About Excellent Care for All
Regulations
Update - as of November 2022
Notice of decision of the Minister of Health under s. 16(7) of the Excellent Care for All Act, 2010: Proposed amending regulation to support home and community care modernization
Under subsection 16(7) of the Excellent Care for All Act, 2010 (ECFAA), the Minister of Health may decide that the public consultation requirements under subsections 16(2) to (6) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 16(1) of ECFAA. The Minister is required to provide public notice of this decision and a statement of the reasons for the decision.
The Government of Ontario is proposing to amend O.Reg. 236/16 (Definitions) of ECFAA to prescribe the following services provided by local health integration networks for the purposes of the subclause (c)(iii) of the definition of ‘health sector organization in s. 1 of the Act:
- the home and community care services that are professional services, personal support services, and homemaking services as defined in regulations under the Connecting Care Act, 2019.
The proposed regulation would come into effect upon filing of the regulation.
I have determined that the foregoing proposed amendments clarify the intent or operation of ECFAA; in particular the amendments to the definition of ‘health sector organization’. Clarification is required to address the need to re-establish the Patient Ombudsman’s jurisdiction over LHINs with regard to their provision of home and community care services arising from a technical error that caused the premature revocation of a similar provision originally intended to be enacted for the same purpose on May 1, 2022.
The proposed regulations under ECFAA would prescribe LHINs as ‘health sector organizations’ with respect to their provision of home and community care services and clarify the scope of the Patient Ombudsman’s jurisdiction. The proposed regulation changes are consistent with the Government’s previously communicated and consulted-upon plans to continue the jurisdiction of the Patient Ombudsman over the local health integration networks while they continue to provide home and community care services.
The Honourable Sylvia Jones
Minister of Health
Update - as of February 2022
Notice of decision of the Minister of Health under s. 16(7) of the Excellent Care for All Act, 2010: Proposed amending regulation to support the implementation of the Government’s health system reforms as enabled by the Connecting People to Home and Community care Act, 2020
Under subsection 16(7) of the Excellent Care for All Act, 2010 (ECFAA), the Minister of Health may decide that the public consultation requirements under subsections 16(2) to (6) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 16(1) of ECFAA. The Minister is required to provide public notice of this decision and a statement of the reasons for the decision.
The Government of Ontario is proposing to amend O.Reg. 236/16 (Definitions) of ECFAA to prescribe the following for the purposes of the definition of 'health sector organization' [here] in s. 1 of the Act:
- every health service provider (HSP) or Ontario Health Team (OHT) funded under s. 21 of the Connecting Care Act, 2019 to provide home and community care services that are professional services, personal support services, and homemaking services for which charges are prohibited, as those types of services are defined in regulations under the Connecting Care Act, 2019 (CCA), is a HSP or OHT for the purposes of clause (b); and
- professional services, personal support services, and homemaking services as defined in regulations under the CCA are the types of home and community care services provided by a local health integration network (LHIN) in subclause (c.1)(i) until such time and the Local Health System Integration Act, 2006 is repealed.
The proposed regulation would come into effect at the same time as the provisions amending ECFAA in the Connecting People to Home and Community Care Act, 2020 (CPHCCA) come into force.
I have determined that the foregoing proposed amendments clarify the intent or operation of ECFAA; in particular the amendments to the definition of ‘health sector organization’ in ECFAA that will be made by the CPHCCA when that Act is proclaimed in force. Clarification is required to address the successor legislation and regulations governing home and community care service provision in Ontario. The proposed amendments will clarify the intent and operation of ECFAA once the Home Care and Community Services Act, 1994 is repealed and replaced with amendments to the CCA and new regulations under the CCA. The proposed regulations under ECFAA would prescribe the types of home and community care services as defined in new regulations under the CCA that would clarify the scope of the Patient Ombudsman’s jurisdiction. The proposed regulation changes are consistent with the Government’s previously communicated and consulted-upon plans to extend the jurisdiction of the Patient Ombudsman to all organizations providing the home and community care services that local health integration networks currently provide.
The Honourable Christine Elliott
Minister of Health
Update - as of October 2019
Notice of decision of the Minister of Health under s. 16(7) of the Excellent Care for All Act, 2010: Proposed amending regulation to support the transfer of the Ontario Health Quality Council (o/a Health Quality Ontario) into Ontario Health
Under subsection 16(7) of the Excellent Care for All Act, 2010 (ECFAA), the Minister of Health may decide that the public consultation requirements under subsections 16(2) to (6) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 16(1) of ECFAA. The Minister is required to provide public notice of this decision and a statement of the reasons for the decision.
