Private health facilities in Ontario: government continues to release details on the new regime

The Ontario government is soliciting feedback on draft regulations concerning changes to the province’s privately operated independent health facilities regime. These changes relate to Ontario’s Bill 60, Your Health Act, 2023, which received Royal Assent on May 18, 2023. Once proclaimed into force, Bill 60 will replace the existing regime and expand the scope of OHIP-insured surgeries delivered outside of hospitals in Ontario. The deadline for feedback on the draft regulations is July 9, 2023.

What you need to know

• Incoming ICHSC regime. Ontario’s new Integrated Community Health Services Act, 2023 (the New Act) has received Royal Assent but has not yet come into force. Once proclaimed into force, the New Act will replace the Independent Health Facilities Act (the Existing Act)¹.
  • Existing independent health facilities (IHFs) will be automatically transitioned to integrated community health services centres (ICHSCs). IHFs currently licensed in Ontario provide an array of diagnostic services (e.g., ultrasounds, radiography, MRIs) but limited surgery services (e.g., eye surgery and plastic surgery).
  • Applications for licences under the New Act are expected to be solicited through calls for application, which will specify the types of services for which facility applications are sought.
• Regulatory details to be finalized. In anticipation of the New Act coming into force, the Ontario Ministry of Health published draft regulations under the New Act (Draft Regulations) on June 9, 2023. Comments on the Draft Regulations are being received until July 9, 2023².
  • In addition to the Draft Regulations, the Ontario Ministry of Health has signalled that additional regulations addressing further quality assurance, safety and inspection requirements will be published in Fall 2023.
• Continuity and enhancements. The New Act and Draft Regulations carry over a number of regulatory requirements that currently apply to IHFs licensed under the Existing Act. The Ontario government intends to supplement the oversight mechanisms under the IHF regime, including by implementing formal patient complaint channels.

Integrated community health services centres regime

Certain details of the new ICHSC regime are already finalized under the New Act. The recently published Draft Regulations provide further clarity on the structure of the new regime for these facilities in Ontario.

Licensing process under the New Act

Parties currently operating IHFs³ under the Existing Act will be grandfathered under the New Act. Similar to the process that has been historically used for IHF licensing⁴, licences under the New Act are expected to be issued through a call for application process. The New Act specifies a number of application requirements; for example, applicants must provide details on how the facility will improve patient wait times. Notably, unlike the Existing Act, New Act applicants must also describe current linkages with health system partners and how the applicant will maintain and improve those linkages to promote optimal patient care pathways.

Operations under the New Act

The New Act outlines a number of operational parameters for licensees:

• Oversight. The New Act will require the licensee to establish and maintain a process for receiving and responding to patient complaints, and require licensees to maintain quality standards, establish incident review processes and report incidents.
• Operational costs. The New Act allows the Ontario government to pay all or a portion of the facility operating costs of an ICHSC, while prohibiting any person from charging or accepting payment of a facility cost for, or in respect of, an insured service provided in a place that is not a licensed ICHSC. The New Act defines “facility cost” in a similar manner to how “facility fee” is defined in the Existing Act.
• Patient fees. The New Act explicitly prohibits charging an OHIP-insured person a fee for preferential access to an insured service at an ICHSC. The New Act also prohibits charging and receiving facility costs from anyone other than the Ministry of Health or additional persons prescribed by regulation.

Draft Regulations requirements, new and old

The Draft Regulations carry over a number of principles from the regulations currently made under the Existing Act.

• Like the Application and Exemptions Regulation⁵ under the Existing Act, the Draft Regulations include exemptions from the application of the New Act for: (i) various types of health facilities/services (e.g., long-term care homes, private hospitals, psychiatric facilities, public hospitals, laboratory services, ambulance services); and (ii) services provided by specified healthcare providers (e.g., podiatrists, dentists, optometrists). Furthermore, services provided to any individual that is not OHIP-insured are exempt from the New Act.
• The Draft Regulations include quality assurance requirements, operational standards, employee record requirements and qualifications, patient record management requirements, and notice requirements applicable to ICHSCs, similar to those currently applied to IHFs through the General Regulation⁶ made under the Existing Act.
• Under the Existing Act, the Facility Fees Regulation⁷ includes more detail regarding facility fees than included in the Draft Regulations under the New Act. However, despite the differences in language, the operation of ICHSCs in respect of facility costs is unlikely to be different from how IHFs are currently operated under the Existing Act.

The Draft Regulations include some concepts not embodied by the Existing Act:

• Licensees must establish a patient complaints process with minimum standards for how such complaints will be investigated and resolved.
• Both the College of Physicians and Surgeons of Ontario and the College of Midwives of Ontario are granted inspection powers of facilities.
• Licensees must publicly post certain information, including a price list for uninsured services, their patient complaint process and contact information of the Ministry’s designated patient ombudsman⁸.

What’s next

As further details of the new ICHSCs regime are published, potential applicants should become familiar with the additional application requirements and engage with both industry and local stakeholders to support their case for offering connected and convenient care through methods such as reducing wait times, improving patient experience and integrating effectively with the health system.