Modernization and update of the fee schedule is currently managed by the SMA Tariff Committee. This includes the establishment of new fees, as well as changes in assessment rules, fee code descriptions, clarification of appropriate billing protocols, and any other facet of the fee schedule.
The Tariff Committee works closely with Ministry of Health representatives who also attend its meetings. Any fee schedule changes are subject to final approval by the conjoint SMA/Government Payment Schedule Review Committee.
To see the timeline from when a request is submitted to when it is implemented, see the timeline.
Physicians are encouraged (though not required) to first discuss their ideas with their specialty section representative, and to complete and submit a New Fee Item Request Form (doc, PDF) to the Tariff Committee. Those requesting technical fees should also complete a Technical Fee Worksheet to assist in the calculation of equipment, facility and staff costs for the procedure.
Several considerations guide the Committee's review:
Does the section support the proposal?
Is the procedure supported by medical evidence?
Does the new procedure substitute for existing fees (this can be especially relevant from a costing perspective)?
Has the fee been implemented in other jurisdictions (provinces), and if so, how does the recommended fee compare with what is paid elsewhere?
How does the fee compare with work of similar complexity, time and effort?
What is the estimated annual volume of services?
After considering these factors, the Tariff Committee will make a recommendation to either adopt the fee, adopt the fee with changes, or reject the proposal.
If accepted, the Committee will send the proposal forward to the Payment Schedule Review Committee (PSRC). The PSRC is the forum where the SMA and Government provide formal input and make a final decision on whether or not to implement. At this stage, the prioritization of items also becomes an issue, as there are often more items than the New Items budget can cover. Some items may be postponed for future budget years, or possibly be passed to sections for implementation with their next fee schedule allocations.