Publicly Funded Physiotherapy
Publicly Funded Physiotherapy may be accessible for some patients. Achieva Health has funding agreements with the Ministry of Health and Long Term Care that provides public funding for patients in Community Clinics who meet the eligibility criteria. Achieva Health also provides public-funded physiotherapy services to Residents in over 200 Long Term Care Homes across Ontario. No government funding currently exists for chiropractic care, massage therapy, nutritional counselling or massage therapy in Achieva Health Clinics.
Achieva Health Community Clinics
Publicly Funded Episodes of Care Goal
The Province is funding the delivery of Physiotherapy Services to eligible persons who have been referred to specified physiotherapy clinics by a physician or nurse practitioner. The funding must be used to assist persons who require physiotherapy assessment, diagnosis, and treatment provided at a community based ambulatory physiotherapy clinic.
Definition of Funded Physiotherapy Services
The Physiotherapy Services funded under this program are those physiotherapy services being assessment, diagnosis, and treatment to improve, develop or rehabilitate physical function and/or promote mobility when that function and/or mobility has been 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 judgment of a physiotherapist to perform and must be performed by either a physiotherapist or a physiotherapist support personnel who has been assigned the performance of the services in accordance with the applicable College of Physiotherapists of Ontario standards of professional practice.
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 judgment 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.
A referral from a physician or nurse practitioner is required for each episode of care prior to the initiation of services.
Patient Eligibility Criteria
To be eligible for the publicly funded community-based physiotherapy program, patients must, for each episode of care, be assessed by a qualified physiotherapist as experiencing acute episodes or worsening of symptoms that lead to decreased function or mobility and must also meet the other eligibility requirements of the program as follows:
- be insured under the Ontario Health Insurance Plan and referred by a physician or nurse practitioner based on an assessment that the person requires physiotherapy services and is within one of the following categories:
- aged 65 years and older;
- aged 19 years and younger;
- recently discharged as an inpatient of a hospital after an overnight stay and require physiotherapy for the condition, illness or injury for which the person was admitted to the hospital.
- be referred by a physician or nurse practitioner based on 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.
In addition, the person must not be concurrently receiving physiotherapy services for the same condition or diagnosis provided or funded by other Ministry of Health and Long-Term Care (ministry) or health system programs or through automotive insurance or the insurance plan established under the Workplace Safety and Insurance Act. Only patients who meet the eligibility criteria above and who are assessed on or after the effective date of the Agreement are eligible for treatment under the Program.
Achieva Health Provides Publicly Funded Physiotherapy to Residents in Long Term Care Homes
A Resident in LTC may qualify to access publicly funded physiotherapy services through Achieva Health provided they meet the eligibility criteria.
Definition and Goal of Publicly Funded Physiotherapy Services within the context of LTC (“Physiotherapy”)
Funded Physiotherapy Services are limited to those physiotherapy services being the assessment, diagnosis and treatment(s) provided to improve, develop or restore physical function (neuromuscular, musculoskeletal and cardio-respiratory systems) and/or to promote mobility and/or to prevent a decline in functional/clinical status when that function and/or mobility and/or clinical status has been lost or impaired or is at increased risk of decline as a result of de-conditioning, disease, pain, injury or surgical procedure.
Funded Physiotherapy Services are provided in accordance with a resident’s plan of care and assessed need for an episode of care and are of a level of complexity that requires the clinical knowledge, skills or judgment of a physiotherapist to perform and/or direct and supervise a Support Personnel to perform, which Support Personnel has been assigned the performance of the services in accordance with the applicable College of Physiotherapists of Ontario standards of professional practice.
Funded Physiotherapy Services do not include any physiotherapy services provided after the physiotherapist determines that: the therapeutic objectives in the treatment plan have been achieved; or, any further gains could be achieved through a general exercise class or other services as identified in the resident’s plan of care; or, no further gains are achievable.
Resident Eligibility Criteria
The resident must have a referral either from a physician or nurse in charge.
Physiotherapy Funding can only be used for Physiotherapy provided on a one-on-one basis to any resident:
- who is assessed as requiring physiotherapy;
- whose plan of care sets out the physiotherapy services to be provided to the resident; and
- whose plan of care sets out the therapeutic goals that these services are intended to achieve and includes directions to staff and others relating to these services (s. 6 of the LTCHA), including frequency, intensity and duration of services required to achieve predetermined milestones or goals of care.
If you have questions about accessing publicly funded physiotherapy, or would like further information on whether you qualify for publicly funded physiotherapy services, please contact us by phone at 416-489-8888 or by email at firstname.lastname@example.org.