Independent Health Facilities Act to be Repealed
In February, the Ontario government introduced Bill 60, also known as the Your Health Act, 2023 (the “YHA”), following the announcement of its plan to reduce patient wait times for surgeries, procedures, and diagnostic imaging by allowing private clinics to conduct more surgeries covered by the Ontario Health Insurance Plan (“OHIP”).[1] The YHA received Royal Assent in May. This means that, if proclaimed into force, the Independent Health Facilities Act (the “IHFA”) as well as the four regulations under the IHFA will be repealed and replaced by the new Integrated Community Health Services Centres Act, 2023 (the “ICHSCA”).[2]
The Ontario government publicly posted the proposed draft regulation to the ICHSCA on June 9, 2023 (the “Proposed Regulation”). The Proposed Regulation carries over the regulatory requirements that currently exist under the IHFA, with a few key differences.
This blog will provide a brief overview of the ICHSCA and highlight some key changes under the Proposed Regulation.
Current Regime
Currently, the IHFA regulates privately owned independent health facilities. These independent health facilities are able to perform some procedures that are insured and payable under OHIP, such as diagnostic imaging and surgical procedures. The Ministry of Health has created a Schedule of Facility Fees for Independent Health Facilities, as well as a Schedule of Benefits for Physician Services, which provide a list of services that are insured under OHIP.[3] Independent health facilities must be licensed under the IHFA, and cannot charge fees for insured services outside of the Schedule of Facility Fees.
New Regime
The ICHSCA regulates integrated community health services centres (“IHCs”), which will replace independent health facilities and are defined as follows:
(a) a health facility, including a community surgical and diagnostic centre, in which one or more members of the public receive services for or in respect of which facility costs are charged or paid; or
(b) a health facility, including a community surgical and diagnostic centre, or a class of health facilities, that is prescribed.[4]
All independent health facilities currently licensed under the IHFA will become IHCs under the ICHSCA when the ICHSCA comes into force.[5] The ICHSCA also provides that the Minister of Health may authorize a call for new IHC license applications by either:
(a) sending a call for applications to one or more specified persons; or
(b) publishing a call for applications to the public.[6]
Contemplating new licenses is a significant change, as no new licenses have been issued under the IHFA in many years.
Similarly to the IHFA, under the ICHSCA no person can charge or accept payment of a facility cost for or in respect of an insured service provided in an IHC unless the centre is operated by a licensee,[7] and IHCs cannot charge or accept payment from an insured person if they give the person a preference in obtaining access to the insured service.[8] The provincial government has indicated that the new IHCs would be able to provide a broader range of services covered by OHIP compared to independent health facilities.
Additional Requirements under the Proposed Regulation
The Proposed Regulation carries over many of the requirements that currently exist under the IHFA, but also imposes new additional requirements. These include the following:
Posting Requirements: The Proposed Regulation will add a requirement for licensees to post a list of prices for all uninsured services that a patient may choose to purchase. The licensee must post this on their website. If they do not have a website, it must be posted in a conspicuous place at the licensee’s IHC.[9] Additionally, licensees must post their license, the phone number and email address for the Ministry of Health’s Protecting Access to Public Healthcare program, the contact information for the patient ombudsman, and the licensee’s process for receiving and responding to patient complaints.[10]
Required Complaints Process: The Proposed Regulation will add a requirement for licensees to have a patient complaints process to deal with written or verbal complaints concerning the care of a patient or the operation of the IHC.[11] This includes maintaining a record of all complaints and reporting certain complaints to the Director.[12]
Timeline for Claim Submission: The Proposed Regulation will add a requirement that all claims for payment must be submitted to the Minister of Health no later than three months after the service is rendered at the IHC.[13]
Quality Assurance Advisor and Advisory Committee: The Proposed Regulation will add a requirement that each IHC appoint a quality assurance advisor to advise on the quality and safety standards of services provided in the centre.[14] If all of the insured services provided in the IHC are provided by physicians, then this quality assurance advisor must be a physician. Each licensee must also appoint an advisory committee to advise the quality assurance advisor, consisting of health professionals who provide health services in or in connection with the IHC.[15]
Change to Exemptions: Chiropractors are expressly exempt from the IHFA, such that they are not able to provide services that are insured by OHIP in independent health facilities.[16] The Proposed Regulation adds a requirement that all charges, fees, or payments for therapeutically necessary radiography ordered by a member of the College of Chiropractors of Ontario in an IHC is prescribed as a facility cost, meaning that these radiographs will be insured under OHIP.[17] The Proposed Regulation also no longer expressly exempts services provided by osteopaths and physiotherapists from application of the ICHSCA; both osteopaths and physiotherapists were exempt from the application of the IHFA.[18]
If the ICHSCA is proclaimed into force, the Ministry of Health also intends to propose another set of regulatory amendments under the ICHSCA to address quality assurance, safety, and inspections.[19] The Proposed Regulation is now open for public commentary until July 9, 2023.
[1] Ontario News Release: Ontario Reducing Wait Times for Publicly Funded Surgeries and Diagnostics (February 21, 2023).
[2] Integrated Community Health Services Centres Act, 2023, S.O. 2023, c. 4, Sched. 1 (the “ICHSCA”), s. 66.
[3] At the time of writing, the most current versions of these two Schedules were effective as of April 1, 2023. The Schedules are updated from time to time and posted on the Ministry website.
[4] ICHSCA, s. 1(1).
[5] ICHSCA, s. 62(2).
[6] ICHSCA, s. 5(1).
[7] ICHSCA, s. 29(3).
[8] ICHSCA, s. 29(5).
[9] Proposed Regulation, s. 26(1).
[10] Proposed Regulation, s. 26(1).
[11] Proposed Regulation, ss. 21-22.
[12] Proposed Regulation, ss. 22(2), 23, and 24.
[13] Proposed Regulation, s. 27.
[14] Proposed Regulation, s. 7.
[15] Proposed Regulation, s. 8.
[16] R.R.O. 1990, Reg. 649: Application and Exemptions, s. 4.
[17] Proposed Regulation, s. 32(1).
[18] R.R.O. 1990, Reg. 649: Application and Exemptions, s. 4.
