Bill 41, Patients First Act, 2016

Hoskins, Hon. Eric Minister of Health and Long-Term Care

Versions

Bill 41 2016

An Act to amend various Acts in the interests of patient-centred care

Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:

Local Health System Integration Act, 2006

1. (1) Subsection 2 (1) of the Local Health System Integration Act, 2006 is amended by adding the following definition:

"medical officer of health" has the same meaning as in the Health Protection and Promotion Act; ("médecin-hygiéniste")

(2) Subsection 2 (1) of the Act is amended by adding the following definition:

"de-identify" has the same meaning as in subsection 47 (1) of the Personal Health Information Protection Act, 2004; ("anonymiser")

(3) Subsection 2 (1) of the Act is amended by adding the following definition:

"personal health information" has the same meaning as in section 4 of the Personal Health Information Protection Act, 2004; ("renseignements personnels sur la santé")

(4) Paragraph 7 of the definition of "health service provider" in subsection 2 (2) of the Act is repealed.

(5) Paragraph 11 of the definition of "health service provider" in subsection 2 (2) of the Act is repealed and the following substituted:

11. A not for profit entity that operates a family health team.

12. A not for profit entity that operates a nurse-practitioner-led clinic.

13. A not for profit entity that operates an Aboriginal health access centre.

14. A person or entity that provides primary care nursing services, maternal care or inter-professional primary care programs and services.

15. A not for profit entity that provides palliative care services, including a hospice.

16. A person or entity that provides physiotherapy services in a clinic setting that is not otherwise a health service provider.

17. Any other person or entity or class of persons or entities that is prescribed.

(6) Section 2 of the Act is amended by adding the following subsection:

Exclusion, community services

(4) A person or entity that provides, as a service provider within the meaning of the Home Care and Community Services Act, 1994, a community service that has been purchased by a local health integration network, is not a health service provider within the meaning of this Act in respect of the provision of the purchased service.

2. (1) Subsection 3 (4) of the Act is amended by adding the following clause:

(b.1) change the geographic area of one or more local health integration networks;

(2) Clause 3 (4) (d) of the Act is amended by striking out the portion before subclause (i) and substituting the following:

(d) do all things necessary to accomplish the amalgamation, dissolution, division or change of geographic area of one or more local health integration networks made by a regulation under clause (a), (b) or (b.1), including,

. . . . .

3. Section 4 of the Act is amended by adding the following subsection:

Non-application of single employer rule

(5) Subsection 1 (4) of the Labour Relations Act, 1995 does not apply to a local health integration network.

4. (1) Clause 5 (b) of the Act is repealed and the following substituted:

(b) to identify and plan for the health service needs of the local health system, including needs regarding physician resources, in accordance with provincial plans and priorities and to make recommendations to the Minister about that system, including capital funding needs for it;

(2) Section 5 of the Act is amended by adding the following clause:

(e.1) to promote health equity, including equitable health outcomes, to reduce or eliminate health disparities and inequities, to recognize the impact of social determinants of health, and to respect the diversity of communities and the requirements of the French Language Services Act in the planning, design, delivery and evaluation of services;

(3) Section 5 of the Act is amended by adding the following clause:

(e.2) to participate in the development and implementation of health promotion strategies in cooperation with primary health care services, public health services and community-based services to support population health improvement and outcomes;

(4) Section 5 of the Act is amended by striking out "and" at the end of clause (m) and by adding the following clauses:

(m.1) to provide health and related social services and supplies and equipment for the care of persons in home, community and other settings and to provide goods and services to assist caregivers in the provision of care for such persons;

(m.2) to manage the placement of persons into long-term care homes, supportive housing programs, chronic care and rehabilitation beds in hospitals, and other programs and places where community services are provided under the Home Care and Community Services Act, 1994;

(m.3) to provide information to the public about, and make referrals to, health and social services;

(m.4) to fund non-health services that are related to health services that are funded by the Minister or a local health integration network; and

5. Paragraphs 6 and 7 of subsection 6 (3) of the Act are repealed.

6. (1) Subsection 7 (1) of the Act is repealed and the following substituted:

Board of directors

(1) Each local health integration network shall consist of no more than 12 members appointed by the Lieutenant Governor in Council who shall form the board of directors of the network, except that the Lieutenant Governor in Council may prescribe a higher number of members that is not more than 14.

(2) Subsection 7 (2) of the Act is repealed and the following substituted:

Term

(2) Subject to subsection (3), the following provisions apply respecting the term of members of the board of directors of a local health integration network:

1. Each member shall hold office for a term of up to three years at the pleasure of the Lieutenant Governor in Council and may be reappointed for any number of terms of up to three years.

2. Despite paragraph 1, no person may be a member for more than six years in total.

3. Despite paragraph 2, a member who is designated as chair under subsection (6) after serving at least three years as a member may, despite anything else in subsection (6), be appointed for one further term of up to three years while designated as chair.

(3) Subsection 7 (4) of the Act is repealed.

(4) Subsection 7 (10) of the Act is repealed and the following substituted:

Where no designation

(10) If the Lieutenant Governor in Council has not designated a chair or a vice-chair of a network, the members of the board of directors may select a chair or vice-chair from among their members to hold office as provided for by by-law, until such time as the Lieutenant Governor in Council makes a designation.

7. (1) Subsection 8 (2) of the Act is repealed and the following substituted:

By-laws and resolutions

(2) Subject to subsections (3) and (4), a board of directors may make by-laws and pass resolutions regulating its proceedings and generally for the conduct and management of the affairs of the local health integration network including establishing committees.

Officers

(2.1) Without limiting the generality of subsection (2), a board of directors may make by-laws or pass resolutions to appoint officers and assign to them such powers and duties as the board considers appropriate.

Delegation

(2.2) A board of directors may delegate any of its powers or duties under this Act or any other Act to such person or persons as the board considers appropriate and may impose conditions and restrictions with respect to the delegation.

Restrictions on delegation

(2.3) Despite subsection (2.2), a board of directors may not delegate any power under the following provisions of this Act:

1. Subsection 20 (8) and clause 20 (11) (c).

2. Clause 25 (2) (a).

3. Section 26.

4. Section 27.

(2) Subsection 8 (2.3) of the Act, as enacted by subsection (1), is amended by adding the following paragraphs:

1.1 Section 20.2.

1.2 Section 21.1.

1.3 Section 21.2.

(3) Subsection 8 (8) of the Act is repealed.

8. Section 9 of the Act is amended by adding the following subsection:

Educational or training sessions

(5.1) Despite subsection (4), a local health integration network may exclude the public from a meeting if the following conditions are both satisfied:

1. The meeting is held for the purpose of educating or training the members of the local health integration network.

2. At the meeting, no member discusses or otherwise deals with any matter in a way that materially advances the decision-making of the local health integration network.

9. Section 10 of the Act is amended by adding the following subsection:

Medical officer of health engagement

(3.1) A local health integration network shall ensure that its chief executive officer engages with each medical officer of health for any health unit located in whole or in part within the geographic area of the network, or with the medical officer of health's delegate, on an ongoing basis on issues related to local health system planning, funding and service delivery.

10. The Act is amended by adding the following sections:

Directives by Minister

11.1 (1) The Minister may issue operational or policy directives to a local health integration network where the Minister considers it to be in the public interest to do so.

Binding

(2) A local health integration network shall comply with every directive of the Minister.

General or particular

(3) An operational or policy directive of the Minister may be general or particular in its application.

Non-application of Legislation Act, 2006

(4) Part III (Regulations) of the Legislation Act, 2006 does not apply to operational or policy directives.

Public availability

(5) The Minister shall make every directive under this section available to the public.

Law prevails

(6) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Provincial standards

11.2 (1) The Minister may issue provincial standards for the provision of health services that are provided or arranged by local health integration networks or health service providers where the Minister considers it to be in the public interest to do so.

General or particular

(2) A standard of the Minister may be general or particular in its application.

Obligations re standards

(3) Every local health integration network and health service provider to which a standard under this section is directed shall comply with the standard.

Non-application of Legislation Act, 2006

(4) Part III (Regulations) of the Legislation Act, 2006 does not apply to a standard under this section.

Resolving differences over priorities

(5) If a standard of a local health integration network or a health service provider conflicts with a provincial standard, the provincial standard prevails.

Same

(6) In the event of a conflict between a standard issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Public availability

(7) The Minister shall make every standard under this section available to the public.

11. The Act is amended by adding the following sections:

Investigators

12.1 (1) The Minister may appoint one or more investigators to investigate and report on the quality of the management and administration of a local health integration network, or any other matter relating to a local health integration network, where the Minister considers it in the public interest to do so.

Powers

(2) An investigator may, without a warrant and at reasonable times,

(a) enter the premises of a local health integration network; and

(b) inspect the premises and the records relevant to the investigation.

Identification

(3) An investigator conducting an investigation shall produce, on request, evidence of his or her appointment.

Powers of investigator

(4) An investigator conducting an investigation may,

(a) require the production of records or anything else that is relevant to the investigation, including books of account, documents, bank accounts, vouchers, correspondence and payroll records, records of staff hours worked and records of personal health information;

(b) examine and copy any record or thing required under clause (a);

(c) upon giving a receipt and showing the evidence of appointment, remove a record or anything else that is relevant to the investigation for review or copying, as long as the review or copying is carried out with reasonable dispatch and the record or thing is promptly returned to the local health integration network;

(d) in order to produce a record in readable form, use data storage, information processing or retrieval devices or systems that are normally used in carrying on business in the place; and

(e) question a person on matters relevant to the investigation.

Obligation to produce and assist

(5) If an investigator requires the production of a record or anything else that is relevant to the investigation, the local health integration network that has custody of the record or thing shall produce it and, in the case of a record, shall on request provide any assistance that is reasonably necessary to interpret the record or to produce it in a readable form.

Restriction

(6) An investigator shall not exercise the investigator's powers under subsections (4) and (5) to access personal health information except,

(a) with the consent of the individual who is the subject of the personal health information; or

(b) in such circumstances as may be prescribed.

Same

(7) If an investigator accesses personal health information under subsection (6), the investigator shall not,

(a) collect, use or disclose the personal health information if other information will serve the purpose of the investigation; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purpose of the investigation.

Confidentiality

(8) An investigator and his or her agents shall keep confidential all information that comes to the investigator's knowledge in the course of an investigation under this Act and shall not communicate any information to any other person except as required by law or except where the communication is to the Minister or a person employed in or performing services for the Ministry.

Report

(9) The investigator shall, upon completion of an investigation, make a report in writing to the Minister.

De-identification of personal health information

(10) Before providing a report to the Minister under subsection (9), the investigator shall ensure that all personal health information is de-identified.

Same

(11) The Minister shall cause a copy of the report of an investigation, with all personal health information de-identified, to be delivered to the chair of the board of directors of the local health integration network.

Public availability

(12) The Minister shall make every report of an investigation available to the public.

Local health integration network supervisor

12.2 (1) On the recommendation of the Minister, the Lieutenant Governor in Council may appoint a person as a local health integration network supervisor where the Lieutenant Governor in Council considers it in the public interest to do so.

Notice of appointment

(2) The Minister shall give the board of a local health integration network at least 14 days notice before recommending to the Lieutenant Governor in Council that a local health integration network supervisor be appointed.

Term of office

(3) The appointment of a local health integration network supervisor is valid until terminated by order of the Lieutenant Governor in Council.

Powers of supervisor

(4) Unless the appointment provides otherwise, a local health integration network supervisor has the exclusive right to exercise all of the powers of the board of the network and of the network and its directors, officers and members.

Same

(5) The Lieutenant Governor in Council may specify the powers and duties of a local health integration network supervisor appointed under this section and the terms and conditions governing those powers and duties.

Additional powers of supervisor

(6) If, under the order of the Lieutenant Governor in Council, the board of the network continues to have the right to act with regard to any matters, any such act of the board is valid only if approved in writing by the local health integration network supervisor.

