Lead the Way.ca

OHIP Covered Physiotherapy

Lead the Way Group of Clinics are pleased to be able to offer OHIP covered Physiotherapy services. Please see below for clinic locations and frequently asked questions regarding these services.

Community OHIP Physiotherapy Clinics FAQ's

What services are covered under publicly funded clinic-based physiotherapy services?

Under the "Episode of Care"(EOC) funding model, funded physiotherapy services include: 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. Funding for physiotherapy services includes payment in full for the assessment, diagnosis, treatment and discharge summary reporting to the referring physician or nurse practitioner.

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.

Patient Eligibility Criteria

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

Be referred 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:

  • aged 65 years and older;
  • aged 19 years and younger; or
  • 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 by a physician or nurse practitioner based on the findings of an assessment that the person requires physiotherapy services and be eligible for funding of services under the Ontario Disability Support (ODSP) or Ontario Works (OW) programs.
Is maintenance funded?

No. The clinic physiotherapy services funded under this program are aimed at addressing acute episodes or worsening of symptoms that lead to decreased function or mobility (e.g. debilitating event or disease (including chronic disease), pain, injury or surgical procedure). Should a patient’s condition change or deteriorate, their function decrease or their mobility level worsen, (i.e. as a result of a debilitating event or disease, pain, injury or surgical procedure), they may become eligible for funding for an EOC in a clinic setting provided that all eligibility criteria, including a separate referral, are met.

Maintenance of good health and function is important and this can be supported through access to resources such as exercise and falls prevention classes. These classes will be available in more communities across the province to help seniors stay healthy, active and living in their own home longer.

Is physiotherapy for chronic diseases funded?

Yes. Clinic-based physiotherapy services for chronic diseases are funded if all the eligibility criteria are met.

Under the EOC funding model, the physiotherapy services funded 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. This would apply to chronic diseases such as arthritis or multiple sclerosis.

As part of the assessment, the physiotherapist and the patient will identify therapeutic objectives or goals for treatment. Once the therapeutic objectives identified in the treatment plan have been achieved, or when any reasonably equivalent gains could be achieved through self-care, an exercise or falls prevention, activation, or similar program, or when no further gains are likely to be achieved from continuing the physiotherapy services, patients are discharged from their EOC. Clinics are to provide each patient with information on self-management and/or local programs including exercise, falls prevention, activation, or similar programs, as appropriate and the patient’s referring provider with appropriate discharge reporting.

The Ministry is also working with LHINs to compile information on local programs and resources so that this information is available for patients and providers to facilitate referrals and transfers after patients have completed their EOC.

Waiting lists for access to community based clinic services?

Physiotherapy will be funded in a manner similar to many other publicly funded programs including hospitals, long-term care homes, etc. There is an overall provincial budget for funding of clinic-based physiotherapy services. Clinics may have waiting lists for publicly funded care. The ministry’s expectation is that clinics will continue to provide services in every month during which the funding agreement is effective and, as such, clinics will need to manage their EOC and their budget to best meet this need.

Wait lists may occur and we will work to manage our wait list within the budget we have been allocated by the MOHLTC with transparency of process, diligence and efficiency.

Please review our wait list management framework:

  • Client’s name and contact information, eligibility criteria (as per MOHLTC), physician/nurse practitioner diagnosis and date of referral are documented at the time of referral.
  • Client’s are prioritized based on acuity of condition:
    1. post-op or recent fractures
    2. recent soft tissue injuries
    3. chronic conditions
  • Clients’ are generally provided with an estimated wait time based on guidelines noted above (taking into consideration referral volume) and provided with alternate, privately funded and OHIP physiotherapy providers in the area in cases of excessive wait times or in response to queries.
  • The receptionist is accountable for wait list management to the clinic coordinator/manager (Physiotherapist) who reviews the wait list and priorities on a regular basis.

If you have any questions or concerns or would like us to provide you with options for privately funded physiotherapy services please feel free to ask us.

What other publicly funded programs provide funding for physiotherapy?

Government-funded physiotherapy may also be provided to eligible patients by, for example:

Community Care Access Centres to people who require physiotherapy in their homes due to their condition or injury;

Long-Term Care homes; hospitals to their inpatients or through their outpatient physiotherapy departments; special rehabilitation programs/organizations such as Children’s Treatment Centres or the Ontario Stroke Network; some Community Health Centres;

Beginning in September 2013, additional publicly-funded physiotherapists will be integrated into existing interdisciplinary primary health care programs in family health care settings such as Family Health Teams, additional Community Health Centres, Nurse Practitioner-Led Clinics and Aboriginal Health Access Centres.

Can a patient receive more than one episode of care in a year?

Yes. A patient can receive more than one episode of care in a year provided that all eligibility criteria, including a separate referral is met for each individual episode of care. Each episode of care is one discrete group of condition/diagnosis specific, time-limited, goal-oriented physiotherapy services provided to a specific patient and must involve an assessment, diagnosis, treatment (according to a set plan with treatment goals), and discharge (including reporting on specific outcome measures).

Clinic locations providing OHIP Covered Physiotherapy Services

Contact these clinic locations for more information.

Clinic locations providing OHIP Covered Physiotherapy Services

 


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Chemong Physiotherapy
Lindsay Physiotherapy Services
Lindsay Rehab Health Centre
Trent Health in Motion
Peterborough Physiotherapy
& Sports Injuries Clinic
Lakefield Physiotherapy
& Foot Health Clinic
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