PRESCRIBED POLICY STATEMENTS

Medical conditions re: special diets 1. (1) For the purposes of paragraph 4 of subsection 41 (1), paragraph 3 of subsection 44 (1), paragraph 5 of subsection 44 (2), paragraph 3 of subsection 44 (3) and clause 57 (5) (c) of Ontario Regulation 134/98 (General) made under the Act, the following is the policy for interpreting and applying those provisions: 1. The only medical conditions requiring special diets are those set out in Column A of Schedule 1, subject to subsections (2) and (3). 2. The amount to be included in a recipient’s budgetary requirements if a member of the recipient’s benefit unit has a medical condition requiring a special diet shall be determined in accordance with section 2. O. Reg. 472/06, s. 1; O. Reg. 352/11, s. 1. (2) If a member of a recipient’s benefit unit has gestational diabetes, the administrator shall include in the recipient’s budgetary requirements the amount for that condition determined in accordance with section 2 for the remainder of the member’s pregnancy and for a period of up to three months after the end of the pregnancy. O. Reg. 14/11, s. 1 (1). (3) If a member of a recipient’s benefit unit has a medical condition referred to in item 30 or 31 of Schedule 1 relating to breastfeeding infants, the administrator shall not include the special diet allowance for that condition in the recipient’s budgetary requirements after the first birthday of the infant in question. O. Reg. 14/11, s. 1 (2); O. Reg. 352/11, s. 1; O. Reg. 277/18, s. 1 (2). Budgetary requirements re: special diets 2. (1) For the purposes of subparagraph 4 i of subsection 41 (1), subparagraph 3 i of subsection 44 (1), subparagraph 5 i of subsection 44 (2), subparagraph 3 i of subsection 44 (3) and subclause 57 (5) (c) (i) of Ontario Regulation 134/98 (General) made under the Act, the amount determined in accordance with Schedule 1 that the administrator shall include in the recipient’s budgetary requirements shall be, for each medical condition requiring a special diet that a member of the recipient’s benefit unit has, (a) the amount set out in Column C of Schedule 1, subject to subsections (4) to (9); or (b) if Column B of Schedule 1 indicates that the medical condition is a condition that may cause weight loss, the amount determined in accordance with subsections (2) and (3). O. Reg. 14/11, s. 2; O. Reg. 352/11, s. 1; O. Reg. 24/13, s. 1 (1); O. Reg. 224/14, s. 1 (1). (2) If a member of a recipient’s benefit unit has a medical condition that may cause weight loss, as indicated in Column B of Schedule 1, the amount that shall be included in the recipient’s budgetary requirements shall be, subject to subsection (3), (a) if the member has lost more than 5 per cent but no more than 10 per cent of his or her usual body weight, the amount set out in Column C of Schedule 1; or (b) if the member has lost more than 10 per cent of his or her usual body weight, $242. O. Reg. 14/11, s. 2. (3) If a member of a recipient’s benefit unit has more than one medical condition that may cause weight loss, as indicated in Column B of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had one such condition. O. Reg. 14/11, s. 2. (4) If a member of the recipient’s benefit unit has more than one of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1: 1. Diabetes. 2. Gestational Diabetes. 3. Hypercholesterolemia or Hyperlipidemia. 4. Hypertension. 5. Extreme Obesity. 6. Prader-Willi Syndrome. 7. Congenital heart defect — Have had Ross procedure or arterial switch procedure or have coexisting coarctation of aorta. O. Reg. 14/11, s. 2; O. Reg. 424/12, s. 1 (1); O. Reg. 224/14, s. 1 (2). (4.1) If a member of the recipient’s benefit unit has the medical condition referred to in item 5 (Chronic Hepatitis C (BMI < 25)) of Schedule 1 and one or more of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1: 1. Chronic wounds or burns requiring protein. 2. Renal Failure — Pre-Dialysis (GFR < 30). 3. Renal Failure — Peritoneal/Hemodialysis. 4. Any medical condition listed in Schedule 1 that is identified in Column B of the Schedule as a medical condition that may cause weight loss. O. Reg. 24/13, s. 1 (2); O. Reg. 277/18, s. 2 (2). (4.2) If a member of the recipient’s benefit unit has the medical condition referred to in item 6 (Chronic Hepatitis C (BMI < 25) with interferon treatment) of Schedule 1 and one or more of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1: 1. Chronic Hepatitis C (BMI < 25). 2. Chronic wounds or burns requiring protein. 3. Renal Failure — Pre-Dialysis (GFR < 30). 4. Renal Failure — Peritoneal/Hemodialysis. O. Reg. 224/14, s. 1 (3); O. Reg. 277/18, s. 2 (3). (5) If a member of the recipient’s benefit unit has both Stages 1 and 2 and Stages 3 and 4 chronic wounds referred to in items 7 and 8 (Chronic wounds or burns requiring protein) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be $191. O. Reg. 10/12, s. 1; O. Reg. 277/18, s. 2 (4). (6) If a member of the recipient’s benefit unit has a medical condition referred to in item 16, 17, 18 or 19 (Food Allergy — Milk/Dairy) of Schedule 1 and a medical condition referred to in item 20, 21, 22 or 23 (Food Allergy — Lactose Intolerance) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be the amount the member is entitled to receive for item 16, 17, 18 or 19 (Food Allergy — Milk/Dairy). O. Reg. 277/18, s. 2 (5). (7) If a member of the recipient’s benefit unit has the medical conditions referred to in item 24 (Food Allergy — Wheat) and item 4 (Celiac Disease) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be $97. O. Reg. 14/11, s. 2; O. Reg. 277/18, s. 2 (6). (8) If a member of the recipient’s benefit unit has the medical conditions in item 41 (Renal Failure (GFR < 30)), causing weight loss, and item 42 (Renal Failure — Pre-Dialysis (GFR < 30)) or 43 (Renal Failure — Peritoneal/Hemodialysis) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be the amount the member is entitled to receive for item 41 (Renal Failure (GFR < 30)). O. Reg. 277/18, s. 2 (7). (9) If a member of the recipient’s benefit unit has the medical condition referred to in item 44 (Rett Syndrome (BMI < 18.5)) of Schedule 1 and one or more of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1: 1. Chronic Hepatitis C (BMI < 25). 