OHIPFunded Physiotherapy in LongTerm Care Homes

1
OHIP-Funded Physiotherapy in Long-Term Care
Homes

• Prepared by Provider Services Branch
• Health System Accountability and Performance
  Division
• Ministry of Health and Long-Term Care
• May 2008

2
OHIP-Funded Physiotherapy

• As of April 1, 2005, OHIP-funded physiotherapy
  services are available to
• seniors 65 and older
• people aged 19 and younger
• long-term care (LTC) residents of all ages
• people of all ages needing short-term
  physiotherapy in their home or after overnight
  hospitalization
• people of all ages receiving benefits under the
  Ontario Disability Support, Ontario Works, and
  Family Benefits programs
• Physiotherapy services provided in the community
  or in a patients home (excluding LTC homes) are
  covered by OHIP only when ordered by a physician
  and rendered by a Designated Physiotherapy
  Clinic. Only designated clinics (previously
  known as Schedule 5 Clinics) are permitted to
  bill OHIP on a fee-for-service basis for the
  provision of insured physiotherapy services.

3
OHIP-Funded Physiotherapy in LTC Homes

• In order to improve access to physiotherapy
  services provided to residents of LTC homes, OHIP
  funds physiotherapy in LTC homes under two
  models fee-for-service and alternative payment
  plans.
• Only Designated Physiotherapy Clinics are
  permitted to submit claims to OHIP under the
  fee-for-service model but both designated and
  non-designated physiotherapists may provide
  services under the alternative payment plan.
• Regardless of age, insured residents of LTC homes
  are eligible for OHIP-funded physiotherapy
  services when referred by a physician or by the
  registered nurse most responsible for the
  residents care.
• The residents attending physician, along with
  the LTC homes multidisciplinary team, will
  determine which residents may require
  physiotherapy. Throughout the course of
  treatment, the physiotherapist will assess
  therapy requirements and progress.
• Physiotherapy is provided by a physiotherapist,
  registered with the College of Physiotherapists
  of Ontario, or by an assistant, under the
  supervision of the treating physiotherapist, in
  accordance with College guidelines, and in
  accordance with the standards of the LTC home.

4
Fee-For-Service Model

• Designated Physiotherapy Clinics have the option
  of receiving payment under either a monthly
  funding allocation or under established
  fee-for-service arrangements based on claims
  submissions.
• Claims for servcies rendered are submitted and
  paid through the ministrys existing claims
  processing system.
• Services provided by designated clinics under the
  fee-for-service model are subject to an annual
  per patient maximum of 100 services.
• In exceptional circumstances based on medical
  need, the per patient service maximum may be
  increased by up to 50 services per fiscal year.
• Claims submitted for services beyond the maximum
  must be submitted under a special fee code and
  the provider must maintain the supporting
  documentation as required under legislation.

5
Alternative Payment Model

• Both designated and non-designated physiotherapy
  providers may provide services under this model.
  Payments are made directly to the provider.
• Funding for each home is based on a per bed
  allocation of 600 per annum. This allocation
  was derived from historical service data based on
  the number of residents requiring physiotherapy,
  the average number of treatments per resident,
  and the rate of turnover.
• Physiotherapy services provided in LTC homes
  under this model are not subject to per patient
  service maximums.
• There is no specified amount of time the
  physiotherapy provider must spend with the
  resident during each session. The
  physiotherapist develops a treatment plan in
  conjunction with the resident. The amount of
  time per session will depend on the treatment
  required and the clinical assessment of the
  resident.
• A service agreement is signed between the LTC
  home and the service provider. The ministry then
  issues a Memorandum of Understanding for funding
  that details the roles and responsibilities of
  each party. The ministry, the LTC home, and the
  physiotherapy service provider are all parties to
  the memorandum.

6
Alternative Payment Model Current Status

• The program to provide OHP-funded physiotherapy
  services to residents of LTC homes under the
  alternative payment model has been extended to
  March 31, 2009.
• All physiotherapy providers and LTC homes with
  existing Memorandums of Understanding have been
  notified of the programs extended end date.
• An addendum has been sent out to these homes to
  extend the funding of existing agreements on an
  interim basis until June 30th. Minor revisions
  are being made to the current agreement template.
  Upon completion, the final version will be
  distributed for signing and will be effective
  until March 31, 2009.
• Funding for this program will continue in the
  form of an annual allocation of 600 per bed per
  home