Changes to the core service list for Family Health Organization group physicians

To: Family Health Organization physicians
Category: Primary Health Care Services
Written by: Physician Relations & Contract Oversight Branch
Date issued: November 3, 2023
Bulletin Number: 231104

Further to INFOBulletin #221203, the Ministry of Health and the Ontario Medical Association have agreed to the following implementation changes related to the Family Health Organization primary care model.

Core services

Starting November 1, 2023, the following services have been removed from the basket of core services and will be paid through fee-for-service to align with similar face-to-face services. This change is effective retroactive to December 1, 2022. All approved claims for the below services to enrolled patients submitted after November 1, 2023, will now pay Fee-For-Service.

  • A010A – General Practitioner (GP) focused practice consultation by video
  • A011A – GPfocused practice repeat consultation by video
  • A906A – GP focused practice limited consultation by video
  • A913A – GP focused practice special consultation by video
  • A914A – v focused practice comprehensive consultation by video
  • A814A – Midwife or Aboriginal Midwife-Requested Assessment (MAMRA) by video
  • A817A – Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA) by video
  • A818A – Midwife or Aboriginal Midwife-Requested Anaesthesia Assessment (MAMRAA) by video

No further action is required from physicians for claims that have already been submitted and processed prior to November 1, 2023. A future Medical Claims Adjustment (MADJ) will be scheduled to adjust previously approved claims, hard cap, and outside use. More details will be provided on the timeline of the Medical Claims Adjustment when available.

Keywords/Tags

Family Health Organization; FHO; Virtual Care; Included Codes; Excluded Codes; A010A; A011A; A814A; A817A; A818A; A906A; A913A; A914A; Midwife; GP focus

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.