Right of access

(7) A local health integration network supervisor appointed for a local health integration network has the same rights as the board and the chief executive officer of the network in respect of the documents, records and information of the board and the network.

Restrictions, personal health information

(8) A local health integration network supervisor shall not,

(a) collect, use or disclose personal health information if other information will serve the purposes of the supervisor; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purposes of the supervisor.

Minister's directions

(9) The Minister may issue directions to a local health integration network supervisor with regard to any matter within the jurisdiction of the supervisor.

Directions to be followed

(10) A local health integration network supervisor shall carry out every direction of the Minister.

Report to Minister

(11) A local health integration network supervisor shall report to the Minister as required by the Minister.

De-identification of personal health information

(12) Before providing a report to the Minister under subsection (11), the local health integration network supervisor shall ensure that all personal health information is de-identified.

Public availability

(13) The Minister shall make every report of a supervisor available to the public.

12. Section 14 of the Act is amended by adding the following subsection:

Adhering to French Language Services Act

(5) In developing priorities and strategic directions for the health system and the local health systems in the provincial strategic plan, the Minister shall ensure that the priorities and strategic directions foster the provision of health services in a way that meets the requirements of the French Language Services Act.

13. The Act is amended by adding the following section:

Sub-regions

14.1 (1) Each local health system integration network shall establish geographic sub-regions in its local health system for the purposes of planning, funding and integrating services within those geographic sub-regions.

Maps

(2) Each network shall make a map of the sub-regions available to the public.

14. (1) Section 15 of the Act is amended by adding the following subsection:

Sub-regions, direction

(2.1) The integrated health service plan shall include strategic directions and plans for the geographic sub-regions of a local health system in order to achieve the purposes of this Act.

(2) Section 15 of the Act is amended by adding the following subsection:

Consultations

(4) A local health integration network shall engage and seek advice from each board of health for any health unit located in whole or in part within the geographic area of the network in developing its integrated health service plan.

15. (1) Section 16 of the Act is amended by adding the following subsection:

Patient and family advisory committee

(4.1) Each local health integration network shall establish one or more patient and family advisory committees.

(2) Subsection 16 (5) of the Act is amended by striking out "shall establish" and substituting "may establish".

16. Subsection 18 (4) of the Act is amended by striking out "as defined in subsection 31 (5) of the Commitment to the Future of Medicare Act, 2004".

17. Subsection 19 (1) of the Act is repealed and the following substituted:

Funding of health service providers

(1) A local health integration network may provide funding,

(a) to a health service provider in respect of services that the service provider provides in or for the geographic area of the network; and

(b) to a health service provider in respect of services that the service provider provides in or for the geographic area of another network.

18. Section 20 of the Act is repealed and the following substituted:

Service accountability agreement

20. (1) Where a local health integration network proposes to provide funding to a health service provider or amend a service accountability agreement with a health service provider, the network and the provider shall enter into a service accountability agreement or amend such an agreement in accordance with this section.

Notification required

(2) A local health integration network shall notify a health service provider that it intends to enter into a service accountability agreement with the provider or that it seeks to amend such an agreement.

Negotiation

(3) After being notified under subsection (2), the parties shall seek to negotiate the terms and conditions of the service accountability agreement or the amendment.

Where agreement cannot be negotiated

(4) If the parties have not negotiated a service accountability agreement or an amendment within 90 days of the notice under subsection (2), each party shall, within a further 60 days, develop a written issues statement and provide a copy to the other party.

Written issues statement

(5) The written issues statement mentioned in subsection (4) shall include,

(a) a description of the facts and events leading to the inability to negotiate the service accountability agreement or amendment;

(b) a consideration as to whether the facts and events leading to the inability to negotiate the service accountability agreement or amendment affect the health service provider alone or whether they affect more than one provider, including the health system generally; and

(c) a list of potential options for settling the terms and conditions of the service accountability agreement or amendment that are at issue.

Meeting of CEOs

(6) If the parties have not negotiated a service accountability agreement or amendment within the 60 day period mentioned in subsection (4), the chief executive officer of the local health integration network shall offer to meet the chief executive officer of the health service provider within 14 days of the expiry of that 60 day period, and, if they meet, they shall seek to negotiate the terms and conditions of the service accountability agreement or the amendment. If the parties have not negotiated a service accountability agreement or an amendment through their respective chief executive officers within 21 days of the first meeting, then either party may refer the matter to the chairs of their boards of directors.

Meeting of chairs

(7) If a referral to the chairs is made under subsection (6), the chair of the board of the local health integration network shall offer to meet with the chair of the board of the health service provider within 14 days of the end of the 21 day period mentioned in subsection (6) and, if they meet, they shall seek to negotiate the terms and conditions of the service accountability agreement or the amendment.

Where chairs do not agree

(8) If the parties have not negotiated a service accountability agreement or an amendment within 21 days after the expiry of the 14 day period mentioned in subsection (7), then, at any time after the 21st day, the local health integration network may deliver a notice of an offer to the health service provider setting out the terms and conditions of the proposed service accountability agreement or amendment, and the network shall notify the Minister of that offer.

Deemed acceptance

(9) If the health service provider does not deliver a rejection notice within 30 days of receiving the notice of an offer under subsection (8), then the notice of offer shall be deemed to be the service accountability agreement between the network and the provider or an amendment to such an agreement, as the case may be, and the network and the provider shall comply with that agreement.

Rejection

(10) The health service provider may reject any offer referred to in subsection (8) by providing a notice to the network and the Minister within 30 days of receiving the notice of offer from the network and the provider shall state its reasons for rejecting the offer.

Setting the terms

(11) If the health service provider delivers a notice under subsection (10),

(a) the local health integration network shall consider the reasons for rejecting the offer that are stated in the notice;

(b) the local health integration network may at any time give notice to the provider that it intends to set the terms and conditions of the service accountability agreement or amendment to such an agreement, as the case may be, and, if such notice is provided, the local health integration network shall give the Minister a copy of the notice;

(c) at any time more than 30 days after giving notice under clause (b), if the local health integration network and the provider have not negotiated a service accountability agreement or amendment, as the case may be, the local health integration network may, if it considers it in the public interest to do so, deliver an offer of a service accountability agreement or amendment on the terms and conditions that the network determines, which shall be deemed to be the service accountability agreement, or amendment as the case may be, between the local health integration network and the provider; and

(d) the network and the provider shall comply with the terms and conditions of the agreement or amendment as set out in the offer under clause (c).

Saving

(12) Nothing in subsections (4) to (11) prevents the network and the provider from negotiating a service accountability agreement or an amendment during the time periods set out in those subsections.

Interpretation

(13) In this section, a reference to a chief executive officer or a chair refers to any person in the relevant party with such a title, a person holding an equivalent position, or a person who has been designated by the party to act in respect of the matters referred to in this section.

No restriction on patient mobility

20.1 (1) A local health integration network shall not enter into any agreement or other arrangement, including issuing an integration decision under Part V of this Act, that restricts or prevents an individual from receiving services based on the geographic area in which the individual resides.

Geographic restrictions for homecare services

(2) For greater certainty, subsection (1) applies to a service accountability agreement in respect of funding provided by a local health integration network for the delivery of services by a health service provider under section 20, but it does not apply to any agreement between a local health integration network and a service provider under the Home Care and Community Services Act, 1994 that requires the service provider to deliver services in the geographic area or a sub-region of the network.

19. The Act is amended by adding the following section:

Directives by local health integration networks

20.2 (1) A local health integration network may issue operational or policy directives to a health service provider to which it provides funding where the network considers it to be in the public interest to do so.

Exception

(2) Subsection (1) does not apply to a licensee within the meaning of the Long-Term Care Homes Act, 2007, a person or entity that operates a public hospital within the meaning of the Public Hospitals Act, or the University of Ottawa Heart Institute/Institut de cardiologie de l'Université d'Ottawa.

Notice

(3) Before issuing a directive, a local health integration network shall give notice of a draft directive to the Minister and to each health service provider to which it is intended to be issued.

Restriction

(4) A directive shall not unjustifiably as determined under section 1 of the Canadian Charter of Rights and Freedoms require a health service provider that is a religious organization to provide a service that is contrary to the religion related to the organization.

Binding

(5) A health service provider shall comply with every directive of a local health integration network.

General or particular

(6) An operational or policy directive of a local health integration network may be general or particular in its application.

Law prevails

(7) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Non-application of Legislation Act, 2006

(8) Part III (Regulations) of the Legislation Act, 2006 does not apply to the operational or policy directives.

Public availability

(9) A local health integration network shall make every directive under this section available to the public.

20. Section 21 of the Act is repealed and the following substituted:

Audits, reviews, etc.

21. A local health integration network may at any time direct that a health service provider that receives funding from the network,

(a) engage or permit one or more auditors licensed under the Public Accounting Act, 2004 to audit the accounts and financial transactions of the service provider; or

(b) engage in or permit an operational review or peer review of the provider's activities.

21. The Act is amended by adding the following sections:

Investigators

21.1 (1) A local health integration network may appoint one or more investigators to investigate and report on the quality of the management of a health service provider, the quality of the care and treatment of persons by a health service provider or any other matter relating to a health service provider where the local health integration network considers it to be in the public interest to do so.

Application

(2) Subsection (1) applies to health service providers that receive funding from the local health integration network but does not apply to a licensee within the meaning of the Long-Term Care Homes Act, 2007.

Notice of appointment

(3) Before appointing an investigator, the local health integration network shall give notice of its intention to appoint an investigator to the Minister and the health service provider.

Powers

(4) An investigator may, without a warrant and at reasonable times,

(a) enter the premises of a health service provider that may be investigated under this section;

(b) subject to subsection (5), enter any premises where a health service provider provides services; and

Dwellings

(5) No investigator shall enter a place that is being used as a dwelling, except with the consent of the occupier.

Identification

(6) An investigator conducting an investigation shall produce, on request, evidence of his or her appointment.

Powers of investigator conducting investigation

(7) An investigator conducting an investigation may,

(b) examine and copy any record or thing required under clause (a);

(d) in order to produce a record in readable form, use data storage, information processing or retrieval devices or systems that are normally used in carrying on business in the place; and

(e) question a person on matters relevant to the investigation.

Obligation to produce and assist

(8) If an investigator requires the production of a record or anything else that is relevant to the investigation under this section, any of the following who has custody of the record or thing shall produce it and, in the case of a record, shall on request provide any assistance that is reasonably necessary to interpret the record or to produce it in a readable form:

1. The health service provider.

2. Any person employed by the provider.

3. Any person performing services for the provider.

Restriction

(9) An investigator shall not exercise the investigator's powers under subsections (7) and (8) to access personal health information except,

(a) with the consent of the individual who is the subject of the personal health information; or

(b) in such circumstances as may be prescribed.

Same

(10) If an investigator accesses personal health information under subsection (9), the investigator shall not,

(a) collect, use or disclose the personal health information if other information will serve the purpose of the investigation; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purpose of the investigation.

Confidentiality

(11) An investigator and his or her agents shall keep confidential all information that comes to the investigator's knowledge in the course of an investigation under this Act and shall not communicate any information to any other person except as required by law or except where the communication is to the local health integration network or a person employed in or performing services for the local health integration network.

Report of investigator

(12) The investigator shall, upon completion of an investigation, make a report in writing to the local health integration network.

De-identification of personal health information

(13) Before providing a report to the local health integration network under subsection (12), the investigator shall ensure that all personal health information is de-identified.

Same

(14) The local health integration network shall cause a copy of the report of an investigation, with all personal health information de-identified, to be delivered to the health service provider.

Public availability

(15) The local health integration network shall make every report of an investigation available to the public.

Health service provider supervisor

21.2 (1) A local health integration network may appoint a person as a health service provider supervisor of a health service provider to which it provides funding where the network considers it in the public interest to do so.

Certain providers excepted

(2) This section does not apply with respect to a health service provider that is,

(a) a person or entity that operates a hospital within the meaning of the Public Hospitals Act or a private hospital within the meaning of the Private Hospitals Act; or

(b) a licensee within the meaning of the Long-Term Care Homes Act, 2007.