The Government of Ontario is proposing to revoke the provisions of Ontario Regulation 445/10 (General) (the “Regulation”) which will no longer be operative following the transfer of Health Quality Ontario (HQO) into Ontario Health. The transfer of HQO’s functions, assets, liabilities and employees into Ontario Health will be effected by a transfer order which I will issue pursuant to my authority under section 40 of the Connecting Care Act, 2019 (CCA).
The proposed amending regulation would revoke Part II of the Regulation, which addresses HQO’s corporate governance, staffing, audit, and reporting obligations, and Part II.1 which sets out requirements relating to information practices. These provisions will no longer be necessary following the assumption by Ontario Health of HQO’s functions and operations under the CCA. This amending regulation would take effect on filing, which would be coordinated to correspond with the effective date of the HQO transfer order.
I have determined that the foregoing proposed amendments are of a minor and technical nature. Their effect would be to support the implementation of the Government’s health system reforms as enabled by The People’s Health Care Act, 2019. The proposed regulation changes are consistent with the Government’s previously announced plans to consolidate 20 health agencies, including HQO, within Ontario Health. The amendment does not have any material effect on business or introduce any new costs or financial burden to stakeholders or the Government.
The Honourable Christine Elliott
Minister of Health
Update - as of April 2018
The proposal to amend Ontario Regulation 445/10 (General) made under the Excellent Care for All Act, 2010 was approved.
The regulation is available online at e-Laws: O. Reg. 445/10
Update - as of January 2018
Proposal to amend Ontario Regulation 445/10 (General) made under the Excellent Care for All Act, 2010 (ECFAA or the “Act”) in order to: (1) prescribe purposes for which the Ontario Health Quality Council (operating as Health Quality Ontario or “HQO”) is authorized to collect, use and disclose personal health information; and (2) extend the term limit applicable to HQO board appointees who are designated to serve as Chair.
The Government of Ontario is proposing to amend Ontario Regulation 445/10 (General) made under ECFAA (the “Regulation”) to make certain changes respecting the operations of HQO. Specifically, the proposed regulations would do two things:
- They would confer new authority on HQO to collect, use and disclose personal health information for the limited purposes described in the regulation, and would establish conditions that HQO must meet in exercising this new authority; and
- They would amend the provisions respecting the appointment of HQO board members by permitting a Board member who is also designated as Chair to serve for an additional three-year term.
HQO and personal health information
Under section 13.0.1 of ECFAA, HQO may only collect, use, or disclose personal health information (PHI) for purposes related to the functions of the patient ombudsman, or for purposes that may be prescribed by regulation.
The proposed regulations would confer new authority on HQO to collect, use, and disclose PHI for two purposes:
- Collecting stories from patients and their caregivers relating to their personal experiences in the health care system, and publishing those stories in various places, including on HQO’s website, in its yearly reports and in other publications; and
- Facilitating the participation of patients and caregivers in public engagement initiatives; specifically HQO’s Patient, Family, and Public Advisors Council and the Patient, Family, and Public Advisors Network.
This proposed amending regulation is intended to enable HQO to include in its reports, and other communications, a diverse representation of patient and caregiver perspectives that acknowledges their lived experiences, and to facilitate meaningful communication and engagement with Ontarians.
HQO would be prohibited from collecting, using or disclosing PHI unless it first obtains the express written consent of the person to whom the PHI relates or, if that person is incapable or deceased, of that person’s substitute decision-maker. HQO would also be prohibited from collecting an individual’s PHI indirectly through a third party, such as a health service organization. However, HQO would be permitted to collect PHI about a consenting patient through that patient’s caregiver.
In addition, ECFAA currently prohibits HQO from collecting, using or disclosing PHI if other information will serve the purpose, and from collecting, using or disclosing more PHI than is reasonably necessary.
HQO Board Chair term limit
Current regulations under ECFAA limit all HQO board members, including members designated as board chair, to a term limit of 6 years.
The proposed amending regulation would allow for an HQO board member who is designated as chair to be appointed for one additional term of up to three years, resulting in a potential maximum length of service on HQO’s board of 9 years (e.g. 3 years as member and up to an additional 6 years as chair).
These proposed regulations are intended to promote continuity in HQO’s governance. They would also be consistent with the term limit applicable to board chairs of the Local Health Integration Networks.
