O. Reg. 381/92: MAXIMUM ALLOWABLE CONSIDERATION

Independent Health Facilities Act
Loi sur les établissements de santé autonomes

ONTARIO REGULATION 381/92

Amended to: O. Reg. 94/03

MAXIMUM ALLOWABLE CONSIDERATION

Note: This Regulation was revoked on November 26, 2002. See: O. Reg. 94/03, s. 1.

This Regulation is made in English only.

Application

1. (1) Subject to subsection (2), this Regulation applies with respect to independent health facilities to which section 7 of the Act applied on the 23rd day of April, 1990. O. Reg. 381/92, s. 1 (1).

(2) Sections 10 and 11 apply to all independent health facilities. O. Reg. 381/92, s. 1 (2).

Calculation of Maximum Allowable Consideration

2. (1) The maximum allowable consideration in relation to a licence is 104 per cent of the income, as determined under section 5 or 6, arising from services rendered at the facility during a one-year period elected by the licensee. O. Reg. 381/92, s. 2 (1).

(2) The maximum allowable consideration shall be adjusted annually for inflation in accordance with subsection (3). O. Reg. 381/92, s. 2 (2).

(3) On the 1st day of April of each year, commencing in 1991, the maximum allowable consideration shall be adjusted by the percentage change in the Consumer Price Index for the twelve-month period ending at the end of the preceding October. O. Reg. 381/92, s. 2 (3).

(4) In subsection (3),

“Consumer Price Index” means the Consumer Price Index for Canada (All Items), as published by Statistics Canada under the authority of the Statistics Act (Canada). O. Reg. 381/92, s. 2 (4).

3. (1) The one-year period elected by a licensee must contain the 23rd day of April, 1990. O. Reg. 381/92, s. 3 (1).

(2) If licensees are licensed to carry on business collectively and they do not agree on the election of a one-year period, they shall be deemed to have elected the one-year period beginning on the 23rd day of April, 1990. O. Reg. 381/92, s. 3 (2).

4. The maximum allowable consideration in relation to a licence, determined in accordance with this Regulation, is binding on subsequent licensees. O. Reg. 381/92, s. 4.

Determination of Income for Calculating
Maximum Allowable Consideration

5. (1) In this section, a fee is “connected” to an insured service if the fee is for or in respect of a service or operating cost that supports, assists or is a necessary adjunct, or any of them, to the insured service. O. Reg. 381/92, s. 5 (1).

(2) The income arising from services rendered at a facility during a one-year period is the sum of the following:

1. Each fee paid under the Health Insurance Act that was for an insured service rendered at the facility during the one-year period and that was set out in a column denoted by the letter “T” in Regulation 552 of the Revised Regulations of Ontario, 1990.

2. Each fee that was paid under section 24 of the Act and set out in the publication entitled “Facility Fee Schedule for Independent Health Facilities” published by the Ministry of Health and that was connected to an insured service rendered at the facility during the one-year period.

3. A professional component for each fee included in paragraph 1 or 2 equal to the product of the fee multiplied by the percentage set out in Column 2 of the Schedule opposite the service or operating cost that the fee is for or in respect of.

4. Each fee, other than a fee included in paragraph 1 or 2, that was connected to an insured service set out in the licence initially issued to operate the facility, as a primary insured service, and that was rendered at the facility during the one-year period.

5. The fee for each insured service, to which a fee included in paragraph 4 was connected, that was set out in the licence initially issued to operate the facility, as a primary insured service, and that was rendered at the facility during the one-year period. O. Reg. 381/92, s. 5 (2).

(3) If a licensee is licensed for the same facility as other licensees but the licensee is not licensed to carry on business collectively with the others, the income arising from services rendered at the facility for the licence is determined in accordance with subsection (2) with the following modifications:

1. Under paragraphs 1 and 5 of subsection (2), only fees for insured services rendered by the licensee shall be included.

2. Under paragraphs 2 and 4 of subsection (2), only fees connected to insured services rendered by the licensee shall be included. O. Reg. 381/92, s. 5 (3).

(4) If a licensee is licensed to carry on business collectively with other licensees, the maximum allowable consideration shall be determined for all the licences together. O. Reg. 381/92, s. 5 (4).

6. (1) For the purpose of determining the maximum allowable consideration, a person designated by the Minister in writing may determine the income arising from services of a facility if, in that person’s opinion,

(a) it is not possible to determine the income under section 5 because, through no fault of the licensee, necessary records have been destroyed; or

(b) the operation of the facility was interrupted for more than four weeks during the one-year period, the interruption was for reasons beyond the control of the licensee and the interruption results in a lower income, as determined under section 5, than would have been the case had the interruption not occurred. O. Reg. 381/92, s. 6 (1).

