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

OHIP-Funded Physiotherapy As of April 1, 2005, OHIP-funded physiotherapy services are available to: o seniors 65 and older o people aged 19 and younger o long-term care (LTC) residents of all ages o people of all ages needing short-term physiotherapy in their home or after overnight hospitalization o 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 patient’s 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.

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 resident’s care. The resident’s attending physician, along with the LTC home’s 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.

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 ministry’s 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.

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.

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, All physiotherapy providers and LTC homes with existing Memorandums of Understanding have been notified of the program’s 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 30 th. 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, Funding for this program will continue in the form of an annual allocation of $600 per bed per home