|
Manitoba

Manitoba Health, Seniors and Active Living

Set text to smallest size Set text to normal size Set text to larger size Set text to largest size
Primary Care Home Clinic - graphic

Comprehensive Care Management Tariffs - Frequently Asked Questions

The purpose of this list of Frequently Asked Questions is to provide fee-for-service family physicians and Home Clinics information on the Comprehensive Care Management (CCM) Tariffs. The CCM Tariffs are tightly linked with becoming a Home Clinic and enrolling patients.  For further information on Home Clinic and patient enrolment, please refer to the Manitoba eHealth website. The Manitoba Health, Seniors and Active Living and Manitoba eHealth websites provide complimentary information to help guide clinics on how to become a Home Clinic and also become eligible to claim the CCM tariffs.

1. What are the Comprehensive Care Management (CCM) Tariffs?

There are five CCM tariffs available as of April 1, 2017 to eligible physicians for the annual management of primary care for enrolled patients in the following categories:

  • Patients between 50 and 74 years of age without a chronic disease
  • Patients 75 years of age and over without a chronic disease
  • Patients diagnosed with one Chronic Disease
  • Patients diagnosed with two Chronic Diseases
  • Patients diagnosed with three or more Chronic Diseases

For the purpose of the CCM tariffs, “Chronic Diseases” shall be Diabetes, Asthma/COPD (COPD is only eligible as of April 1, 2018), Congestive Heart Failure, Hypertension, and Coronary Artery Disease.

2. What are the eligibility requirements to be able to claim the CCM Tariffs?

Manitoba Health, Seniors and Active Living has developed a web-based enrollment portal to be used for enrolling patients. This portal is called the Home Clinic Portal. Clinics that enroll patients are called Home Clinics.

Manitoba's Home Clinic Criteria aligns with the conditions associated with the Comprehensive Care Management tariffs. It also aligns with the College of Family Physicians of Canada: A Vision for Canada: Family Practice: The Patient's Medical Home. We recommend you review the Home Clinic Criteria and the CCM Tariff Rate table prior to registering as a Home Clinic.

Full details on the CCM tariffs including eligibility and other requirements will be published in the Manitoba Physician’s Manual on April 1, 2017. Prior to April, the new tariff numbers and tariff descriptions can be found on MHSAL’s Claims Processing System (CPS) webpage.

3. Why do the CCM tariffs require that physicians claiming them belong to a “registered Home Clinic”?

In 2011, The College of Family Physicians of Canada released the report, “A Vision for Canada: Family Practice – The Patient’s Medical Home.” The goals and recommendations in this report have been a key factor in setting the strategic direction for MHSAL Primary Health Care policies and planning around My Health Teams and Home Clinic Implementation, including recommendation 10.5 that states “Blended payment models should be introduced in every province / territory as a preferred option for remunerating family physicians in practices functioning as Patients’ Medical Homes.”

CCM tariffs support comprehensive care, which is different from episodic care. Home Clinics agree to provide comprehensive, coordinated and continuous care to their patients and enrolment is the process whereby the provider/clinic and the patient recognize and agree to this on-going relationship. The CCM tariffs are designed to support the coordination efforts required by the fee for service family physician in providing comprehensive care, recognizing that the interprofessional care team may be providing some of the hands-on delivery of care, which is another principle of the Home Clinic.

Note 2 of the CCM Tariff states:  Tariffs may only be claimed by physicians who provide comprehensive care to enrolled patients and who have provided Manitoba Health Primary Care Branch with the location of the Home Clinic (address and contact information), and number and types of practitioners providing services at that location. Eligible physicians who choose to claim the CCM tariff will meet the clinic contact and provider information requirement by using the Home Clinic Portal to register their clinic as a Home Clinic, and by keeping the contact and provider information for their Home Clinic up to date.

