On September 27, 2017, Bill 160, the Strengthening Quality and Accountability for Patients Act, 2017 passed first reading in the Ontario legislature. Bill 160 proposes material changes to 10 health sector Acts, including the enactment of 3 new Acts, the repeal (and in some cases, the replacement) of various Acts, and consequential amendments to approximately 20 others. In introducing Bill 160 to the legislature, the Minister of Health and Long-Term Care (the “Minister”), Dr. Eric Hoskins, explained that its purpose is to increase transparency and oversight, and help to ensure quality control. Provided here is a summary of the substantial provisions of the bill. The full text of Bill 160 can be found here.
Health Sector Payment Transparency Act, 2017
Bill 160 proposes to enact the Health Sector Payment Transparency Act, 2017, which would require information about financial relationships in the health care system, including in education and research, to be reported to the Minister who would in turn be required to: (i) analyze such information for the purpose of health system research and evaluation, planning and policy analysis; and (ii) publicly disclose such information, including personal information. The bill also permits - but does not require - the Minister to publish the results of any analysis conducted using information collected under the Act.
Persons and organizations in the medical products industry and who organize continuing education would be required to report transactions in which value is transferred to persons or entities prescribed by regulation. Bill 160 also empowers the Minister and inspectors appointed under the Act to serve orders requiring persons to comply with the Act. A full summary of the implications can be found here.
Oversight of Health Facilities and Devices Act, 2017
Bill 160, if enacted, will introduce the Oversight of Health Facilities and Devices Act, 2017 (the “OHFDA”) to provide a new regime for community health facilities and energy applying and detecting medical devices (“EADMDs”). As a result, the Independent Health Facilities Act, Private Hospitals Act and Healing Arts Radiation Protection Act would be repealed. Under the OHFDA, an executive officer will be appointed to oversee community health facilities and EADMDs. The executive officer will accept applications for licenses to operate as community health facilities or to operate EADMDs and in considering such applications will look to enumerated factors, with such factors depending, in part, on whether or not the facility seeks to provide services funded by government sources (e.g. insured services or services funded by the Minister).
Subject to minor exceptions, existing independent health facility licenses would transition to the OHFDA.
Community Health Facilities
The OHFDA provides for various transitional provisions in the shift from private hospitals and independent health facilities to community health facilities. Licenses for independent health facilities will be replaced with community health facility licenses. Existing private hospitals will be deemed under the Act to be community health facilities. Various Acts that currently apply to independent health facilities and private hospitals will be amended to apply to community health facilities that were formerly licensed under the Independent Health Facilities Act and Private Hospitals Act, respectively.
The OHFDA contains provisions intended to increase safety and oversight, including provisions that:
- require community health facility licensees to have a quality advisor and quality committee that comply with the requirements of the Act;
- permit the Lieutenant Governor in Council to enact regulations that designate inspecting bodies of community health facilities;
- permit the executive officer to appoint inspectors, and allow such inspectors or the executive officer to make compliance or cessation orders and impose administrative penalties; and
- permit the executive officer to appoint community health facility supervisors able to exercise all powers of the licensee of the facility.
The OHFDA also addresses health system administration and accountability. If the OHFDA is enacted, the executive officer will be able to suspend, revoke or refuse to renew a license for factors related to the management of the health care system, including the need for services. The Act will restrict the ability of community health facilities to charge, obtain or accept a benefit for providing an insured person with access to an insured service at a community health centre facility. No facility fee will be permitted with respect to an insured service to an insured person unless the fee is charged to, and accepted from, the Minister or a prescribed person.
Transitional provisions are proposed to come into force on Royal Assent, with a later date to be proclaimed for repealing existing regimes for private hospitals and independent health facilities.
The purpose of the new regime is to expand legislation applicable to X-rays and X-ray machines and equipment. If enacted, no person will be permitted to operate a device for diagnosis, treatment, mitigation or prevention of disease or for detection of radiation unless duly licensed, and licensees would be required to have a safety officer. The executive officer will have the authority under the Act to appoint inspectors to inspect premises at which an EADMD is located. Like a community health facility license, an EADMD license can be suspended, revoked or refused for renewal for factors related to the management of the health care system.