Notice of appointment

(3) The local health integration network shall give the Minister and the governing body of the health service provider at least 14 days notice before appointing the supervisor.

Immediate appointment

(4) Subsection (3) does not apply if there are not enough members of the governing body to form a quorum.

Term of office

(5) The appointment of a health service provider supervisor is valid until terminated by order of the network.

Powers of supervisor

(6) Unless the appointment provides otherwise, a health service provider supervisor has the exclusive right to exercise all of the powers of the governing body of the provider and its directors, officers, members or shareholders as the case may be.

Same

(7) The local health integration network may specify the powers and duties of a health service provider supervisor appointed under this section and the terms and conditions governing those powers and duties.

Additional powers of supervisor

(8) If, under the order of the network, the governing body continues to have the right to act with regard to any matters, any such act of the body is valid only if approved in writing by the health service provider supervisor.

Right of access

(9) A health service provider supervisor appointed for a health service provider has the same rights as the governing body and the chief executive officer of the provider in respect of the documents, records and information of the body and the provider.

Restriction

(10) A health service provider supervisor shall not,

(a) collect, use or disclose personal health information if other information will serve the purposes of the supervisor; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purposes of the supervisor.

Reports

(11) A health service provider supervisor shall make a report to the network as required by the network.

De-identification of personal health information

(12) Before providing a report to the network under subsection (11), the health service provider supervisor shall ensure that all personal health information is de-identified.

Network's directions

(13) The local health integration network may issue directions to a health service provider supervisor with regard to any matter within the jurisdiction of the supervisor.

Directions to be followed

(14) A health service provider supervisor shall carry out every direction of the network.

Public availability

(15) The network shall make every report of a supervisor available to the public.

22. (1) Subsection 22 (1) of the Act is amended by striking out "as defined in subsection 31 (5) of the Commitment to the Future of Medicare Act, 2004".

(2) Subsection 22 (2) of the Act is amended by striking out,

(a) "as defined in subsection 31 (5) of the Commitment to the Future of Medicare Act, 2004"; and

(b) "or Part III of the latter Act".

(3) Clause 22 (4) (a) of the Act is amended by striking out "or Part III of the Commitment to the Future of Medicare Act, 2004".

23. (1) The following provisions of section 27 of the Act are amended by striking out "60" and substituting "90":

1. Clause (3) (c).

2. Clause (3) (d), in the portion before subclause (i).

3. Subsection (4), in the portion before clause (a).

4. Subsection (6).

(2) Subsection 27 (3) of the Act is amended by striking out "and" at the end of subclause (d) (iii) and by adding the following clause:

(d.1) despite clauses (c) and (d), may proceed with the integration at any time if the network notifies the provider that the network does not intend to give notice of a proposed decision under subsection (4) or issue a decision under subsection (6); and

(3) Section 27 of the Act is amended by adding the following subsections:

Exceptions

(3.1) Subsection (3) does not apply to an integration that requires a decision of the Minister or a director under the Independent Health Facilities Act or the Long-Term Care Homes Act, 2007.

Requirements of notice

(3.2) A notice under clause (3) (a) must include,

(a) a description of the integration proposed by the health service provider, including the identity of the parties involved with the integration;

(b) the health service provider's analysis of any financial implications, service delivery implications, health system implication or human resource implications of the proposed integration, where applicable;

(c) where applicable, a description of any community engagement processes that the provider used to consider the proposed integration, and a description of any issues that were raised in those consultation processes and the provider's analysis, if any, of those issues;

(d) a description of the proposed timing or staging of the implementation of the proposed integration; and

(e) a description of the level of approval received by the provider within its organization.

(4) Subsection 27 (4) of the Act is amended by adding the following clause:

(0.a) request more information about the proposed integration from the provider and where such a request has been made,

(i) the provider shall provide such information within 30 days of the request by the network, and

(ii) the time limit for the network to take the steps set out in clauses (a), (b) and (c) shall be extended, once only, by an additional 60 days;

24. Subsection 31 (3) of the Act is amended by striking out "a person who suffers" and substituting "a person or entity, including a health service provider, who suffers".

25. Section 33 of the Act is repealed.

26. The Act is amended by adding the following Part:

PART V.1
TRANSFER OF COMMUNITY CARE ACCESS CORPORATIONS TO LOCAL HEALTH INTEGRATION NETWORKS

Definition

34.1 In this Part,

"community care access corporation" means a corporation continued or incorporated under the Community Care Access Corporations Act, 2001.

Transfer order

34.2 (1) Despite anything in the Community Care Access Corporations Act, 2001, the Corporations Act or any other Act, but subject to the processes and requirements set out in this Part and any regulations made under this Part, the Minister may make an order,

(a) transferring all of the assets, liabilities, rights and obligations of a community care access corporation to the local health integration network that has the same geographic area as the community care access corporation; and

(b) transferring all of the employees of a community care access corporation to the local health integration network that has the same geographic area as the community care access corporation.

Notification requirement

(2) Before the Minister makes an order under subsection (1), the Minister shall notify the affected community care access corporation and local health integration network.

Contents of order

(3) An order made under subsection (1),

(a) shall specify a date on which the transfer of assets, liabilities, rights, obligations or employees, as the case may be, takes effect; and

(b) may specify that issues arising out of the interpretation of the order be resolved by the method specified in the order.

Non-application of Legislation Act, 2006

(4) Part III (Regulations) of the Legislation Act, 2006 does not apply to an order made under subsection (1).

Notice of order

(5) The Minister shall provide each affected community care access corporation and local health integration network with a copy of the order, and shall make the order available to the public.

Same, duty of corporation

(6) Each community care access corporation and local health integration network that receives a copy of an order provided under subsection (5) shall,

(a) provide notice of the order and make copies available to affected employees and their bargaining agents and to other persons or entities whose contracts are affected by the order; and

(b) make copies of the order available to the public.

Assumption of rights, obligations, etc.

34.3 (1) If the Minister makes an order under subsection 34.2 (1),

(a) the local health integration network affected by the transfer assumes the operations, activities and affairs of the community care access corporation affected by the transfer, as of the date of the transfer; and

(b) all assets, liabilities, rights and obligations of the community care access corporation affected by the transfer, including contractual rights, interests, approvals, registrations and entitlements that exist immediately before the transfer date continue as the assets, liabilities, rights and obligations of the local health integration network affected by the transfer, and are transferred to the local health integration network affected by the transfer, without compensation.

Convictions, rulings etc.

(2) A conviction against, or ruling, order or judgment in favour of or against a community care access corporation affected by a transfer may be enforced by or against the local health integration network affected by the transfer.

Civil actions, etc.

(3) The local health integration network affected by a transfer shall be deemed to be the party plaintiff or the party defendant, as the case may be, in any civil action commenced by or against the community care access corporation affected by the transfer before the date of the transfer.

No change of control

(4) A transfer of the assets, liabilities, rights and obligations of the community care access corporation to the local health integration network shall not constitute a change of control of the community care access corporation in respect of any asset, liability, right or obligation of the community care access corporation affected by the transfer.

No breach, etc.

(5) A transfer is deemed not to,

(a) constitute a breach, termination, repudiation or frustration of any contract, including a contract of employment or insurance or a collective agreement;

(b) constitute a breach of any Act, regulation or municipal by-law;

(d) give rise to a breach, termination, repudiation or frustration of any licence, permit or other right;

(e) give rise to any right to terminate or repudiate a contract, licence, permit or other right; or

(f) give rise to any estoppel.

No new cause of action

(6) A transfer does not create any new cause of action in favour of,

(a) a holder of a debt instrument that was issued by the community care access corporation affected by the transfer before the transfer; or

(b) a party to a contract with the community care access corporation affected by the transfer that was entered into before the transfer.

Transfer binding

(7) Despite any other Act that requires notice or registration of a transfer, a transfer is binding on the local health integration network affected by the transfer and all other persons.

Non-application of other Acts

(8) The Bulk Sales Act, the Land Transfer Tax Act and the Retail Sales Tax Act do not apply to the transfer.

Application of FIPPA

(9) The Freedom of Information and Protection of Privacy Act applies to a record that is transferred from a community care access corporation to a local health integration network, unless the record was in the custody or control of the community care access corporation before January 1, 2007.

Transfer of property held for specified charitable purpose

(10) If a Minister's order transfers to a local health integration network property that a community care access corporation holds for a specified charitable purpose, the local health integration network shall use it for the specified charitable purpose.

Application

(11) Subsection (10) applies whether the will, deed or other document by which the gift, trust, bequest, devise or grant is made, is executed before or after this section comes into force.

Regulations

(12) The Lieutenant Governor in Council may make regulations,

(a) prescribing contracts to which subsections (5) and (6) do not apply;

(b) prescribing Acts, in addition to those listed in subsection (8), that do not apply to the transfer.

Non-application of s. 38

(13) Section 38 does not apply to the making of regulations under subsection (12).

No expropriation

(14) Nothing in this Part and nothing done or not done in accordance with this Part constitutes an expropriation or injurious affection for the purposes of the Expropriations Act or otherwise at law.

Immunity re transfer

(15) No proceeding for damages or otherwise shall be commenced against a director or officer of a local health integration network, a director or officer of a community care access corporation, or any person employed by a network or an access corporation in respect of a claim arising in connection with a transfer.

Definition

(16) In this section and in section 34.4,

"transfer" means a transfer made pursuant to an order under subsection 34.2 (1).

Employees continued

34.4 (1) Persons who are employees of a community care access corporation affected by an order under subsection 34.2 (1) immediately before the transfer become employees of the local health integration network affected by the order as of the date of the transfer.

Same

(2) For all purposes, the employment of the employees described in subsection (1) immediately before and after the transfer is continuous.

Same

(3) For all purposes, including the purposes of an employment contract, a collective agreement and the Employment Standards Act, 2000, the employment of the employees described in subsection (1) is not terminated or severed and those employees are not constructively dismissed because of the transfer.

Terms of employment

(4) All rights, duties and liabilities relating to all employees and former employees of the community care access corporation affected by the transfer that are vested in or bind the community care access corporation affected by the transfer immediately before the effective date of the transfer are vested in or bind the local health integration network affected by the transfer instead of the community care access corporation affected by the transfer immediately after the transfer.

Application of s. 69 of Labour Relations Act, 1995

(5) A transfer is deemed to be a sale of a business under section 69 of the Labour Relations Act, 1995 and that section applies to the transfer.

Pay Equity Act

(6) A transfer is deemed to be a sale of business under section 13.1 of the Pay Equity Act and that section is deemed to apply to the transfer.

Non-application of s. 9, Public Sector Labour Relations Transition Act, 1997

(7) A transfer is not a health services integration for the purposes of section 9 of the Public Sector Labour Relations Transition Act, 1997.

Application of ss. 36 (2) to (7), Public Sector Labour Relations Transition Act, 1997

(8) Subsections 36 (2) to (7) of the Public Sector Labour Relations Transition Act, 1997 apply to a collective agreement binding on a local health integration network and a bargaining agent that represented employees subject to a transfer.

Same

(9) For the purposes of subsections 36 (2) to (7) of the Public Sector Labour Relations Transition Act, 1997, the community care access corporation and the local health integration network subject to a transfer are predecessor employers and the local health integration network is the successor employer.

Dissolution order

34.5 (1) The Minister may make an order to dissolve a community care access corporation that is affected by an order made under subsection 34.2 (1).

Dissolution of community care access corporation

(2) If the Minister makes an order under subsection (1), the community care access corporation affected by the order is dissolved as of the date specified in the order, despite any requirement that would otherwise apply under the Community Care Access Corporations Act, 2001.

Members terminated

(3) The persons who are the members of the community care access corporation affected by the order immediately before the dissolution cease to be members on the day of the dissolution.

Directors terminated

(4) The terms of office of the directors and officers of the community care access corporation affected by the order who are in office immediately before its dissolution are terminated on the day of the dissolution.