4. What is involved in “registering” a Home Clinic? 

To register as a Home Clinic, the clinic/practice must first agree to the conditions outlined by MHSAL, which are aligned with the conditions of the CCM tariff, and, if agreeable, the clinic can then register with MHSAL as a Home Clinic. The initial criteria to be a Home Clinic align with the requirements outlined in the CCM tariff rate table. Information on Home Clinics and the Home Clinic registration and patient enrolment processes can be found at the Home Clinic Registration webpage.

5. Why can CCM tariffs only be claimed for patients who are “enrolled”? 

Enrolment is defined as the process by which a patient agrees to be registered to the Home Clinic as their main provider of primary health care and the Home Clinic agrees to provide comprehensive, continuous primary care and to coordinate with other providers as per the Home Clinic definition.

When a patient is enrolled with a Home Clinic, a Most Responsible Provider (MRP) is linked to the enrolled patient. The MRP is the provider who has the lead role and medico-legal responsibility for overseeing the patient’s care needs throughout their lifespan. The MRP provides ongoing, comprehensive primary care, including ongoing coordination with other health care providers, respecting management and monitoring of patient condition(s) and the patient care plan(s) and providing ongoing communication with the patient.  A patient can have only one MRP at any point in time.

Most Responsible Providers (MRPs) will support the whole patient, not just illness, and they will focus on wellness, not just treatment.  MRP’s will emphasize health promotion, chronic disease prevention and risk reduction, early detection of health problems, self-care, and evidence-informed chronic disease management, including mental illness, and will develop patient-centred strategies to ensure patients can make informed choices and are partners in care planning and management.

The tariff is not intended for episodic care provided by a clinic or a provider, and is therefore reserved for the family physician who is the one MRP for a patient.

6. How are patients “Enrolled”?

Patients may be enrolled using one of two methods: Active or Passive enrolment.

Active patient enrolment directly involves the patient in the enrolment decision. The process involves direct communication with the patient, and ensures their understanding of the benefits of Home Clinic enrolment. The communication also clarifies the responsibilities of both parties - the Home Clinic and the enrolled patient. When an active enrolment occurs, and there is an enrolment agreement, the date of the active enrolment is documented in the EMR as the Enrolment Start Date. An active enrolment communication can occur with new or existing patients, and also with patients who were initially passively enrolled. Review our active enrolment supports for Home Clinics.

Passive enrolment does not involve communication with the patient. Candidates for passive enrolment are identified by the Home Clinic through analysis of data within their Electronic Medical Record (EMR) system. Review our tips for this analysis before you get started.

Click for information on submitting your enrolment data.

7. What if I cannot get all my patients enrolled by April 1, 2017?  Does this mean I cannot claim CCM patients until a year later? 

Tariffs are payable only to the physician who has provided the patient ongoing comprehensive primary care during the preceding 12 months.  The CCM tariff is payable if:

  • the patient is enrolled at the time of claiming the CCM tariff and;
  • the physician has provided the patient with ongoing comprehensive primary care during the preceding 12 months, even if the patient has not been enrolled for the full 12 month period.

8. If a patient declines to enrol with the Home Clinic, can a fee-for-service family physician still claim the CCM tariff?

No. CCM tariffs may only be claimed for enrolled patients for whom the fee-for-service family physician has provided the patient ongoing comprehensive primary care during the preceding 12 months.

9. Why did MHSAL introduce the Comprehensive Care Management (CCM) tariffs?  How are these substantially different from the CDM tariffs?  Why do we have both?

The CCM tariffs are a component of the evolution towards the College of Family Physicians of Canada’s (CFPC) vision of the Patient’s Medical Home. MHSAL recognizes that coordinating care for more complex patients with multiple chronic conditions takes additional effort.  The purpose of the CCM tariffs is to support physicians in the provision of care to complex patients to promote continuity, comprehensiveness, coordination, access, and patient centered care.

The tariffs also encourage the use of interprofessional teams to support this care and promote preventative care to help patients stay well. Additionally, the requirement of an Electronic Medical Record (EMR) promotes the use of EMRs to support planning, evaluation, and continuous quality improvements.

