SOMB retroactive increases coming this week

December 6, 2018

Dear Members:

This fall, we have been moving forward on making payments owed to physicians under our Amending Agreement. The AMA issued the 2017 Retention Benefit payments on Friday, November 2. Today I’m writing to provide you with some dates and details about the retroactive payments for the Schedule of Medical Benefits and Alternative Relationship Plans cost-of-living adjustment.

Most of the payments will be made on December 7, including:

• Fee-for-service retroactive payments, covering the April 1, 2017 – March 31, 2018 fiscal year, as well as the April 1, 2018 through October 31, 2018 period, for claims submitted as of November 9. Retroactive amounts will be based on the section allocation percentages given in Appendix A (below).
• ARP payments, also covering the April 1, 2017 – March 31, 2018 fiscal year.
• Rural Remote Northern Program payments, covering the 2017-18 fiscal year. Note that total RRNP payments for that fiscal year, including the retroactive amount, are capped at $60,000 maximum per physician. Physicians who have previously received less than the capped amount can expect to receive up to a 1.05 percent retroactive payment.

We understand that retroactive Business Cost Program payments for 2017-18 will be delayed for at least one additional week due to some delays with processing BCP data. These will also be paid at 1.05 percent.

Sometime around May 2019, a final retroactive payment will settle any remaining amounts payable to physicians. We need to wait until May for a couple of reasons:

• To allow for 180 days to ensure claims for all services provided before November 1 are paid retroactively.
• To allow for year-end reconciliation of ARP full-time-equivalent numbers, using rates identified in Appendix B (below), as well as RRNP maximum benefits.

The final retroactive payment will address all residual fee-for-service, ARP, Business Cost Program and Rural Remote Northern Program retroactive amounts. It will also address any retroactive amounts from the SOMB amendments listed below.

Further details regarding these payments are contained in Alberta Health’s latest bulletin.

In January: Correction to four fee codes

Please be aware that a system error in the AMA’s process of allocating fees has affected the pricing of the following four fee codes:

03.03E	Periodic chronic care visit to a long-term-care patient.
03.03EA	Visit to a long-term-care patient in association with a special callback.
03.05O	Direct management, reassessment, education and/or general counselling of patient with chronic pain.
08.11B	Evidence from a psychiatrist at a review panel on behalf of a specific patient, as required under section 37(3) of the Mental Health Act.

Instead of being increased, these fee codes were inadvertently decreased.

At the AMA’s request, the trilateral AMA/AH/AHS Management Committee has agreed to correct this issue as soon as possible. Given the time required to create a Ministerial Order to adjust rates in the SOMB, we anticipate the corrected fees will be in place within approximately eight working weeks. Retroactive amounts will be reimbursed to physicians for the difference on services billed using these four codes between November 1, 2018 and the date of the new Ministerial Order.

We apologize for any inconvenience these errors may have caused and we have taken steps to ensure this does not happen again.

The SOMB update will also include some (minor) amendments to the SOMB. These items will be communicated via an Alberta Health bulletin at the time of the Ministerial Order change.

If you have any questions regarding either the retroactive payments or the SOMB corrections/amendments, please contact our Health Economics Branch:

• Jim Huston, Assistant Executive Director, Health Economics
  jim.huston@albertadoctors.org
• Allan Florizone, Senior Advisor, Health Policy and Economics
  allan.florizone@albertadoctors.org

Warm regards,

Alison M. Clarke, MD, CCFP, FCFP
President