************************************************************************************************************************************************************************
2 VETERANS AFFAIRS CANADA PAGE 1 ACUPUNCTURIST - INITIAL VISIT MD,NP MAC 1 VISIT/CY $ ACUPUNCTURIST - SUBSEQUENT VISIT MD,NP MAC 15 VISITS/CY $ CHIROPRACTOR - INITIAL VISIT MAC 1 VISIT/CY $70.00 CHIROPRACTOR - INITIAL VISIT (ACUPUNCTURE) MAC 1 VISIT/CY $65.00 CHIROPRACTOR - REPORT MAC MAC 2/1 CY $25.00/HR Y CHIROPRACTOR - SUBSEQUENT VISIT MAC 20 VISITS/CY $50.00 CHIROPRACTOR - SUBSEQUENT VISIT (ACUPUNCTURE) MAC 15 VISITS/CY $40.00 CHIROPRACTOR - X-RAY MAC CLINICAL CARE MANAGER - TRAVEL EXPENSES CST CST Y
3 VETERANS AFFAIRS CANADA PAGE 2 DIETICIAN - REPORT MAC MAC $50.00/HR Y DIETICIAN - VISIT MD,NP MAC MAC $100.00/HR KINESIOLOGIST - REPORT MAC MAC $60/HOUR Y KINESIOLOGIST - VISIT MD,NP MAC 20/CY $120/HOUR MASSAGE THERAPIST - REPORT MAC MAC 2 / CY $45.50 Y MASSAGE THERAPIST - VISIT MD,NP MAC 15 / CY $91.00 NURSE - CLINICAL CARE MANAGER DO DO 90/1 CY /HALF HOUR OCCUPATIONAL THERAPIST - CLINICAL CARE MANAGER DO DO 90 OCC / CY $60.00 PER HALF HOUR OCCUPATIONAL THERAPIST - VAC REQUESTED ASSESSMENT VST,VSA VST,VSA $60.00/HALF HOUR Y
4 VETERANS AFFAIRS CANADA PAGE 3 OCCUPATIONAL THERAPIST - VISIT MAC MAC $ OSTEOPATH - VISIT MD,NP MAC 20/CY $ OSTEOPATH REPORT MAC MAC 2/1 CY $50.00/HR Y OTHER RELATED HEALTH CARE SERVICE MD,NP MAC MAC Y SEE NOTES 2, 4, 5 PHYSIOTHERAPIST - INITIAL VISIT MAC 1 VISIT/CY $95.00 PHYSIOTHERAPIST - INITIAL VISIT (ACUPUNCTURE) MAC 1 VISIT/CY $80.00 PHYSIOTHERAPIST - REPORT MAC MAC 2/1 CY $37.50/HR Y PHYSIOTHERAPIST - SUBSEQUENT VISIT MAC 20 VISITS/CY $75.00 PHYSIOTHERAPIST - SUBSEQUENT VISIT (ACUPUNCTURE) MAC 15 VISITS/CY $55.00
5 VETERANS AFFAIRS CANADA PAGE 4 PHYSIOTHERAPY - INITIAL VAC REQUESTED ASSESSMENT DO,FNS DO,FNS Y PHYSIOTHERAPY - SUBSEQUENT VAC REQUESTED DO,FNS DO,FNS Y ASSESSMENT PODIATRIST/CHIROPODIST - INITIAL VISIT MAC 1 VISIT/CY $75.00 PODIATRIST/CHIROPODIST - SUBSEQUENT VISIT MAC 10 VISITS/CY $75.00 PROVIDER TIME-IN-TRAVEL COSTS IN EXCESS OF 1 HOUR MAC,DO MAC,DO Y PER RETURN TRIP PSYCHOLOGIST - ASSESSMENT MAC MAC 15HRS/1 CY $225.00/HOUR Y PSYCHOLOGIST - CLINICAL CARE MANAGER DO DO 90/1 CY $112.50/HALF HOUR PSYCHOLOGIST - COUPLE OR FAMILY VISIT MAC MAC 25/CY $225.00/HOUR SEE NOTE 4 PSYCHOLOGIST - GROUP THERAPY FOR CLIENT MAC MAC 25/CY $32.50 PER HOUR SEE NOTE 6
