The Financial Services Commission of Ontario (FSCO) has released the revised Attendant Care Hourly Rate Guideline, which took into effect April 14, 2018. The revised Attendant Care Hourly Rate Guideline has been approved by the Superintendent for use in connection with the Statutory Accident Benefits Schedule – Effective September 1, 2010 (SABS). This revised guideline replaces the previously issued guideline.
Attendant Care Hourly Rate Guideline
Calculation of Monthly Benefit
The Attendant Care Hourly Rate Guideline has been revised to require that the maximum hourly rates set out in the guideline be used with the Assessment of Attendant Care Needs (Form 1) to calculate the monthly attendant care benefit in accordance with section 19 (2) of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (SABS).
The maximum hourly rates applicable to accidents occurring before April 14, 2018 continue unchanged. For example, the rates applicable to accidents occurring on or after January 1, 2018 and before April 14, 2018 are governed by Superintendent’s Guideline No. 03/17. See the Financial Services Commission of Ontario website for previous Superintendent’s Guidelines.
Insurers are not prohibited from paying above the maximum hourly rates established in this Guideline.
The maximum hourly rates to be used with the Assessment of Attendant Care Needs (Form 1) to calculate the monthly attendant care benefit payable are set out below. Once a notice to the insured person has been issued pursuant to s. 42(3) or s. 42(13) of the SABS, insurers shall use the resulting monthly attendant care benefit amount to pay the benefit.
Previous guidelines could be interpreted to strictly apply the maximum hourly rates as the maximum payable for attendant care services, rather than using the hourly rates to calculate a monthly benefit as was originally intended.
|Attendant Care Costs||Maximum Hourly Rate|
|Part 1: Hourly Rate A|
Level 1 Attendant Care is for routine personal care.
|Part 2: Hourly Rate B|
Level 2 Attendant Care is for basic supervisory functions.
|Part 3: Hourly Rate C|
Level 3 Attendant Care is for complex health/care and hygiene functions.
In respect of any expense referenced in this Guideline, the amount which an insurer would otherwise be liable to pay is subject to reduction by that portion of the expense for which payment is reasonably available under any insurance plan or law or under any other plan or law.
The hourly rates referred to in s. 19 (2) (a) of the SABS and this Guideline include all administration costs, overhead, and related costs, fees, expenses, charges and surcharges that have the result of increasing the maximum hourly rates. Insurers are not liable for any administration or any other charges or surcharges that have the result of increasing the effective hourly rate beyond what is payable under this Guideline.
Professional Services Guideline
FSCO has received a number of inquiries regarding how regulated and unregulated health care providers are paid for their services under the Professional Services Guideline (PSG) .
As specified in the PSG and in Bulletin A-02/04, unregulated providers and other regulated providers not listed in the PSG (e.g., social workers and physicians) are not covered by the PSG. The amount payable to service providers not covered by the PSG is to be determined by the parties involved.
Expenses for regulated and unregulated providers identified in the PSG are payable according to their professional designation and not by the services they provide. For example, case management services provided by an occupational therapist are payable at the occupational therapist rate and not at the case manager rate.