Canada-Ontario Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19

BETWEEN:

HER MAJESTY THE QUEEN IN RIGHT OF CANADA (hereinafter referred to as “Canada”) as represented by the Minister of Health (herein referred to as “the federal Health Minister”)

- and -

HER MAJESTY THE QUEEN IN RIGHT OF ONTARIO (hereinafter referred to as “Ontario”) as represented by the Minister of Health (herein referred to as “Ontario Health Minister”)

REFERRED to collectively as the “Parties”, and individually as a “Party”

PREAMBLE

WHEREAS Canada and Ontario are in the midst of the COVID-19 pandemic, which has required provinces and territories to rapidly deploy virtual care services to meet health needs of Canadians;

WHEREAS Canada and Ontario agree that immediate action and collaboration was and continues to be needed among governments to expand virtual care services to support improved access to publicly insured health care services for Canadians and to work together to further accelerate the use of virtual care services as a critical channel for delivering care during COVID-19;

WHEREAS funding to support the pan-Canadian virtual care priorities was announced by the Prime Minister of Canada on May 3, 2020, of which $150 million will flow to provinces and territories through bilateral agreements for virtual care and up to $50 million to Canada Health Infoway to support PTs as they implement new initiatives pursuant to the bilateral agreements;

WHEREAS, on May 19, 2020, federal, provincial and territorial Deputy Ministers of Health agreed to the five priority areas for immediate action to support further embedding virtual care services within Canadian health systems, namely secure messaging and file transfer; secure videoconferencing; remote patient monitoring; patient access to their test results; back-end supports for integration and/or alignment of these new platforms or existing tools to meet the first four priorities;

WHEREAS Deputy Ministers also agreed that these new federal investments needed to be guided by the principles that will prioritize user experience, data security/privacy, interoperability/data integration, and cross-jurisdictional solutions to accommodate patient flow;

WHEREAS this Agreement respects jurisdictional responsibilities, and in particular, recognizes that the Government of Ontario is responsible for the design and delivery of publicly insured health care services in Ontario, with federal funding aimed at supporting Ontario’s work to augment virtual services as an essential medium of services during COVID-19;

WHEREAS Canada has established a transfer payment program called the Virtual Care COVID-19 Priorities Fund and authorizes the federal Health Minister to enter into agreements with provinces and territories to provide targeted funding to the provincial and territorial governments for the rapid deployment of virtual care in response to COVID-19 in keeping with the priorities agreed to by federal, provincial and territorial Deputy Ministers on May 19, 2020;

WHEREAS this funding is also in addition to $50 million in incremental federal funding provided to Canada Health Infoway to develop pan-Canadian standards on secure messaging and videoconferencing, undertake procurement, and provide support to provinces and territories to implement initiatives aligned with these pan-Canadian priorities;

WHEREAS the Government of Ontario is authorized to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Ontario for the provision of health services which includes virtual care services; and

WHEREAS Canada and Ontario agree that data collection and public reporting of outcomes are key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;

NOW THEREFORE, Canada and Ontario agree as follows:

1.0 Purpose

1.1 The purpose of this Agreement is to provide financial support from Canada to Ontario to rapidly deploy virtual care solutions to ensure that Canadians can continue to access high-quality care during COVID-19. This funding will support projects that will build on and enhance existing Ontario initiatives, capacity, and priorities.

2.0 Virtual Care

2.1 Objectives

2.1.1 Canada and Ontario agree that over the period of this Agreement, with financial support from Canada, Ontario will work to accelerate implementation of interoperable and connected virtual tools and services in response to the COVID-19 pandemic.

2.2 Eligible Expenditures

2.2.1 Ontario agrees to allocate funds provided by Canada under this Agreement toward initiatives and actions within one or more of the following eligible areas of expenditures, as agreed to by FPT Deputy Ministers of Health on May 19, 2020:

2.2.2 Ontario agrees to use the funding provided by Canada under this Agreement for expenditures that are directly related to or required in order to carry out initiatives or actions in the areas referred to in section 2.2.1, which may include:

2.2.3 In developing initiatives in support of expanding virtual care under this Agreement, Ontario agrees to implement measures that also respond to the needs of underrepresented populations in Ontario.

