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Community Physiotherapy

Clinic Services: Selection of

Transfer Payment Recipients

Application Guidelines

Ministry of Health and Long-Term Care

June 2013

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Table of Contents

Introduction

Service Description 3

Submission of Application 6

Assessment of Application 6

What If My Application is Successful? 7

Instructions for Completing the Application

Applicant Information 8

Community Physiotherapy Clinic Services Information 9

Functional Plan 10

Operating Budget 11

Appendices

Glossary 13

Considerations for Health Service Providers 15

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Introduction

On April 18, 2013, the Minister of Health and Long-Term Care announced that beginning August

1, 2013, one-on-one physiotherapy, group exercise classes and falls prevention services will be

available to more people in long-term care homes and in communities across Ontario. For

further information, see the news release located at:

http://news.ontario.ca/mohltc/en/2013/04/more-seniors-to-benefit-from-physiotherapy-and-

exercise.html.

The announcement included a commitment to expand the funding for community clinic-based

physiotherapy services in order to increase access to eligible Ontarians across the province.

$44.5M in funding is being dedicated to funding ambulatory physiotherapy services in clinic

settings across Ontario. It provides for the continued delivery of clinic-based services in the

locations where they are currently provided and the funding of new locations and volumes to

improve geographic access to eligible Ontarians. This funding will enable the preservation and

expansion of access for 90,000 more seniors and eligible patients, benefitting 150,000 people in

total.

Publicly funded clinic-based physiotherapy will be governed and funded under transfer payment

agreements with the ministry rather than through submission of fee-for-service claims to OHIP

as of August 1, 2013.

A key objective of the program is to improve geographic access to Physiotherapy Services. The

selection of successful applicants and the volumes they are assigned will reflect Local Health

Integration Network (LHIN) needs and priorities.

Physiotherapy Services Description

Definition of Funded Physiotherapy Services

The physiotherapy services funded under this program are assessment, diagnosis and

treatment to improve, develop or rehabilitate physical function and promote mobility lost or

impaired as a result of a debilitating event or disease, pain, injury or surgical procedure. The

services must be provided in accordance with a written treatment plan for an episode of care

and be of a level of complexity that requires the clinical knowledge, skills or judgement of a

physiotherapist to perform and/or assign these services to duly qualified support personnel in

accordance with the College of Physiotherapists of Ontario standards of professional practice.

Funding represents payment in full for the assessment, diagnosis, treatment and discharge

summary reporting to the referring physician or nurse practitioner.

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The funding under the program is not intended for group exercise, activation, or falls prevention

classes or services provided solely to maintain an existing level of function, or services provided

concurrently with physiotherapy services already provided or funded by other Ministry of Health

and Long-Term Care (MOHLTC) or health system programs or through automotive insurance or

the insurance plan established under the Workplace Safety and Insurance Act.

The costs of any equipment or supplies, including equipment or supplies recommended for

individual home use, are not eligible for funding under this program.

Episode of Care

An Episode of Care is one discrete group of condition/diagnosis specific, time-limited,

goal-oriented physiotherapy services provided to a specific patient.

A new referral from a physician or nurse practitioner is required for each Episode of

Care.

The number, frequency and duration of visits offered during each Episode of Care must

be necessary and reasonable for the treatment of the condition as determined by the

treating physiotherapist using his/her professional and clinical judgement of the patient’s

individual need and evidence-based best practices. While there is no fixed limit to the

number of episodes of care a person may receive, all eligibility criteria, including a

separate referral, must be met for each episode of care.

Patient Eligibility Criteria

To be eligible for physiotherapy services funded under this program, a person must, for each

episode of care:

be referred to a specified clinic by a physician or nurse practitioner based on the findings

of an assessment that the person requires physiotherapy services, be an insured person

under the Health Insurance Act and be within one of the following categories:

o aged 65 years and older;

o aged 19 years and younger; or

o 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 to a specified clinic by a physician or nurse practitioner based on the findings

of an assessment that the person requires physiotherapy services and are in receipt of

Ontario Disability Support Program or Ontario Works benefits.

As well, the person must not presently be receiving physiotherapy services provided or funded

by other Ministry of Health and Long-Term Care or health system programs or through

automotive insurance or the insurance plan established under the Workplace Safety and

Insurance Act for the same condition/diagnosis.

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Delivery Requirements

Physiotherapy Services must be delivered at the clinic address stated in the agreement and

by, or under the direct supervision of, a physiotherapist who is registered and in good

standing with the College of Physiotherapists of Ontario (the ‘College’).

