According to the Funding Agreement, practice group partners are responsible for preparing practice budget for submission to their transfer payment agency (TPA). The budget submission includes a request for approved courses of care (billable courses of care (BCC) and caseload variables (CV), schedules, disbursements and grants (e.g., leasehold improvements). Practices should also develop an internal budget to plan how they will spend the income (e.g., how much on rent, staffing, supplies).
There may be some variation year-to-year regarding TPA-MPG budget submission timelines, but generally budget packages are sent to practices in December or January for submission to the TPA and Ontario Midwifery Program (OMP) a month later for the upcoming April 1 to March 31 fiscal year.
The TPA reviews the submitted proposals and creates an overall budget for all of the MPGs it administers, which it submits to the TPA. The OMP uses the business cases and rationales submitted by TPAs with their annual budget proposals to examine and determine how it will distribute funds; these factors include the overall OMP budget, health planning by region, existing midwifery and obstetrical services provided by midwives, demand for midwifery services, and the capacity of the community to absorb an increase in midwifery service.
The Funding Agreement is a three-year contract that requires MPGs to submit an annual budget as well as their two year caseload planning numbers. This budget includes requests for billable courses of care (BCCs) as per Schedule “C” of the agreement, caseload variables (CVs) as per Schedule A, and disbursements and grant monies as per schedules “D” and “G” respectively. In the budget process, practices can also estimate services provided for physician patients (Schedule O). It also contemplates expanded models and disability accommodation through Schedule “Q” and far north practice supplements through Schedule "P".
The Funding Agreement includes each of the types of funding addressed below.
In their annual budget, practices propose how many clients they will bill for in the following year (i.e., the number of courses of care) and the number and type of caseload variables. The budget that is subsequently approved by the TPA is how much the practice can actually bill for within that fiscal year.
Within the limits of an approved budget, care provided to a client is billable if:
- the client lives within the catchment area or where pre-approval of the TPA was received; and
- either 12 weeks of midwifery care was provided to the client OR the midwives attended the client’s labour and birth.
Caseload variables MUST be pre-approved through the budget cycle. They are intended to compensate practices for not taking a client into care because they have had to do other work, and include:
- “Special” populations
- Non-clinical hospital work
- Travel in large and remote areas
- Supervision or mentorship of NR
- Hospital integration issues
- New practice group
For each approved course of care that the practice bills for, it will receive the following (according to schedules “A” and “C” of the Funding Agreement):
- Experience fee and on-call fee
- Secondary care fee
- Experience fee for rural and remote supplements
- Operation fee portion of BCC and CVs that are approved and for which the practice projects to invoice the TPA
- Operation fee supplement for small rural and remote practices
Further information on caseload budgeting coming soon.
The Funding Agreement also provides funding for certain disbursements. These purchases generally do not require receipts to be retained for TPA purposes (with the exception of benefits and professional liability insurance) and can be used according to the midwife’s or practice’s discretion. However, receipts are needed for tax purposes. Disbursements include:
- Travel portion of BCCs and CVs the practice projects to invoice the TPA (intended for distribution to the midwives), which varies according to the formula in the Funding Agreement.
- Home birth supplies and reprocessing funding per planned or actual home birth, to ensure there is no financial disincentive to home birth to clients or midwives because of the additional costs involved.
- Clinical equipment for midwives funding is directed to each midwife for the purposes of replacing or acquiring clinical equipment necessary for the provision of midwifery care. Such equipment remains the property of the individual midwife. Funding may be used for purchase, lease or repair of equipment and furnishings. In an August 2018 memo, the OMP clarified that "TPAs do not require routine submission of supporting receipts and invoices" for this funding. Instead, an annual "letter of attestation" will be adequate.
- Clinical and office equipment and furnishings funding is directed to the MPG for the purposes of acquiring equipment and furnishings for the provision of midwifery services in the clinic or for sharing by multiple midwives. Funding may be used for purchase, lease or repair of equipment and furnishings. Such items remain the property of the MPG.
Second attendant supplements, for MPGs that meet the criteria, may receive disbursements for the cost of procuring second attendants, such as paying for them to be on call, in addition to the availability of the Secondary Care Fee for attendance at births.
Administrative support: $20,000 annually for MPGs with 120 approved courses of care or fewer; or $10,000 for practices with approved courses of care between 121 and 160.
Malpractice liability insurance expense funds for practicing midwives.
Benefits contribution equal to 20% of the experience fee, on-call fee, retention incentive, secondary care fee and experience fee rural and remote supplement and far north retention premium, paid to the practice and then to the AOM Benefits Trust.
Grant monies are provided by the ministry for use on items/services approved by the Ministry. Grant monies must be accounted for, thus MPGs must retain receipts for review by their TPA if requested. The reimbursement for grants will be equivalent to the actual expenditures in relation to the grant item, or less if the expenditures exceed the approved grant amount. Practices need to keep track of grant purchases because funding must be directed to the approved items within the budget year and cannot be used in the practice's general pool of operating funds or carried forward.
Grant items include:
- New registrant equipment, which remains the property of the individual midwife.
- Special practice group equipment and furniture, which MPGs apply for grant by demonstrating that they could not reasonably afford such items with their disbursement.
- Accommodation funding to support midwives with disabilities, where such items or services are not covered by the insurance plan(s) and not affordable within the MPG’s budget allocation. Non-fixture equipment remain property of the individual midwife.
- IT equipment replacement funding available in each year of the three-year contract. Funding may be used for leases, licenses, repairs or server solutions. Although a midwifery specific electronic medical record (EMR) has been proposed by BORN, EMRs are currently not funded by the OMP.
- Infection prevention and control improvements, equipment and training.
- Minor and major leasehold improvement grants (as per Schedule “G”), which can be requested mid-year when it has not been possible to anticipate the need at time of budget submission.
For information on new midwifery practice group budget planning and submission, refer to Start a New Clinic