3.0 Effective Date, Duration

3.1 This Agreement will come into effect upon the last signature being affixed [Effective Date] and will remain in effect until March 31, 2022, unless terminated in writing by Canada or Ontario in accordance with the terms and conditions set out in section 11.

3.2 Subject to 4.4 and 4.5, funding provided under this Agreement may be used by Ontario for expenditures described in section 2.2 that are incurred from April 1, 2020, to March 31, 2022.

3.3 Canada and Ontario concur that the purpose of this time-limited, one-time agreement is to help Ontario more rapidly deploy virtual care solutions and back-end support for integration of new platforms and supports, in keeping with the priorities agreed to by Deputy Ministers on May 19, 2020, and that Canada will not be responsible for any ongoing funding for enhanced initiatives established under this Agreement.

4.0 Financial Provisions

4.1 The contributions made under this Agreement are in addition to and not in lieu of those that Canada currently provides to Ontario under the Canada Health Transfer to support delivering health care services within their jurisdiction.

4.2 Allocation to Ontario

4.2.1 In this Agreement, “Fiscal Year” means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

4.2.2 Canada has designated a maximum one-time amount of funding to be transferred in total to all provinces and territories of $150,000,000.

4.2.3 The total amount to be paid to Ontario will be calculated using the following formula:

B + ((F – (N x 3,000,000)) x (K/L)), where:

4.2.4 Based on the formula described in section 4.2.3, Ontario’s share of the amounts identified in section 4.2.2 is:

Table 1: Ontario’s Share of the Amounts Identified in section 4.2.2
Amount to be paid to Ontario in 2020-21
$46,014,591.00

4.3 Payment

4.3.1 Half of the amount set out in section 4.2.4 will be paid by Canada to Ontario within approximately 30 business days of the Effective Date.

4.3.2 The remainder of Canada’s contribution under this Agreement will be paid after October 1, 2020, and within 30 business days of:

  1. the mutual agreement by the officials identified in section 12 (hereinafter ‘Designated Officials’) of the Action Plan described in section 5.1.
  2. agreement by Ontario to spend this second installment in a manner consistent with the Action Plan agreed to in subsection 4.3.2(a).

4.3.3 Subject to sections 4.3.4 and 4.4, Ontario agrees to spend the entire amount of Canada’s contribution under this Agreement by no later than March 31, 2022. Any amount unexpended on March 31, 2023 is a debt due to Canada and must be repaid by Ontario within 60 days. 

4.3.4 Payment of Canada’s contribution referred to in section 4.2.4 is subject to the statutory appropriations under the Public Health Events of National Concern Payments Act.

4.4 Carry Forward

4.4.1 With notice to Canada, Ontario may retain and carry forward to the 2022-23 Fiscal Year up to 10 percent of the allocation paid to Ontario under section 4.2.4 that has not yet been spent on eligible expenditures, and use the amount for eligible expenditures incurred in 2022-23. 

4.4.2 With mutual agreement in writing by the Parties, Ontario may retain and carry forward an amount exceeding 10 percent of the allocation paid to Ontario under section 4.2.4 that has not yet been spent on eligible expenditures, and use the amount for eligible expenditures incurred in 2022-23. 

4.4.3 Ontario will report to Canada on the management and spending of the funds carried forward under sections 4.4.1 or 4.4.2 on a quarterly basis until funds are fully expended and reported.

4.5 Repayment of Overpayment

4.5.1 Canada and Ontario agree that every effort has been made to ensure that the calculation of Canada’s contribution installment to Ontario is accurate.

4.5.2 In the event payment made to Ontario exceeds the amount to which Ontario is to be provided under this Agreement, the amount of the excess is a debt due to Canada and Ontario will repay the amount to Canada within 90 calendar days of written notice from Canada.