Draft regulation can be downloaded here:
Members of the public may also review information concerning this proposed regulatory amendment on the Government of Ontario’s Regulatory Registry website.
The content of the final regulations are at the discretion of the LGIC who may make the regulations with any changes that the LGIC considers appropriate.
Members of the public are invited to provide written comments on the proposed changes to the Regulation. The ministry will consider comments received on or before March 1st, 2018 at midnight EST (“comment period.”). Please be advised that submissions received after the comment period may not be considered.
Please submit your written comments to:
Policy & Innovation Branch
Ministry of Health and Long-Term Care
5th Floor Hepburn Block, 80 Grosvenor Street
Toronto ON M7A 1R3
E-mail: ecfaa@ontario.ca
Statement about Comments
Unless requested and otherwise agreed to by the ministry, all materials or comments received from organizations in response to the notice will be considered public information and may be used and disclosed by the ministry as part of its review. The ministry may disclose materials or comments, or summaries of them, to other interested parties during and after the comment period. An individual who makes a submission and who indicates an affiliation with an organization in his or her submission will be considered to have made his or her submission on behalf of the affiliated organization. The ministry will not disclose any personal information contained in a submission of an individual who does not specify an organizational affiliation in his or her submission without the individual’s consent unless required by law. However, the ministry may use and disclose the content of the individual’s submission to assist the ministry in its review. If you have any questions about the collection of this information, you can contact the ministry’s Freedom of Information and Privacy Coordinator at (416) 327-7040.
Update - as of November 2017
Notice of decision of the Minister of Health and Long-Term Care under s. 16(7) of the Excellent Care for All Act, 2010
Under subsection 16(7) of the Excellent Care for All Act, 2010 (ECFAA), the Minister of Health and Long-Term Care may decide that the public consultation requirements under subsections 16(2) to (6) should not apply to the power of the Lieutenant Governor in Council (LGIC) to make a regulation under section 16(1) of ECFAA. The Minister is required to provide public notice of this decision and a statement of the reasons for the decision.
The Government of Ontario is proposing to amend sections 14 and 15 of O. Reg. 445/10 made under ECFAA (the “Regulation”) to make the timing and tabling requirements applicable to the annual reports and audit reports of the Ontario Health Quality Council [operating as Health Quality Ontario (“HQO”)] consistent with the annual reporting requirements that are being established for all provincial agencies. Specifically, the proposed amendments would:
- Require HQO to prepare and submit their annual report to the Minister no later than 120 days after the end of the fiscal year, rather than within six months as the Regulation currently requires, and to make the annual report available to the public.
- Require HQO to submit its annual audit report to the Minister no later than 120 days after the end of the fiscal year, rather than within six months as the Regulation currently requires.
- Require HQO to comply with any directives as may be issued by Management Board of Cabinet (MBC) with respect to the form and content of the annual report and when and how to make it public.
- Remove the current requirement for the Minister to submit HQO’s annual report to the LGIC before tabling it in the Assembly.
- Require the Minister to table HQO’s annual report in the Assembly and to comply with directives as may be issued by MBC with respect to when to table it.
These amendments would come into force on the later of January 1, 2018 and the day the amending regulation is filed.
I have determined that the foregoing proposed amendments are of a minor and technical nature. Their effect would be to make the Regulation reflective of HQO’s current reporting practices and consistent with MBC directives on reporting by provincial agencies. They would also promote greater administrative efficiency in the government’s annual tabling process for provincial agency reports. The amendment does not have any material effect on business or introduce any new costs or financial burden to stakeholders or the Government.
The Honourable Dr. Eric Hoskins
Minister of Health and Long-Term Care
Update - as of March 2017
Proposal to amend Ontario Regulation 445/10 made under the Excellent Care for All Act, 2010 (ECFAA or the “Act”) to support amendments made to ECFAA by the Patients First Act, 2016 (PFA) related to the Ontario Health Quality Council (operating as Health Quality Ontario) and other housekeeping changes
The ministry is proposing to amend Ontario Regulation 445/10 made under ECFAA (the “Regulation”) to address certain amendments made to ECFAA by the PFA. If approved by the Lieutenant Governor in Council (“LGIC”), most of the Regulation amendments would take effect at the same time that the ECFAA amendments effected by subsections 37(3), (4) and (5) of the PFA are proclaimed into force, which is anticipated to be May 1, 2017 (the “ECFAA Amendments”). The purpose of the ECFAA Amendments was to make the statutory changes necessary to confer authority on HQO to retain assets and revenues outside of the Province’s consolidated revenue fund.