Final annual report

(5) Despite the dissolution of a community care access corporation affected by an order, the chair and chief executive officer of the local health integration network affected by the order shall prepare and deliver the annual report for every fiscal year of the community care access corporation affected by the order before its dissolution for which the annual report has not already been delivered by the community care access corporation.

Same

(6) For the purposes of subsection (5), if the community care access corporation affected by the order is dissolved in any year on a date other than March 31, its last fiscal year is deemed to be from the preceding April 1 to the date of its dissolution.

Other filings

(7) The chair and chief executive officer of the local health integration network affected by the order shall make any other filings or reports that a community care access corporation may make or that would have been required of the community care access corporation immediately before its dissolution, and the chair and chief executive officer are deemed to have all the rights of a member, director or officer of the community care access corporation to make the filings or reports.

No change of control

(8) The dissolution of the community care access corporation affected by the order shall not constitute a change of control of the community care access corporation in respect of any asset, liability, right or obligation of the community care access corporation referred to in subsection (1).

27. (1) Section 35 of the Act is repealed and the following substituted:

Public interest

35. In making a decision in the public interest under this Act, the Lieutenant Governor in Council, the Minister or a local health integration network, as the case may be, may consider any matter they regard as relevant including, without limiting the generality of the foregoing,

(a) the quality of the management and administration of the local health integration network or the health service provider, as the case may be;

(b) the proper management of the health care system in general;

(c) the availability of financial resources for the management of the health care system and for the delivery of health care services;

(d) the accessibility to health services in the geographic area or sub-region where the local health integration network or the health service provider, as the case may be, is located; and

(e) the quality of the care and treatment of patients.

No liability

35.1 (1) No proceeding for damages or otherwise, other than an application for judicial review under the Judicial Review Procedure Act or a claim for compensation that is permitted under subsection 31 (3) of this Act, shall be commenced against any of the following with respect to any act done or omitted to be done or any decision, directive, standard or order made or issued under this Act that is done in good faith in the execution or intended execution of a power or duty under this Act:

1. The Crown.

2. The Minister.

3. A local health integration network.

4. Any member, director or officer of a local health integration network or an agent or a volunteer of a local health integration network.

5. Any person employed by the Crown, the Minister or a local health integration network.

6. An investigator or a supervisor appointed under section 12.1 or 12.2, or their staffs.

No protection re negligent health service delivery

(2) Nothing in subsection (1) prevents a claim for compensation with respect to the delivery of services by a local health integration network or the delivery of services arranged by a local health integration network, and, for greater certainty, a local health integration network does not deliver services, and services are not arranged by a local health integration network, when the network funds services under subsection 19 (1) to be delivered by a health service provider.

(2) Paragraph 6 of subsection 35.1 (1) of the Act, as enacted by subsection (1), is amended by striking out "under section 12.1 or 12.2" and substituting "under section 12.1, 12.2, 21.1 or 21.2".

28. Subsection 37 (1) of the Act is amended by adding the following clause:

(i.1) respecting the content or terms and conditions of a service accountability agreement under section 20;

29. The Act is amended by adding the following section:

Information and reports

37.1 The Lieutenant Governor in Council may make regulations respecting the provision of information, other than personal health information, from prescribed persons and entities to a local health integration network in order to support collaboration between health service providers, local health integration networks, physicians and others in the health care system, and to support planning of primary care services, including physician services, that ensure timely access and improve patient outcomes, including information to facilitate understanding by the network of,

(a) transitions in practice, including opening, closing, retirements and extended leaves; and

(b) practice and service capacity to address population needs of the local health system in the geographic area of the network.

30. Sections 39 and 40 of the Act are repealed and the following substituted:

Corporation

39. (1) The Lieutenant Governor in Council may by regulation incorporate a corporation without share capital to provide shared services to local health integration networks and others.

Matters in regulations

(2) The Lieutenant Governor in Council may, in the regulations incorporating the corporation without share capital, or in other regulations, make regulations with respect to the following:

1. The name of the corporation.

2. The conditions and restrictions that apply with respect to the corporation.

3. The composition of the corporation.

4. The composition of the board of directors and the appointment and remuneration of directors. As an option, the regulation may authorize the Lieutenant Governor in Council to make the appointment and determine the remuneration.

5. The objects of the corporation, which may include the provision of shared services to local health integration networks, health service providers or other entities whose primary function is to deliver health services.

6. The capacity, rights, powers and privileges of the corporation and any restrictions on them.

7. The office of a chair and one or more vice-chairs, and their functions.

8. The appointment and remuneration of the chief executive officer. As an option, the regulation may authorize the Lieutenant Governor in Council to make the appointment and determine the remuneration.

9. The appointment of auditors.

10. The frequency, nature and scope of reporting from the corporation and to whom the reports will be given.

11. The corporation's authority to employ or otherwise engage persons for the proper conduct of its activities.

12. Requirements for the investigation, review and audits of the corporation by the Minister or his or her delegate.

13. The application or non-application to the corporation of the Business Corporations Act, the Corporations Information Act or the Corporations Act or any provisions of those Acts or any successor of those Acts or any regulations under any of those Acts.

14. The procedures and administration of the corporation.

15. Directives and policies that the Minister may issue to the corporation relating to the exercise of its powers or the performance of its duties and the duty of the board of directors to ensure that the directives and policies are implemented promptly and efficiently.

16. Amalgamating the corporation or any part of it with any other person or entity or dissolving the corporation or any part of it, and doing all things necessary to accomplish the amalgamation or dissolution, including dealing with the assets and liabilities of the corporation, and transferring such assets or transferring employees to the Crown, a Crown agent or another corporation.

17. Any other matters the Lieutenant Governor in Council considers necessary or desirable.

Crown agency

(3) The corporation is a Crown agent for all purposes unless a regulation specifies otherwise.

Non-application of s. 38

(4) Section 38 does not apply to the making of a regulation under this section.

No personal liability

(5) No action or other proceeding for damages may be instituted against any member, director, officer, employee or agent of the corporation for any act done in the execution or intended execution of the person's duty or for any alleged neglect or default in the execution in good faith of the person's duty.

Non-application of single employer rule

(6) Subsection 1 (4) of the Labour Relations Act, 1995 does not apply to the corporation.

Restrictions on borrowing, etc.

(7) The corporation shall not, as a Crown agent, borrow, invest funds or manage financial risks, unless it is permitted to do so by regulation and unless the activity is authorized by a by-law that has been approved in writing by the Minister of Health and Long-Term Care and by the Minister of Finance.

Same

(8) Subject to subsection (9), the Ontario Financing Authority shall co-ordinate and arrange all borrowing, investing of funds and managing of financial risks for the corporation.

Direction re borrowing, etc.

(9) The Minister of Finance may, in writing, direct a person other than the Ontario Financing Authority to coordinate and arrange the borrowing, investing of funds and managing of financial risks for the corporation.

Same

(10) The direction under subsection (9) may be general or specific and may include terms and conditions that the Minister of Finance considers advisable.

Use of certain revenues

(11) The revenues that the corporation receives as a Crown agent shall be used for the purposes specified by regulation, and for no other purpose.

Information disclosure

(12) If the corporation is requested by a local health integration network to provide assistance to the network to process a person's request under the Freedom of Information and Protection of Privacy Act, the network shall disclose such information to the corporation as is necessary for that purpose, including personal information, but shall not disclose any information whose disclosure is not necessary for the purpose of processing the request.

Definition

(13) In this section,

"corporation" means the corporation without share capital incorporated by regulation under subsection (1).

Transfer order

40. (1) Despite anything in the Corporations Act or any other Act, but subject to the processes and requirements set out in this section and any regulations made under this section, the Minister may make an order,

(a) transferring the assets, liabilities, rights and obligations from the Ontario Association of Community Care Access Centres or its successor corporation to a corporation without share capital incorporated under subsection 39 (1); and

(b) transferring employees from the Ontario Association of Community Care Access Centres or its successor corporation to a corporation without share capital incorporated under subsection 39 (1).

Notification requirement

(2) Before the Minister makes an order under subsection (1), the Minister shall notify the affected corporations.

Contents of order

(3) An order made under subsection (1),

(a) shall specify a date on which the transfer of assets, liabilities, rights, obligations or employees, as the case may be, takes effect; and

(b) may specify that issues arising out of the interpretation of the order be resolved by the method specified in the order.

Non-application of Legislation Act, 2006

(4) Part III (Regulations) of the Legislation Act, 2006 does not apply to an order made under subsection (1).

Notice of order

(5) The Minister shall provide each affected corporation with a copy of the order, and shall make the order available to the public.

Same, duty of corporation

(6) Each corporation that receives a copy of an order provided under subsection (5) shall,

(a) provide notice of the order and make copies available to affected employees and their bargaining agents and to other persons or entities whose contracts are affected by the order; and

(b) make copies of the order available to the public.

Rules regarding a transfer of assets by order

(7) The following provisions apply to the transfer of assets, liabilities, rights and obligations to a corporation without share capital incorporated under subsection 39 (1) in accordance with an order made under subsection (1), unless the regulations provide otherwise:

1. A conviction against, or ruling, order or judgment in favour of or against a person from whom any assets, liabilities, rights or obligations are transferred to the corporation may be enforced by or against the corporation.

2. The corporation shall be deemed to be the party plaintiff or the party defendant, as the case may be, in any civil action commenced by or against a person from whom any assets, liabilities, rights or obligations are transferred to the corporation before the date of the transfer.

3. A transfer of the assets, liabilities, rights and obligations from a person to the corporation shall not constitute a change of control in respect of any asset, liability, right or obligation of the person.

4. A transfer of the assets, liabilities, rights and obligations from a person to the corporation is deemed not to,

i. constitute a breach, termination, repudiation or frustration of any contract, including a contract of employment or insurance,

ii. constitute a breach of any Act, regulation or municipal by-law,

iii. constitute an event of default or force majeure,

iv. give rise to a breach, termination, repudiation or frustration of any licence, permit or other right,

v. give rise to any right to terminate or repudiate a contract, licence, permit or other right, or

vi. give rise to any estoppel.

5. A transfer of the assets, liabilities, rights and obligations from a person to the corporation does not create any new cause of action in favour of,

i. a holder of a debt instrument that was issued by the person before the transfer, or

ii. a party to a contract with the person that was entered into before the transfer.

6. Despite any other Act that requires notice or registration of a transfer, a transfer is binding on the corporation and all other persons.

7. The Bulk Sales Act, the Land Transfer Tax Act and the Retail Sales Tax Act do not apply to the transfer.

8. Nothing in this section and nothing done or not done in accordance with this section constitutes an expropriation or injurious affection for the purposes of the Expropriations Act or otherwise at law.

9. No proceeding for damages or otherwise shall be commenced against a director or officer of the corporation or any person employed by the corporation in respect of a claim arising in connection with a transfer in accordance with a regulation made under this section.

Rules regarding a transfer of employees by order

(8) Persons who are employees of the Ontario Association of Community Care Access Centres or its successors affected by an order under subsection (1) immediately before the transfer become employees of a corporation without share capital incorporated under subsection 39 (1) in accordance with an order made under subsection (1) as of the date of the transfer, and the following rules apply:

1. For all purposes, including for the purposes of an employment contract, a collective agreement and the Employment Standards Act, 2000, the employment of the employees is not terminated or severed and the employees are not constructively dismissed because of a transfer to the corporation.

2. For all purposes, the employment of the employees immediately before and after the transfer is continuous.

3. All rights, duties and liabilities relating to all employees and former employees of the Ontario Association of Community Care Access Centres or its successors affected by the transfer that are vested in or that bind the Ontario Association of Community Care Access Centres or its successors affected by the transfer immediately before the effective date of the transfer are vested in or bind the corporation without share capital incorporated under subsection 39 (1) affected by the transfer instead of the Ontario Association of Community Care Access Centres or its successors immediately after the transfer.