6 VETERANS AFFAIRS CANADA PAGE 5 PSYCHOLOGIST - GROUP THERAPY FOR FAMILY MEMBER MAC MAC 25/CY $32.50 PER HOUR Y SEE NOTES 3 AND 5 PSYCHOLOGIST - INDIVIDUAL VISIT MAC 25/CY $225.00/HOUR SEE NOTE 6 PSYCHOLOGIST - REPORT MAC MAC $225.00/HOUR Y PSYCHOLOGIST VISIT - FAMILY MEMBER(S) MAC MAC 25/1 CY $225.00/HOUR Y SEE NOTES 3 AND 5 PSYCHOTHERAPY - ASSESSMENT MAC MAC 15 HOURS/1 $ CY PSYCHOTHERAPY - COUPLE/FAMILY COUNSELLING MAC MAC 25/1 CY PSYCHOTHERAPY - GROUP THERAPY FOR CLIENT MAC MAC 25/1 CY PSYCHOTHERAPY - REPORT MAC MAC $ PSYCHOTHERAPY - SPOUSE/DEPENDENT VIST MAC MAC 25/1 CY Y
7 VETERANS AFFAIRS CANADA PAGE 6 PSYCHOTHERAPY - VISIT MAC MAC 25/1 CY $ REHABILITATION PROGRAM - EXERCISE/SWIMMING MD,OT,RN,PT MO N/A $500/CY Y SEE NOTE 2 PROGRAM FEES NP SOCIAL WORKER - ASSESSMENT MAC MAC 15HRS/1CY $195.00/HOUR Y SOCIAL WORKER - CLINICAL CARE MANAGER DO DO 90/1 CY /HALF HOUR SOCIAL WORKER - COUPLE OR FAMILY VISIT MAC MAC 25/CY $ SEE NOTE 4 SOCIAL WORKER - GROUP THERAPY FOR CLIENT MAC MAC 25/CY $32.50 PER HOUR SEE NOTE 6 SOCIAL WORKER - GROUP THERAPY FOR FAMILY MEMBER MAC MAC 25/CY $32.50 PER HOUR Y SEE NOTES 3 AND 5 SOCIAL WORKER - REPORT MAC MAC $ Y SOCIAL WORKER - VISIT MAC MAC 25/CY $ SEE NOTE 6
8 VETERANS AFFAIRS CANADA PAGE 7 SOCIAL WORKER - VISIT FAMILY MEMBER(S) MAC MAC 25/1CY Y SEE NOTES 3 AND 5 SPEECH LANGUAGE PATHOLOGIST MD,NP MAC $120.00/HR SPEECH LANGUAGE PATHOLOGIST - REPORT MAC MAC $60.00/HOUR Y TAXES - GST/HST (GST/HST REGISTRATION NUMBER 0GST REQUIRED) TELEMENTAL HEALTH MAC MAC
9 VETERANS AFFAIRS CANADA PAGE 8 - GENERAL NOTES - VAC WILL AUTHORIZE SERVICES UNDER A REGISTERED PROVIDERS SCOPE OF PRACTICE UP TO THE BENEFIT GRID LIMIT - EXCEEDING FREQUENCIES - VAC PRE-AUTHORIZES POC 12 SERVICES UP TO AN ANNUAL FREQUENCY LIMIT AS IDENTIFIED ON THE VAC BENEFIT GRIDS. APPROVAL OF SESSIONS BEYOND THE ANNUAL FREQUENCY LIMIT MAY BE APPROVED TO ADDRESS CLIENT NEEDS WHEN A TREATMENT CAN BE SHOWN THAT IT HAS BEEN EFFECTIVE AND IS REASONABLY EXPECTED TO CONTINUE TO BE EFFECTIVE IN REACHING THE DESIRED TREATMENT OUTCOMES. THE VAC FORM ½REQUEST FOR EXTENSION OF TREATMENT AND/OR A TREATMENT PLAN FROM THE PROVIDER ARE TO BE USED IN DETERMINING IF EXCEEDING THE FREQUENCY IS JUSTIFIED. - USE OF ½OTHER CODES - THE MAC MAY REQUIRE SUPPORTING DOCUMENTATION FROM