The text of the proposed Regulation amendments is set out below. The proposed amendments, if approved, would:
- Delete provisions in the Regulation relating to the corporate status and powers of Health Quality Ontario (HQO) which, pursuant to the ECFAA Amendments, have been moved into the Act [s.3(1), 4, 7, 9 of the current Regulation];
- Make the following housekeeping changes:
- Delete and amend outdated provisions in the Regulation relating to sections of the Act that were previously repealed [s.3(4) and (4) of the current Regulation]
- Provide for the substitution of the reference to the Corporations Act in section 5 of the Regulation with a reference to the Not-for-Profit Corporations Act, 2010 (NFPCA), once the NFPCA is proclaimed into force.
Draft regulation can be downloaded here:
Members of the public may also review written information concerning this proposed regulatory amendment, as well as other regulatory proposals in connection with the PFA, on the Government of Ontario’s Regulatory Registry website. The Regulatory Registry website can be accessed at: http://www.ontariocanada.com/registry/
The content of the final regulations are at the discretion of the LGIC who may make the regulations with any changes that the LGIC considers appropriate.
Members of the public are invited to provide written comments on the proposed changes to the Regulation. The ministry will consider comments received on or before April 2, 2017 at midnight EST (“comment period.”). Please be advised that submissions received after the comment period may not be considered.
Please submit your written comments to:
Health System Quality and Funding Division
Ministry of Health and Long-Term Care
1075 Bay Street, 12th Floor
Toronto ON M5S 2B1
E-mail: ECFAA@ontario.ca">ECFAA@ontario.ca
Statement about Comments
Unless requested and otherwise agreed to by the ministry, all materials or comments received from organizations in response to the notice will be considered public information and may be used and disclosed by the ministry as part of its review. The ministry may disclose materials or comments, or summaries of them, to other interested parties during and after the comment period. An individual who makes a submission and who indicates an affiliation with an organization in his or her submission will be considered to have made his or her submission on behalf of the affiliated organization. The ministry will not disclose any personal information contained in a submission of an individual who does not specify an organizational affiliation in his or her submission without the individual’s consent unless required by law. However, the ministry may use and disclose the content of the individual’s submission to assist the ministry in its review. If you have any questions about the collection of this information, you can contact the ministry’s Freedom of Information and Privacy Coordinator at (416) 327-7040.
Update - as of January 2016
In 2014, amendments were made to the Excellent Care for All Act, 2010 (ECFAA) under the Public Sector and MPP Accountability and Transparency Act, 2014 to establish a Patient Ombudsman in Ontario. Once these amendments come into force, the Patient Ombudsman will be able to investigate, facilitate the resolution of, and report on complaints made by patients, former patients, and their caregivers that relate to the care or health care experience of the patient or former patient at a hospital, long-term care home, or community care access centre. This will help to strengthen complaints management processes across the health system and allow patient voices to be better heard.
The Patient Ombudsman is a Lieutenant Governor in Council (LGIC) appointment and will be an employee of Health Quality Ontario. The Patient Ombudsman will be supported by an Office of the Patient Ombudsman, which will be a part of Health Quality Ontario. Situating the office within Health Quality Ontario will help to strengthen the linkages between the Patient Ombudsman's work and Health Quality Ontario's ongoing efforts related to province-wide health care system quality improvement.
In order to support the Patient Ombudsman role, and to enhance the clarity of ECFAA, the following regulatory changes are being proposed:
- Defining the term 'caregiver' in regulation
- The ministry is proposing to provide a meaning for the term 'caregiver' that would apply to all references in ECFAA and its regulations.
- The intent is to further define who is able to bring forward a complaint to the Patient Ombudsman and to enhance the clarity and consistency of provisions under ECFAA.
- The proposed definition would apply to any provisions pertaining to caregivers under ECFAA. These include surveying caregivers concerning their satisfaction with services provided by a health care organization (2010, c. 14, s. 5); engaging caregivers in the development of Quality Improvement Plans for health care organizations (O. Reg. 187/15); and requirements related to the patient relations process in health care organizations (O. Reg. 188/15).
- In order to have one definition of caregiver that applies across all of ECFAA, the ministry is also proposing to amend O. Reg. 188/15 to remove an existing definition of caregiver that applies only to the patient relations process in hospitals.
Draft regulations can be downloaded here:
- Clarify references to personal health information.
