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O. Reg. 381/92: MAXIMUM ALLOWABLE CONSIDERATION

under Independent Health Facilities Act, R.S.O. 1990, c. I.3

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Versions
revoked or spent November 26, 2002

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Note: This Regulation was revoked on November 26, 2002.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.