Regulations

(9) The Lieutenant Governor in Council may make regulations,

(a) governing the transfer of assets, liabilities, rights and obligations in accordance with an order made under subsection (1);

(b) governing the transfer of employees in accordance with an order made under subsection (1);

Non-application of s. 38

(10) Section 38 does not apply to the making of a regulation under this section.

Other Amendments, Repeals, etc.

Broader Public Sector Accountability Act, 2010

31. (1) The definition of "community care access corporation" in subsection 1 (1) of the Broader Public Sector Accountability Act, 2010 is repealed.

(2) Clause (e) of the definition of "designated broader public sector organization" in subsection 1 (1) of the Act is repealed.

Broader Public Sector Executive Compensation Act, 2014

32. Paragraph 8 of subsection 3 (1) of the Broader Public Sector Executive Compensation Act, 2014 is repealed.

Commitment to the Future of Medicare Act, 2004

33. Part III of the Commitment to the Future of Medicare Act, 2004 is repealed.

Community Care Access Corporations Act, 2001

34. The Community Care Access Corporations Act, 2001 is repealed.

Electronic Cigarettes Act, 2015

35. (1) Clause (a) of the definition of "home health-care worker" in subsection 11 (5) of the Electronic Cigarettes Act, 2015 is repealed.

(2) The definition of "home health-care worker" in subsection 11 (5) of the Act is amended by adding the following clause:

(a.1) a local health integration network as defined in section 2 of the Local Health System Integration Act, 2006, or

Employment Standards Act, 2000

36. (1) Section 74.2 of the Employment Standards Act, 2000 is amended by striking out "Long-Term Care Act, 1994" in the portion before clause (a) and substituting "Home Care and Community Services Act, 1994".

(2) Section 74.2 of the Act is repealed.

(3) The Act is amended by adding the following section:

Assignment employees

74.2.1 This Part does not apply in relation to an individual who is an assignment employee assigned to provide professional services, personal support services or homemaking services as defined in the Home Care and Community Services Act, 1994 if the assignment is made under a contract between,

(a) the individual and a local health integration network within the meaning of the Local Health System Integration Act, 2006; or

(b) an employer of the individual and a local health integration network within the meaning of the Local Health System Integration Act, 2006.

Excellent Care for All Act, 2010

37. (1) Clause (b) of the definition of "health sector organization" in section 1 of the Excellent Care for All Act, 2010 is repealed.

(2) The definition of "health sector organization" in section 1 of the Act is amended by striking out "and" at the end of clause (c) and by adding the following clause:

(c.1) a local health integration network within the meaning of the Local Health System Integration Act, 2006, but only with respect to,

(i) professional services, personal support services and homemaking services as defined in the Home Care and Community Services Act, 1994 provided by or arranged by a local health integration network under that Act,

(ii) the placement of a person into,

(A) a long-term care home within the meaning of the Long-Term Care Homes Act, 2007,

(B) a supportive housing program funded by the Ministry of Health and Long-Term Care or a local health integration network under the Home Care and Community Services Act, 1994,

(D) an adult day program that is provided under the Home Care and Community Services Act, 1994, or

(iii) any other services that are prescribed, and

(3) Subsection 10 (1) of the Act is amended by adding "as a corporation without share capital" at the end.

(4) The Act is amended by adding the following sections:

Crown agent

10.1 The Council is for all its purposes an agent of the Crown and its powers may be exercised only as an agent of the Crown.

Powers of Council

10.2 (1) The Council has the capacity, rights, powers and privileges of a natural person for carrying out its functions, except as limited by this Act or the regulations.

Revenues and assets

(2) Despite Part I of the Financial Administration Act, the assets and revenues of the Council do not form part of the Consolidated Revenue Fund.

Use of revenues

(3) The Council shall carry out its operations without the purpose of gain for its members and all revenues of the Council, including all money or assets received by the Council by grant, gift, contribution, profit or otherwise, shall be used to further its functions.

Lieutenant Governor in Council approval

(4) The Council shall not, without the approval of the Lieutenant Governor in Council,

(a) acquire, dispose, lease, mortgage, charge, hypothecate or otherwise transfer or encumber any interest in real property;

(b) pledge, charge or encumber any of its personal property;

(d) do anything else that the regulations provide may not be done without such approval.

Investments, etc.

10.3 (1) The power of the Council to borrow, make short-term investments of funds, manage risk associated with financing and investment or incur liabilities in order to facilitate financing by others may only be exercised under the authority of a by-law that has been approved in writing by the Minister and the Minister of Finance.

Co-ordination of financing activities

(2) All borrowing, financing, short-term investment of funds and financial risk management activities of the Council shall be co-ordinated and arranged by the Ontario Financing Authority, unless the Minister of Finance approves otherwise.

Control

10.4 (1) The affairs of the Council are under the management and control of its board of directors.

By-laws

(2) The Council may, subject to the approval of the Minister, pass by-laws and resolutions for conducting and managing its affairs, including,

(a) appointing officers and assigning to them such powers and duties as the board considers appropriate;

(b) maintaining bank accounts and making other banking arrangements;

(c) establishing committees, including committees to develop recommendations about clinical care standards and performance measures; and

(d) anything else provided for in the regulations.

Delegation of Council functions

(3) Subject to the approval of the Minister, the Council may by by-law delegate any of its powers or functions to a committee that is established under the by-laws of the Council.

Conditions, etc. and delegation

(4) A delegation under subsection (3) is subject to any conditions or restrictions set out in the by-law.

(5) Section 11 of the Act is repealed and the following substituted:

No personal liability

11. (1) No action or other proceeding for damages may be instituted against any member, officer, employee or agent of the Council, or a member of a committee established under the by-laws of the Council for any act done in the execution or intended execution in good faith of the person's function or duty under this Act or the regulations or for any alleged neglect or default in the execution in good faith of the person's function or duty.

Council remains liable

(2) Subsection (1) does not relieve the Council of any liability to which it would otherwise be subject in respect of a cause of action arising from any act, neglect or default referred to in subsection (1).

No actions or proceedings against the Crown

11.1 (1) No action or other proceeding for damages may be instituted against the Crown, the Minister or any person employed by the Crown for any act, neglect or default by a person referred to in subsection 11 (1) or for any act, neglect or default by the Council.

Same

(2) Subsection (1) does not apply to a proceeding to enforce against the Crown its obligations under a written agreement under which the Crown expressly assumes liability for the acts or omissions of the Council.

Unpaid judgments against the Council

11.2 The Minister of Finance shall pay from the Consolidated Revenue Fund the amount of any judgment against the Council that remains unpaid after the Council has made all reasonable efforts, including liquidating its assets, to pay the amount of the judgment.

(6) Subclause 12 (1) (a) (iii) of the Act is amended by striking out "consumer" at the beginning and substituting "patient".

(7) Clause 12 (1) (c) of the Act is repealed and the following substituted:

(i) making recommendations to health care organizations and other entities on clinical care standards

(ii) making recommendations to the Minister concerning,

(A) the Government of Ontario's provision of funding for health care services and medical devices, and

(B) clinical care standards and performance measures relating to topics or areas that the Minister may specify;

(8) Subsection 12 (4) of the Act is amended by striking out "subclause (1) (c) (ii)" at the end and substituting "clause (1) (c)".

(9) Section 13 of the Act is repealed and the following substituted:

Reports

13. (1) The Council shall deliver to the Minister,

(a) a yearly report on the state of the health system in Ontario; and

(b) any other reports required by the Minister.

Publication on website

(2) The Council shall publish any recommendation it makes under clause 12 (1) (c) on its website.

Tabling

(3) The Minister shall table every yearly report under this section in the Legislative Assembly within 30 days of receiving it from the Council.

Purpose of reporting

(4) The purpose of reporting under clause (1) (a) is to,

(a) encourage and promote an integrated, patient centred health system;

(b) make the Ontario health system more transparent and accountable;

(d) help Ontarians to better understand their health system.

(10) The definition of "patient or former patient" in subsection 13.1 (9) of the Act is amended as follows:

1. By adding the following clause:

(c.1) a person who receives or has received services from a local health integration network, but only with respect to matters described in clause (c.1) of the definition of "health sector organization" in section 1,

2. By striking out "(c) or (d)" in clause (e) and substituting "(c), (c.1) or (d)".

(11) Subsection 13.2 (1) of the Act is amended by striking out "A patient" at the beginning of the portion before clause (a) and substituting "Subject to any prescribed limitations with respect to time, a patient".

(12) Subsections 13.7 (1) and (2) of the Act are repealed and the following substituted:

Immunity

(1) No proceeding shall be commenced against the patient ombudsman or any employee of the Council for any act done or omitted in good faith in the execution or intended execution of the patient ombudsman's functions under this Act.

(13) Clause 16 (1) (d) of the Act is amended by striking out "structure and legal status" at the end and substituting "and structure".

(14) Clause 16 (1) (m) of the Act is repealed and the following substituted:

(m) respecting and prescribing purposes for which personal health information may be collected, used or disclosed by the Council under subsections 13.6 (1), (2) and (3);

(m.1) respecting conditions, restrictions or requirements that apply to the Council in its collection, use and disclosure of personal health information under subsections 13.6 (1), (2) and (3);

(15) Clause 16 (1) (p) of the Act is repealed and the following substituted:

(p) governing the purposes for which the Council may use its assets and revenues;

(p.1) governing the Council's ability to borrow or invest funds and the Council's management of financial risks;

Health Insurance Act

38. Section 2 of the Health Insurance Act is amended by adding the following subsections:

LHIN as agent

(2.1) The Minister may appoint a local health integration network within the meaning of the Local Health System Integration Act, 2006 as the Minister's agent for the purpose of carrying out any function, obligation or right under an arrangement referred to in clause 2 (2) (a) of this Act, and the network shall have all rights and obligations of the Minister under such an arrangement to the extent that the network has been appointed as the Minister's agent, despite any provision of such an arrangement. The Minister shall give notice of the appointment of a network as an agent of the Minister to any other parties to the arrangement.

No amendment

(2.2) Despite subsection (2.1), a local health integration network shall not be authorized to amend any arrangement for which it has been appointed as an agent of the Minister.

Health Protection and Promotion Act

39. (1) Section 67 of the Health Protection and Promotion Act is amended by adding the following subsections:

Engagement with LHIN

(5) The medical officer of health of a board of health shall engage on issues relating to local health system planning, funding and service delivery with the chief executive officer or chief executive officers of the local health integration network or networks whose geographic area or areas cover the health unit served by the board of health.

Delegation

(6) A medical officer of health may only delegate his or her responsibilities under subsection (5) to another medical officer of health for a health unit within the relevant local health integration network, with the agreement of that other medical officer of health.

(2) Paragraph 2 of the definition of "health care provider or health care entity" in subsection 77.7 (6) of the Act is repealed and the following substituted:

2. A service provider within the meaning of the Home Care and Community Services Act, 1994 who provides a community service to which that Act applies.

(3) Paragraph 3 of the definition of "health care provider or health care entity" in subsection 77.7 (6) of the Act is repealed.

(4) Paragraph 5 of the definition of "health care provider or health care entity" in subsection 77.7 (6) of the Act is repealed and the following substituted:

5. A pharmacy within the meaning of the Drug and Pharmacies Regulation Act.

(5) The definition of "health care provider or health care entity" in subsection 77.7 (6) of the Act is amended by adding the following paragraph:

9.1 A local health integration network within the meaning of the Local Health System Integration Act, 2006.

Home Care and Community Services Act, 1994

40. (1) Subsection 28 (2) of the Home Care and Community Services Act, 1994 is repealed and the following substituted:

Rules for charges for other services

(2) Subject to subsection (3), if an approved agency provides or arranges the provision to a person of a homemaking or community support service in accordance with the person's plan of service, the approved agency may require payment from the person for the service and may accept a payment made by or on behalf of the person for the service.

LHINs providing services

(3) If a local health integration network provides or arranges the provision to a person of a homemaking or community support service in accordance with the person's plan of service, the network shall not require payment from the person for the service and shall not accept a payment made by or on behalf of the person for the service.

