Ontario Health Insurance Plan

INFOBulletin

Virtual Care Services and Outside Use/Access Bonus

Virtual care services will now contribute to Outside Use effective October 1, 2021


To: Primary Care Patient Enrolment Model (PEM) Physicians
Blended Salary Model (BSM), Family Health Network (FHN), Family Health Organization (FHO), and Group Health Centre (GHC)
Category: Primary Health Care Services
Written by: Negotiations Branch, OHIP, Pharmaceuticals and Devices Division
Date Issued: October 5, 2021
Bulletin Number: 211002


Temporary Physician Funding Related to COVID-19

To ensure patients continue to access the heath care they need through the gradual reopening of the province and roll out of the COVID-19 vaccine, the Ministry of Health (ministry) and the Ontario Medical Association (OMA) have reached an agreement to extend existing temporary physician funding initiatives under the Ontario Health Insurance Plan (OHIP) to September 30, 2022, as outlined below.

Further to INFOBulletin #210704, this INFOBulletin is intended to advise of the changes to Outside Use and Access Bonus in Primary Care agreements for physicians in the Blended Salary Model (BSM), Family Health Network (FHN), Family Health Organization (FHO), and Group Health Centre (GHC) Primary Care Patient Enrolment Models (PEMs).

Outside Use and Access Bonus

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 PEMs receiving Access Bonus Payments:

  • Blended Salary Model (BSM)
  • Family Health Network (FHN)
  • Family Health Organization (FHO)
  • Group Health Centre (GHC)

GP Focused Practice Designation

Physicians with General Practitioner (GP) Focus Practice designations at the ministry each have a list of fees and/or diagnostic codes representative of the focused practice area. K080, K081, K082 services will not impact the Access Bonus when claimed using a designated diagnostic code.

New: GP Focus Psychotherapy designated physicians K082 services billed with a mental health disorder diagnostic code in the ranges from 290 to 319 and 897 to 909 will be exempted from Outside Use.

Keywords/Tags

OHIP; Primary Care Physicians; COVID-19; Outside Use; Access Bonus; Virtual Care Services

Contact Information

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

 

For More Information

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