What health care professionals need to know

About the Special Diet Allowance

The Special Diet Allowance (SDA) helps eligible Ontario Works and Ontario Disability Support Program (ODSP) recipients with the extra costs of a special diet for an approved medical condition that:

  • is generally considered by the Ontario medical community to be an adjuvant to the treatment of the medical condition, and
  • results in additional costs above a normal, healthy diet.

How the Special Diet Allowance has changed

  • As of April 1, 2011, there is a new Special Diets Schedule of eligible medical conditions and a new SDA application form.
  • Here is the list of health care professionals who are authorized to complete the SDA application form:
    • a physician registered with the College of Physicians and Surgeons of Ontario
    • a Registered Nurse in the Extended Class registered with the College of Nurses of Ontario
    • a Registered Dietitian registered with the College of Dietitians of Ontario
    • a Registered Midwife* registered with the College of Midwives of Ontario, or
    • a Traditional Aboriginal Midwife* recognized and accredited by her or his Aboriginal community.

(*Note: Registered Midwives and Traditional Aboriginal Midwives are only approved to confirm the need for a special diet for the condition of insufficient lactation to sustain breast-feeding or breast-feeding is contraindicated.)

Key Changes to the Special Diets Schedule

  • The Special Diets Expert Review Committee found that certain medical conditions do not require a special diet. These medical conditions have been removed from the schedule. The conditions include:
    • egg allergy
    • soy allergy
    • chronic constipation
  • We have clarified the eligibility criteria for some conditions. For example:
    • recipients with dysphasia are eligible for an allowance only where they require thickened fluids
    • recipients with renal failure are eligible for an allowance only where they are pre-dialysis with a GFR <30
    • recipients with unintended weight loss are eligible for an allowance only where they have lost at least >5% of usual body weight.
    • an untreated person is defined as having hypertension if they have:
      • ≥160 systolic blood pressure or ≥100 diastolic blood pressure on three consecutive clinic visits or ≥140 systolic blood pressure; or
      • ≥90 diastolic blood pressure on four or more consecutive clinic visits.
    • a person is defined as having osteoporosis if they have:
      • A T score <-2.5 on bone density studies; and/or
      • Clinic evidence of a fragility fracture.
    • a person is define as having diabetes if they have:
      • A fasting blood glucose level of 6.1 mm to 6.9 mm and a two hour glucose tolerance test of 7.8 mm to 11.0 mm (with fasting blood glucose < 6.1 mm); or
      • A glycated haemoglobin (HbA1c) between 5.7% and 6.4%; or
      • Levels above these limits.
    • Note: many health care professionals interpret the first two diabetes criteria as pre-diabetes and levels above these limits as diabetes. A Special Diet Allowance applicant with any of these specific lab results should be captured within the diabetes category.
  • To qualify under the new schedule of conditions, all applicants must meet the eligibility criteria for a listed condition at the time of application.

  • Patients with documented unintended weight loss/body wasting due to an eligible medical condition and who have successfully regained weight at the time of application for the new Special Diets Schedule, will qualify for the new SDA so long as the health professional can attest to each of the following:

    1. the diagnosis of an eligible medical condition that is listed on the new Special Diets schedule for unintended weight loss/body wasting
    2. unintended weight loss/body wasting of at least >5%, past or present, is due to the eligible medical condition diagnosed in step (1), and
    3. a medical opinion that a special diet is necessary to maintain body weight.

Key Changes to the SDA Application Form

  • We have expanded the health care professional’s confirmation to include confirmation that the information provided on the form is true in his/her professional opinion.
  • Applicants must agree to sign a consent (which is included on the application form) for the release of relevant medical information as a requirement for eligibility for the SDA.
  • The consent will give us authorization to obtain copies of information in the health care professional’s records to confirm recipients’ eligibility for the SDA in certain cases.

Process for reviewing patient’s medical information

  • The ministry and/or Ontario Works Administrator will monitor the program to:
    • identify unexpected or highly improbable trends in SDA uptake, and
    • request and review medical records, in rare cases where an investigation is needed to verify the information stated on the application form.
  • The ministry and/or Ontario Works Administrator will engage medical expertise to help us identify unexpected or highly improbable trends and to review health care professionals’ records in cases where such records are requested.
  • Social assistance caseworkers will not be able to request or review a patient’s medical records. However, caseworkers can view the SDA application form.

Form Completion Fee

  • The form completion fee is $20.
  • Physicians completing the SDA application form can continue to use OHIP billing code K055.
  • Other approved health care professionals who complete the SDA application form can continue to submit an invoice in the amount of $20 to the appropriate local Ontario Works or ODSP office.
  • There is no fee paid by applicants.

Pregnancy And Breast- Feeding Nutritional Allowance (PBFNA)

  • Effective February 1, 2011, a stand alone PBFNA form (Form # 3109) came into effect.
  • The following health care professionals are approved to complete the PBFNA application form:
    • a physician registered with the College of Physicians and Surgeons of Ontario
    • a Registered Nurse in the Extended Class registered with the College of Nurses of Ontario
    • a Registered Dietitian registered with the College of Dietitians of Ontario
    • a Registered Midwife registered with the College of Midwives of Ontario; or a Traditional Aboriginal Midwife recognized and accredited by her or his Aboriginal community.
  • The form completion fee is $20.
  • Physicians completing the PBFNA application form can use OHIP billing code K056. Other approved health care professionals who complete the PBFNA application form can submit an invoice in the amount of $20 to the appropriate local Ontario Works or ODSP office.