Physiotherapy support personnel assisting in the delivery of physiotherapy services must

have the appropriate skills and knowledge to provide safe and effective care, as determined

by the physiotherapist and as required by the College.

Patients must be assessed at least upon admission and immediately prior to discharge

using evidence-based outcome measures appropriate for the patient’s presenting condition.

An individualized, assessment-based, time-limited treatment plan with measurable goals

must be developed for each patient at the commencement of an episode of care and

maintained in accordance with College standards of professional practice.

Clinics are expected to provide the goal-oriented best-practice physiotherapy services each

patient requires to treat their particular condition.

No more than 10% of the funds provided for physiotherapy services can be used for patient

group education and training. All other visits must be provided on a 1:1 basis between the

patient and a physiotherapist or physiotherapist support personnel.

Discharge Requirements

Each clinic must discharge a patient once the therapeutic objectives identified in the

treatment plan have been achieved, or when any reasonably equivalent gains could be

achieved through an exercise, falls prevention, activation, or similar program, or when no

further gains are likely to be achieved from continuing the physiotherapy services.

Each clinic must, within a reasonable time after discharge, provide the referring clinician with

a discharge summary report that includes outcome measure scores.

At discharge, each clinic must provide each patient with access to information on self-

management and local programs including exercise, falls prevention, activation, or similar

programs, as appropriate.

Change from Prior Funding Model

The Health Insurance Act fee-for-service funding model for physiotherapy clinic services is

replaced with an Episode of Care funding model.

Under this Episode of Care funding model, the Ministry will enter into individual funding

agreements with selected eligible physiotherapy clinics. Under each agreement, the Ministry

will pay the clinic a set price of $312 per episode of care to provide physiotherapy services for a

total target number of episodes per clinic within the time period of the agreement. The number

of visits each patient receives is to be determined in accordance with the individual patient’s

needs, best practices, and professional standards. Funding amounts will be regularly

reconciled against the actual total number of episodes of care and reporting on service

encounters and other clinical information will be required.

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Submission of Application

This is an application process for the selection of transfer payment recipients; this is not

a procurement process or request for proposals. The Application Form should be

completed by persons wishing to apply for funding to deliver publicly funded

physiotherapy services in a clinic setting in a locality in Ontario.

Completed Applications are to be sent electronically, via email, to the MOHLTC. The deadline

for submission of Applications is July 7, 2013 at 17:00:00 (Eastern Standard Time), according to

the time that the e-mail is received in the MOHLTC’s e-mail system. Please note that the

documentation required must be submitted in its entirety. The Application Form must be

downloaded, filled out electronically, printed, signed and submitted as a scanned PDF

document.

Documents that do not form part of the Application Form or that are not required as part of the

Application Form will not be reviewed.

The Application Form must be submitted electronically. Do not submit a hard copy of the

Application Form, or any part of it.

Applicants should:

1. Fully review the Application Guidelines and the Application Form. A Glossary is located

in Appendix A of the Application Guidelines for definitions of terms used in the

Application Guidelines and Application Form.

2. Complete the Application Form, referring to the Application Guidelines where necessary.

Submit all the required information.

3. Submit the completed Application Form via email, using “Community Physiotherapy

Clinic Services Application” in the subject line, to the following address:

PhysiotherapyProviders@ontario.ca.

Applicants will be sent an electronic confirmation of receipt of their Application. Any costs

associated with preparing and/or submitting the Application Form are solely the responsibility of

the Applicant. The MOHLTC is not responsible under any circumstances whatsoever for any

expenses related to the Application process.

Assessment of Applications

The MOHLTC will review all Applications based on such factors as the MOHLTC, in its sole

discretion, determines to be relevant and appropriate, using the Application Guidelines as a

non-exclusive guide.

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The ministry is looking to maximize access and value for its investment by allocating funding to

communities across the province. The ministry is working closely with the LHINs to determine

the appropriate distribution of Physiotherapy Services. The distribution of funding will be

determined by the greatest need as identified by the LHINs. Health Service Providers, as

defined in Section 2 of the Local Health System Integration Act, are also required to complete

this Application Form in order to be considered by the Ministry (see Appendix B for

considerations). Applicants will need to indicate the optimal volume of Episodes of Care based

on the ability of the clinic to deliver timely access to these services effective August 1, 2013.

