Copyright and Disclaimer Print


AR 137/2006 PODIATRIC SURVERY BENEFITS REGULATION

(Consolidated up to 15/2016)

ALBERTA REGULATION 137/2006

Alberta Health Care Insurance Act

PODIATRIC SURGERY BENEFITS REGULATION

Table of Contents

                1      Definitions

                2      Eligibility

                3      Benefits payable


                4      Included in amount of benefits

                6      Coming into force

List of Podiatric Surgery Services

Definitions

1   In this Regulation,

                               (a)    “Act” means the Alberta Health Care Insurance Act;

                              (b)    “podiatric surgeon” means a podiatrist that

                                        (i)    possesses current certification granted by the American Board of Podiatric Surgery, and

                                      (ii)    has been granted surgical privileges by a regional health authority in a hospital or in an accredited surgical facility under contract to that regional health authority;

                               (c)    “podiatric surgery services” means the services in the List of Podiatric Surgery Services in this Regulation;

                              (d)    “podiatric wound care specialist” means a podiatrist that

                                        (i)    possesses current certification in Prevention and Treatment of Diabetic Foot Wounds and in Diabetic Foot Wear granted by the American Board of Multiple Specialties in Podiatry, and

                                      (ii)    has been granted surgical privileges by a regional health authority in a hospital or in an accredited surgical facility under contract to that regional health authority;

                               (e)    “Schedule of Podiatric Surgery Benefits ” means the Schedule of Podiatric Surgery Benefits prepared and published by the Department of Health and approved by the Minister.

AR 137/2006 s1;170/2012

Eligibility

2(1)  Benefits are payable in accordance with the regulations under the Act for podiatric surgery services provided in Alberta to a resident of Alberta by a podiatric surgeon or podiatric wound care specialist.

(2)  Notwithstanding subsection (1), benefits are not payable for podiatric surgery services if a declaration under section 25 of the Health Insurance Premiums Act is in effect in respect of the person who receives the services.

Benefits payable

3(1)  The benefits payable for podiatric surgery services and the descriptions of those services are set out in the Schedule of Podiatric Surgery Benefits.

(2)  Notwithstanding subsection (1), the benefits payable for podiatric surgery services provided in Alberta to a resident of Alberta by a podiatric surgeon or podiatric wound care specialist are limited to the lesser of

                               (a)    the amount claimed, and

                              (b)    the rates established in the Schedule of Podiatric Surgery Benefits.

Included in amount of benefits

4   The benefits payable for podiatric surgery services provided in Alberta to a resident of Alberta by a podiatric surgeon or podiatric wound care specialist include an amount for the following:

                               (a)    performing the podiatric surgery services;

                              (b)    administration;

                               (c)    recording of information regarding the services provided unless the recording of the information is for the purposes of a third party;

                              (d)    completing and submitting claims;

                               (e)    discussion or correspondence with a referring health care professional regarding treatment or a service to be provided to a patient directly related to managing the patient’s care, unless otherwise provided in this Regulation or the Alberta Health Care Insurance Regulation (AR 76/2006).

 

5   Repealed AR 15, 2016 s5.

Coming into force

6   This Regulation comes into force on June 1, 2006.


List of Podiatric Surgery Services   

                               (a)    suture of cranial and peripheral nerves;

                              (b)    freeing of adhesions and decompression of cranial and peripheral nerves;

                               (c)    cranial or peripheral nerve graft;

                              (d)    other cranial or peripheral neuroplasty;

                               (e)    invasive diagnostic procedures on peripheral nervous system;

                               (f)    sequestrectomy;

                               (g)    bone graft;

                              (h)    open reduction of fracture (without internal fixation);

                               (i)    closed reduction of dislocation of joint;

                               (j)    open reduction of dislocation of joint;

                              (k)    arthroscopy;

                               (l)    arthrodesis of foot and ankle;

                             (m)    arthroplasty of foot and toe;

                              (n)    other operations on joints;

                              (o)    arthroplasty of knee and ankle;

                              (p)    division of muscle, tendon and fascia;

                              (q)    excision of lesion of muscle, tendon, fascia and bursa;

                               (r)    suture of muscles, tendon and fascia;

                               (s)    reconstruction of muscle and tendon;

                               (t)    other plastic operations on muscles, tendon and fascia;

                              (u)    other operations on muscle, tendon, fascia and bursa;

                              (v)    amputation of lower limb;

                              (w)    free skin graft;

                              (x)    flap or pedicle graft;

                              (y)    other repair and reconstruction of skin and subcutaneous tissue.