Clinical Alternative Relationship Plans (ARP)

Blended Capitation model

Blended Capitation ARP compensation is based on an annual amount per rostered patient plus a component of fee for service payment.

• Learn about the Blended Capitation Clinical ARP model
• Rates determined by patient panel complexity. Alberta Health offers financial modelling for your clinic if you are interested. Contact us at health.arpinfo@gov.ab.ca.

Establish a Clinical ARP

Establishing a Clinical ARP includes:

• developing an expression of interest
• developing an application
• developing the conditions of payment
• implementing the Clinical ARP

To establish a Clinical ARP, a physician group works with Alberta Health Services (AHS) to explore whether a Clinical ARP is an appropriate way to support the delivery of a service or program.

After both parties agree a Clinical ARP is worth establishing, the ARP Physician Support Services (ARP PSS) is contacted to help with the application process and create a framework.

A Clinical ARP framework defines:

• the program parameters which set out the general rules for all Clinical ARPs
• the conditions of payment for the specific Clinical ARP

The Clinical ARP framework supports transparency, equity, and consistency across the Clinical ARP program.

• Read the Clinical ARP Framework Explained document
• Read the Clinical ARP Program Parameters 2014

Initial development

The development of a Clinical ARP begins when AHS or a physician group identifies services that could benefit from a Clinical ARP, such as a service gap or existing services that struggle under the existing compensation structure.

At this point, physicians and AHS work with the ARP PSS to further explore whether a Clinical ARP is a good fit to meet the service gap or inadequacy.

If the physician group and AHS determine they want to pursue a Clinical ARP, ARP PSS staff help them develop an expression of interest.

• Learn how to apply for a Clinical ARP on the ARP PSS website

Access to data

To develop a Clinical ARP proposal, physician groups, AHS, and the ARP PSS might need access to related data, including data about the services currently provided by physicians who would become part of the Clinical ARP. A request for this data is made to the health ministry and AHS.

Once the required consent forms are received and approved, required information is provided throughout the development process.

The Freedom of Information and Protection of Privacy (FOIP) Act governs the disclosure of physicians’ personal information, including their billing information. In order to adhere to the FOIP Act and other applicable laws, the Alberta government requires physicians submit consent forms that authorize the Alberta government to disclose this information to the ARP PSS.

Expression of interest

An expression of interest is a short document that informs the Alberta government, AHS, and the ARP Physician Support Services (ARP PSS) that a physician group is interested in pursuing a Clinical ARP application, or expanding their current Clinical ARP.

The expression of interest includes basic information about the proposed Clinical ARP, including intended location, patients to be served, and program services to be provided.

• The expression of interest is not an exhaustive review of the proposed program.
• Download the Expression of Interest document (PDF, 173 KB)

Application

Once the expression of interest has been accepted, the physician group and AHS work with the ARP PSS and Alberta government staff to draft a Clinical ARP application.

The application includes detailed information about goals, program services, patients, service delivery model, practice management, governance, and non-physician professional support of the Clinical ARP.

• Download the Clinical ARP application template (PDF, 427 KB)
• Read the Clinical ARP application guidelines (PDF, 936 KB)

Conditions of payment

Once the Clinical ARP application has been accepted by all stakeholders, Alberta government staff draft the Clinical ARP’s Conditions of Payment (CoP). The CoP is based on the information in the application form.

Once the CoP is approved by all stakeholders, it is sent for approval under a Ministerial Order.

Clinical ARP operations

Service event reports

Service event reports are submitted via H-Link, similar to fee-for-service reports. Participating physicians use their ARP Business Arrangement (BA) when submitting, and can use codes from either the SOMB or the non-SOMB Schedule.

Sessional invoicing

Sessional Clinical ARPs submit their claims for benefits using the service event reporting tool. A time modifier is added to the health service code that records the amount of time spend on that service in 5-minute allotments.

Program service definitions (annualized models)

In order to calculate monthly full-time equivalents (FTEs), follow the Clinical ARP’s FTE definition. Clinical ARPs have an FTE definition in program service hours or program service days.

• The Clinical ARP’s FTE definition is on the first page of Schedule A in the CoP.
• The FTE definition may have 2 parts:
  • the FTE definition
  • a supplementary definition that provides further detail

Reconciliation (annualized models)

Payments are reconciled against FTE reports once a year. This reconciliation is done using the amount of FTEs identified in the CoP. The reconciliation takes into account any expansion that occurred during the fiscal year.

• Read more about the FTE Reconciliation Policy

Changing Authorized Representatives

To change the authorized representative for a Clinical ARP, submit a change authorized representative letter.

• Change Authorized Representative sample letter (PDF, 18 KB)

Locum Process

Clinical ARPs also compensate for program services provided by locum physicians by completing a locum registration form.

• Download the Locum Physician Registration Letter form (PDF, 1.6 MB)

The Alberta government does not have a direct role in obtaining, compensating, or otherwise managing locum physicians. Advice may be given to authorized representatives to assist them in these activities.

A Clinical ARP needing to terminate a locum physician must submit a Locum Physician Termination letter. (PDF, 1.6 MB).