Ministry of Health and Long-Term Care Local Health System Integration Act, 2005 Bill 36

1. Ministry of Health and Long-Term CareLocal Health System Integration Act, 2005Bill 36

2. Introduction of Legislation • On November 24, 2005, the Honourable George Smitherman, Minister of Health and Long-Term Care, introduced the Local Health System Integration Act, 2005. • The purpose of the legislation is to build a system for managing health care in Ontario and to continue the 14 LHINs. • The legislation would provide for an integrated health system to improve the health of Ontarians through: • better access to health services; • coordinated health care; and • effective and efficient management at the local level by LHINs.

3. Government’s goals and principles for health care in Ontario • Government’s multi-year plan for transforming health care is about changing culture, expectations and behaviours to achieve a vision of health care that is patient-focused, results-driven, integrated and sustainable. • Local Health Integration Networks (LHINs) are a key new partner in this system. They would put decision-making power at the community level and focus the local health system on the community’s needs.

4. The New Health Care System Would be... • Community-based:engage the local community about needs and priorities • Based on Partnerships: system partners are Minister, Ministry, LHINs and service providers • Forward Looking: emphasis on planning and priority setting • Efficient: effective allocation of funding to achieve priorities • Accountable: clearly defined expectations and measurement of achievement; monitoring and public reporting provide checks and balances in system • Integrated: coordinated health care with focus on client needs

5. Key Components of the Legislation The Legislation includes the following key components: • Part I: Interpretation and Definitions • Part II: Local Health Integration Networks • Part III: Planning and Community Engagement • Part IV: Funding and Accountability • Part V: Integration and Devolution • Part VI: General • Part VII: Complementary Amendments • Part VIII Consequential Amendments

6. Part I - Interpretation and Definitions • The proposed legislation sets out the purpose of the Act and defines key terms used in the Act. • The definition section includes a list of health service providers that would be responsible to and receive funding from LHINS, which include: • Hospitals • Most psychiatric facilities • Long-term care homes • Community care access corporations • Community service providers • Community mental health and addiction service providers • There would be LGIC authority to include other providers under the LHIN umbrella in the future; certain providers could also be excluded by LGIC regulation. • The definition would specifically exclude physicians, podiatrists, dentists, and optometrists who offer their professional services to individuals.

7. MINISTRY HEALTH SERVICE PROVIDERS The Ministry would continue to be responsible for: • public health • individual practitioners and Family Health Teams • ambulance services • laboratories • provincial networks and programs (e.g. Telehealth, Trillium Gift of Life Network, Cancer Care Ontario)

8. Part II - Local Health Integration Networks The Legislation would: • Continue LHINs as corporations under the Local Health System Integration Act, 2005 , and set out their corporate structure and Board Composition. • Require that LHIN board meetings be open to the public. Instances where meetings are to be in-camera could be set out in regulation. • Provide Minister with authority to make a regulation requiring LHINs to create certain board committees and specify requirements for those committees (e.g. audit committee, nominating committee) • Require the Auditor General to conduct annual audits of LHINs.

9. Part III - Planning and Community Engagement • The Minister would be required to develop and publish a provincial strategic plan that would include a vision, priorities and strategic directions for the health system. • LHINs would be required to develop an Integrated Health Service Plan (IHSP). • The IHSP would include a vision, priorities and strategic directions for the local health system. • The IHSP must be consistent with the provincial strategic plan and the funding provided to the LHINs. It must also include any planned integration strategies.

10. Part III - Planning and Community Engagement … cont’d Legislation would require: • LHINs to engage the community and service providers about the needs and priorities of the local health system on an ongoing basis. • Service providers to engage the community when developing plans and setting priorities for the delivery of health services. • LHINs to establish a Health Professional Advisory Committee to act in an advisory capacity. • Regulations could also set out other requirements for community engagement.

11. Part IV - Funding and Accountability • Sets out authority for Minister to fund LHINs on terms and conditions Minister considers appropriate. • Establishes a requirement for Minister and LHIN to enter into an accountability agreement and sets out general content of such agreements. Other terms could be prescribed. • Permits Minister to adjust a LHIN’s funding to take into account a portion of any savings generated through efficiencies in a previous year to be used for patient care in subsequent years. • Provides LHINs with the authority to fund health service providers in accordance with LHINs’ agreement with the Ministry. • Establishes a requirement for LHINs and health service providers to enter into service accountability agreements under Commitment to the Future of Medicare Act and provides LHINs with compliance authorities under that Act.

12. Part IV - Funding and Accountability …cont’d • Prohibits LHINs from entering into any arrangement that would limit a patient to receiving care only in a particular LHIN area. • Creates authority for LHINs to require audits of their health service providers and require information from them. • Permits LHINs to share information they receive in order to facilitate cross-boundary planning and integration. LHINs could also disclose information to the Minister and to the Ontario Health Quality Council.

