Quick answer
FHO+ is a modernization of Ontario’s existing FHO model—not an unrelated payment model. Effective April 1, 2026, it added hourly payment codes for eligible direct and indirect care and clinical administration. It also increased the blended fee-for-service premium for most in-basket services to 30%, increased the eligible after-hours premium to 50%, and ended the former access bonus and outside-use deductions.
Why the change matters operationally
Traditional FHO workflows were built primarily around capitation, shadow billing and other defined payments. FHO+ introduces a second layer: the practice must identify eligible physician work, place it in the right hourly category, accumulate minutes by category and service date, apply limits and rounding, and retain enough information to reproduce the calculation.
That makes FHO+ more than a new set of codes. It is a daily documentation and monthly review workflow.
FHO compared with FHO+
| Area | Traditional FHO | FHO+ change |
|---|---|---|
| Core model | Capitation plus blended fee-for-service and other payments | Core capitation remains, with a modernized compensation structure |
| Eligible physician time | No equivalent four-code hourly layer | Q310A–Q313A recognize defined direct, indirect and clinical-administration time |
| Most in-basket services | 19.41% blended fee-for-service premium | 30% for services on or after April 1, 2026; check current Ministry guidance for services receiving a further increase |
| Eligible after-hours services | 30% premium | 50% premium on relevant codes billed with Q012 |
| Outside use | Could reduce the access bonus | Outside-use deductions and access-bonus payments ended April 1, 2026 |
See the complete FHO vs. FHO+ comparison →
The four FHO+ hourly-rate categories
Direct care: in person or video
Eligible direct clinical services for enrolled patients, including defined in-office virtual care and video care.
Out-of-office telephone care
Eligible telephone-based virtual care for enrolled patients when the physician is outside the usual practice setting.
Indirect patient care
Patient-specific eligible work without direct contact, such as defined charting, results review, referrals and care coordination.
Clinical administration
Qualifying non-patient-specific work requiring physician expertise for management of the roster or enrolled population.
Calculation support
Turn daily minutes into estimated Q-code units.
Codes are calculated in 15-minute units, accumulated by category across the calendar day. The Ministry says a remainder of eight minutes or more counts as another unit. Q310A, Q312A and Q313A have a base value of $20 per unit; Q311A has a base value of $17 per unit. Relativity adjustments may also apply.
A practical HYPEMedical workflow
- Find relevant activity.Use billing-cycle and roster information to identify a reviewable starting set of eligible activity.
- Classify and calculate.Separate the four categories, preserve actual service dates and calculate daily units using consistent rules.
- Apply controls.Check daily and monthly maximums, category ratios, exceptions and changes to source claims.
- Review before submission.Present the calculation and supporting record for physician review and approval.
- Retain a reproducible record.Keep enough detail to understand how a past day’s units and final claims were produced.
HYPEMedical is intended to reduce repetitive identification and calculation work while keeping professional judgement and physician approval in place.
Frequently asked questions
What is FHO+?
FHO+ is the name commonly used for Ontario’s modernized Family Health Organization model. Changes effective April 1, 2026 retained core FHO capitation while adding hourly payments for eligible direct care, indirect care and clinical administration, and changing several premiums and accountability mechanisms.
When did FHO+ take effect?
The Ministry’s principal FHO+ implementation and hourly-rate changes took effect April 1, 2026. Later Ministry bulletins may refine processing instructions, so practices should confirm the current guidance.
What are Q310A, Q311A, Q312A and Q313A?
They are the four hourly-rate fee codes for, respectively, direct in-person or video care, out-of-office telephone care, indirect patient care and qualifying clinical administration.
Are FHO+ hourly codes patient-specific claims?
The Ministry directs that the health number, version code and birthdate fields be left blank on hourly-rate claims. Practices still need supporting records that connect the claimed time to eligible physician work.
Does HYPEMedical decide whether a service is billable?
No. HYPEMedical can help organize eligible billing activity, calculations and review steps. Physicians remain responsible for determining eligibility, maintaining records and approving claims.
Official sources
Rules and processing instructions can change. Confirm current requirements before submitting claims.
- Ontario Ministry of Health INFOBulletin 260308: FHO+ implementations for April 2026
- Ontario Ministry of Health INFOBulletin 260309: FHO hourly-rate payments
- Ontario Ministry of Health INFOBulletin 260501: hourly-rate payment processing update
- Ontario Medical Association FHO+ resource centre
- Ontario Medical Association FHO+ hourly-rate guide