(2) The Act is amended by adding the following Part:

Part VII.1
PROVISION OF COMMUNITY SERVICES BY LOCAL HEALTH INTEGRATION NETWORKS

Provision of community services

28.1 (1) Despite subsection 5 (1), the Minister may approve a local health integration network to provide a community service for the residents of the geographic area of the local health integration network.

Effective date of approval

(2) If the Minister so specifies, an approval under subsection (1) shall be deemed to have taken effect on a day fixed by the Minister that is before the day on which the approval is given.

Terms and conditions

28.2 The Minister may impose terms and conditions on an approval given under subsection 28.1 (1) and may from time to time amend or remove the terms and conditions or impose new terms and conditions.

Funding, etc.

28.3 (1) If the Minister approves a local health integration network to provide a community service under section 28.1, the Minister may,

(a) fund the local health integration network for the purpose of providing community services and set terms and conditions with respect to such funding; and

(b) enter into an agreement with the local health integration network for the purpose of providing community services.

Deemed accountability agreement

(2) An agreement entered into under subsection (1) is deemed to be an accountability agreement for the purposes of section 18 of the Local Health System Integration Act, 2006.

Application of Act to LHIN providing community services

28.4 (1) When a local health integration network provides a community service as approved by the Minister under subsection 28.1 (1), the network is deemed to be an approved agency or service provider, as the case may be, for the purpose of this Act and the regulations under this Act, and the network shall provide the services in accordance with this Act and the regulations under this Act except that the following provisions of this Act and the regulations that apply under those sections do not apply to a network:

1. Sections 19, 20 and 21.

2. Clause 25 (2) (e) and subsection 25 (5).

3. Clause 31 (b).

4. Part X (other than subsection 56 (1)).

Clarification

(2) For greater clarity, a local health integration network is deemed to be an approved agency and not a service provider for the purposes of clauses 25 (2) (a) and (b), subsection 26 (1) and section 29.

Funding by LHINs

28.5 (1) The Minister may approve a local health integration network to provide funding to or on behalf of a person to purchase a prescribed community service in accordance with this section.

Effective date of approval

(2) If the Minister so specifies, an approval under subsection (1) shall be deemed to have taken effect on a day fixed by the Minister that is before the day on which the approval is given.

Terms and conditions of approval

(3) The Minister may impose terms and conditions on an approval given under subsection (1) and may from time to time amend or remove the terms and conditions or impose new terms and conditions.

Requirements

(4) The following requirements apply with respect to funding provided by a local health integration network pursuant to an approval given under subsection (1):

1. The network may only provide funding for those community services that are prescribed.

2. Funding may only be provided for a person for whom the network has developed a plan of service under section 22.

3. The person may apply to the network for the funding after the plan of service has been developed, and the network may determine whether the person is eligible for funding in accordance with the approval and the regulations, if any.

4. If the network determines that the person is eligible to receive funding, the network may provide the funding based upon the person's plan of service, and in accordance with the approval and the regulations, if any.

5. The network shall, when it reviews and evaluates the person's plan of service under subsection 22 (2), make any revisions to the funding that are appropriate in consequence, and despite paragraph 7, Part IX applies with respect to a decision by the network respecting the amount of any community services to be included in the person's plan of service.

6. The local health integration network may impose terms and conditions on the funding provided to or on behalf of the person to purchase the community services set out in the person's plan of service and may from time to time amend or remove the terms and conditions or impose new terms and conditions.

7. The other provisions of this Act, and the regulations made under this Act, do not apply to the network, other than,

i. the definitions in Part II,

ii. section 22,

iii. sections 59, 59.1, 64 and 66,

iv. the regulations made for the purposes of this section,

v. any provisions of this Act or the regulations that are made to apply by virtue of regulations made for the purposes of this section.

Protection from liability

(5) No action or other proceeding for damages or otherwise, other than an application for judicial review under the Judicial Review Procedure Act, shall be commenced against the Crown, the Minister, a local health integration network, any member, director or officer of a local health integration network, or any person employed by the Crown, the Minister or a local health integration network with respect to any act done or omitted to be done or any decision made under this section that is done in good faith in the execution or intended execution of a power or duty under this section.

(3) The definition of "approved services" in subsection 59 (1) of the Act is amended by adding "and includes services for which funding is provided under section 28.5" at the end.

(4) Subsection 62 (2) of the Act is amended by adding "or section 28.3" after "clause 4 (c)" in the portion before clause (a).

(5) Paragraph 1 of subsection 64 (1) of the Act is repealed and the following substituted:

1. Ensuring compliance with this Act, the regulations, an agreement made under clause 4 (c) or clause 28.3 (1) (b), a service accountability agreement with a local health integration network or a term or condition imposed by the Minister under this Act.

(6) Subsection 68 (1) of the Act is amended by adding the following paragraphs:

27.1 governing approvals, funding and related matters for the purposes of section 28.5;

27.2 prescribing the community services that may be funded for the purposes of section 28.5;

27.3 providing for additional provisions of this Act and the regulations that apply to the provision of funding under section 28.5, and clarifying the application of this Act and the regulations to such funding;

Ministry of Health and Long-Term Care Act

41. The Ministry of Health and Long-Term Care Act is amended by adding the following section:

Patient and Family Advisory Council

10. The Minister may establish a Patient and Family Advisory Council to provide patient perspectives and advice on strategic health policy priorities to the Minister.

Ombudsman Act

42. Section 13 of the Ombudsman Act is amended by adding the following subsection:

Application to local health integration networks

(9) This Act does not apply to local health integration networks within the meaning of the Local Health System Integration Act, 2006 with respect to matters described in subclauses (c.1) (i), (ii) and (iii) of the definition of "health sector organization" in section 1 of the Excellent Care for All Act, 2010.

Personal Health Information Protection Act, 2004

43. (1) Paragraph 3 of the definition of "health information custodian" in subsection 3 (1) of the Personal Health Information Protection Act, 2004 is repealed.

(2) Paragraph 2 of subsection 3 (6) of the Act is repealed.

(3) The Act is amended by striking out "paragraph 1, 2, 3 or 4 of the definition of "health information custodian"" wherever it appears in the following provisions and substituting in each case "paragraph 1, 2 or 4 of the definition of "health information custodian"":

1. Subsections 20 (2) and (3).

2. Clause 38 (1) (a).

3. Subclause 39 (1) (d) (i).

Poverty Reduction Act, 2009

44. Clause 8 (1) (c) of the Poverty Reduction Act, 2009 is amended by striking out "community care access corporations".

Private Hospitals Act

45. (1) The Private Hospitals Act is amended by adding the following section:

Directives by Minister

14.1 (1) The Minister may issue operational or policy directives to a licensee of a private hospital where the Minister considers it to be in the public interest to do so.

Binding

(2) A licensee shall carry out every directive of the Minister.

General or particular

(3) An operational or policy directive of the Minister may be general or particular in its application.

Law prevails

(4) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Non-application of Legislation Act, 2006

(5) Part III (Regulations) of the Legislation Act, 2006 does not apply to the operational or policy directives.

Public availability

(6) The Minister shall make every directive under this section available to the public.

(2) Section 15.3 of the Act is amended by striking out "15.1 or 15.2" and substituting "14.1, 15.1 or 15.2".

(3) Clause 15.6 (a) of the Act is repealed and the following substituted:

(a) the issuing of a directive under section 14.1 or a decision, revocation, termination or reduction under section 15.1 or 15.2; or

Public Hospitals Act

46. (1) Section 8 of the Public Hospitals Act is amended by adding the following subsections:

Disclosure

(5) The Minister shall make the report public.

Personal health information to be removed

(6) Before making the report public, the Minister shall ensure that all personal health information in the report is redacted.

(2) The Act is amended by adding the following section:

Directives by Minister

8.1 (1) The Minister may issue operational or policy directives to the board of a hospital where the Minister considers it to be in the public interest to do so.

Restriction

(2) A directive shall not unjustifiably as determined under section 1 of the Canadian Charter of Rights and Freedoms require the board of a hospital that is associated with a religious organization to provide a service that is contrary to the religion related to the organization.

Binding

(3) A board shall carry out every directive of the Minister.

General or particular

(4) An operational or policy directive of the Minister may be general or particular in its application.

Law prevails

(5) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Non-application of Legislation Act, 2006

(6) Part III (Regulations) of the Legislation Act, 2006 does not apply to the operational or policy directives.

Public availability

(7) The Minister shall make every directive under this section available to the public.

(3) Section 9 of the Act is amended by adding the following subsections:

Disclosure

(9.1) The Minister shall make any report provided to the Minister under subsection (9) public.

Personal health information to be removed

(9.2) Before making the report public, the Minister shall ensure that all personal health information in the report is redacted.

(4) Subsection 9.1 (2) of the Act is repealed and the following substituted:

No proceeding against Crown

(2) No proceeding, other than a proceeding referred to in subsection 10 (2), shall be commenced against the Crown or the Minister with respect to a decision or direction under section 5, 6 or 9, the issuing of a directive under section 8.1, the appointment of an investigator or a hospital supervisor under section 8 or 9, the appointment of an inspector under section 18 or any action or omission of an investigator, hospital supervisor or inspector done in good faith in the performance of a power or of an authority under any of those sections or under the regulations.

(5) Subsection 18 (4) of the Act is repealed and the following substituted:

Disclosure

(4) The Minister shall make any report provided to the Minister under subsection (2) public.

Personal health information to be removed

(5) Before making a report public, the Minister shall ensure that all personal health information in the report is redacted.

Public Sector Labour Relations Transition Act, 1997

47. The definition of "health services integration" in section 2 of the Public Sector Labour Relations Transition Act, 1997 is amended by striking out "either" at the end of the portion before clause (a), by striking out "or" at the end of clause (a), by adding "or" at the end of clause (b) and by adding the following clause:

Retirement Homes Act, 2010

48. (1) Clause 54 (2) (p) of the Retirement Homes Act, 2010 is repealed.

(2) Subsection 54 (2) of the Act is amended by adding the following clause:

(p.1) contact information for the local health integration network within the meaning of the Local Health System Integration Act, 2006 for the geographic area in which the retirement home is located;

Smoke-Free Ontario Act

49. (1) Clause (a) of the definition of "home health-care worker" in subsection 9.1 (5) of the Smoke-Free Ontario Act is repealed.

(2) The definition of "home health-care worker" in subsection 9.1 (5) of the Act is amended by adding the following clause:

(a.1) a local health integration network as defined in subsection 2 (1) of the Local Health System Integration Act, 2006; or

Commencement and Short Title

Commencement

50. (1) Subject to subsections (2) and (3), this Act comes into force on the day it receives Royal Assent.

Same

(2) Subsection 35 (1) comes into force on the later of the day subsection 11 (5) of the Electronic Cigarettes Act, 2015 comes into force and the day section 34 of this Act comes into force.

Same

(3) The following provisions of this Act come into force on a day to be named by proclamation of the Lieutenant Governor:

1. Subsection 1 (4).

2. Subsection 7 (2).

3. Section 19.

4. Section 21.

5. Subsection 27 (2).

6. Section 29.

7. Section 31.

8. Section 32.

9. Section 34.

10. Subsection 35 (2).

11. Subsection 36 (2).

12. Subsections 37 (1), (3), (4), (5), (10) and (12).

13. Section 38.

14. Subsection 39 (3).

15. Section 43.

16. Section 44.

17. Subsection 48 (1).

18. Subsection 49 (1).

Short title

51. The short title of this Act is the Patients First Act, 2016.

EXPLANATORY NOTE

This Explanatory Note was written as a reader's aid to Bill 41 and does not form part of the law. Bill 41 has been enacted as Chapter 30 of the Statutes of Ontario, 2016.

The Bill amends the Local Health System Integration Act, 2006 and makes related amendments to several other Acts. The major elements of the Bill are described below.

Local Health System Integration Act, 2006

Community care access corporations (CCACs) are removed from the definition of a "health service provider". Several new entities are added.

