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Out of Province/Out of Country (OOP/OOC) Funding

OOP/OOC Program Update: May 11, 2020 bulletin (PDF)

The Agency, under the delegated authority of the Laboratory Services Act, is responsible for reviewing and making funding decisions on medically appropriate laboratory and genetic tests that are not provided by BC laboratories. 
 
Inquiries regarding the OOP/OOC application process can be sent to ooc@phsa.ca or phone 604-714-2850.
 

How to apply?

Please send funding applications for OOP/OOC laboratory and genetic testing services to the Agency.
 
Print and complete the Agreement and Consent Form and the Funding Application Form.

(If the forms do not open, right-click each form link above, select ‘save link as’ or ‘save target as’ and save the file prior to editing.)

Referring practitioners submit the funding application and supporting documents on behalf of the patient by:
  • MAIL
    Out of Province/Out of Country Program
    BC’s Agency for Pathology and Laboratory Medicine
    Suite 300-1867 West Broadway
    Vancouver, BC V6J 4W1

    or

  • FAX  604-730-1928 / 1-877-806-8833
Please do not submit any patient information or personal identifiable information via email.
 
Note: The Agency does not accept funding applications for laboratory and genetic tests that have already been performed outside of BC without prior approval from the OOP/OOC Program.

The Application


The OOP/OOC Program reviews and makes decisions regarding the requested test and associated funding based on medical necessity. The decisions are made without precedent, and are specific to the patient and/or clinical indication.


The program does not fund tests performed in the province of BC. The Laboratory Services Outpatient Payment Schedule identifies outpatient tests funded by the Medical Services Plan (MSP).

The program also does not fund tests managed and funded by a specific provincial program, interprovincial reciprocal billings or for tests covered by Health Authority global funding (which includes lab tests associated with most acute care services).

All relevant in-province testing options must be completed prior to submitting a funding application.

The referring practitioner, on behalf of the patient, is required to submit the following by mail or FAX:


  1. OOP/OOC laboratory and genetic testing services funding application form.
  2. Copy of medical consult note. If this cannot be provided, please include justification in detail on the funding application form.
  3. Agreement and Consent for Out of Province Testing form.

‎Yes. A thoroughly completed application reduces the ambiguity of the supporting documents, (e.g., consult note). Your responses help identify alignment with funding guidelines and clearly demonstrates how the test result influences patient management. Incomplete applications may delay decision-making or, in some cases, be denied funding until information is clarified.

The Agency (now part of the Provincial Laboratory Medicine Services, PLMS) was established to provide oversight and service planning for diagnostic lab services within the province. Our goal is to ensure that clinical laboratory diagnostics are quality driven, achieve excellent clinical outcomes, and remain sustainable through effective and efficient provisioning.


PLMS has reviewers with technical expertise in laboratory medicine and genetics. This team will review and make decisions according to program guidelines on each application. An adjudication committee of additional experts may be engaged for appeals or complex cases.
Urgent processing and review of an application will be conducted when a significant reason is provided on the application form (e.g., expedited testing is required).

Additional funding to expedite genetic testing will be approved when rapid receipt of the results will affect patient management AND:
  • the patient is either pregnant or acutely ill (i.e., admitted to the hospital) AND
  • the test results are required for treatment decisions within 2-4 weeks of the application submission 
If there is an express test option, please provide these details in the “Test Requested” section of the application.

An expired approval letter is not cause for an urgent review and these letters will be reviewed in the order received.
Changes are difficult to incorporate once the application is received. You may request the program to cancel the application so that you may submit a new application. Otherwise, upon receipt of the decision letter, please contact program staff to cancel the funding and resubmit a new application, CLEARLY indicating 1) the application number you want cancelled and 2) that testing will not proceed on the previous decision. That letter must be destroyed to prevent inadvertent use of a now cancelled letter.

Submitting a new application to reflect changes to an application is different from an appeal, which requires additional information to support another review of a denied application.

The program requires a new application to be submitted. Please identify that the patient has had previously approved funding (reference the previous application number) and provide documentation that supports the need to fund additional tests (e.g., test results, new consult note, etc.).