5.0 Accountability and Reporting

5.1 Action Plan

5.1.1 Ontario will, within 90 days of the Effective Date of this Agreement, complete and share with Canada an Action Plan in the form agreed upon by the Parties and satisfactory to Canada. The Action Plan will:

  1. provide an overview of virtual care in Ontario;
  2. identify Ontario’s specific priority areas for expenditure and objectives, and which build upon the progress to date in delivering virtual care;
  3. highlight those initiatives Ontario has or will undertake and describe how they align with the priorities agreed to by Deputy Ministers on May 19, 2020, and outlined in section 2.2.1, including initiatives undertaken by Ontario as of April 1, 2020;
  4. indicate how these initiatives will address shared principles for virtual care presented to Deputy Ministers on May 19, 2020, namely prioritizing user experience, data security/privacy, interoperability/data integration, as well as enabling cross-jurisdictional solutions to accommodate patient flow;
  5. include a breakdown of planned expenditures by initiative;
  6. highlight how the needs of underrepresented populations in Ontario will be addressed within one or more identified initiative;
  7. identify how Ontario will work in collaboration with Canada Health Infoway, Canadian Institute for Health Information [CIHI], and, as appropriate, with other pan-Canadian health organizations (Canadian Patient Safety Institute, Canadian Foundation for Health Improvement, Canadian Agency for Drug Technologies and Health, Mental Health Commission of Canada, Canadian Centre on Substance Use and Addiction, and the Canadian Partnership Against Cancer) to implement initiatives; and
  8. h) outline the performance measures and targets that align with the province’s program measures Ontario will use to track progress according to Ontario’s planned activities.

5.1.2 Ontario acknowledges that Canada will make publicly available its Action Plan to ensure transparency to Canadians on the specific initiatives being supported by these investments.

5.1.3 The Action Plan may be amended by Ontario, with consent from Canada, not to be unreasonably withheld, should Ontario need to shift its approach, necessitated by changing circumstances or priorities. Canada will make publicly available the amended Action Plan.

5.1.4 Upon receipt of the annual financial report referred to in section 5.2.4, Canada will update the breakdown of planned expenditures referred to in subsection 5.1.1(e), and make the updated Action Plan publicly available, providing at least a notice of 10 days to Ontario of the public release. 

5.2 Reporting

5.2.1 Within 90 days of Canada and Ontario agreeing to an Action Plan, Ontario agrees to provide CIHI with available baseline data on the performance measures and targets identified in the Action Plan, as outlined in subsection 5.1.1 (h).

5.2.2 Ontario agrees to provide to CIHI, by October 1, 2022, data demonstrating the results of its initiatives from the performance measures and targets identified in the Action Plan, as outlined in subsection 5.1.1 (h), and acknowledges that CIHI will, with appropriate advance notice to Ontario, make this information available publicly.

5.2.3 Ontario agrees to work collaboratively with CIHI to identify common pan-Canadian indicators using existing data, in order to allow CIHI to report publicly on progress on virtual care implementation.

5.2.4 By no later than October 1, 2021, in relation to Fiscal Year 2020-2021, and October 1, 2022, in relation to Fiscal Year 2021-2022, Ontario will provide to Canada an annual financial statement, with attestation from the Province’s Chief Financial Officer, of revenues and expenses received from Canada under this Agreement during the preceding Fiscal Year:

  1. The revenue section of the statement will show the amount received from Canada under this Agreement during the Fiscal Year.
  2. The total amount of funding used for eligible areas of expenditures activities under section 2.2.
  3. If applicable, the amount carried forward by Ontario under section 4.4.
  4. If applicable, the amount of any funds that are to be repaid to Canada under section 4.5.

5.2.5 Canada may, with prior written notice to Ontario, incorporate all or any part or parts of the financial report described into any public report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

5.3 Audit

5.3.1 Ontario will ensure that expenditure information presented in the report required under section 5.2 is, in accordance with Ontario standard accounting practices, complete and accurate.