The Lieutenant Governor in Council is given the power to change the geographic area of local health integration networks by regulation.

New subsection 4 (5) specifies that subsection 1 (4) of the Labour Relations Act, 1995 does not apply to local health integration networks.

The objects of local health integration networks are modified. Several amendments are made to the size of the board of directors of these networks and to the term of members of the board of directors.

The boards of directors of local health integration networks are provided with new by-law making authorities, including the ability to appoint officers and delegate certain powers to other persons.

New section 11.1 gives the Minister of Health and Long-Term Care the power to issue operational or policy directives to local health integration networks. Local health integration networks must comply with these.

New section 11.2 gives the Minister the power to issue provincial standards for the provision of health services. Local health integration networks and health service providers must comply with these.

New section 12.1 gives the Minister the power to appoint investigators to investigate local health integration networks. New section 12.2 allows the Lieutenant Governor in Council to appoint a supervisor for local health integration networks, on the recommendation of the Minister, if the Lieutenant Governor in Council considers it to be in the public interest to do so.

Local health integration networks are required to establish geographic sub-regions in their local health system for the purposes of planning, funding and service integration. They must develop strategic directions and plans for these sub-regions in their integrated health service plan.

Local health integration networks are required to establish one or more patient and family advisory committees. The establishment of a health professionals advisory committee becomes optional.

Local health integration networks are given the ability to provide funding to health service providers in respect of services provided in or for the geographic area of another network.

New procedures and requirements are provided for service accountability agreements. The provision about local health integration networks not being allowed to enter into agreements or other arrangements that restrict or prevent an individual from receiving services based on the geographic area in which the individual resides is re-enacted in a new section.

New section 20.2 allows local health integration networks to issue operational or policy directives to a health provider to which it provides funding. The health service provider must comply with these.

Local health integration networks are given the power to engage in or permit operational reviews or peer reviews of a health provider's activities.

Local health integration networks are given the power to appoint investigators to investigate certain health service providers that receive funding from the network. The local health integration network may appoint a health service provider supervisor to exercise the powers of the governing body of certain health service providers if it considers it to be in the public interest to do so.

Section 27 is amended to revise and update the local health integration networks' integration power.

New Part V.1 is added to the Act. New subsection 34.2 (1) provides the Minister with the ability to transfer the assets, liabilities, rights, obligations and employees of a community care access corporation to the local health integration network that has the same geographic area as the CCAC. Various rules regarding these transfers are set out.

Employees transferred under an order become employees of the local health integration network affected by the order.

The Minister is also given the power to make an order to dissolve a CCAC that is affected by an order under subsection 34.2 (1). The legal effect of this order is set out.

Guidelines are provided to specify certain factors that the Lieutenant Governor in Council or the Minister may consider when making a decision in the public interest under the Act.

No proceeding for damages, with certain exceptions, may be commenced against the Crown, the Minister, local health integration networks, members, directors or officers of local health integration networks, investigators, supervisors, and any person employed by the Crown, the Minister or a local health integration network with respect to certain actions or omissions under the Act. This does not prevent a claim for compensation with respect to the delivery of services by or arranged by a local health integration network.

The Lieutenant Governor in Council is given the power to make regulations respecting the provision of certain information by prescribed persons and entities to local health integration networks.

The Lieutenant Governor in Council is given the power to incorporate a corporation without share capital to provide shared services to local health integration networks and others. The Minister is given the power to make an order transferring the assets, liabilities, rights, obligations and employees from the Ontario Association of Community Care Access Centres to this corporation. Various rules regarding these transfers are set out.

Broader Public Sector Accountability Act, 2010

Several amendments are made to remove references to CCACs.

Broader Public Sector Executive Compensation Act, 2014

A reference to CCACs is removed.

Commitment to the Future of Medicare Act, 2004

Part III of this Act is repealed.

Community Care Access Corporations Act, 2001

This Act is repealed.

Electronic Cigarettes Act, 2015

The reference to CCACs in the definition of "home health-care worker" is removed and replaced with a reference to local health integration networks.

Employment Standards Act, 2000

Several consequential amendments are made. A provision dealing with assignment employees providing services under a contract with a CCAC is removed and replaced with a similar provision in respect of local health integration networks.

Excellent Care for All Act, 2010

The Council is given the ability to make clinical standards recommendations to the Minister. The Council is also given the ability to receive, retain and use revenue outside of the Consolidated Revenue Fund. Other powers and duties with respect to financial matters are set out. Changes are made to the purpose, timing, and content of the Council's reporting obligations.

The Crown and members, officers, employees and agents of the Council and are protected from certain types of liability. This does not protect the Council itself from liability.

Amendments are made to the rules governing the collection, use and disclosure of personal health information by the Council.

The Patient Ombudsman is given oversight of complaints about home and patient care, and other prescribed services, provided by local health integration networks. Time limits for complaints to the Patient Ombudsman may be set in regulations.

Health Insurance Act

The Minister is allowed to make local health integration networks an agent of the Minister for the purpose of certain funding arrangements.

Health Protection and Promotion Act

Medical officers of health are required to engage with their local health integration networks. The Chief Medical Officer of Health is given the power to issue directives to local health integration networks, rather than CCACs.

Home Care and Community Services Act, 1994

Several amendments are made to permit the Minister to approve and fund local health integration networks and provide the services currently provided by CCACs under the Act. Approved agencies are permitted to charge fees for homemaking and community support services, while local health integration networks are prohibited from charging such fees. A protection from liability is set out.

Ministry of Health and Long-Term Care Act

The Minister is given the power to establish a Patient and Family Advisory Council.

Ombudsman Act

The Ombudsman Act is amended to provide that it does not apply to local health integration networks with respect to certain matters that are to be overseen by the Patient Ombudsman.

Personal Health Information Protection Act, 2004

CCACs are removed from the list of health information custodians.

Poverty Reduction Act, 2009

A reference to CCACs is removed.

Private Hospitals Act

The Minister is given the power to issue operational or policy directives to a licensee of a private hospital. These directives must be complied with.

Public Hospitals Act

The Minister must make certain reports on hospitals public.

The Minister is given the power to issue operational or policy directives to the board of a hospital. These directives must be complied with.

Public Sector Labour Relations Transition Act, 1997

A reference to a local health integration network is added to the definition of "health service integration".

Retirement Homes Act, 2010

A reference to CCACs is removed and a new reference to local health integration networks is added.

Smoke-Free Ontario Act

A reference to CCACs is removed and a new reference to local health integration networks is added.

[41] Bill 41 As Amended by Standing Committee (PDF)

Bill 41 2016

An Act to amend various Acts in the interests of patient-centred care

Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:

Local Health System Integration Act, 2006

1. (1) Subsection 2 (1) of the Local Health System Integration Act, 2006 is amended by adding the following definition:

"medical officer of health" has the same meaning as in the Health Protection and Promotion Act; ("médecin-hygiéniste")

(1.1) Subsection 2 (1) of the Act is amended by adding the following definition:

"de-identify" has the same meaning as in subsection 47 (1) of the Personal Health Information Protection Act, 2004; ("anonymiser")

(1.2) Subsection 2 (1) of the Act is amended by adding the following definition:

"personal health information" has the same meaning as in section 4 of the Personal Health Information Protection Act, 2004; ("renseignements personnels sur la santé")

(2) Paragraph 7 of the definition of "health service provider" in subsection 2 (2) of the Act is repealed.

(3) Paragraph 11 of the definition of "health service provider" in subsection 2 (2) of the Act is repealed and the following substituted:

11. A not for profit entity that operates a family health team.

12. A not for profit entity that operates a nurse-practitioner-led clinic.

13. A not for profit entity that operates an Aboriginal health access centre.

14. A person or entity that provides primary care nursing services, maternal care or inter-professional primary care programs and services.

15. A not for profit entity that provides palliative care services, including a hospice.

16. A person or entity that provides physiotherapy services in a clinic setting that is not otherwise a health service provider.

17. Any other person or entity or class of persons or entities that is prescribed.

(4) Section 2 of the Act is amended by adding the following subsection:

Exclusion, community services

2. (1) Subsection 3 (4) of the Act is amended by adding the following clause:

(b.1) change the geographic area of one or more local health integration networks;

(2) Clause 3 (4) (d) of the Act is amended by striking out the portion before subclause (i) and substituting the following:

. . . . .

3. Section 4 of the Act is amended by adding the following subsection:

Non-application of single employer rule

(5) Subsection 1 (4) of the Labour Relations Act, 1995 does not apply to a local health integration network.

4. (1) Clause 5 (b) of the Act is repealed and the following substituted:

(2) Section 5 of the Act is amended by adding the following clause:

(e.1) to promote health equity, reduce health disparities and inequities, and respect the diversity of communities and the requirements of the French Language Services Act in the planning, design, delivery and evaluation of services;

(2.1) Section 5 of the Act is amended by adding the following clause:

(3) Section 5 of the Act is amended by striking out "and" at the end of clause (m) and by adding the following clauses:

(m.3) to provide information to the public about, and make referrals to, health and social services;

(m.4) to fund non-health services that are related to health services that are funded by the Minister or a local health integration network; and

5. Paragraphs 6 and 7 of subsection 6 (3) of the Act are repealed.

6. (1) Subsection 7 (1) of the Act is repealed and the following substituted:

Board of directors

(2) Subsection 7 (2) of the Act is repealed and the following substituted:

Term

(2) Subject to subsection (3), the following provisions apply respecting the term of members of the board of directors of a local health integration network:

1. Each member shall hold office for a term of up to three years at the pleasure of the Lieutenant Governor in Council and may be reappointed for any number of terms of up to three years.

2. Despite paragraph 1, no person may be a member for more than six years in total.

(3) Subsection 7 (4) of the Act is repealed.

(4) Subsection 7 (10) of the Act is repealed and the following substituted:

Where no designation

(10) If the Lieutenant Governor in Council has not designated a chair or a vice-chair of a network, the
members of the board of directors may select a chair or vice-chair from among their members to hold office as provided for by by-law, until such time as the Lieutenant Governor in Council makes a designation.

7. (1) Subsection 8 (2) of the Act is repealed and the following substituted:

By-laws and resolutions

Officers

Delegation

Restrictions on delegation

(2.3) Despite subsection (2.2), a board of directors may not delegate any power under the following provisions of this Act:

1. Subsection 20 (8) and clause 20 (11) (c).

2. Clause 25 (2) (a).

3. Section 26.

4. Section 27.

(2) Subsection 8 (2.3) of the Act, as enacted by subsection (1), is amended by adding the following paragraphs:

1.1 Section 20.2.

1.2 Section 21.1.

1.3 Section 21.2.

(3) Subsection 8 (8) of the Act is repealed.

8. Section 9 of the Act is amended by adding the following subsection:

Educational or training sessions

(5.1) Despite subsection (4), a local health integration network may exclude the public from a meeting if the following conditions are both satisfied:

1. The meeting is held for the purpose of educating or training the members of the local health integration network.

2. At the meeting, no member discusses or otherwise deals with any matter in a way that materially advances the decision-making of the local health integration network.

9. Section 10 of the Act is amended by adding the following subsection:

Medical officer of health engagement

10. The Act is amended by adding the following sections:

Directives by Minister

11.1 (1) The Minister may issue operational or policy directives to a local health integration network where the Minister considers it to be in the public interest to do so.

Binding

(2) A local health integration network shall comply with every directive of the Minister.

General or particular

(3) An operational or policy directive of the Minister may be general or particular in its application.

Non-application of Legislation Act, 2006

(4) Part III (Regulations) of the Legislation Act, 2006 does not apply to operational or policy directives.

Public availability

(5) The Minister shall make every directive under this section available to the public.

Law prevails

(6) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Provincial standards

General or particular

(2) A standard of the Minister may be general or particular in its application.

Obligations re standards

(3) Every local health integration network and health service provider to which a standard under this section is directed shall comply with the standard.