(2) In determining income under clause (1) (a), the person designated by the Minister shall estimate the income using the approach set out in section 5. O. Reg. 381/92, s. 6 (2).

(3) In determining income under clause (1) (b), the person designated by the Minister shall estimate the income that would have arisen from services of the facility if the interruption had not occurred. O. Reg. 381/92, s. 6 (3).

(4) In determining income under this section, the person designated by the Minister may make any estimations or assumptions that he or she considers appropriate. O. Reg. 381/92, s. 6 (4).

Allocation of Maximum Allowable Consideration

7. (1) If licensees are licensed to carry on business collectively, the maximum allowable consideration shall be allocated among the licences in proportion to the interests of the licensees in the business that they are licensed to carry on. O. Reg. 381/92, s. 7 (1).

(2) If a licensee is a corporation the shares of which are not traded on a stock exchange in Canada or the United States of America, the maximum allowable consideration shall be allocated among the shares in proportion to the property the holders of the shares would receive on the dissolution of the corporation. O. Reg. 381/92, s. 7 (2).

(3) If a licensee is a corporation the shares of which are traded on a stock exchange in Canada or the United States of America, the maximum allowable consideration shall be allocated among the shares as determined by a person designated by the Minister in writing. O. Reg. 381/92, s. 7 (3).

MAC Returns

8. (1) A maximum allowable consideration (“MAC”) return is a report that sets out,

(a) the licensee’s election of the one-year period mentioned in subsection 2 (1);

(b) a record of the fees relevant to the calculation of income as determined under section 5 or a statement as to why they are not available;

(c) the licensee’s calculation of maximum allowable consideration, if applicable; and

(d) the allocation of the maximum allowable consideration, if necessary, and an explanation of how it was determined. O. Reg. 381/92, s. 8 (1).

(2) A licensee may file a MAC return with the Director unless a MAC return has already been filed with the Director in respect of the licence. O. Reg. 381/92, s. 8 (2).

(3) If a licensee wishes to transfer the licence, the licensee shall, unless a MAC return has already been filed with the Director in respect of the licence, file a MAC return with the Director to assist him or her in deciding whether to consent to the transfer. O. Reg. 381/92, s. 8 (3).

(4) When a licensee files a MAC return, the licensee shall file, at the same time, a MAC return for every licence the licensee holds. O. Reg. 381/92, s. 8 (4).

(5) Subsection (4) does not apply with respect to licences to carry on business collectively. O. Reg. 381/92, s. 8 (5).

(6) Every licensee shall file a MAC return within three years of the date the licence was issued. O. Reg. 381/92, s. 8 (6).

(7) A licensee that is a corporation shall file a MAC return with the Director within ninety days after receiving notice from a shareholder that the shareholder wants to transfer shares of the corporation. O. Reg. 381/92, s. 8 (7).

(8) The election of a one-year period by a licensee in a MAC return filed with the Director is binding on subsequent licensees. O. Reg. 381/92, s. 8 (8).

Records and Reports

9. Every licensee of an independent health facility shall maintain the records that are necessary to determine the maximum allowable consideration for the facility for at least six years after a MAC return is filed with the Director. O. Reg. 381/92, s. 9.

10. Before transferring a licence, the licensee shall file a report with the Director setting out the consideration for the transfer of the licence. O. Reg. 381/92, s. 10.

11. A licensee shall furnish such information and accounts as may be required by the Director relating to the maximum allowable consideration of the licence or any allocation of the maximum allowable consideration or relating to any transfer of the licence or any consideration for such a transfer. O. Reg. 381/92, s. 11.

SCHEDULE

PROFESSIONAL COMPONENTS FOR CERTAIN FEES

Nuclear Medicine — in Vivo

COLUMN 1	COLUMN 2
Code for Fee	Percentage
J802/J602 J804/J604 J867/J667 J806/J606 J807/J607 J808/J608 J810/J610 J811/J611 J812/J612 J813/J613 J814/J614 J815/J615 J816/J616 J868/J668 J869/J669 J817/J617 J870/J670 J818/J618 J871/J671 J820/J620 J872/J672 J821/J621 J823/J623 J824/J624 J873/J673 J825/J625 J874/J674 J826/J626 J875/J675 J827/J627 J829/J629 J876/J676 J877/J677 J830/J630 J878/J678 J879/J679 J831/J631 J832/J632 J833/J633 J834/J634 J835/J635 J880/J680 J836/J636 J837/J637 J838/J638 J839/J639 J840/J640 J841/J641 J843/J643 J847/J647 J848/J648 J849/J649 J881/J681 J882/J682 J883/J683 J884/J684 J850/J650 J851/J651 J852/J652 J853/J653 J854/J654	36.9 107.2 44.0 53.0 19.5 28.5 40.2 53.0 52.4 55.0 78.6 28.7 9.8 11.1 8.1 63.7 61.3 51.7 32.2 26.7 19.5 20.4 19.0 15.9 12.5 11.1 14.8 14.8 14.9 78.1 37.8 65.9 62.8 39.6 29.6 56.9 37.0 43.0 34.5 35.8 47.8 40.0 35.7 22.8 22.8 19.0 52.8 21.0 19.0 8.0 24.4 21.5 43.0 48.5 14.5 12.8 47.5 48.5 29.7 33.3 29.5

