New ODSP Medical Reviews Start This Month

The Ministry of Community and Social Services is putting in place a new medical review process that will be a big improvement for people on ODSP. Starting this month, all medical reviews will be done using the new process, which includes new forms and better decision-making.

These changes are the result of many years of advocacy by ISAC, the community legal clinic system, and partners in the health care and disability sectors.

Medical reviews are an important part of the ODSP system that allows people with short-term disabilities to access critically important financial supports. You don’t have to be permanently disabled to get ODSP benefits, so a review is required for people with disabilities or medical conditions that could improve over time.

New forms will be used that are much more understandable and get at the real issue, which is whether or not the impairments that a person experiences due to their medical condition have improved since they were first approved for ODSP.

Until now, reviews were done using the same forms that were used for initial applications. This meant people effectively had to reapply for ODSP. The forms were also very confusing for health care providers to complete.

The new forms will let health care providers simply indicate whether or not “clinically significant” improvement has been made to a person’s impairments.

If there’s been no improvement, or none is expected, the health care provider’s professional opinion will be enough and the medical review will be complete. This will reduce health care costs by eliminating the need for medically unnecessary tests and specialist referrals that were often required under the old system.

More information will only be required if there has been improvement, or if the prognosis for improvement is unknown.

The forms also include a section for new medical conditions, as well as information that health care providers need about the disability-related reasons that the person was initially approved for ODSP.

The Ministry is also reviewing the files of everyone scheduled for a medical review to determine whether any new health-related information is required. In many cases, no new information is needed so no forms are sent out. This means the person on ODSP doesn’t have to get their health care provider to fill out any forms. It saves a lot of stress for the person on ODSP, and a lot of work for the health care provider and costs to the medical system.

Ministry decision-makers are learning from the file review process about how to be more selective when assigning medical reviews in the first place. This is reducing the number of people who will have to have a medical review in the future.

Other improvements in decision-making are also being made that are increasing the number of people who will continue to get ODSP benefits without having to appeal.

All of these changes will mean fewer people will have to get legal help to navigate the medical review process and appeal negative decisions. This will give legal clinic caseworkers more time to help people with other legal needs and save on costs in the legal clinic and appeal tribunal systems.

The Ministry will use the new process to increase the number of medical reviews being done each month, in order to reduce a significant backlog that built up over many years. Had the backlog been addressed using the old process, people going through medical reviews and their health care providers would have been subject to an unmanageable burden that would have also impacted the legal clinic system.

After many years of advocacy, we’re pleased that Minister Jaczek listened to community concerns and has worked to ensure this important change has happened.

Thanks to our partners: the legal clinic system’s Steering Committee on Social Assistance, the ODSP Action Coalition, the Ontario College of Family Physicians’ Committee on Poverty and Health, the Canadian Mental Health Association – Ontario, the Association of Community Health Centres and Regent Park Community Health Centre, and support from the Registered Nurses Association of Ontario.

 

Information about our advocacy on medical reviews is here: http://incomesecurity.org/our-work/policy-development-and-advocacy/odsp-medical-reviews/.

The Ministry’s announcement about the new medical review system is here: http://mcss.gov.on.ca/en/mcss/programs/social/odsp/income_support/odsp_medical.aspx.

A story in the Toronto Star about the new process is here: https://www.thestar.com/news/gta/2017/04/05/ontario-ends-onerous-reviews-for-disabled-people-on-welfare.html.

Posted April 12th, 2017

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