Helping Ontario's Seniors Stay Healthy and Active

Funding for clinic-based physiotherapy in Ontario is based on an Episode of Care model. This means funding is provided to cover an entire course of treatment instead of individual visits.

An Episode of Care refers to all clinically-related health services used to treat one patient who has been diagnosed with distinct conditions arising from injury or health-related issues. An Episode of Care lasts from the physiotherapist’s assessment and diagnosis of the symptoms, and the delivery of treatment until the patient has reached their goals as indicated by the treatment plan and is discharged.

Patients are not limited to a specific number of visits per Episode of Care under publicly-funded clinic-based physiotherapy. The number and frequency of visits provided will be determined by the treating physiotherapist in consultation with the patient. It will be based on the physiotherapist’s professional skill and clinical judgment, and the patient’s individual needs.

Yes. A patient can receive more than one episode of care in a year provided that all eligibility criteria, including a separate referral, are met for each individual episode of care.

Patients can also be referred for physiotherapy to treat more than one condition at the same time. Both conditions would be treated under one Episode of Care.

To be eligible for publicly-funded physiotherapy services, a person must, for each Episode of Care:

• be referred by a physician or nurse practitioner based on the findings of an assessment that the person requires physiotherapy services, be an OHIP insured person under the Health Insurance Act and be within one of the following categories:
  • aged 65 years and older;
  • aged 19 years and younger; or
  • recently discharged as an inpatient of a hospital and in need of physiotherapy clinic services that are directly connected to the condition, illness or injury for which the person was admitted to the hospital.

OR

• be referred by a physician or nurse practitioner based on the findings of an assessment that the person requires physiotherapy services and be eligible for funding of services under the Ontario Disability Support or Ontario Works programs.

Patients with chronic diseases such as arthritis or multiple sclerosis can receive publicly-funded physiotherapy if all the eligibility criteria are met.

The clinic physiotherapy services funded under this program are aimed at addressing acute episodes or worsening of symptoms that lead to decreased function or mobility (e.g. debilitating event or disease (including chronic disease), pain, injury or surgical procedure).

No. There are no fees payable by the patient for services covered under the Episode of Care. The funding provided for an Episode of Care covers the assessment, diagnosis, physiotherapy treatment (including on-site clinic use of equipment or supplies) and discharge report. Clinics may offer other services not covered under EOC funding for which patients may be charged. The Ministry of Health and Long-Term Care does not set or regulate such services or fees.

If a patient requires physiotherapy in their home because they are unable to attend a clinic due to their condition, they can contact their local Home and Community Care Support Services organization by calling 310-2222.

Long-term care home residents who are assessed with a need for physiotherapy will be provided with these services in their homes at no cost to them. The frequency and duration of that physiotherapy will be determined by the registered physiotherapist, who will conduct the assessment and determine a treatment plan. Residents can access this service by speaking with the regulated health professional (physician, nurse practitioner or physiotherapy provider) in their home to organize an assessment.

Patients are discharged from care when:

• they have achieved their goals, as set during the assessment with their physiotherapist;
• they can achieve the set goals on their own;
• they can achieve the set goals in an exercise or falls prevention class;
• they are unlikely to improve from any further physiotherapy; or
• they determine independently that no further treatment is required.

The clinic can provide patients with information about how to manage their condition and any programs nearby that could help, including exercise and falls prevention classes.

A list of publicly-funded physiotherapy locations can be found at Ontario.ca/physiotherapy. Alternatively, patients can contact their local Home and Community Care Support Services at 310-2222.

If you have further questions about publicly-funded physiotherapy in Ontario, please call the Senior’s INFOline at 1-888-910-1999; TTY 1-800-387-5559.

To be eligible for publicly-funded physiotherapy services, a person must:

• be referred by a physician or nurse practitioner based on the findings of an assessment that the person requires physiotherapy services, be an OHIP insured person under the Health Insurance Act  and be within one of the following categories:
  • aged 65 years and older;
  • aged 19 years and younger; or
  • recently discharged as an inpatient of a hospital and in need of physiotherapy clinic services that are directly connected to the condition, illness or injury for which the person was admitted to the hospital.

OR

• be referred by a physician or nurse practitioner based on the findings of an assessment that the person requires physiotherapy services and be eligible for funding of services under the Ontario Disability Support or Ontario Works programs.