Where applicable, the ministry is also seeking the minimum amounts of Episodes of Care that

can be accommodated at the clinic considering the clinic’s current volume of patients, any

waitlists, physical space etc.

The ministry will determine the number of Episodes of Care to be provided by the Applicants

when preparing the funding agreements. It may also reject any or all Applications, consider only

part of any Application, request clarification or modification of any Application or seek further

information regarding any Application. If the information provided in the Application is

incomplete or unclear, the ministry, in its sole discretion, may deem the Application incomplete

and discontinue assessment. The Application Guidelines and the submission of the

Application Form and/or other material in connection with the Application Guidelines do

not create any contractual or other legally enforceable obligation on the ministry to the

Applicant or to anyone.

Short-listing

The ministry reserves the right, in its sole discretion, to identify a short list of Applicants

following the Application deadline, and to request such further or other information from those

Applicants, or to request interviews, as the ministry, in its sole discretion, determines to be

necessary or appropriate.

Questions and Answers

Any clarifications and/or updates on the Application process will be posted on the ministry

website. Applicants are encouraged to check the site:

http://www.health.gov.on.ca/en/public/programs/physio/ regularly and/or send questions to

PhysiotherapyProviders@ontario.ca.

What if my Application is Successful?

You will receive notice by the ministry (Notice) that the Application was successful, subject to

completion of requirements as follows:

Provide evidence that the Applicant is incorporated. If you are not already incorporated,

you must become incorporated within 30 calendar days following the date of the notice,

otherwise MOHLTC may, in its sole discretion and without penalty or liability, withdraw its

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approval of the Application. You will also be required to provide details of your

corporation’s governance structure.

Enter into a Funding Agreement with the MOHLTC that will outline the proposed patient

volume and associated funding and other terms relating to the requirements expected from

the Applicant.

Instructions for Completing the Application

The Application consists of several sections, all of which must be completed in their entirety

using the format identified in the Community Physiotherapy Clinic Services Application Form.

These sections are:

General Information

Physiotherapy Clinic Information

Operating Budget

Applicant Information

This section provides the MOHLTC with information about the Applicant. The following

headings will guide you through the different sections to be completed within the Application

Form.

1. Applicant Overview

The MOHLTC needs to know basic information about the Applicant such as their full and

accurate legal name(s), address, email address and telephone number.

2. Local Health Integration Network

Please identify in which Local Health Integration Network your physiotherapy clinic is located.

3. Previous/Existing Funding

Identify if the Applicant has received government funding for the delivery of physiotherapy

services previously. Please identify the source and the specifics of the funding, the nature of

the services delivered for the funding and the timeframe during which the funding was provided.

If the funding is ongoing please indicate the current level of funding being received and the

deliverables associated with the funding. Please indicate whether or not you are a Health

Service Provider as described in Section 2 of the Local Health System Integration Act. Please

also identify any other revenue streams (e.g. private insurance, WSIB etc.) of the Applicant.

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4. Legal Status of Organization

If the Applicant is not yet incorporated, the Applicant will be required to become incorporated

prior to entering into a Funding Agreement with the MOHLTC.

Please see the following resources for more information on incorporation and how to

incorporate:

http://www.ontario.ca/en/business/STEL02_163197.html

http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/nfpinc/

Please complete the tables provided in the Application package as they pertain to the current

legal status of your organization.

5. Clinical Team Capacity

Applicants must demonstrate that they have sufficient staff or capacity to accommodate

additional staff to deliver the Physiotherapy Services. The Application will be reviewed to

ensure that the Clinical Team and Management Team can provide physiotherapy as described

in the Physiotherapy Service Description section of this Guideline.

The Applicant must demonstrate strong governance, business, human resources, and financial

capacity and describe how management of the clinic will meet all management responsibilities

including, but not limited to, financial accountability, operations (including facility management

and quality assurance) and human resources. Please identify how long your clinic has been in

operation as well as physiotherapy credentials, qualifications and/or accreditations achieved

and staffing complements.

6. Catchment Area

This section allows you to indicate your current catchment area. Please describe or include a

map showing the catchment area and location of your clinic including where possible the

Forward Sortation Areas (FSAs the first three characters of the postal code) from which your

patients, or the majority of your patient population, is drawn. Please see the glossary for more

information.

The clinic may or may not be situated within a community with existing physiotherapy resources

and the Applicant should consider supply and demand for already existing physiotherapy

services in the area. The selection of successful applicants and the volumes they are assigned

will reflect LHIN needs and priorities. The MOHLTC will consider where publicly funded

services are currently being delivered.