Diagnostic Radiology

COLUMN 1	COLUMN 2
Code for Fee	Percentage
X001 X009 X003 X004 X005 X006 X012 X007 X008 X010 X011 X016 X017 X018 X019 X020 X025 X202 X203 X027 X204 X028 X205 X206 X032 X033 X031 X034 X207 X035 X208 X036 X037 X211 X048 X212 X049 X213 X050 X214 X051 X215 X216 X052 X217 X053 X218 X054 X219 X055 X220 X056 X221 X038 X045 X209 X046 X210 X047 X080 X081 X090 X091 X092 X039 X040 X096 X100 X101 X105 X106 X107 X108 X104 X103 X109 X110 X111 X112 X113 X114 X120 X116 X229 X072 X230 X064 X057 X058 X189 X155 X179 X180 X181 X182 X140 X160 X161 X174 X175 X198 X199 X132 X133 X156 X200 X164 X167 X169 X170 X171 X192 X135 X131 X191 X138 X139 X134 X136 X141 X143 X144 X147 X148 X195 X196 X197 X184 X185 X186 X187 X194 X201 X150 X193 X173 X190 X154 X176 X177 X183 X166	34.9 34.6 34.0 37.4 34.0 37.4 34.9 37.4 37.4 39.3 37.4 48.0 121.2 42.4 45.4 45.4 24.2 25.1 25.6 26.3 26.6 24.2 25.1 25.8 30.4 37.4 34.3 20.3 26.6 37.4 35.4 34.0 26.0 32.2 35.0 32.2 35.0 32.2 34.0 31.1 34.0 31.1 29.7 34.0 31.1 34.0 31.1 34.0 31.1 47.3 44.1 31.4 34.0 25.4 34.0 30.2 37.4 34.5 35.0 35.5 35.5 34.0 37.6 34.6 34.4 34.4 34.0 34.0 31.2 69.5 69.5 49.6 51.2 53.8 54.0 52.0 52.0 49.6 44.6 45.7 34.9 26.2 37.4 31.1 31.4 34.0 37.4 34.0 37.1 234.7 25.6 34.3 52.0 34.3 38.7 38.7 62.8 58.8 34.3 52.0 34.7 34.7 62.8 57.8 86.1 89.4 69.8 37.4 25.6 69.8 41.4 37.4 44.2 72.3 37.4 37.4 37.4 34.4 34.4 36.2 34.0 37.4 34.3 52.0 110.5 110.5 110.5 45.5 46.0 36.7 36.0 61.1 61.1 56.1 69.8 70.5 34.4 25.6 34.3 51.6 62.8 0.0

Diagnostic Ultrasound

COLUMN 1	COLUMN 2
Code for Fee	Percentage
J122/J422 J102/J402 J103/J403 J107/J407 J108/J408 J105/J405 J106/J406 J125/J425 J135/J435 J128/J428 J159/J459 J162/J462 J163/J463 J138/J438 J190/J490 J191/J491 J192/J492 J201/J501 J193/J493 J194/J494 J195/J495 J202/J502 J198/J498 J205/J505 J200/J500 J196/J496 J197/J497 J203/J503 J204/J504 J180/J480 J182/J482 J127/J427 J183/J483 J149	59.4 151.4 102.3 100.5 102.7 59.5 42.5 59.6 59.6 59.9 59.6 59.6 59.9 59.6 47.6 47.6 51.7 59.4 75.9 93.8 83.4 59.4 159.7 75.9 127.1 153.2 133.3 27.2 49.6 63.6 59.7 59.7 59.5 59.5

Pulmonary Function Studies

COLUMN 1	COLUMN 2
Code for Fee	Percentage
J311 J307 J305 J306 J340 J309 J310 J308 J328 J315 E450 E451 J316 J317 J330 J319 J318 J320 J331 J313 J323 J332 J334 J322 J333 J335 J341	88.8 83.2 85.2 81.8 100.0 76.4 68.9 67.0 100.0 66.8 50.4 115.1 58.7 60.1 60.2 0.0 0.0 38.2 50.0 33.3 100.0 50.0 43.3 100.0 58.8 54.7 85.2

O. Reg. 381/92, Sched.