Patients with chronic diseases such as arthritis or multiple sclerosis can receive publicly-funded physiotherapy if all the eligibility criteria are met.

The clinic physiotherapy services funded under this program are aimed at addressing acute episodes or worsening of symptoms that lead to decreased function or mobility (e.g. debilitating event or disease including chronic disease, pain, injury or surgical procedure).

An Episode of Care refers to all clinically-related health services used to treat one patient who has been diagnosed with distinct conditions arising from injury or health-related issues. The care delivered under an Episode of Care lasts from the onset of symptoms until treatment is complete as determined once a patient is considered to have met their therapeutic recovery goals.

An Episode of Care can consist of multiple visits and is not limited to a maximum number.

Registered physiotherapists will be required to use their clinical judgment when assessing patients and determining the care plan for eligible patients. Should the physiotherapist feel that a patient does not meet the eligibility criteria for the program, they should inform the referring physician or nurse practitioner and recommend alternate treatment for the patient. This may include exercise or falls prevention classes, or other community resources programs that are better suited for the care needs of the patient. 

Should a patient not meet the eligibility criteria or no longer need physiotherapy services under their Episode of Care, they may purchase services privately. Clinics are allowed to offer privately-funded services in addition to publicly-funded services.

Only OHIP-insured persons under the Health Insurance Act who meet the eligibility criteria can receive publicly-funded physiotherapy.

Maintenance of good health and function is important and this can be supported through access to resources such as exercise and falls prevention classes. 

Should a patient’s condition change or deteriorate, their function decrease or their mobility worsen (i.e. as a result of a debilitating event or disease, pain, injury or surgical procedure), they may become eligible for funding for an Episode of Care in a clinic setting provided that all eligibility criteria - including a separate referral - are met.  

Clinics are required, as part of the discharge process, to provide patients with post discharge treatment plans that should include information about self-management and information about local programs including exercise, falls prevention, activation, or similar programs, as appropriate and available.

For more information on exercise and falls prevention classes offered in your community, access your Home and Community Care Support Services website or contact the Senior’s INFOline at 1-888-910-1999; TTY: 1-800-387-5559.

Requirements for the record keeping of treatment plans are outlined in Schedule A of your Transfer Payment Agreement sent by the ministry. In addition, patient records must be kept in accordance with the standards and guidelines of the College of Physiotherapists of Ontario.

No. You cannot charge patients for services covered under the Episode of Care. The funding provided for an Episode of Care covers the assessment, diagnosis, physiotherapy treatment (including on-site clinic use of equipment or supplies) and discharge report. Clinics may charge for other services not covered under Episode of Care funding. The ministry does not set or regulate these services or fees.

No. Patients do not pay for assessments if they are referred to a clinic and it is determined they do not require physiotherapy. The assessment would still qualify as an Episode of Care. However, the registered physiotherapist would need to explain their decision to their referral in writing, and record this as “abandoned care.”

Physiotherapy clinics funded by the ministry may also offer privately-funded physiotherapy services. Patients are able to access privately-funded options at their own expense or through private insurance.

Clinics are not permitted to charge or bill anyone for physiotherapy services provided under a publicly-funded Episode of Care.

If the patient’s health number appears on your error report, you must obtain the updated information from your patient. Only patients who are insured by OHIP under the Health Insurance Act and who meet the eligibility requirements are eligible to receive publicly-funded physiotherapy. Patients without OHIP coverage who are on Ontario Disability Support or Ontario Works are exempted from this requirement. Services will not be funded if a patient’s version code or health number is not valid.

An A36 ERROR code indicates that funding has been denied because of a duplicate submission. This means the same service on the same date with the same health card number has already been submitted by another provider. In Ontario, eligible patients may only be treated for an Episode of Care at one, designated clinic. Multiple clinics cannot treat the same patient for a same or similar Episode of Care simultaneously. This policy is in accordance with all other publicly-funded services for all other health professionals, including physicians.

In order to avoid duplicate submissions, clinics and clinicians must be diligent when screening patients for publicly-funded physiotherapy.

Here are some tips to help avoid duplicate submissions:

• Referral check:
  - Ensure the patient provides the original referral form from their physician or nurse practitioner.
• Intake pre-screening:
  - Include a question on the intake questionnaire that asks if the patient is currently receiving physiotherapy for the same or similar issue at another clinic.
• Assessment:
  - Include further questions on the initial assessment that thoroughly explore a patient’s current and/or previous treatments for the same or similar conditions.
• Follow-up:
  - Monitor the patient’s care to see if it is progressing as expected. Responses to treatment that seem out of the ordinary could indicate that the patient is attending treatment with another health care professional.