Bill 160 proposes amendments to the Ambulance Act to increase flexibility in the provision of care by paramedics. The amendments enable the Minister to make directives to the operator of a land ambulance service for matters including delivering patients to destinations other than hospitals and providing responsibilities in addition to ambulance services such as treatment by paramedics to persons who do not require transportation. Bill 160 also proposes powers for investigators to inspect ambulances, vehicles, supplies or equipment.
Long-Term Care Homes Act
The Act would be amended to increase enforcement by:
- raising the maximum fines under the Act by four times their current level;
- providing inspectors with the power to require a licensee to pay an administrative penalty of up to $100,000 for non-compliance;
- providing the Director and the Minister power to suspend a license and appoint an interim manager of a long-term care home; and
- providing the Minister with authority to issue binding directives.
Bill 160 also proposes to remove provisions of the Act related to “secure units” and to introduce provisions permitting the confinement of a resident, if it is included in the resident’s plan of care and done in accordance with prescribed requirements in the Act and regulations.
Medical Radiation and Imaging Technology Act, 2017
Under Bill 160, the Medical Radiation Technology Act, 1991 would be repealed and replaced by the Medical Radiation and Imaging Technology Act, 2017. The intention of the new regime is to encompass all of the medical radiation and imaging technology profession, by expanding the membership of the current College of Medical Radiation Technologists of Ontario to include diagnostic medical sonographers. In order to reflect such expansion, the Act also proposes changes to the College’s (i) name, specifically to: the “College of Medical Radiation and Imaging Technologists of Ontario”; and (ii) scope of practice statement, to specifically reference the practise of diagnostic medical sonographers, namely “application of soundwaves”.
Other Proposed Amendments
- The Ontario Drug Benefit Act would be amended so that regulations under the Act are not required in order for the Minister and the executive officer to disclose personal information for the purpose of administering the Act. The Act would also be amended to permit the executive officer to establish reimbursement criteria for certain drug benefits relating to any prescriber or class of prescribers, such as nurse practitioners, and not only physicians (as is currently the case under the Act).
- The Excellent Care for All Act, 2010 would be amended to enable the Ontario Health Quality Council (the “Council”) to. among other things, collect, use and disclose personal health information for purposes related to the function of the patient ombudsman or as prescribed by regulation. The amendments would also exempt records in the custody or control of the Council that contain information prepared or obtained in investigations by the patient ombudsman from the Freedom of Information and Protection of Privacy Act.
- The Health Protection and Promotion Act would be amended by replacing references to “guidelines” published by the Minister with “public health standards” and “reportable disease” with “disease of public health significance”. Additionally, diseases of public health significance and deaths from such diseases will be required to be reported to the Ontario Agency for Health Protection and Promotion in addition to the Ministry of Health and Long-Term Care. The Minister would also be provided with the ability to issue orders to health care providers if there is an immediate risk as a result of a new or emerging disease.
- The Retirement Homes Act, 2010 would be amended to give the Minister Responsible for Seniors the power to unilaterally amend its memorandum of understanding with the Retirement Homes Regulatory Authority (the “Authority”) and to require the Authority to establish advisory committees and engage in reviews. The Authority would also be required to make compensation information for members of its board, officers or employees available to the public. The Auditor General would be given the authority to conduct an audit of the Authority.
- The Retirement Homes Act, 2010 would also be amended to revise provisions for confinement, including to ensure no prohibited devices are used. The Registrar would be given a right to appoint an inspector with respect to confinement.
 The Council may also disclose (but not collect or use) personal health information where it is required by law or by an arrangement or agreement made under the authority of a statue of Ontario or Canada.
 The Authority is accountable to the Crown through this memorandum of understanding. The memorandum of understanding also sets out the roles, duties and responsibilities of the Authority and the Minister (as representative of the Crown) with respect to matters related to the Retirement Homes Act, 2010.