By Anne C. Corbett and John M. Risk
On February 15, the Legislative Assembly’s Standing Committee on Social Policy (the "Committee") completed its clause-by-clause review of the Local Health System Integration Act, 2005 ("Bill 36" or the "Bill" or "Act"). The Committee’s review followed the public hearings on Bill 36 in early February. There are a number of amendments to Bill 36 as a result of this process. The purpose of this bulletin is to summarize the key amendments.
- For an overview of Bill 36, please see our Hospital Law Bulletin from December 2005 available through our website. The revised version of Bill 36 may be found on the Legislative Assembly’s website (we have provided a link to the website at the end of this bulletin).
- It is likely (although not certain) that Bill 36 will become law in this form. The Bill must receive Third Reading to become law. Amendments to a government bill during Third Reading are rare.
Purpose and Objects
- Bill 36 did not refer to the concept of quality of care, and the statement of the express purpose of the Act did not suggest a role for LHINs in the co-ordination of health services from a provincial perspective. Changes to the purpose statement for Bill 36 (section 1) add references to quality and provincial co-ordination of health care. Section 1 now reads, "The purpose of this Act is to provide for an integrated health system to improve the health of Ontarians through better access to high quality health services, co-ordinated health care in local health systems and across the province and effective and efficient management of the health system at the local level by local integration networks." (New wording is in italics.)
- The amendments also add explicit references to continuous quality improvement in the Preamble, and patient care and access to high quality health services to paragraph (h) of the objects of local health integration networks (LHINs) (section 5).
- Section 5 of Bill 36, which deals with the objects of the LHINs, did not identify the purpose or goals for which the LHINs should undertake these objects. A change to the introductory wording in section 5 ties the corporate objects of LHINs to the purpose of the Act. The objects of a LHIN are to, "plan, fund and integrate the local health system to achieve the purpose" of the Act. The purpose of the Act now functions as the goal or objective for which a LHIN’s powers and objects are to be exercised. This should provide guidance to a LHIN board in exercising their powers and determining what is in the best interest of the LHIN.
- The legislation was silent concerning the contribution of education and research to improving health care. Academic health science centres have been added to the list of entities with which LHINs should co-operate in improving integration and coordination of health services.
- Section 9 of the Bill requires LHIN board and committee meetings to be open to the public. Previously, exceptions to this requirement would have to be set out in regulations. The amendments now set out in the Act the situations where a LHIN may exclude the public from any part of a meeting. The changes also require a LHIN to provide reasonable notice to the public of its board and committee meetings (section 9).
- There are changes to Section 16 of the Bill, which requires a LHIN to engage the community of diverse persons and entitles involved in the local health system. (The addition of the word "diverse" is one of the changes.) The Bill now includes a definition of "community," which includes health providers, patients in the geographic area of the network, and employees involved in the local health system.
- The changes also add a subsection concerning methods of engagement, which may include community or focus group meetings or establishing advisory committees.
Assignment of Agreements
- The Act permits the Minister to assign agreements to the LHINs. Section 19 now includes a new subsection that prevents the Minister from assigning agreements involving health professionals (physicians, dentists, chiropractors and optometrists) that the Minister enters into under the authority of specific provisions in the Ministry of Health and Long-Term Care Act or the Health Insurance Act. These provisions relate to remuneration for services on a basis other than fee for service. The practical effect of the new subsection is that the Minister cannot assign certain agreements involving hospitals and physicians, for example those relating to the Hospital On-Call Coverage Program, Alternative Funding Arrangements (AFAs), and Alternative Funding Plans (AFPs).
- There are several amendments to the process by which a LHIN or the Minister may integrate the system. The most important of these relates to "due process" for integration decisions by the LHIN and integration orders by the Minister. ‘Due process’ involves the LHIN providing at least 30 days notice before issuing a decision, providing a copy of the proposed decision to the service provider, and making copies of the proposed decision available to the public. Any person may then make a written submission about the proposed decision. This process applies where the LHIN requires a health service provider to integrate (section 26), where a health service provider proposes to voluntarily integrate its services with another entity (section 27), and to integration orders by the Minister (section 28). Previously there was no prior notice of an integration order or decision.
- Provisions that entitled a health service provider to request a reconsideration of a decision of the LHIN or Minister have been deleted in favour of the prior notice.
- A change to section 25(4) adds a new requirement in connection with LHIN integration decisions (and integration orders by the Minister). Parties to the decision (or order) are required to develop a human resources adjustment plan relating to the integration. This requirement also applies to parties subject to integration of non-clinical services by Lieutenant Governor in Council ("LGIC") (section 33).
- There are also changes relating specifically to integration orders by the Minister. Previously, the Minister could only issue orders to a health service provider that receives funding from a LHIN and carries on its operation on a not for profit basis. The scope of integration orders now include health providers that receive LHIN funding and carry out their operations on a for profit basis. However, such an order cannot require a not for profit health service provider to amalgamate with one or more for profit health service providers.
- The changes relating to integration orders also include restrictions concerning transfer of charitable property. Orders by the Minister cannot require a health service provider to transfer charitable property to a person or entity that is not a charity. An order also cannot require a health service provider that is not a charity to hold property for a charitable purpose and to receive property from a person or entity that is not a charity. In the previous version of the Bill, these restrictions applied to LHIN integration decisions only.
- The power of the LGIC under section 33 of the Bill to make regulations integrating non-clinical services will cease on April 1, 2007.
- Subsection 50(11) of Bill 36 amended the Public Hospitals Act to give the Minister power through regulation to require a hospital foundation to provide financial reports to the Minister and a LHIN. The Committee struck out this amendment. The Public Hospitals Act continues to allow the Minister to, by regulation, require a hospital subsidiary or hospital foundation to provide financial reports and returns to the Minister.
- Under subsection 22(2) of Bill 36, a LHIN may require information from a person or entity that is not a health service provider (for example, a hospital foundation). However, this requires a regulation by the LGIC. Section 37 of the Bill requires public consultation before making regulations.
- Under a new section (35.1), the Minister and each LHIN must establish and maintain a website. The Minister and each LHIN must publish on their websites the documents that the Act requires them to make public.
- Section 37 of the Bill sets out and requires a process of public consultation before making regulations. Subsection 37(2) of the previous version of the Bill exempted certain regulations from this process. The Committee struck out this subsection. However, the Minister may decide that the consultation process will not apply if, in the Minister.s opinion, the urgency of the situation requires it, the proposed regulation clarifies the intent of the Act, or the proposed regulation is of a minor nature.
- A committee of the Legislative Assembly will begin a review of the Act and its regulations between three and four years after the Bill comes into force. Within one year of beginning its review, the committee will make recommendations to the Assembly concerning amendments to the Act and its regulations.
Bill 36 is reported as amended and reported back to the Legislative Assembly for Third Reading, which was debated on February 21 and 22. Further amendments as a result of the debate during Third Reading are unlikely.
To view or download a copy of Bill 36 as amended by the Standing Committee on Social Policy, go to the Legislative Assembly’s website at www.ontla.on.ca/index.htm and click on "Bills" and then "Public Bills Index". You can then access the Bill through its number (36) or first letter (L).
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.