THE PROVIDER AND/OR OTHER HEALTH PROFESSIONALS AND/OR MAY NEED TO CONSULT WITH HEALTH PROFESSIONALS AND/OR OTHERS BEFORE AUTHORIZING THE REQUESTED SERVICE UNDER THE ½OTHER CODE. A RATIONALE MUST BE DOCUMENTED WHEN USING THE POC 12 ½OTHER CODE. - REHABILITATION - ALL BENEFITS FOR REHABILITATION CLIENTS MUST BE PRE- AUTHORIZED. THE FREQUENCY AND MAXIMUM LIMITS ARE GUIDELINES ONLY. LIMITS MAY BE EXCEEDED BY WAIVING THE RULES FOR FREQUENCY AND MAXIMUM IN THE AUTHORIZATION IF DIRECTED IN THE WORK ITEM BY THE CASE MANAGER. - REPORTS - OCCURRENCE WILL EQUAL ONE HOUR UNLESS OTHERWISE NOTED. IF MORE TIME IS REQUIRED TO COMPLETE A REPORT, ADDITIONAL OCCURRENCE(S) CAN BE AUTHORIZED. RATIONALE MUST BE DOCUMENTED. - SPECIAL NOTES - NOTE 2- EXERCISE PROGRAMS MUST BE BOTH STRUCTURED AND SUPERVISED. - NOTE 3 û SERVICES FOR FAMILY MEMBERS ARE TO BE AUTHORIZED TO THE EXTENT THAT THEY ARE REQUIRED TO ACHIEVE THE TREATMENT OUTCOMES THAT HAVE BEEN ESTABLISHED FOR THE VETERAN. THE NEED TO INCLUDE FAMILY MEMBERS IN A VETERAN'S TREATMENT PLAN MUST BE ESTABLISHED BY THE CLIENT'S TREATING HEALTH PROFESSIONAL IN A TREATMENT PLAN, OR BE IDENTIFIED IN THE VAC REHABILITATION PLAN. - NOTE 4 û THESE SERVICES ARE INTENDED FOR THOSE SESSIONS WHERE THE FAMILY MEMBER(S) AND THE VETERAN ARE BOTH PARTICIPATING. - NOTE 5 û THESE SERVICES ARE INTENDED FOR THOSE SESSIONS WHERE THE FAMILY MEMBER(S) IS PARTICIPATING WITHOUT THE VETERAN. - NOTE 6- THESE SERVICES ARE INTENDED FOR THOSE SESSIONS WHERE THE VETERAN IS PARTICIPATING WITHOUT ANY FAMILY MEMBER(S). - NOTE 8 - QUALIFIED PROVIDERS INCLUDE: REGISTERED PSYCHOEDUCATORS WITH A BACHELOR'S DEGREE IF GRADUATED BEFORE 2002, OR A MASTERS DEGREE IF GRADUATED AFTER 2002.
VETERANS AFFAIRS CANADA PAGE 1 PRINT DATE: JUNE 08, 2018 BENEFIT GRID
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ROYAL CANADIAN MOUNTED POLICE PAGE 1 PRINT DATE: SEPTEMBER 12, 2018 BENEFIT GRID
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RECOMMENDER REQUIRED PRE-AUTH GROUP A PRE-AUTH GROUP B
COMPLETION OF MEDICAL CERTIFICATE 2135 - OHC 249105 01-Feb-15 N CORRECTIVE LASER EYE SURGERY BY AN OPHTHALMOLOGIST (OHC) 299999 01-Jun-11 MD, O YES Y EMPLOYER MAND ASSESSMENT - EMOTIONAL HEALTH PROVIDED
VETERANS AFFAIRS CANADA PAGE 1 PRINT DATE: JULY 24, 2018 BENEFIT GRID
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