Ontario Introduces Legislation to Significantly Expand the Authority of LHINs
At the start of June 2016, the Ontario government introduced Bill 210, Patients First Act, 2016, which would, if passed, expand the mandate of Ontario’s 14 Local Health Integration Networks (“LHINs”) to include the planning, delivery and management of primary care, and home and community care. According to the Ministry of Health and Long-Term Care (“Ministry”), the purpose of Bill 210 is to improve patient access to care and increase integration and equity within the health care system in furtherance of Ontario’s “Patients First: Action Plan for Health Care”, which was released in February 2015. In this blog post, we summarize some of the key amendments set out in Bill 210.
Key Amendments Under Bill 210
It is clear that if Bill 210 becomes law, it will have sweeping implications for primary care and home and community care, and for the health care professionals and organizations that are involved in the provision of these services. Bill 210 proposes to amend twenty existing pieces of legislation – including the Local Health System Integration Act, 2006 (“LHSIA”), the Public Hospital Act, the Commitment to the Future of Medicare Act, and the Home Care and Community Services Act – and repeal the Community Care Access Corporations Act, 2001 once the functions of the CCACs have been fully transferred to the LHINs in the same geographic area.
Under the LHSIA, LHINs are currently responsible for funding and overseeing the following health service providers: public and private hospitals; certain psychiatric facilities; the University of Ottawa Heart Institute; long-term care homes; CCACs; home care service providers; community health centres; and community mental health and addiction services organizations. One of the most significant amendments that would be introduced through Bill 210 is an expansion of the LHINs’ responsibility to include the following additional health service providers:
family health teams, nurse practitioner-led clinic, and Aboriginal health access centres;
persons or entities that provide primary care nursing services, maternal care or inter-professional primary care programs and services;
providers of palliative care services, including hospices;
physiotherapy clinics; and
any other person or entity that is prescribed in the regulations.
The funding and oversight of health service providers is governed through service accountability agreements (“SAAs”) between these providers and the LHINs. Notably, physicians have not been named as health service providers in Bill 210 and would therefore not be required to enter into SAAs with a LHIN. Although Bill 210 allows for additional health service providers to be prescribed in regulation, this does not apply to physicians due to the specific exemption applicable to them under the LHSIA.If Bill 210 passes in its current form, some of the additional key changes would include:
An increase in the Ministry’s role and authority over health services providers and LHINs, including the power to issue: (a) binding operational and policy directives without prior consultation or notice; and (b) provincial standards for the provision of health care services, which LHINs and health services providers would be required to comply with.
The power of the Ministry to appoint supervisors for LHINs and investigators to investigate and report on the quality of management and administration of the LHINs.
LHINs would have the authority to issue binding operational or policy directives to health service providers to which it provides funding (with the exception of long-term care homes).
LHINs would have the power to: (a) require health service providers to undergo an audit of accounts and financial transactions; (b) engage in or permit an operational review or peer review of a health service provider’s activities; (c) appoint investigators to conduct investigations and report on the quality of the management of a health service provider (except long-term care homes); and (d) appoint supervisors for health service providers (except hospitals and long-term care homes).
Where a LHIN provides funding to a health service provider, they would be required to enter into a SAA. LHINs will be permitted to set or amend the terms and conditions of SAAs on 30 days’ notice to a health service provider and the Minister.
The LHINs’ responsibility to identify and plan for the health service needs of their local health system and to make recommendations to the Minister about the system, including funding needs, will be expanded to include needs regarding physician resources (physicians, however, will continue to be funded by the Ministry).
The requirement for LHINs to have a Health Professionals Advisory Committee would become optional.
LHINs would be required to have at least one Patient and Family Advisory Committee in order to foster community engagement.
LHINs would be required to establish geographic sub-regions in their local health systems for the purposes of planning, funding and integrating services within those geographic sub-regions.
Health Quality Ontario’s role in setting clinical standards would be expanded to include the authority to make recommendations regarding clinical care standards to the Minister, health care organizations and other entities.
Complaints regarding home and community care services provided by or arranged by a LHIN would be handled by the Patient Ombudsman, whereas the LHINs other functions would continue to be overseen by the Ontario Ombudsman.
Furthermore, Bill 210 would grant LHINs the power to audit and peer review a health service provider’s activities.
What’s Next?
Bill 210 has only passed first reading and will be debated when the Ontario Legislature resumes sittings this fall. In light of concerns that have already been raised regarding the bill by commentators, health professionals and professional associations, it is possible the bill may undergo several revisions before it becomes law. We will follow these developments closely and provide relevant updates on our blog in due course.
