Communiqué 571 | Framework Agreement with MSSS: Official signature and start of RAMQ payments to participating dentists

Following ratification of the Framework Agreement by the Treasury Board and the Minister of Health and Social Services (MSSS), we are finally pleased to announce that the Régie de l’assurance maladie du Québec (RAMQ) will be initiating the lump sum payment process over the next few days.

Obviously, we are greatly disappointed by the complexity and length of the process. In fact, following the adoption of the Agreement in principle on October 5, 2022, we had to revise certain points that had already been agreed at the negotiating table, giving rise to lengthy discussions around the facts that had already been presented to you and on which you had voted. After many months of discussion, we were ready to sign the texts of the Agreement at the beginning of May 2023. We have invested a great deal of time and energy in moving this dossier forward as quickly as possible, and we have made numerous representations to government bodies to speed things up, but to no avail.

As for the lump sum reimbursement process, remember that these payments relate to the public dental plan, which covers a period of just over 8 years. They will be paid in two instalments:

• A first retroactive payment from April 1st, 2015, to March 31, 2022,
• A second payment for the period from April 1st, 2022, to the date of implementation of the new fee schedule (to be confirmed by RAMQ).

To help you understand how this agreement applies to you, read the terms and conditions of the Framework Agreement (in French).

PARAMETERS OF THE FRAMEWORK AGREEMENT

Fee-for-Service Dentists
For fee-for-service dentists, the cumulative rate increase is 32.5% on April 1, 2022.

Fixed-Fee and Hourly-Rate Dentists
The Framework Agreement provides for a cumulative increase on April 1st, 2022, of 18%, as well as the introduction of new premiums, effective on August 27, the first Sunday following the signature of the Agreement by all parties.

A bonus of 4% of fees will be granted to people who work a total of 35 hours weekly, and a bonus of 2% to those who work a period of 28 hours or more, but less than 35 hours, weekly.

Please note that a lump sum of 1% will be paid for the period from April 1st, 2015, to March 31, 2016.

Dentists Practicing in the Northern Region
Incentives have been adjusted in line with those offered to other professionals in the healthcare network, such as transportation and food expenses, housing, and phased retirement. In addition, Northern dentists holding an appointment may bill thirty-five (35) hours per week without being subject to the seven (7) hour daily limit on weeks when an outbound or inbound trip is made.

Since April 1st, 2015, retroactive payments on remoteness or isolation premiums have been planned for dentists working in the remote regions defined in the Agreement. Retroactive lump sum amounts for resourcing or professional development stays also apply.

TWO-PART PAYMENT METHOD

For the period from April 1, 2015, to March 31, 2022, payments will be made to the dentists who performed the procedures, RAMQ will pay 100% of the retroactive amounts due to the dentists who performed the procedures. A few weeks after this payment, RAMQ will send you, by secure email, a report in which you will find details of the retroactive payments made to you, broken down by account and by year. This delay is necessary to make the technological changes required to comply with the ACDQ's request. This report will be sent only to dentists who claim fee-for-service, for services rendered in the office or in a facility.

• The first instalment will be made no later than 30 days following the date of signature of the Framework Agreement.

For the period April 1, 2022, to the date of implementation of the new fee schedule, RAMQ will adjust the rates in its remuneration systems. Payment will be made to the account where the service was initially paid for by RAMQ, either the personal account of the dentist who performed the treatment or that of the dental clinic.

• The second instalment, covering the period between April 1st, 2022, and the implementation date of the new fee schedule, will be paid no later than 60 days following the date of signature of the Framework Agreement.

To help you with this process, we've produced a set of frequently asked questions and a reference document setting you in situation.

Further details:

• For the period starting April 1, 2023, to date, the Framework Agreement has not been negotiated. However, you will receive a retroactive amount with your second payment, representing the difference between the rates of the current fee schedule and the new fee schedule (i.e., a difference of 32.5%) for procedures paid for the period from April 1, 2023, to the implementation date of the new fee schedule.
• Payment dates will be indicated in the RAMQ newsletter.
• You are responsible for updating your information in your RAMQ file. It is very important to make the necessary updates before the RAMQ issues the payments.
• Neither the RAMQ nor the ACDQ can intervene or advise you in fee-splitting discussions on retroactive payments, since these are personalized, private agreements between dentists.
• In the event of a discrepancy between the amounts paid by the RAMQ and your calculations, we invite you to contact the RAMQ directly to better understand the reasons for the discrepancy. The ACDQ does not have access to your RAMQ data, since it is confidential, and cannot substitute itself for the paying organization.
• Finally, as mentioned last December 2022, the ACDQ will promptly destroy all the non-participation forms you have sent us in the past.

Managing a RAMQ-orchestrated process with its share of challenges
Given the complexity of the issue, the ACDQ has made representations to the RAMQ to implement measures to facilitate the analysis and processing of payments by dentists. The RAMQ listened to our requests and worked with us to implement a process that is a little more helpful. However, we know that combining income repayments with professional relationships that go back over eight years is not without its challenges.

We appeal to the spirit of cooperation and professionalism of each and every one of you to ensure that the settlement of these long-earned revenues is carried out diligently and in good faith. We will continue to keep you informed throughout the process, answering your questions and, if necessary, clarifying certain points of interest to all dentists participating in RAMQ.

Carl Tremblay, DMD
President