Ontario Health Insurance Plan

INFOBulletin

Temporary increases for primary health care services

The ministry will temporarily increase physician payments by 2.01% for the period April 1, 2022 to March 31, 2023.


To: Primary Care Physicians
Category: Physician Services; Primary Health Care Services
Written by: Claims Services Branch; OHIP, Pharmaceuticals and Devices Division
Date issued: April 1, 2022
Bulletin Number: 220403


Physician Services Agreement Initiatives Effective April 1, 2022

The Ministry of Health and the Ontario Medical Association have been working together to implement physician compensation increases in accordance with the 2021 Physician Services Agreement.

Year 2 (2022-2023) of the Agreement provides for a lump sum payment that will be applied as a temporary 2.01% global increase to the value of Fee Schedule Codes (FSCs) for physician services rendered between April 1, 2022 and March 31, 2023. This will be achieved through an update to the Fee Schedule Master (FSM).

Temporary compensation increase effective April 1

Effective April 1, 2022, the payment elements under your funding agreement identified in the table “Payment Increase Application by Contract Type” will be increased by 2.01% and will be reflected on your Remittance Advice (RA) beginning in May 2022.

Also effective April 1, 2022, the Fee Schedule Master (FSM) will be updated to reflect the 2.01% increases to FFS and Primary Care Q-codes. Claims processed through the Medical Claims Payment System (MCPS) with a service date between April 1, 2022 and March 31, 2023 will reflect these increases and will be reported on your RA.

The ministry is working with the OMA to flow lump sum payments to any group payments that are not included in the table below and will provide an update on timing of payments by the end of April 2022.

Payment Increase Application by Contract Type

Contract Type

One-Time Lump Sum (2.01%) Application

Aboriginal Family Health Team (AFHT)

  • Base Payment

Blended Salary Model (BSM)

  • Base, Benefits and Locum Remuneration
  • Comprehensive Care Capitation Daily Rate
  • Base Payment for Income Stabilization
  • Fee-for-Service (FFS) Ceiling Cap (Hard Cap)

Comprehensive Care Model (CCM)

  • Comprehensive Care Capitation Daily Rate

Family Health Group (FHG)

  • Comprehensive Care Capitation Daily Rate

Family Health Network (FHN)

  • Base Rate Capitation Regular Daily Rate
  • Base Rate Capitation Long-Term Care Daily Rate
  • Comprehensive Care Capitation Daily Rate
  • Base Payment for Income Stabilization
  • Base Payment for New Graduate Entry Program (NGEP)
  • Fee-for-Service (FFS) Ceiling Cap (Hard Cap)

Family Health Organization (FHO)

  • Base Rate Capitation Regular Daily Rate
  • Base Rate Capitation Long-Term Care Daily Rate
  • Comprehensive Care Capitation Daily Rate
  • Base Payment for Income Stabilization
  • Base Payment for New Graduate Entry Program (NGEP)
  • Fee-for-Service (FFS) Ceiling Cap (Hard Cap)

GP Focus Practice (GPFP) Care of the Elderly (COE)

  • Base Payment
  • Administration Payments

GP Focus Practice (GPFP) HIV

  • Comprehensive Care Capitation Daily Rate
  • Base Payment
  • Administration Payments
  • HIV Compensation Payments

GP Focus Practice (GPFP) Palliative Care (PC)

  • Base Payment
  • Administration Payments

Group Health Centre (GHC)

  • Base Rate Capitation Regular Daily Rate
  • Base Rate Capitation Long-Term Care Daily Rate
  • Comprehensive Care Capitation Daily Rate
  • Fee-for-Service (FFS) Ceiling Cap (Hard Cap)

Inner City Health Associates (ICHA)

  • Administration Payments

Rural and Northern Physician Group Agreement (RNPGA)

  • Comprehensive Care Capitation Daily Rate

Shelter Health Network (SHN)

  • Administration Payments

St. Joseph’s Health Centre (SJHC)

  • Base Payment
  • Comprehensive Care Capitation Daily Rate

Toronto Palliative Care Associates (TPCA)

  • Base Payment
  • Administration Payments
  • TPCA After-Hours On-Call Payments

Update your billing software

Please ensure that your billing software is updated to reflect the new FSC values for any services rendered on or after April 1, 2022. This file will be available for download by April 7, 2022.See “Updates to the Vendor Fee Schedule Master” for more details.

Keywords/Tags

PSA; payments; physicians; Physicians Services Agreement; Primary Care

Contact Information

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

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