Decision Letters

Once the program reviews the funding application and supporting documents, a decision letter will be sent* to the referring practitioner. The referring practitioner will contact patients regarding the funding decision.


The review process from some applications may take longer than 7 business days but the program attempts to process urgent applications within 24-48 hours. Applications that are complete and contain all the necessary information facilitate a quicker review. Please do not submit duplicate applications. You may contact the program for the status of your application if a decision was not received within the expected timeframe.

*Only urgent funding application decisions will be faxed. All other application decisions will be mailed to the referring practitioner.

‎The three-month timeframe allows the referring practitioner time to coordinate the patient’s specimen collection.


This window ensures funding is accessible and equitably allocated in a timely manner when medically necessary testing is required. It also keeps the program fiscally responsible to forecast program expenditures every month.

Specimens for approved testing associated with an expedited turnaround time for test results should be sent to the testing laboratory as soon as the approval letter is received.


‎If a sample cannot be collected within 3 months of the approval letter’s expiry, a new application must be submitted, which will be subject to the program’s current guidelines at that time. New information may be requested upon re-application, based on the time passed since the last approval or evolving approval guidelines.


Only resubmit an application after the approval letter has expired.  Provide the original application number, and indicate 1) that it is a resubmission, and 2) testing has not proceeded under the previous approval. Duplicate testing for the same patient will not be funded by the program and may result in patient pay. 

The program does not allow for extensions.


‎An application will be cancelled if:

  • the patient’s Personal Health Number is invalid
  • the consent form was not submitted or signed
  • other required documentation is not submitted (e.g., consult note, previous test result, etc.)
  • the application is illegible or incomplete

The decision letter will identify the reasons for denying funding. Please read the decision letter in its entirety.


Incomplete or unclear applications may lead to a denial.


Examples:
  • the requested test was not clearly identified (Question #5)
  • the impact on patient management is unclear or marked as having no impact without a sufficient explanation provided to justify funding the test  (Question #11)
  • the implications for the patient if funding is not approved was not provided (Question #13)
If the application does not meet the funding guidelines or has not demonstrated how it meets the guidelines, funding may be denied. Refer to the Guidelines for further details. 

‎If the denial letter indicates that additional evidence is required for a review, you may submit a letter of appeal to the program via fax along with supporting evidence.  To avoid delays, CLEARLY provide the application number for the case you wish to appeal. Appeal reviews require additional time to adjudicate and the program does not process appeals in the same timeframe as new applications. 


If an application is denied because it was determined not to meet program criteria, the appeal must include new information that was not presented in, or available, at the time of the initial application.

The program may place restrictions on the number of times an application can be appealed if the new information received still does not meet funding criteria and/or sufficient time has not passed to evolve the guidelines further to reflect new evidence. This will be indicated on the decision letter. Guideline development is a dynamic process and the program will update the published guidelines as they evolve.
 

Get Tested

‎Patients will need to visit one of BC’s public laboratories to arrange a time for specimen collection. On the day of specimen collection, patients may be required to bring:


  1. Approval letter from the OOP/OOC laboratory and genetic program
  2. BC Laboratory requisition (for specimen collection)
  3. Laboratory requisition and consent form specific to the testing laboratory, if appropriate
The hospital laboratory will collect the specimen(s) and send it to the approved laboratory identified in the approval letter. Please note that some personal information, along with the specimen, will be sent to the laboratory performing the test.

‎The laboratory identified in the approval letter will perform the approved laboratory or genetic test(s). The laboratory will send the test result to the referring practitioner who requested the test. Referring practitioners should contact patients to discuss the test result and care  management. 

Invoices

Bills for approved OOP/OOC laboratory and genetic tests should not be sent to the patients, referring practitioners, or hospital laboratories responsible for specimen collection and shipment. For all tests that receive a funding letter of approval, the program is responsible for making payments to the laboratories performing testing.

Instructions for billing are detailed in the patient’s approval letter. 

Invoices should be submitted by mail to:
Out of Province/Out of Country Program
BC’s Agency for Pathology and Laboratory Medicine
Suite 300-1867 West Broadway
Vancouver, BC V6J 4W1

Related resources

SOURCE: Out of Province/Out of Country (OOP/OOC) Funding ( )
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