1. To: Ontario Health, and
  2. To: Every Local Health Integration Network
  3. Re: Home and Community Care Modernization: Service Provider Organization Agreements and the Sharing of Information
  4. Effective: November 14, 2023

Background

  1. Home and community care modernization plan

Home and community care is key to Your Health: A Plan for Connected and Convenient Care, the government’s plan to connect people in Ontario to the health care they need, when they need it. Building on work to date to connect people to home and community care, the province is moving forward with the plan to modernize home care and advance the implementation of Ontario Health Teams (OHTs).

The next steps in home care modernization include the integration of home care into OHTs, updating the service provider organization selection and contracting process and the implementation of new models of integrated home care delivery.

  1. Home and community care support services

The province currently relies on the fourteen (14) local health integration networks, operating as Home and Community Care Support Services (HCCSS) organizations, to provide home care services. HCCSS contracts with service provider organizations to deliver home care services on their behalf, including personal support and homemaking services, nursing, and other professional services. Currently the fourteen (14) HCCSS organizations in Ontario contract with approximately one hundred and sixty-three (163) service provider organizations to deliver home care services to their clients.

The provincial home care modernization plan includes a review of the current HCCSS contracts with service provider organizations to support updating the service provider organization selection and contracting process (which includes updating the contracts and how service volumes are allocated) and the implementation of new models of integrated home care delivery.

  1. Ontario Health mandate

​​​​​In the 2023–24 Mandate Letter, the Ministry of Health (MOH) directed Ontario Health (among other things) to continue to work with the MOH and HCCSS to (collectively the “Mandate”):

  1. Plan for and implement approved transition of resources, functions and responsibilities for home and community care service provision, including the management of contracted service providers, referrals and placements,
  2. Evaluate and update templates for home and community care client services contracts and provide guidance on their implementation and management, and
  3. Implement changes to pre-qualification, provider selection and contracts.
  1. Authority to issue directive

​​​​​​​​​​​​This directive is issued pursuant to subsection 20(1) of the Connecting Care Act, 2019 (“CCA”), which authorizes the Minister of Health (“Minister”) to issue directives to Ontario Health where the Minister considers it to be in the public interest to do, and pursuant to subsection 11.1(1) of the Local Health System Integration Act, 2006 (“LHSIA”) which authorizes the Minister to issue operational or policy directives to the Local Health Integration Networks (“LHINs”) where the Minister considers it to be in the public interest to do so.

Ontario Health and every LHIN will comply with every directive issued by the Minister under the CCA or LHSIA that applies to Ontario Health or the LHIN. In the event of any conflict between this directive and a provision of the CCA, LHSIA, or any provision or rule of any other applicable law, the provision or rule of the CCA, LHSIA or other applicable law prevails.

Effective date

This directive is effective as of November 14, 2023.

Definitions

“Agreement” means each agreement between a LHIN and each of its service provider organizations for the purchase of home and community care services from that service provider organizations, including its General Conditions and Schedules.

“Confidential Information” means, with respect to an Agreement, the information that falls within the definition of Confidential Information in Article 1.1 of the General Conditions of that Agreement, or wherever else the definition may appear in the Agreement, which for certainty does not include Personal Information or Personal Health Information.

“FIPPA” means the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, C. F. 31, as amended or replaced from time to time.

“LHIN” means a local health integration network under and as defined in s. 2(1) of the Local Health System Integration Act, 2006.

“Ontario Health” means the corporation continued under s. 3 of the Connecting Care Act, 2019.

“Personal Health Information” has the same definition as in s. 4 of the Personal Health Information Protection Act, 2004, as amended.

“Personal Information” has the same definition as in s. 2 of FIPPA, as amended.

Interpretation

For the purposes of interpretation, “include”, “includes” and “including” denote that the subsequent list is not exhaustive.

I hereby issue the following directive to Ontario Health and to every LHIN:

  1. Ontario Health
    1. As part of its Mandate and subject to requisite ministry direction and approvals, Ontario Health will develop and execute a plan to modernize and update:
      1. the centralized selection process for entities that provide home and community care services on behalf of a LHIN (currently service provider organizations), which includes pre-qualification, procurement of services and negotiated allocation of services, and
      2. the contractual terms for the delivery of home and community care services, (collectively the “Purposes”).
    2. Ontario Health is directed to carry out the Purposes.
  2. LHINs to Share Information with Ontario Health for the Purposes
    1. Every LHIN will disclose to Ontario Health any information in its custody and control, other than Personal Information or Personal Health Information, relating to any or all Agreements, including Confidential Information, requested in writing by Ontario Health as being reasonably necessary to fulfill the Purposes.
    2. Every LHIN will disclose the information requested by Ontario Health in the form and manner determined by Ontario Health, which may include aggregate data reports, so long as the form and manner requested is reasonable and can be reasonably fulfilled by the LHIN.
    3. Every LHIN and Ontario Health will work collaboratively to facilitate the sharing of information under this Directive.
    4. Nothing in this Directive will be construed as requiring or authorizing the collection, use or disclosure of Personal Information or Personal Health Information. Should Ontario Health determine Personal Information or Personal Health Information is reasonably necessary to fulfill the Purposes, the LHIN may disclose Personal Information or Personal Health Information to Ontario Health only if and to the extent permitted by FIPPA or the Personal Health Information Protection Act, 2004.
  3. Ontario Health Responsibilities in Requesting Information from a LHIN
    1. Ontario Health will only request Confidential Information that is reasonably necessary to fulfill the Purposes.
    2. Ontario Health will not request Confidential Information if other information will serve the Purposes and will not request more Confidential Information than is reasonably necessary to fulfill the Purposes.
    3. Ontario Health will use Confidential Information only for the Purposes and not for any other purpose.
    4. Ontario Health will not disclose Confidential Information except as permitted by this Directive or where required by applicable laws.
    5. Ontario Health will take steps that are reasonable in the circumstances to ensure that Confidential Information, once disclosed to and in the custody and control of Ontario Health, is protected against theft, loss and unauthorized use or disclosure and to ensure that the records containing Confidential Information are protected against unauthorized copying, modification, or disposal.
    6. Ontario Health will immediately notify the Ministry of Health upon becoming aware of any:
      1. Theft, loss, unauthorized use or disclosure of Confidential Information; or
      2. Disclosures required by law as described in subsection (e), in which case Ontario Health will make redactions to ensure that only the minimum amount of Confidential Information as required by law is disclosed.
    7. If Ontario Health retains an external person or entity to assist with its fulfillment of one or more of the Purposes, Ontario Health may provide Confidential Information to the external person or entity only if:
      1. The provision of the Confidential Information is required for the Purposes;
      2. No other information could serve the Purposes;
      3. Ontario Health enters into a written contract with the external person or entity on terms substantially similar to those of this Directive and ensures that the external person or entity uses the same degree of care to protect the security of the Confidential Information as Ontario Health, and in any event uses a standard no less than a reasonable degree of care; and
      4. Ontario Health prohibits the external person or entity from further disclosing the Confidential Information, except in accordance with specific written authorization of Ontario Health for the Purposes, and as may be required by applicable laws.
  4. Interpretation
    1. If either a LHIN or Ontario Health has a question about the interpretation of this directive, the LHIN or Ontario Health should contact Amy Olmstead, Director of the Home and Community Care Branch, at amy.olmstead@ontario.ca.

Original signed by

Sylvia Jones
Deputy Premier and Minister of Health

Dated on this 14th day of November 2023