On August 12, 2013, the Ministry of Health and Long-Term Care
(the "Ministry") posted two proposals to
the Regulatory Registry website1 for regulation changes
that together are aimed at facilitating funding of Community-Based
Specialty Clinics by Local Health Integration Networks
("LHINs")2 and Cancer Care
In January 2012, the Ministry released its Action Plan for
Health Care which included, among other things, a commitment
to move certain surgical procedures out of hospitals and into
so-called "Community-Based Specialty Clinics". To date,
no procedures have been moved out of hospitals and how such
Community-Based Specialty Clinics would be funded has been a
lingering question. The Ministry is now proposing regulation
changes that would allow the Ministry to create a model whereby
Community-Based Specialty Clinics may be granted an Independent
Health Facility ("IHF") licence under
the Independent Health Facilities Act (Ontario) (the
"IHFA") and funded directly by a LHIN
(or CCO if it was providing cancer-related services). Under the
existing legislative regime only the Ministry may fund IHFs in
respect of services rendered to persons insured under the
Health Insurance Act (Ontario).
The Proposed Regulation Changes
The Ministry is proposing amendments to O. Reg. 264/07 made
under the Local Health System Integration Act, 2006
(Ontario) (the "LHSIA") and the creation
of a new regulation under the IHFA.4
Section 19(1) of the LHSIA permits the Ministry to fund a
"health service provider in respect of services that the
service provider provides in or for the geographic area of the
network." Section 2(2) of the LHSIA sets out 11 categories of
"health service provider" including, at paragraph 11,
"Any other person or entity or class of persons or entities
that is prescribed."5 The Ministry is proposing to
amend Regulation 264/07 such that IHFs will be prescribed as
"health service providers" under the LHSIA which would
permit LHINs to fund IHFs.
Section 3(3) of the IHFA states that:
No person shall charge a facility fee, or accept payment of a
facility fee, for or in respect of a service provided to an insured
person in an independent health facility operated by a person
licensed under this Act, unless the fee is charged to, or the
payment is received from, the Minister [of Health and Long-Term
Care] or a prescribed person. [emphasis added]
The Ministry has proposed adding LHINs and CCO as
"prescribed persons" under the IHFA to provide certainty
regarding their entitlement to pay amounts to an IHF that could
constitute facility fees.
If the regulatory changes are ultimately approved, the Ministry
will have the option of issuing IHF licences to Community-Based
Specialty Clinics and having those clinics funded through the
payment of facility fees by the LHIN in which the IHF is
geographically located or CCO if cancer-related services are being
The regulatory changes are meant to come into effect
concurrently. Comments on the postings may be submitted on the
Regulatory Registry website until October 11, 2013. No draft
regulations will be released as part of the consultation process.
Based on this timing, it seems likely that the earliest the
Ministry will begin the process to transfer procedures from
hospitals to Community-Based Speciality Clinics would be late 2013
or early 2014.
2. LHINs are created under the Local Health Systems
Integration Act, 2006 (Ontario) and currently provide funding
to public hospitals, private hospitals and certain other health
service providers within specified geographic regions.
3. Cancer Care Ontario currently oversees in excess of
$800M in funding for hospitals and other providers of cancer care
4. It appears that the posting proposes to create a new
regulation under the IHFA. It would also be possible to accomplish
this change through an amendment to one of the existing regulations
made under the IHFA.
5. For the purposes of the LHSIA "prescribed"
means prescribed by the regulations.
6. Section 5(1) of the IHFA requires the Ministry to
issue an RFP (either broadly or directed) prior to issuing an IHF
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