Quick answer
The simplest distinction is that FHO+ adds time-based compensation to the existing FHO foundation. It also changes blended fee-for-service and after-hours premiums, ends the former access-bonus/outside-use arrangement and introduces new practice-management considerations.
What stayed familiar
FHO+ did not discard the entire FHO model. The OMA states that capitation payments remain. Practices still need accurate enrolment, service and claims workflows, and ordinary fee-for-service or shadow-billing rules continue to matter alongside the new hourly layer.
Side-by-side comparison
| Topic | Before FHO+ | Under FHO+ | Workflow implication |
|---|---|---|---|
| Physician time | No Q310A–Q313A hourly-code framework | Four codes for defined direct, indirect and clinical-administration work | Track actual eligible time by date and category |
| Most in-basket BFFS | 19.41% | 30% from April 1, 2026 | Continue accurate underlying service claims |
| After-hours premium | 30% on eligible Q012 claims | 50% on relevant eligible codes | Confirm the service and Q012 meet current requirements |
| Access bonus/outside use | Outside use could reduce access-bonus payment | Access-bonus payments and outside-use deductions ended | Do not assume continuity expectations disappeared; use current FHO+ accountability guidance |
| Comprehensive care capitation | CC cap payments were part of the model | Payments ended April 1, 2026, with a defined reconciliation period | Keep prior-period reconciliation separate from the new workflow |
| Group leadership | Existing GMLP | Enhanced GMLP added for contract-compliance leadership | Clarify ownership for group-level obligations |
The biggest practical change: time becomes a billing input
The hourly codes introduce a chain of evidence that starts when the work occurs. A reliable process should answer five questions:
- Was the work personally performed by the physician and otherwise eligible?
- Which category describes the work?
- On what actual calendar date did it occur?
- How many minutes accumulated in that category that day?
- How did those minutes become the submitted units and fee amount?
This is why reconstructing an entire month from schedules or memory creates avoidable risk. The closer documentation is to the underlying work, the easier calculation and physician review become.
What FHO+ does not mean
Not every activity becomes billable
Eligibility remains defined. Examples excluded by OMA guidance include non-clinical clinic administration, uninsured services, work by other team members and care for non-rostered patients.
Not every category has the same limits
Combined daily and monthly limits apply, and Q312A/Q313A have additional ratio constraints. A calculator should not treat all minutes as interchangeable.
Automation does not replace approval
Software can organize activity and apply calculation rules, but the physician remains responsible for the claim and supporting record.
Where to go next
If you need the mechanics, use the Q310A–Q313A guide. If you are evaluating your current process, work through the documentation checklist or complete the free assessment.
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