- Regulation under ECFAA (O. Reg. 445/10 'General') includes a provision which states that Health Quality Ontario "may only collect de-identified personal health information for the purposes of carrying out its functions and making its reports" (s. 11).
- This provision would be made superfluous once the amendments to ECFAA that relate to the Patient Ombudsman come into force. This is because the amendments to ECFAA state that, "Despite any other Act, the Council [Health Quality Ontario] may only collect personal health information where the patient ombudsman collects that information in exercising his or her powers under this Act."
- To ensure clarity regarding Health Quality Ontario's specific permissions with respect to collecting personal health information, the ministry is proposing that the superfluous provision be removed (i.e., removal of s. 11 of O. Reg. 445/10 'General').
Draft regulation can be downloaded here:
In accordance with relevant Government of Ontario standards, the Ministry is seeking comments on the proposed regulations from January 29, 2016 until March 14, 2016. All comments received during the consultation period will be considered. Content of final regulations are at the discretion of the Minister of Health and Long-Term Care or the Lieutenant Governor in Council, who may make changes as appropriate.
Comments on these draft regulatory amendments can be submitted through Ontario's Regulatory Registry, emailed to ecfaa@ontario.ca, or sent to the following mailing address:
Policy & Innovation Branch
Health System Quality & Funding Division
Ministry of Health and Long-Term Care
5th Floor Hepburn Block,80 Grosvenor Street
Toronto ON M7A 1R3
The draft regulations and descriptions of the draft regulations will be available on the Ministry website and on the Ontario Regulatory Registry until March 14, 2016.
Update - as of September 2015
The Ministry of Health and Long-Term Care (MOHLTC) has introduced two new Minister's regulations under the Excellent Care for All Act, 2010. Both regulations came into force on September 1, 2015 and currently apply to hospitals as defined by the Public Hospitals Act.
Background
On June 8, 2010, the Excellent Care for All Act, 2010 (ECFAA) received Royal Assent and most requirements in the Act came into force. The Act requires health care organizations, beginning with public hospitals, to :
- Develop and post annual quality improvement plans.
- Implement patient and employee satisfaction surveys and a patient relations process.
- Link executive compensation to achievement of quality plan performance improvement targets.
- Develop declarations of values after public consultation.
- Create quality committees to report to each hospital board on quality related issues.
New Regulations introduced to strengthen Patient Relations Processes and ensure patients and their caregivers are engaged as part of the Quality Improvement Plan process.
The MOHLTC introduced two new regulations under ECFAA to enhance complaints management processes and expand patient engagement in hospitals. These new regulations were announced on July 7, 2015 and came into effect on September 1, 2015. As of this writing, the requirements under ECFAA apply to health care organizations, defined as hospitals within the meaning of the Public Hospitals Act.
As of September 1, 2015, under O. Reg. 188/15: Patient Relations Process, health care organizations are required to:
- Have practices in place for handling patient complaints as part of the organization's overall patient relations process. As part of these practices, health care organizations are be required to :
- have processes in place for reviewing and resolving complaints made by patients and caregivers
- record, monitor, and analyze key information about each complaint, including the name of the person who made the complaint (except in the case of an anonymous complaint), the date the complaint was made, the subject matter, whether the complaint was resolved, and if so, when and how the complaint was resolved
- inform the person who made the complaint of its review status, within five days of the date the complaint was made and whenever the person who made the complaint reasonably requests further information
- Designate an individual as its patient relations process delegate and to make that individual's contact information available to the public. This individual is responsible for :
- overseeing the patient relations process
- presenting aggregate data related to the organization's patient relations process to the organization's quality committee at least twice a year
- Engage patients in designing, reviewing, and maintaining an organization's patient relations process.
As of September 1, 2015, under O.Reg. 187/15: Annual Quality Improvement Plan, health care organizations are required to:
- Engage patients and their caregivers in the development of its annual quality improvement plan
- Contain a description of the organization's patient engagement activities in their annual quality improvement plan and include an explanation of how these activities inform the development of the quality improvement plan
The full text of these Regulations under ECFAA is available on the e-laws website site at:
Supports and Resources
Supports and resources for improving patient relations practices in Ontario's hospitals and engaging with patients and caregivers about patient relations are available on Health Quality Ontario's website at:
The Ontario Hospital Association (OHA) has developed a patient relations toolkit to support the ongoing work of hospitals in enhancing patient relations processes. The OHA patient relations toolkit is available on the OHA's website:
Overview of Regulations
The text of ECFAA and all of its subordinate regulations is available on the e-laws website at:
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