Non-application of Legislation Act, 2006

(4) Part III (Regulations) of the Legislation Act, 2006 does not apply to a standard under this section.

Resolving differences over priorities

(5) If a standard of a local health integration network or a health service provider conflicts with a provincial standard, the provincial standard prevails.

Same

(6) In the event of a conflict between a standard issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Public availability

(7) The Minister shall make every standard under this section available to the public.

11. The Act is amended by adding the following sections:

Investigators

Powers

(2) An investigator may, without a warrant and at reasonable times,

(a) enter the premises of a local health integration network; and

(b) inspect the premises and the records relevant to the investigation.

Identification

(3) An investigator conducting an investigation shall produce, on request, evidence of his or her appointment.

Powers of investigator

(4) An investigator conducting an investigation may,

(b) examine and copy any record or thing required under clause (a);

(d) in order to produce a record in readable form, use data storage, information processing or retrieval devices or systems that are normally used in carrying on business in the place; and

(e) question a person on matters relevant to the investigation.

Obligation to produce and assist

(5) If an investigator requires the production of a record or anything else that is relevant to the investigation, ~~the person who has custody~~ the local health integration network that has custody of the record or thing shall produce it and, in the case of a record, shall on request provide any assistance that is reasonably necessary to interpret the record or to produce it in a readable form.

Restriction

(5.1) An investigator shall not exercise the investigator's powers under subsections (4) and (5) to access personal health information except,

(a) with the consent of the individual who is the subject of the personal health information; or

(b) in such circumstances as may be prescribed.

Same

(5.2) If an investigator accesses personal health information under subsection (5.1), the investigator shall not,

(a) collect, use or disclose the personal health information if other information will serve the purpose of the investigation; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purpose of the investigation.

Confidentiality

(6) An investigator and his or her agents shall keep confidential all information that comes to the investigator's knowledge in the course of an investigation under this Act and shall not communicate any information to any other person except as required by law or except where the communication is to the Minister or a person employed in or performing services for the Ministry.

Report

(7) The investigator shall, upon completion of an investigation, make a report in writing to the Minister.

De-identification of personal health information

(7.1) Before providing a report to the Minister under subsection (7), the investigator shall ensure that all personal health information is de-identified.

~~Same~~

~~(8) The Minister shall cause a copy of the report of an investigation to be delivered to the chair of the board of directors of the local health integration network.~~

Same

(8) The Minister shall cause a copy of the report of an investigation, with all personal health information de-identified, to be delivered to the chair of the board of directors of the local health integration network.

Public availability

(9) The Minister shall make every report of an investigation available to the public.

~~Personal health information to be removed~~

~~(10) Before making a report available to the public under subsection (9), the Minister shall ensure that all personal health information in the report is redacted.~~

Local health integration network supervisor

Notice of appointment

Term of office

(3) The appointment of a local health integration network supervisor is valid until terminated by order of the Lieutenant Governor in Council.

Powers of supervisor

Same

Additional powers of supervisor

Right of access

Restrictions, personal health information

(7.1) A local health integration network supervisor shall not,

(a) collect, use or disclose personal health information if other information will serve the purposes of the supervisor; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purposes of the supervisor.

Minister's directions

(8) The Minister may issue directions to a local health integration network supervisor with regard to any matter within the jurisdiction of the supervisor.

Directions to be followed

(9) A local health integration network supervisor shall carry out every direction of the Minister.

Report to Minister

(10) A local health integration network supervisor shall report to the Minister as required by the Minister.

De-identification of personal health information

(10.1) Before providing a report to the Minister under subsection (10), the local health integration network supervisor shall ensure that all personal health information is de-identified.

Public availability

(11) The Minister shall make every report of a supervisor available to the public.

~~Personal health information to be removed~~

~~(12) Before making a report available to the public under subsection (11), the Minister shall ensure that all personal health information in the report is redacted.~~

11.1 Section 14 of the Act is amended by adding the following subsection:

Adhering to French Language Services Act

12. The Act is amended by adding the following section:

Sub-regions

Maps

(2) Each network shall make a map of the sub-regions available to the public.

13. (1) Section 15 of the Act is amended by adding the following subsection:

Sub-regions, direction

(2.1) The integrated health service plan shall include strategic directions and plans for the geographic sub-regions of a local health system in order to achieve the purposes of this Act.

(2) Section 15 of the Act is amended by adding the following subsection:

Consultations

14. (1) Section 16 of the Act is amended by adding the following subsection:

Patient and family advisory committee

(4.1) Each local health integration network shall establish one or more patient and family advisory committees.

(2) Subsection 16 (5) of the Act is amended by striking out "shall establish" and substituting "may establish".

~~15. Part IV of the Act is amended by adding the following section:~~

~~Personal health information~~

16.1 In this Part,

~~"personal health information" has the same meaning as in section 4 of the Personal Health Information Protection Act, 2004, except that subsection 4 (3) of that Act does not apply.~~

16. Subsection 18 (4) of the Act is amended by striking out "as defined in subsection 31 (5) of the Commitment to the Future of Medicare Act, 2004".

17. Subsection 19 (1) of the Act is repealed and the following substituted:

Funding of health service providers

(1) A local health integration network may provide funding,

(a) to a health service provider in respect of services that the service provider provides in or for the geographic area of the network; and

(b) to a health service provider in respect of services that the service provider provides in or for the geographic area of another network.

18. Section 20 of the Act is repealed and the following substituted:

Service accountability agreement

Notification required

Negotiation

(3) After being notified under subsection (2), the parties shall seek to negotiate the terms and conditions of the service accountability agreement or the amendment.

Where agreement cannot be negotiated

Written issues statement

(5) The written issues statement mentioned in subsection (4) shall include,

(a) a description of the facts and events leading to the inability to negotiate the service accountability agreement or amendment;

(c) a list of potential options for settling the terms and conditions of the service accountability agreement or amendment that are at issue.

Meeting of CEOs

Meeting of chairs

Where chairs do not agree

Deemed acceptance

Rejection

Setting the terms

(11) If the health service provider delivers a notice under subsection (10),

(a) the local health integration network shall consider the reasons for rejecting the offer that are stated in the notice;

(d) the network and the provider shall comply with the terms and conditions of the agreement or amendment as set out in the offer under clause (c).

Saving

(12) Nothing in subsections (4) to (11) prevents the network and the provider from negotiating a service accountability agreement or an amendment during the time periods set out in those subsections.

Interpretation

No restriction on patient mobility

Geographic restrictions for homecare services

19. The Act is amended by adding the following section:

Directives by local health integration networks

Exception

Notice

(3) Before issuing a directive, a local health integration network shall give notice of a draft directive to the Minister and to each health service provider to which it is intended to be issued.

Restriction

Binding

(5) A health service provider shall comply with every directive of a local health integration network.

General or particular

(6) An operational or policy directive of a local health integration network may be general or particular in its application.

Law prevails

(7) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails.

Non-application of Legislation Act, 2006

(8) Part III (Regulations) of the Legislation Act, 2006 does not apply to the operational or policy directives.

Public availability

(9) A local health integration network shall make every directive under this section available to the public.

20. Section 21 of the Act is repealed and the following substituted:

Audits, reviews, etc.

21. A local health integration network may at any time direct that a health service provider that receives funding from the network,

(a) engage or permit one or more auditors licensed under the Public Accounting Act, 2004 to audit the accounts and financial transactions of the service provider; or

(b) engage in or permit an operational review or peer review of the provider's activities.

21. The Act is amended by adding the following sections:

Investigators

Application

Notice of appointment

(3) Before appointing an investigator, the local health integration network shall give notice of its intention to appoint an investigator to the Minister and the health service provider.

Powers

(4) An investigator may, without a warrant and at reasonable times,

(a) enter the premises of a health service provider that may be investigated under this section;

(b) subject to subsection (5), enter any premises where a health service provider provides services; and

Dwellings

(5) No investigator shall enter a place that is being used as a dwelling, except with the consent of the occupier.

Identification

(6) An investigator conducting an investigation shall produce, on request, evidence of his or her appointment.

Powers of investigator conducting investigation

(7) An investigator conducting an investigation may,

(b) examine and copy any record or thing required under clause (a);

(d) in order to produce a record in readable form, use data storage, information processing or retrieval devices or systems that are normally used in carrying on business in the place; and

(e) question a person on matters relevant to the investigation.

~~Obligation to produce and assist~~

(8) If an investigator requires the production of a record or anything else that is relevant to the investigation under this section, the person who has custody of the record or thing shall produce it and, in the case of a record, shall on request provide any assistance that is reasonably necessary to interpret the record or to produce it in a readable form.

Obligation to produce and assist

1. The health service provider.

2. Any person employed by the provider.

3. Any person performing services for the provider.

Restriction

(8.1) An investigator shall not exercise the investigator's powers under subsections (7) and (8) to access personal health information except,

(a) with the consent of the individual who is the subject of the personal health information; or

(b) in such circumstances as may be prescribed.

Same

(8.2) If an investigator accesses personal health information under subsection (8.1), the investigator shall not,

(a) collect, use or disclose the personal health information if other information will serve the purpose of the investigation; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purpose of the investigation.

Confidentiality

(9) An investigator and his or her agents shall keep confidential all information that comes to the investigator's knowledge in the course of an investigation under this Act and shall not communicate any information to any other person except as required by law or except where the communication is to the local health integration network or a person employed in or performing services for the local health integration network.

Report of investigator

(10) The investigator shall, upon completion of an investigation, make a report in writing to the local health integration network.

De-identification of personal health information

(10.1) Before providing a report to the local health integration network under subsection (10), the investigator shall ensure that all personal health information is de-identified.

~~Report~~

~~(11) The local health integration network shall cause a copy of the report of an investigation to be delivered to the health service provider.~~

Same

(11) The local health integration network shall cause a copy of the report of an investigation, with all personal health information de-identified, to be delivered to the health service provider.

Public availability

(12) The local health integration network shall make every report of an investigation available to the public.

~~Personal health information to be removed~~

~~(13) Before making a report public under subsection (12), the local health integration network shall ensure that all personal health information in the report is redacted.~~

~~Health service provider supervisor~~

21.2 (1) A local health integration network may appoint a person as a health service provider supervisor of a health service provider to which it provides funding when it considers it to be appropriate to do so in the public interest.

Health service provider supervisor

Certain providers excepted

(2) This section does not apply with respect to a health service provider that is,

(a) a person or entity that operates a hospital within the meaning of the Public Hospitals Act or a private hospital within the meaning of the Private Hospitals Act; or

(b) a licensee within the meaning of the Long-Term Care Homes Act, 2007.

~~Notice of appointment~~

~~(3) The local health integration network shall give the governing body of the health service provider at least 14 days notice before appointing the supervisor.~~

Notice of appointment

(3) The local health integration network shall give the Minister and the governing body of the health service provider at least 14 days notice before appointing the supervisor.

Immediate appointment

(4) Subsection (3) does not apply if there are not enough members of the governing body to form a quorum.

Term of office

(5) The appointment of a health service provider supervisor is valid until terminated by order of the network.

Powers of supervisor

Same

Additional powers of supervisor

Right of access

Restriction

(9.1) A health service provider supervisor shall not,

(a) collect, use or disclose personal health information if other information will serve the purposes of the supervisor; or

(b) collect, use or disclose more personal health information than is reasonably necessary for the purposes of the supervisor.

Reports

(10) A health service provider supervisor shall make a report to the network as required by the network.

De-identification of personal health information

(10.1) Before providing a report to the network under subsection (10), the health service provider supervisor shall ensure that all personal health information is de-identified.

Network's directions

(11) The local health integration network may issue directions to a health service provider supervisor with regard to any matter within the jurisdiction of the supervisor.

Directions to be followed

(12) A health service provider supervisor shall carry out every direction of the network.

Public availability

(13) The network shall make every report of a supervisor available to the public.

~~Personal health information to be removed~~

~~(14) Before making a report public under subsection (13), the network shall ensure that all personal health information in the report is redacted.~~