On the advice of our clients, advocates, and stakeholder partners, the Ministry of Community and Social Services is improving the medical review process for people with disabilities who are receiving ODSP. These changes will reduce the burden on clients, health care professionals, stakeholders and staff.

The new medical review initiatives are consistent with a renewed approach to disability adjudication more generally. The ministry is dedicated to a more client-friendly and efficient adjudication process that is both fair and accountable in directing assistance to the people ODSP is intended to help, while reducing the need for appeals.

Medical review dates are currently assigned in about 36 per cent of cases. As ODSP provides income support to people with whose medical conditions may improve, a fair, accountable and responsible way to review eligibility at medically relevant points is required.

Introducing a new, simpler form that eliminates the requirement to duplicate information from the original adjudication

By March 2016, the ministry will begin working with stakeholders and advocates to design a new, simpler medical review process and form.

In the first part of the form, if the client's health care professional can indicate that the client's medical condition, impairments and restrictions have not improved, the second part of the form, which requires additional medical information to be provided, would not need to be completed. There will also be an opportunity for the health care professional to advise of relevant new conditions.

To assist the health care practitioner to complete the new form, clients will be provided with the reasons they were originally found to be eligible for support.

The new process will also provide reassurance to the client and their health care professional that a medical review is not a re-adjudication of the original eligibility finding.

Improving quality assurance and communication

The ministry has implemented new quality assurance mechanisms to ensure the process is more fair, responsible and efficient:

  • Identifying unnecessary medical reviews: A new step in the process ensures that there is a clear need for each medical review to take place. Before a notification letter is sent to the client, all medical review files are now re-examined based on what the ministry has learned so far from conducting these reviews. The additional step has resulted in the early closure of approximately 30 per cent of backlogged medical reviews examined so far.
  • Outreach to vulnerable clients: If a client has not responded to three separate letters regarding their medical review, two attempts are made to reach them by phone. As a result, the ministry is unable to contact the client in about three per cent of cases. As a further step, caseworkers will make one more attempt to contact the client.
  • Improving training and education of adjudicators: The ministry continues to place considerable focus on the education and training of staff. Improved medical education and training regarding the assignment of medical review dates has resulted in a decrease in the number of new medical review dates assigned, from 50 per cent in 2014-15 to 36 per cent so far in 2015-16.
  • Improving communication with clients: The ministry is revising all communications materials regarding medical reviews to make them simpler and easier for clients to understand.

Improving the medical review process is part of a wider effort to improve ODSP disability adjudication and ensure that ODSP will be available for all those who are eligible. Over time, improved information analysis, enhanced training and new processes will support more effective and efficient decision making, so that fewer cases proceed to appeal. The ministry will continue to engage clients, advocates, and stakeholder partners as reform progresses.

This work aligns with the government’s efforts to continue to reform social assistance guided by the principles of fairness and simplicity.

Postponing the increase of medical reviews until new processes in place

The improvements outlined above are important prerequisites to the planned increase in the rate of medical reviews to 1,900 per month. This increase is important to address an unsustainable backlog in medical reviews – but must be accomplished in a manner that is both fair and accountable. The ministry anticipates these improvements will be in place by the fall of 2016. The increase in reviews will not proceed until the improvements are implemented.