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Ministry Status: Routine Monitoring and Engagement

Ontario Health Insurance Plan

OHIP Bulletins


Primary Health Care Services InfoBulletins

Keeping Health Care Providers informed of payment, policy or program changes

To:  Comprehensive Care Model (CCM)
Family Health Group (FHG)
Family Health Network (FHN)

Published by:  Negotiations Branch

Date Issued:  January 12, 2017

Bulletin Number:  11165

Re:  Home Visits: Complex House Call Assessment 20% Payment

Posted Electronically Only

PDF Version Portable Document Format | 135 Kb

The 2012 Physician Services Agreement (PSA) between the Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Medical Association (OMA) includes provisions for annual Year End Home Visits Payments under Appendix D 'Primary Care Initiatives' section 4.3 House Calls (c).

"When a CCM, FHN or FHG physician provides more than 68 House Calls per year to more than 17 patients, physicians will receive a 20% premium payment on the additional House Call Services if at least 75% of the house calls were provided to their enrolled and non-enrolled Home Bound Frail Elderly patients (A900A) during the fiscal year. This payment will be made as an annual payment at Year End."

The ministry has completed the calculation of this premium for the fiscal year April 1, 2015 to March 31, 2016.

Physicians eligible to receive the payment are;

  • those who are signatory members of a CCM, FHG or FHN Group
  • have achieved a Level C Home Visits Special Premium (68 House calls to more than 17 patients)
  • have provided 75% of their Home Visits under the Fee Schedule Code A900A "Complex House call Assessment" to Home Bound Frail Elderly Patients

Physicians will receive an additional payment equaling 20% of the fee approved amount on the following Fee Schedule Code services provided over and above the level C service(s):

Home Visits
A900A Complex House Call Assessment
A901A House Call Assessment
A902A Pronouncement of Death – House Call

Physicians will receive an additional payment equaling 20% of the fee approved amount of any A###A code or K ###A code that is billed together with a B-Code Special Visit (same service date) over and above the level C service(s):

B-Code Special Visit
B990A Special Visit Premium
B992A Special Visit Premium
B993A Special Visit Premium
B994A Special Visit Premium
B996A Special Visit Premium

The payment will be made on the January 2017 Remittance Advice under the following accounting transaction:

  • "CHCA Complex House Call Assessment"

The Complex House Call Assessment payment is not subject to the 2012 PSA section 1.1

  • "the Parties agree to a payment discount of 0.5% on all physician payments in effect from April 1, 2013".

Thank you for your continued participation in advancing Primary Health Care in Ontario.

For any inquiries please contact the Service Support Contact Centre: 1-800-262-6524 or SSContactCentre.MOH@ontario.ca

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