Skip Navigation Links.
 Management and monitoring of patients without a family physician who are enrolled in CSSS access registries
29 Nov 2011


The FMOQ and the MSSS recently signed the Letter of Understanding No. 245. Under the terms of this letter, and as of November 1, 2011, doctors who agree to take on a patient with no family doctor and who is enrolled in a CSSS access registry for “orphan” clients will be entitled to the payment of an additional amount as follows:


  • vulnerable patients: a lump sum payment in the amount of $208.60 for care provided in practices and in the amount of $173.80 for care provided in institutions (CLSC or FMU). The amount is paid when registering on the occasion of an examination or therapy;
  • non-vulnerable patients: a lump sum payment in the amount of $100 for care provided in practices and in the amount of $83 for care provided in institutions (CLSC or FMU). The amount is paid when registering on the occasion of an examination or therapy.


These amounts, which are only paid if the new patient has already been enrolled in a CSSS access registry for “orphan” clients, are added to those already paid under the agreement on family medicine, patient management and patient monitoring services.

In both cases, the registration giving rise to the payment of the amount must be made at a date after the date of referral by the medical coordinator. Registration on behalf of the treating physician must be performed in the following currently allowed settings: private practice, FMG, network clinic, CLSC, FMU or a patient’s home if, in the latter case, it is the primary monitoring setting.

The medical coordinator of the access registry will provide the following information to the physician who agrees to manage and monitor a patient with no family doctor:


  • the referral date
  •  patient identification
  • the patient’s health insurance number
  • relevant clinical information
  • the patient sequence number
  • the CSSS establishment number


Please note that the RAMQ may recover from the doctor half the additional amount paid if, within 12 months of the date of registration: 


  • the doctor voluntarily modifies his or her practice and ceases to manage and monitor patients;
  • the doctor moves his or her practice and deems that he or she is no longer able to provide the management and monitoring of registered patients.


In the two cases above, the physician must notify the RAMQ within 90 days of the change of circumstances. Patients cease to be registered under his or her name as of the date of the modification of the practice. The recovery process described above does not, however, affect any physician’s ability to use the procedure for reinstatement of registration if he or she considers that it was wrong for another physician to register his or her patients.

Please also remember that a patient may ask the registry’s medical coordinator to be registered with another doctor, if necessary, due to incompatibility or lack of access to the services provided by the doctor to whom the patient was initially assigned through the registry. The coordinator will assess patient requests and advise the RAMQ. If necessary, the RAMQ will recover half of the additional amount paid to the first doctor.

It is also important to underscore the fact that the medical coordinator will be responsible for verifying that the management and monitoring of clients referred to a physician are, in fact, being done by the physician in the event that more than 100 patients have been referred. The FMOQ and the ministry have also agreed to the joint development of a management guide that will allow coordinating doctors to effectively achieve the objectives of this agreement. In particular, questions regarding the prioritization of these clients, self-referral and the number of patients referred will be addressed in order to ensure that the measures in place facilitate the achievement of the goals originally established by the parties.

Finally, it is very important to remember that the RAMQ will not be able to process the billing of these supplements before the end of the year. A doctor who sees a patient for whom he or she has obtained, prior to the visit, a referral date and a sequence number must, for the time being, bill only the services provided, the general registration and, where appropriate, the FMG registration, the registration of vulnerable clients and the supplement for vulnerable patients. The doctor must defer the billing for the supplement for the referral of a patient from an access registry. To be able later to later claim this supplement, it is mandatory that the physician keep all the relevant information for each patient that he or she takes on through an access registry, whether the patient is vulnerable or not, as of November 1.

When a doctor, during a visit (with or without appointment), identifies an “orphan” patient, that he or she is ready to take on, and sees that the patient is not registered with an access registry, the doctor may direct the patient to the access registry so that the patient can register to obtain a referral from the medical coordinator. During the first visit, the doctor must only bill the RAMQ for the examination or medical procedure performed. Later, during a subsequent visit, the doctor may complete the required registration and follow the aforementioned procedures for billing.

The newsletter published by the RAMQ on October 27 explains that all the administrative information necessary for the proper implementation of this agreement will be announced in the near future.