There is no annual funding amount for each patient. Funding is instead provided to cover an Episode of Care. Clinics are allocated funding for a specific year under a formal funding agreement between the clinic and the ministry. The ministry provides $312 for each Episode of Care; it does not pay for individual visits. The Episode of Care is comprised of at least, assessment, diagnosis, treatment, and the provision of a discharge summary to the referring provider. Some patients may require only one Episode of Care while others may be referred for multiple Episodes of Care if they have multiple conditions at different times.

In addition, some patients may require more treatments than others as part of their Episode of Care. The number and frequency of services provided as part of an Episode of Care will be determined by the treating registered physiotherapist in consultation with the patient and the treatment goals set out in the treatment plan. Clinics are expected to budget their Episodes of Care, their visits and their overall funding appropriately and according to patients’ needs.

Clinics are unable to apply for funding in addition to what has been allocated for the Episodes of Care.

Schedule B of your Transfer Payment Agreement indicates the maximum number of Episodes of Care for which you will receive funding. Each clinic is responsible for appropriately managing the funding and the scheduling of publicly funded treatments. The ministry’s expectation is that services will be delivered every month in which the funding and agreement apply.

Payments are based on an averaging of service delivery. A clinic may deliver more Episodes of Care in one month and fewer in the next. However, the ministry will reconcile payments made against Episodes of Care provided up to the maximum annual allocation set out in the agreement. This will be done every quarter. The ministry's expectation is that clinics manage their budgets appropriately, and that services will be delivered every month in which the funding and agreement apply.

Payments are based on an averaging of service delivery. A clinic may deliver more Episodes of Care in one month and fewer in the next. However, the ministry will reconcile payments made against the Episodes of Care provided by a clinic, up to the maximum annual allocation set out in the agreement. This will be done every quarter. The ministry's expectation is that clinics manage their budgets appropriately and that services will be delivered every month in which the funding and contract apply.

No. The funding provided under this contract is for the provision of physiotherapy services as defined in the contract. It is not for group exercise classes. However, each provider may use up to 10 per cent of the funds provided to deliver congregate care, training and/or education to patients with the same or similar diagnosis. These congregate setting services must be reported to the ministry. Please see your billing guide for more information.

If the intervention is uniform and provided to more than one patient at a time (e.g. patient education on shoulder surgery), this would be considered congregate. Any group physiotherapy education or training provided as part of an Episode of Care must not be group exercise. 

No more than 10 per cent of physiotherapy services in each funding year can be used for group physiotherapy education or training. All other services (the remaining 90 per cent) must be provided on a one-to-one basis between the patient and a registered physiotherapist or physiotherapist support personnel.

Patient records must be kept in accordance with requirements of the funding agreement and the standards and guidelines of the College of Physiotherapists of Ontario. Any health service provider receiving funding from the government may be audited to ensure accountability and compliance with funding, service delivery and contractual requirements.

As per normal professional practice, an assessment, diagnosis, goal setting, treatment, and discharge must occur by a registered physiotherapist. A discharge summary must be provided to the referral source. Under the funding agreement, there is no requirement for a separate assessment report.

Please note that in all cases registered physiotherapists remain obliged to document all of their care in accordance with the "Standard for Professional Practice: Record Keeping" as set out by the College of Physiotherapists of Ontario.  The standards are available on their website. Specific inquiries related to documentation practices beyond those required by the funding agreement, should be referred to the college directly.

You will receive a report summarizing the Episodes of Care submitted by your clinic and processed by the ministry in your monthly remittance advice report. It will also include accumulated year-to-date counts. 

Publicly-funded physiotherapy clinics that wish to relocate and discontinue the provision of publicly-funded services must notify the ministry immediately so that their Transfer Payment Agreement can be terminated.

Publicly-funded physiotherapy clinics that wish to relocate and want to continue to be funded by the ministry to deliver physiotherapy services under a Transfer Payment Agreement are required to obtain prior approval from the ministry for the proposed new location.  A written request to the ministry is required at a minimum of 60 days prior to relocation. Retroactive requests will not be considered. Each request will be reviewed independently and in consultation with the Home and Community Care Support Services where the clinic is located.

