Ontario Health Insurance Plan

INFOBulletin

Extension of Temporary COVID-19 Primary Care Physician Services

Temporary OHIP physician services funding is being extended until September 30, 2022


To: Primary Care Physicians
Category: Primary Health Care Services
Written by: Negotiations Branch, Ontario Health Insurance Plan Division
Date issued: July 30, 2021
Bulletin Number: 210703


Temporary Physician Funding Related to COVID-19

To support patients continued access to health care as the government gradually reopens the province and rolls out the COVID-19 vaccine, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) have reached an agreement to extend the existing temporary physician funding initiatives under the Ontario Health Insurance Plan (OHIP) to September 30, 2022, as outlined below.

This INFOBulletin is intended to advise of the changes to Primary Care.

Existing Initiatives Being Extended

The ministry is extending the following existing temporary physician funding initiatives:

Virtual Care (“K-codes”)

  • Continue the temporary OHIP virtual care fee codes (K080, K081, K082, and K083) for physician phone and video visits until September 30, 2022.
  • Refer to INFOBulletin 210403 and 11229 for details on this initiative.
  • NEW:  Effective October 1, 2021, K080, K081, and K082, services rendered on or after October 1, 2021 by a family physician outside of the patient’s enrolling group will be considered Outside Use.  The approved amount for these services will be deducted from the enrolling physician’s Access Bonus payment.
    • This change applies to all Patient Enrollment Models (PEMs) receiving Access Bonus Payments:
      • Blended Salary Model (BSM)
      • Family Health Organizations (FHOs)
      • Family Health Networks (FHNs)
      • Group Health Centre (GHC)
    • Additional information will be provided in a future INFOBulletin.
  • NEW:  Effective October 1, 2021, virtual care services billed from one of the pilot Virtual Urgent Care Centres (as defined by Ontario Health) for an enrolled patient will not contribute to the enrolling physician’s outside use and thus will not be deducted from their Access Bonus.
    • Additional information will be provided in a future INFOBulletin
    • Virtual care services billed by a registered GP Focus physician will continue to be excluded from outside use aggregation.

Existing Initiatives Being Modified

The ministry is modifying the following existing temporary physician funding initiatives:

Fee-For-Service Cap (Hard Cap)

  • Hard Cap threshold limits will be restored to their pre-pandemic amounts for the following PEMs:
    • Blended Salary Model (BSM)
    • Family Health Organizations (FHOs)
    • Family Health Networks (FHNs)
    • Group Health Centre (GHC)
  • For Fiscal Year 2021-2022 the hard cap thresholds will be pro-rated to restore the pre-pandemic amounts effective October 1, 2021.
    • Additional information on the new pro-rated thresholds will be provided in a future INFOBulletin.
  • For Fiscal Year 2022-2023 and beyond, the hard cap thresholds will be restored to the pre-pandemic amounts effective April 1, 2022:

Model

Pre-pandemic FFS Ceiling Limit (1.00 FTE)

Blended Salary Model (BSM)

$17,923.77

Family Health Network (FHN)

$55,950.00

Family Health Organization (FHO)

$55,950.00

Group Health Centre (GHC)

$55,183.49

    • Additional information will be provided in a future INFOBulletin.

Related INFOBulletin

A related INFOBulletin is available for all physicians. Read the "Extension of Temporary COVID-19 Physician Services".

Keywords/Tags

OHIP; Physicians; COVID-19; Access Bonus; Hard Cap

Contact Information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

Find INFOBulletins online on the Ministry of Health website.

For More Information

Call ServiceOntario, Infoline at:
1–866–532–3161 (Toll–free)
In Toronto, (416) 314–5518
TTY 1–800–387–5559.
In Toronto, TTY (416)327–4282
Hours of operation: Monday to Friday, 8:30am – 5:00pm

 
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