There will be a transition period as clinics adopt the Home Clinic model. The CCM and CDM tariffs are both available to allow for this transition period.

10. Can I claim both a CDM tariff and a CCM tariff when I provide all the required care for a patient with a chronic disease? 

No. The CCM tariffs can only be claimed once per patient during any twelve month period and cannot be claimed in combination with any other comprehensive care tariff including the CDM tariffs.

11. Can I claim a CDM tariff for one condition and a CCM tariff for a different condition, for the same patient? 

No. The CCM tariffs can only be claimed once per patient during any 12 month period and cannot be claimed in combination with any other comprehensive care tariff including the CDM tariffs.

12. What if I submit a CCM tariff on a patient and another physician has already claimed a CCM tariff for that patient?

If a CCM tariff has already been claimed for that patient by another provider, the second CCM tariff in the 12 month period will be rejected. Providers will have the opportunity to query the rejected claim through the Informal Resolution of Disputes process detailed in the Claims Submission and Payment Procedures section of the Manitoba Physician’s Manual. The requirement that a CCM claim can only be made for patients who were enrolled to the claiming provider’s Home Clinic at the time the claim was made should reduce these conflicts. In the event that conflicts do still arise, preference will be given to the provider who is either documented as the Most Responsible Provider, or who provides evidence that they have provided the majority of continuous, comprehensive care to the patient as it relates to prevention and chronic disease management.

13. What type of documentation will be required to support CCM claims?

Physicians must use an EMR and document enrolment status and medical services consistent with the applicable indicators in the Manitoba Primary Care Quality Indicators Guide in the EMR. 

Physicians must provide periodic data extracts to MHSAL in a provincially-approved format, through a secure data transport mechanism. While you do not need to use a certified or approved EMR product, your EMR must be able to produce the Primary Care Data Extract. For more information on the Primary Care Data Extract, please refer to the Manitoba eHealth EMR Certification site.

14. My clinic focuses exclusively on walk-in care. Am I eligible to claim CCM tariffs?

No. The focus of the CCM tariffs is for clinics that provide comprehensive, patient centred care, and not on episodic care. Clinics, such as QuickCare or fee-for-service walk-in clinics that only provide episodic care would not be eligible.

15. What if I submit a CCM tariff on a patient and another physician has already claimed a CDM tariff for that patient?

If a CDM tariff has already been claimed for that patient by another provider within the last 12 months, the CCM tariff will be rejected. Providers will have the opportunity to query the rejected claim through the Informal Resolution of Disputes process detailed in the Claims Submission and Payment Procedures section of the Manitoba Physician’s Manual. Priority will be given to the Home Clinic to which the patient is enrolled, and to the Most Responsible Provider, that is the provider who provides patient-centred comprehensive care including prevention and chronic disease management.

16. What if I submit a CDM tariff on a patient and another physician has already claimed a CCM tariff for that patient?

If a CCM tariff has already been successfully claimed for that patient by another provider within the last 12 months, the CDM tariff will be rejected. Providers will have the opportunity to query the rejected claim through the Informal Resolution of Disputes process detailed in the Claims Submission and Payment Procedures section of the Manitoba Physician’s Manual. Priority will be given to the Home Clinic to which the patient is enrolled, and to the Most Responsible Provider.

17. If I register as a Home Clinic, does that mean that I am not eligible to claim a CDM tariff for any of my patients and that I must claim the CCM tariffs or nothing?

No. Once registered as a Home Clinic, you will have the option to choose between the CCM and the CDM tariff for each patient. Both tariffs are available to provide a transition period as clinics adopt the Home Clinic model and enrol patients. The intent of the CCM tariff is to ensure that the Most Responsible Provider is appropriately compensated for ensuring their enrolled patients are receiving comprehensive care including prevention, and recognizes the complexity in managing care for patients with more than one chronic condition.

Contact Us at:

Primary Health Care Branch
1090-300 Carlton Street
Tel:  204-788-6732
Fax: 204-943-5305
Email:  phc@gov.mb.ca