Primary Care Covid Funding Update Brief Summary
Changes to Funding:
• Ability/requirement to charge co-pay if patient not eligible for MOH COVID funding.
• A new pricing structure.
• The following 3 services will no longer be funded: ‘Chart Review’, ‘Post-hospital Discharge Review’ and ‘Follow-up check- Patient Initiated’.
Changes to clinical processes:
• Eligibility is outlined in Appendix B of Guidance document. There are four Priority and vulnerable (high risk) populations: ‘Anti-Viral’, ‘Priority’, ‘Vulnerable’, and ‘Clinically High Risk’. Table 1 in the Guidance document lists the funded services and the population groups eligible for funding for each service.
• Guidance regarding RAT and PCR testing has changed and is detailed in the attached documents. See Appendix C in guidance document for the updated COVID-19 Testing Operational Guidance for General Practice and Urgent Care.
• ‘If there is a requirement for a RAT to be done by a clinician as part of an In-person assessment it will only be funded if the result is positive; AND the person meets criteria for antivirals OR is priority/vulnerable group’. (Page 5 of Guidance document)
This is a significant change and practices will need to consider their red stream flows/management.
Patients should be encouraged to do a self-test RAT at home wherever possible before attending a primary care facility. It is also important for general practice to reinforce this message with patients and accept a self-reported RAT when triaging patients on the same day as the self-test RAT. A copayment can need to be charged for those with negative RAT who are diagnosed with ‘other respiratory illness.’’
A critical element in applying these new funding rules is that teams are aware of the criteria for the Priority and vulnerable (high risk) populations, and which funded services they can access. We will work with Karo to ensure the Halcyon COVID claiming system reflects these changes and will be in touch with further detail and clarification as needed.