Community Physiotherapy Clinic Services Information

This section allows you to describe your current services in more detail.

7. Overview of Clinic and Services

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Please consider the following in your overview:

a) Existing patient volumes including, to the extent possible, the percentage of population

aged 65 and over, aged 19 and under, patients receiving treatment following an overnight

hospital stay and Ontario Works or Ontario Disability clients. Please include volumes of

services, average number of services per patient, etc. Please also describe the funding

for these services

b) Any services delivered in a congregate setting (e.g. education sessions for a specific

diagnosis). Please also describe the funding for these services

c) Any specialized physiotherapy services or programs that are provided at the clinic.

Please also describe the funding for these services

d) Describe any non-physiotherapy services provided at your clinic. Please also describe

the funding for these services

e) Describe any outcome measures applicable to the target patient populations for

physiotherapy services routinely collected at your clinic.

8. Management Team Overview

Applicants must demonstrate that they have sufficient staff or capacity to accommodate

additional staff to deliver the Physiotherapy Services. This includes ancillary and administrative

personnel to ensure efficient administration and operation of the clinic. Please complete the

staffing chart for the management team that would be involved in the delivery of the proposed

clinic based Physiotherapy Services under this funding initiative assigning staff to functional

categories, in support of workload. Please indicate who the primary contact for the Application

is, who will be in charge of daily operations, who will be responsible for quality assurance and, if

applicable, any alternate contacts as required.

9. Compliance with Standards of Care and Quality Assessment

Successful applicants may be required to undergo inspections of their clinic premises by the

MOHLTC or its agent. In this section, please describe how the Physiotherapy Services provided

under the funding agreement with the ministry will meet the standards of care as outlined by the

College of Physiotherapists of Ontario (http://www.collegept.org/Standards/English).

10. Defined budget and management of various client funding streams

Describe how the clinic will operate within a defined annual budget in order to ensure that the

delivery of services provides reasonable access to eligible patients. If applicable, how will the

physiotherapy clinic manage the provision of services to its various types of clients (private, auto

insurance, WSIB etc.) while ensuring that patients eligible under the Funding Agreement receive

timely access to care.

Functional Plan

11. Operational Factors

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Please provide:

A description of how the Applicant meets privacy requirements, conducts privacy impact

assessment(s) and risk assessment(s), as needed. Applicants must consider how their

functional plan, business and clinical activities will ensure privacy as well as security of

personal health information.

A description of the Applicant’s records management practices.

A description of how the Applicant will include security measures to prevent staff and

patients from exposure to violence. Applicants must consider how their functional plan,

business and clinical activities will ensure security of staff and clients.

Confirmation that an infection protection and control risk assessment process has been

undertaken to identify any health risks of the catchment area client population profile

and that measures have been identified to mitigate these risks through both physical

design and operational processes.

Applicants who propose to provide Physiotherapy Services located in an area of Ontario

designated in the Schedule of the French Language Services Act (Appendix A) should

demonstrate that they will be able to provide services in French.

12. Overview of Clinical Space

Please provide:

A description and/or a simple drawing of the floor plan for the clinic. Identify functional

areas such as patient care area, general and special purpose rooms.

A description of how the proposed site and facility design specifically addresses the

requirements for delivery of accessible services in compliance with the Accessibility for

Ontarians with Disabilities Act (Appendix A).

A description of how the Applicant’s existing equipment will ensure appropriate delivery

of Physiotherapy Services.

Operating Budget

The payment model will fund Episodes of Care (See Glossary Appendix A) reflecting a course

of specific, time limited, goal oriented patient Physiotherapy Services in accordance with the

best available evidence. Under each funding agreement, the Ministry will pay the clinic a set

price of $312 per Episode of Care to provide Physiotherapy Services.

The agreement will be time-limited and define expectations regarding minimum volumes of

Episodes of Care while providers will determine the number of services provided to each patient

as needed based on individual patient condition. Reporting on service encounters, performance

and outcome measures will also be required. .

The costs of any equipment or supplies, including equipment or supplies recommended for

individual home use, are not eligible for funding under this program.

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Please describe the optimal and minimum volume of publicly funded Episodes of Care that can

be accommodated at your clinic considering your current volume of patients, waitlists, physical

space etc. The selection of successful applicants and the volumes they are assigned will reflect

LHIN needs and priorities.