2. Chronic wounds or burns requiring protein. 3. Renal Failure — Pre-Dialysis (GFR < 30). 4. Renal Failure — Peritoneal/Hemodialysis. 5. Any medical condition listed in Schedule 1 that is identified in Column B of the Schedule as a medical condition that may cause weight loss. O. Reg. 224/14, s. 1 (3); O. Reg. 277/18, s. 2 (8). More than one medical condition 3. Despite section 2, if a member of a recipient’s benefit unit has more than one medical condition that requires a special diet, the maximum amount that may be included in the recipient’s budgetary requirements with respect to all the medical conditions that the member has is $250. O. Reg. 14/11, s. 3; O. Reg. 352/11, s. 1. 4. Revoked: O. Reg. 14/11, s. 4. 5. Revoked: O. Reg. 14/11, s. 5. SCHEDULE 1 SPECIAL DIETS Item Column A Medical Conditions that Require a Special Diet Column B Whether Medical Condition may Cause Weight Loss Column C Monthly Amount for Special Diet Unless Otherwise Specified 1. Amyotrophic Lateral Sclerosis Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 2. Anorexia Nervosa Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 3. Congenital heart defect — Have had Ross procedure or arterial switch procedure or have coexisting coarctation of aorta No $86, subject to subsection 2 (4) 4. Celiac Disease No $97, subject to subsection 2 (7) 5. Chronic Hepatitis C (BMI < 25) No $88, subject to subsection 2 (4.1) 6. Chronic Hepatitis C (BMI < 25) with interferon treatment Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) and subject to subsection 2 (4.2) 7. Chronic wounds or burns requiring protein — Stages 1 and 2 chronic wounds Burns 1 - 10% body surface area No $88, subject to subsection 2 (5) 8. Chronic wounds or burns requiring protein — Stages 3 and 4 chronic wounds Burns > 10% body surface area No $191, subject to subsection 2 (5) 9. Cirrhosis Stages 3 and 4 Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 10. Congestive Heart Failure Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 11. Crohn’s Disease Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 12. Cystic Fibrosis Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 13. Diabetes No $81, subject to subsection 2 (4) 14. Dysphagia, requiring thickened fluids No $125 15. Extreme Obesity: Class III BMI > 40 No $51, subject to subsection 2 (4) 16. Food Allergy — Milk/Dairy — 1 to 8 years of age No $32 17. Food Allergy — Milk/Dairy — 9 to 18 years of age No $63 18. Food Allergy — Milk/Dairy — 19 to 50 years of age No $32 19. Food Allergy — Milk/Dairy — 51 years of age or older No $47 20. Food Allergy — Lactose Intolerance — 1 to 8 years of age No $30, subject to subsection 2 (6) 21. Food Allergy — Lactose Intolerance — 9 to 18 years of age No $59, subject to subsection 2 (6) 22. Food Allergy — Lactose Intolerance — 19 to 50 years of age No $30, subject to subsection 2 (6) 23. Food Allergy — Lactose Intolerance — 51 years of age or older No $45, subject to subsection 2 (6) 24. Food Allergy — Wheat No $97, subject to subsection 2 (7) 25. Gestational Diabetes No $102, subject to subsection 2 (4) 26. HIV/AIDS Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 27. Huntington Disease Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 28. Hyperlipidemia or Hypercholesterolemia No $51, subject to subsection 2 (4) 29. Hypertension No $86, subject to subsection 2 (4) 30. Inadequate lactation to sustain breast-feeding or breast-feeding is contraindicated — Where infant is lactose tolerant No $145 31. Inadequate lactation to sustain breast-feeding or breast-feeding is contraindicated — Where infant is lactose intolerant No $162 32. Lupus Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 33. Malignancy Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 34. Multiple Sclerosis Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 35. Muscular Dystrophy Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 36. Osteoporosis No $38 37. Ostomies [e.g., jejunostomy, ileostomy] Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 38. Pancreatic Insufficiency Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 39. Parkinson Disease Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 40. Prader-Willi Syndrome No $200, subject to subsection 2 (4) 41. Renal Failure (GFR < 30) Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 42. Renal Failure — Pre-Dialysis (GFR <30) No $52, subject to subsection 2 (8) 43. Renal Failure — Peritoneal/Hemodialysis No $88, subject to subsection 2 (8) 44. Rett Syndrome (BMI < 18.5) No $88, subject to subsection 2 (9) 45. Short Bowel Syndrome Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) 46. Ulcerative Colitis Yes $191 or such higher amount as may be permitted in accordance with subsection 2 (2) O. Reg. 277/18, s. 3.