The below list includes the various Blended Capitation Program forms you may need to complete as you apply to or participate in the Model.
All forms can be completed online to make the process as straightforward and efficient as possible. The forms are designed to minimize administrative burden while ensuring all necessary information is captured accurately.
Should you have any questions or require assistance with any of the forms, please contact Jason Clarke at FPRP (jclarke@nlma.nl.ca).
Please refer to the Family Practice Renewal Committee (FPRC) Policy on the Blended Capitation Group Model for additional information and policies pertaining to the Model.
Family physicians, who are interested in participating in the Blended Capitation program, must submit an expression of interest. At this point, the intent is to capture interested physician names and contact information, to facilitate follow-up at a later date. Please note this form is an expression of interest only and represents an ongoing process—there is no deadline for submission. To submit your expression of interest, please complete the form below.
For the first two years of the program, groups that already provide regular, ongoing provision of services to the NL Health Services, such as hospitalist services, primary care services for unattached patients, hospital emergency room coverage, anesthesia services, obstetric services, and long-term care services, will be permitted to redistribute their after-hours service obligations to the Group’s nurse practitioner (NP) or, if the Group has not hired an NP, to seek an exemption from the Blended Capitation after-hours requirement.
Groups may apply to the FPRP to determine if members of the group qualify for exemption by completing this form. For a physician to qualify, they must be providing at least two hours of the types of services described above to NLHS for every one hour of after-hours BCM service exempted or redistributed. Groups that do not provide any of the types of services outlined above do not qualify for the exemption/redistribution.
This exemption will be in effect until August 31, 2025.
If patient care is not covered for a period of leave longer than 30 days, then capitation payments will be paused as of day 31 of leave until the physician resumes their practice. In these cases, physicians are to notify FPRP in writing in advance of the dates of the leave period by submitting this Extended Leave Form.
Please complete this form a minimum of 14 days before Day 1 of your leave. This will help ensure incorrect payments are not issued by MCP and that the payments will not need to be re-collected.
If your leave is unexpected and you are unable to provide 14 days’ notice, please contact the Blended Capitation program specialist, Jason Clarke jclarke@nlma.nl.ca as soon as possible.
Participation in the Blended Capitation Model (BCM) is voluntary, and physicians may discontinue their enrolment by submitting a Blended Capitation Withdrawal Form. Please complete this form and submit to FPRP at least 30 days in advance of your last day billing in the Blended Capitation Model. Once a Withdrawal Form is received by FPRP, the withdrawing physician will be contacted within 30 days with instructions concerning the return of any owing amounts for pro-rated grants and stipends.
If a Blended Capitation Group hires or contracts a Nurse Practitioner (NP) or Registered Nurse (RN) to provide team based primary care within the Group, up to 900 patients per NP and up to 600 patients per RN may be added to the total roster of the Group. There is no cap on the number of NPs or RNs that may be added to a Group, but the total roster addition associated with NPs and RNs is capped at 3000 additional patients for the BCG.
The Group shall promptly notify the FPRC when a NP or a RN joins a Group and advise which physician(s) the extra allocation of rostered patients will be assigned for billing purposes.
Further, the Group shall promptly notify the FPRC when a NP or RN departs a Group so the extra allocation of rostered patients associated with the NP or RN can be removed from the physician(s) roster cap.
Please use the forms below for notification purposes.