For more information, see ministry INFOBulletin #3102

The term of the agreement is from the effective date on the Transfer Payment Agreement until March 31, 2016.  The ministry or clinic may end the funding agreement according to the terms of this agreement. Requirements for transitioning the care of physiotherapy patients would apply.

More information about terminating or modifying agreements can be found in Articles 12 and 32 in your funding agreement.

If clinic owners sell to an owner who does not want to provide publicly-funded physio services, notice must be given to the ministry immediately so the funding agreement can be terminated. This would happen at the date of transfer.

If clinic owners sell to an owner who wants to continue providing publicly-funded physio services, approval must be acquired from the ministry.Clinics must submit a written request to the ministry at a minimum of 60 days prior to the proposed date of transferring ownership. Each request will be reviewed independently and in consultation with the Home and Community Care Support Services where the clinic is located.

For more information, see INFOBulletin #3098.

Should a hip or knee replacement patient require physiotherapy beyond the rehab services they receive through the hospital outpatient department or Home and Community Care Support Services, the patient may be eligible for additional publicly funded clinic-based physiotherapy. As with all care provided under the agreement, the patient would need a referral from a physician or nurse practitioner for clinic-based physiotherapy and also meet all other eligibility criteria.

Patients already receiving services from another ministry-funded program are not eligible for publicly-funded physiotherapy.

A patient may need to be directed back to the hospital, Home and Community Care Support Services or their physician if they do not provide a referral.

No. Please see the Assistive Devices Program ‘s conflict of interest guidelines which are available at the following website: health.gov.on.ca/en/pro/programs/adp/update_vendor_agreements/docs/pp_adp_manual.pdf

While the physiotherapy services funded under the Episode of Care model include an assessment, the ministry does not fund an Episode of Care for the sole purpose of completion of the Assistive Devices Program Application for Funding Assistance. However, if you are providing an Episode of Care to a referred patient and determine in the course of your assessment that the patient needs an assistive device, it is not appropriate to charge the patient for the assessment.

No. You should not charge a patient for an assessment if you are providing an Episode of Care to a referred patient and determine in the course of your assessment that an assistive device is needed.

Discharge from an Episode of Care should only occur once the therapeutic objectives identified in a patient’s treatment plan have been achieved, or when improvements could be achieved through self-care or through an exercise, falls prevention or similar program, or when no further gains are likely to be achieved from continuing the physiotherapy.

The clinic must make every effort to encourage patients to complete their course of care. If the patient abandons care, the course of care can be counted as an Episode of Care.  However, the clinic is required to record this in their claims submission using the code “V842A.” The clinic should also notify the referring physician or nurse as part of the discharge report that the patient has abandoned treatment and, if known, provide the reason. The number of patients abandoning care must be reported on the Outcomes Report (Schedule D1 under the Transfer Payment Agreement). The ministry reviews all service encounter and outcomes reporting submitted by clinics including the number of patients abandoning care.

If a patient does not feel as though they were properly treated by their physiotherapist, complaints should be directed to both the ministry and the College of Physiotherapists of Ontario.

No. This would not constitute group physiotherapy education or training.

Physiotherapy will be funded in a manner similar to many other publicly-funded programs including hospitals and long-term care homes. Physiotherapy clinics may have waiting lists for publicly-funded care due to either clinic capacity or Episode of Care allocation.

Publicly-funded physiotherapy may also be provided to eligible patients by:

• s to eligible people who require physiotherapy in their homes due to their condition or injury;
• Long-Term Care home residents;
• hospitals to their inpatients or through their outpatient physiotherapy departments;
• special rehabilitation programs/organizations such as Children’s Treatment Centres or the Ontario Stroke Network;
• some Community Health Centres

Additional publicly-funded physiotherapists are being integrated into existing interdisciplinary primary health care programs in family health care settings such as selected Family Health Teams, Community Health Centres, Nurse Practitioner-Led Clinics and/or Aboriginal Health Access Centres.

There are no plans at this time for the Ministry of Health and Long-Term Care to receive additional applications for physiotherapy providers to offer publicly-funded, community based physiotherapy services.

If you have further questions, please contact the Senior’s INFOline at Infoline.MOH@ontario.ca or by calling 1-888-910-1999, TTY: 1-800-387-5559.