Regulation - LGIC

Enabling New Models of Care for Select 9-1-1 Patients

Regulation Number(s):
O.Reg 257/00
Regulation 552
Instrument Type:
Regulation - LGIC
Bill or Act:
Ambulance Act & Health Insurance Act
Summary of Decision:
Made: October 25, 2019
Filed: November 1, 2019
Published on e-Laws: November 1, 2019
Printed in The Ontario Gazette: November 16, 2019
Analysis of Regulatory Impact:
The proposed regulatory changes to be made by the Lieutenant Governor in Council are not anticipated to have any financial impacts to businesses.
Further Information:
Proposal Number:
Posting Date:
September 5, 2019
Summary of Proposal:
A proposal to amend regulations under the Ambulance Act and Health Insurance Act to provide select 9-1-1 patients with alternative care options for prehospital care other than transport to the emergency department.

Regulatory Changes:
Ontario's Emergency Health Services system is governed by the Ambulance Act, its regulations and standards to provide access to rapid prehospital emergency care and safe and effective transportation for "patients" to the emergency department.
The Ministry of Health (the ministry) is planning to enable new patient care models for select 9-1-1 patients to provide timely access to definitive care where options other than transport to the emergency department may be done safely and appropriately. New models of care will help end hallway health care and ensure the delivery of high quality, integrated care.

New models of care include:
• Transporting patients to destinations other than the emergency department where they can receive appropriate treatment;
• Treating patients on-scene and referring them to another health care provider;
• Treating and releasing patients on-scene; and
• Referral of select low acuity patients during the 911 call to appropriate care in the community.

Proposed Content (General Regulations):
The Ministry of Health (MOH) is proposing the following amendments to Ontario Regulation 257/00 (O. Reg. 257/00) under the Ambulance Act that will create clear authority for the ministry and ambulance services to implement new models of care:
• Add a new provision that permits the ministry to create a standard that sets out requirements for ambulance services implementing new models of care.
• Consider regulations that enable the ministry to establish standards for health care professionals (e.g., nurses) working at ambulance communication centres for the purposes of providing clinical advice to patients during the 911 call.
• Consider regulatory options that will enable ambulance services to engage with physicians other than those who specialize in Emergency Medicine for medical delegation of controlled acts.
• Consider regulatory options to allow communication services to provide clinical assessments to 911 callers.
• Create a provision that sets out appropriate response time performance plans to support new models of care.
Regulation 552 (Reg. 552) under the Health Insurance Act sets out one of the lowest ambulance fees in Canada (a co-payment of $45) for patients who are transported by ambulance to or from a hospital. Reg. 552 does not set out fees for other services that may be provided by an ambulance service (e.g. transport to a non-hospital destination). The ministry is considering:
• Establishing charges for transportation to non-hospital destinations that align with existing ambulance service charges as currently outlined in Reg. 552.
Contact Address:
5700 Yonge St., Floor 6, Toronto ON M2M 4K5
Effective Date:
November 1, 2019