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Appendices

Appendix A

Glossary

Application: An Application Form for public funding for clinic based Physiotherapy Services in

Ontario submitted by an Applicant.

Clinical Team: The staff members involved in the direct patient care delivery of the proposed

clinic based Physiotherapy Services.

Community Physiotherapy Clinic: A place where one or more members of the public receive

physiotherapy services in accordance with a Funding Agreement.

Episode of Care: An Episode of Care is one discrete group of condition/diagnosis specific,

time-limited, goal-oriented physiotherapy services provided to a specific patient initiated by a

physician or nurse practitioner referral. The number of visits each patient receives within an

Episode of Care is to be determined in accordance with the individual patient’s needs, best

practices, and professional standards.

Forward Sortation Area: A postal code is a uniform six-character code made up of letters and

numbers. The first three characters of the postal code comprise the FSA or Forward Sortation

Area. An FSA (Forward Sortation Area) provides the general area where the mail is going. Go

to: http://www.canadapost.ca/cpc2/addrm/hh/maps/fsa/ca01.pdf to view the FSA Allocation Map of

Canada (PDF format).

Funding Agreement: Transfer Payment Agreement between the Ministry of Health and Long-

Term Care and a provider of Physiotherapy Services which outlines terms and conditions of

funding.

Health Service Provider: As defined in Section 2 of the Local Health System Integration Act

(e.g. Community Health Centre, Hospital)

Local Health Integration Network: Local Health Integration Networks (LHINs) are the health

authorities responsible for regional administration of public healthcare services in the province

of Ontario, Canada.

Management Team: The staff members who facilitate or support the delivery of the proposed

clinic based Physiotherapy Services.

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Physiotherapist: A member of the College of Physiotherapists of Ontario.

Physiotherapy Support Person: Anyone who provides care under the direction and

supervision of a physiotherapist. The physiotherapist is accountable for the treatment planning

and instructions provided to the physiotherapist support person about care.

Physiotherapy Services: Physiotherapy Services funded under the Funding Agreement are

assessment, diagnosis, treatment and discharge reporting to improve, develop or rehabilitate

physical function and promote mobility lost or impaired as a result of a debilitating event or

disease, pain, injury or surgical procedure. See also descriptions of Episode of Care.

In addition, Community Physiotherapy Clinics must be in compliance with all relevant Acts (and

their applicable regulations), including, but not limited to:

AODA: Accessibility for Ontarians with Disabilities Act, 2005:

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_05a11_e.htm

CA: Corporations Act, 1990:

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90c38_e.htm

[The CA is the current legal framework governing Not-for-Profit corporations. It will be

superseded by the Not-for-Profit Corporations Act, 2010 when that Act is proclaimed in

force].

FLSA: French Language Services Act, 1990:

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90f32_e.htm

OHSA: Occupational Health and Safety Act, 1990:

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90o01_e.htm

PHIPA: Personal Health Information Protection Act, 2004:

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_04p03_e.htm

Physiotherapy Act:

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_91p37_e.htm

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Appendix B

Health Service Providers

Health Service Providers (HSPs) are defined in Section 2 of the Local Health System Integration

Act. There may be specific circumstances in some LHINs where it is appropriate for, and Health

Service Providers are able to, operate a community physiotherapy clinic according to all of the

requirements set out in the Service Description (p.3). The ministry is prepared to accept

applications from HSPs in these circumstances and consider them in collaboration with the

Local Health Integration Networks. Some of the considerations taken into account when

reviewing applications submitted by Health Service Providers (and may be considered for other

applicants as appropriate) may include the following:

The ability to deliver the program per the service description, particularly the ability to apply all eligibility criteria for patients funded under the program.

Whether or not physiotherapy is already offered directly by the HSP (e.g. in hospital outpatient departments) and physiotherapy service volumes are stable or have grown in recent years.

The ability to establish baseline utilization data of patients currently being served in order to ensure net new service and patient volumes for the new investment.

Confirmation that no funding for start-up, space or capital is required.

The ability to partition service delivery, funding and reporting under this program from any similar services funded and delivered as part of another program.

Consistency/alignment with HSPs core mandate.

Whether the HSP will accept physiotherapy patient referrals for all eligible patients (e.g. not restrictive to hospital ER patients or inpatients being discharged or clients of a Community Health Centre).

Whether the HSP is located in a rural or remote community recognized by the LHINs as a priority setting for the allocation of service volumes.

Whether the HSP currently serves the patient cohorts identified in the service description and which are the target of the investment.