13. Part V - Integration • LHINs and service providers would be required to develop integration strategies to better coordinate health care and use health resources more efficiently. • Legislation would recognize LHINs could achieve integration through: • funding; • facilitation and negotiation of integration plans with service providers; or • ordering integration. • LHINs would have authority to require the following types of integration where it was in the public interest: • to provide certain services to a specified extent or specified volume; • to cease to provide specified services; • to increase/decrease the extent or volume of specified services; • to move programs/services from one location to another; • to move programs/services from one provider to another; • to take action to give effect to any of the above orders; and, • to amend or revoke an order that has been issued.

14. Part V - Integration … cont’d • LHINs’ ability to require integration would have the following limitations: • Only service providers directly responsible to/funded by LHINs could be required to integrate, and only for LHIN funded services; • LHINs could not require an integration contrary to their IHSP; • LHINs could not require service providers to make corporate changes including amalgamation/division, changes to Boards, or requiring a provider to close/cease corporate operations; and, • LHINs could not require transfer of charitable property to a provider that is not a charity.

15. Part V - Integration … cont’d • On the advice of a LHIN, the Minister may, if it is in the public interest require a not for profit health service provider to: • cease operations; or, • amalgamate with/transfer its operations to another non profit entity. • After receiving notification and a copy of the LHIN integration decision, service providers would have 30 days to ask a LHIN to reconsider any decision that required integration. • LHINs may amend or revoke an integration decision. • Similar notice provisions would apply to Minister’s orders. • Service providers could proceed with their own integration activities, but must first provide notice to relevant LHIN(s). LHINs could issue a decision to stop integration no later than 60 days after receiving notice. Service providers could ask a LHIN to reconsider their decision to stop integration.

16. Part V - Integration … cont’d • Service providers would be required to comply with LHIN integration decisions and integrations required by the Minister. • LHINs and Minister could apply to courts to have decisions/orders enforced. • No compensation would be paid for losses arising from a LHIN integration decision or integration required by the Minister, except that regulations would prescribe compensation for the portion of the value of property transferred not acquired with government funds. • An integration decision issued to a provider that is a religious organization could not require that provider to offer a service contrary to its religion unless it could be justified.

17. Part V - Devolution • The legislation would also permit the LGIC to make regulations devolving any power, duty or function of the Minister or his/her delegate to a LHIN. • The regulation could set conditions on the exercise of the devolved power. • This regulation would be subject to an explicit public consultation process.

18. Part VII - Complementary Amendments Community Care Access Centre Alignment • Legislation would enable the government to align CCACs with LHIN boundaries; • Return CCAC boards to community-based organizations by allowing CCACs to select their directors and Executive Directors; and • Allow the LGIC to add to the mandate of the CCACs to allow them to take on a broader role in the future, such as working with or as part of various social services for children and youth services.

19. Part VII - Complementary Amendments… Cont’d Labour Relations • Integration and other changes in the health system could result in employment and labour relations changes. Accordingly: • The proposed legislation would make the Public Sector Labour Relations Transition Act (PSLRTA) available to employers and their bargaining agents where they are affected by health system integration. • PSLRTA provides framework for resolving complex issues arising from significant reorganizations, addressing: bargaining unit structures, bargaining agents, seniority rights, and collective agreement transitions.

20. Part VIII - Amendments To Other Statutes The legislation proposes complementary and consequential amendments to the following statutes: • Charitable Institutions Act • Commitment to the Future of Medicare Act, 2004 • Community Care Access Corporations Act, 2001 • Health Facilities Special Orders Act • Homes for the Aged and Rest Homes Act • Long-Term Care Act, 1994 • Ministry of Health and Long-Term Care Act • Nursing Homes Act • Pay Equity Act • Personal Health Information Protection Act, 2004 • Public Hospitals Act • Public Sector Labour Relations Transition Act, 1997 • Social Contract Act, 1993 • Tobacco Control Act, 1994 • The proposed consequential amendments are primarily of two types: • To include LHINs as a funder of health service providers; and, • To change phrases such as “service agreement” to “service accountability agreement”.

21. Proclamation Timeframe • It is proposed that the Local Health System Integration Act, 2005 would come into force upon Royal Assent, with some exceptions. For example, the following provisions would be proclaimed in force at a later date: • Public meetings of LHIN Board and committees; • LHINs authority to fund service providers and enter into service agreements with them; • Process for appointment of Director’s and Executive Directors of CCAC;

22. Status • Second reading debated November 29th, December 5th and 6th. • Bill passed second reading and referred to Standing Committee on December 7th. • Standing Committee and public hearings are scheduled from January 30th - February 2nd in: Toronto, Thunder Bay, London and Ottawa. • Comments and input on the Bill welcomed.