Bill 60, Your Health Act, 2023, was tabled on February 21, 2023 by the provincial government. It creates a framework for Integrated Community Health Service Centres (ICHSCs, formerly Independent Health Facilities (IHFs)) under a new Integrated Community Health Services Centres Act (ICHSCA). It also amends several statutes to expand licensing opportunities for regulated health professions.

Timely access to care for patients is currently one of the health system’s greatest challenges. To address this burden, which has been exacerbated by slow downs during the pandemic, the range of options to access care is increasing. The legislation’s goal is to address this challenge by increasing and integrating system capacity. If passed, licensed ICHSCs can provide OHIP-insured services, and possibly non-insured services. Services that have been identified through the government’s public statements include cataract, knee, and hip surgeries, and possibly others. 

The health sector is grappling with what this bill may mean for the relationship between the public and private sectors, and whether it will achieve the intended goals. This article is a summary of key features of the bill as well as issues and opportunities that arise.

Key features the Integrated Community Health Services Centres Act 

The ICHSCA provides a framework for oversight, funding, and licensing requirements of ICHSCs. A Director, yet to be named, will provide licensing and oversight of ICHSCs. There is an administrative burden associated with implementation.

ICHSCs will apply for a license to operate in response to a call for applications. The call for applications can either be broad or specific to a service and/or location, based on system need. The legislation prescribes the application requirements, including:   

• A detailed description of the services, and how the ICHSC will improve wait times and patient experience; 
• Integration with the existing health care sector and consultations with health system partners; 
• The ICHSC’s quality program, patient relations process, and IPAC policies; and
• Staffing models, including compensation rates, number of staff for each position, hospital privileges of any physicians (if applicable).

The Director will consider existing needs for the specific service in the geographic area when granting new licenses.  Existing IHFs will be preapproved as ICHSCs on existing terms.

The Ministry will fund both insured services and “facility costs”, i.e., operational costs to provide insured services. ICHSCs are prohibited from providing preferred access to insured services. 

While ICHSCs can potentially offer uninsured services, they are prohibited from charging patients for insured services or not serving patients who cannot pay for the uninsured service. The penalties for violating these prohibitions can be quite significant, with individuals potentially charged up to $100,000 and corporations up to $500,000 each day of the offence.

Issue: quality of care requirements not yet prescribed 

The quality of care safeguards explicit in the legislation are that ICHSCs must have a process to review patient complaints and “incidents”. “Incidents” has the same definition as a “critical incident” under the Excellent Care for All Act (ECFAA). Patients can also complain about ICHSCs to the Patient Ombudsman. But the ECFAA does not otherwise clearly apply to ICHSCs. 

The bill itself does not yet address other important quality of care elements that other health care organizations are subject to, including the responsibility for oversight of patient quality care and insurance. Currently, these issues will be addressed at the licensing review step, at the discretion of the Director. Further regulations may also prescribe these elements. 

The College of Physicians and Surgeons has stated that stand-alone surgical centres should be affiliated with hospitals for “continuity of care and patient safety”. Currently, ICHSCs are not required to partner with a hospital to obtain a license, but integration with the existing health system will be considered at the licensing stage. 

Issue: health human resources shortages which impact the entire healthcare system   

The bill currently does not explicitly address health human resources (HHR) challenges in terms of protecting the current limited HHR system capacity. Specifically, it does not prescribe the framework for ICHSC integration within the hospital system or health human resource protections for other health care facilities. Instead, staffing models must be included in the licensing application, which will be considered by the Director. These issues may also be potentially addressed in future regulations. 

That said, Bill 60 does amend several statutes to allow health care workers licensed in other provinces to immediately start practicing in Ontario. This is designed to increase the number of healthcare workers available to work at healthcare facilities including ICHSCs. The expanded licenses are available for physicians, registered nurses, registered nurses in the extended class, and registered practical nurses. The bill also expands pharmacists’ scope of practice to include the assessment of conditions for the purposes of providing medication therapies. 

Opportunity: ICHSC integration in the local health system

To become licensed, ICHSCs must detail how they will integrate with the existing local health system, and any previous consultations with health sector partners. ICHSCs are incentivized to work with existing local health organizations before applying for a license. Applications may even be strengthened with a preliminary agreement with local hospitals, as the Director will consider any endorsements from local health partners. 

As a result, other health organizations may have room to facilitate protecting the system, including requirements for: 

• physician privileges, on-call duties, other staffing expectations;
• quality of care policies;
• Insurance; and
• Privacy and compliance standards. 
  

Conclusion

Bill 60 is still at first reading, so amendments may be forthcoming. To ensure all patients benefit from a strong health-care system with robust oversight and protections, the above-noted potential issues and opportunities in the bill will be important to address before implementing the licensing scheme.