5.4 Evaluation

5.4.1 Responsibility for evaluation of programs rests with Ontario in accordance with its own evaluation policies and practices.

6.0 Collaboration

6.1 For the duration of this Agreement, Canada and Ontario agree to collaborate through FPT fora to advance policy supports – including approaches to provider compensation – required for the integration of virtual care into publicly funded health systems in a sustainable manner.

6.2 Canada and Ontario agree to share and release data as available, and to share knowledge, research and information on effective and innovative practices in virtual health services, to further support the development of and reporting on outcomes and to help identify areas for longer-term collaboration, subject to applicable privacy laws of Ontario and Canada.

7.0 Communications

7.1 Canada and Ontario agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

7.2 Canada will make the Bilateral Agreement[s] for Pan-Canadian Virtual Care Priorities in Response to COVID-19 entered into with all provinces and territories, including any amendments, publicly available on a Government of Canada website.

7.3 Each government will give credit and visibility satisfactory to the other government when activities and or initiatives financed by/using funds provided under this Agreement are announced to the public.

7.4 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the bilateral agreements.

7.5 Ontario reserves the right to conduct public communications, announcements, events, outreach and promotional activities related to this Agreement.

7.6 The Parties agree to give each other 10 days advance notice and advance copies of public communication related to this Agreement and to results of initiatives undertaken with funding provided under this Agreement.

8.0 Dispute Resolution

8.1 Canada and Ontario are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

8.2 If at any time either Canada or Ontario is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, Canada or Ontario, as the case may be, may notify the other Party in writing of the issue, failure or breach. Upon such notice, Canada and Ontario will endeavour to resolve the issue in dispute bilaterally through the Associate Assistant Deputy Minister of the Strategic Policy Branch, Health Canada and the, Assistant Deputy Minister of the Digital Health Division, Ministry of Health, as named in the notice section below.

8.3 If either Designated Official concludes that the dispute cannot be resolved by the Designated Officials, then the dispute will be referred to the Deputy Ministers of Health for Canada and Ontario, and if it cannot be resolved by them, then the federal Health Minister and Ontario Health Minister will endeavour to resolve the dispute.

9.0 Amendments

9.1 Subject to section 9.2, amendments to this Agreement may be made at any time upon mutual consent of the Parties. To be valid, any such amendments will be in writing and signed, in the case of Canada, by the federal Health Minister, and in the case of Ontario, by the Ontario Health Minister.

9.2 Amendments to the Action Plan, if any, may be made at any time upon mutual consent of the Parties. To be valid, any such amendments to the Action Plan will be in writing and signed, in the case of Canada, by their Designated Official, and in the case of Ontario, by their Designated Official.

10.0 Equality of Treatment

10.1 During the term of this agreement, if another province or territory, except the province of Quebec, enters into a Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19 with Canada, or amends such an agreement, and if, in the reasonable opinion of Ontario, the amendment or any provision of that agreement is more favourable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement, in order to afford similar treatment to Ontario, if requested by Ontario.

10.2 Any amendments to this Agreement resulting from section 10.1 shall be retroactive to the date on which the Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19 with the other province or territory, or the amendment to such an agreement, as the case may be, comes into effect.   

11.0 Termination, Survival

11.1 Canada may terminate this Agreement at any time if the terms of this agreement are not respected by Ontario by giving at least 6 months written notice of its intention to terminate. Ontario may terminate this Agreement at any time if the terms of this Agreement are not respected by Canada by giving at least 6 months written notice of its intention to terminate.

11.2 As of the effective date of termination of this Agreement under section 11.1, Canada shall have no obligation to make any further payments to Ontario after the date of effective termination.

11.3 Upon termination of this agreement under section 11.1, Ontario will repay any federal funds provided pursuant to the Agreement that have not or will not be used in accordance with section 2.2 of this Agreement.

11.4 Sections 4.4, 5.2, 5.3, and 7 of this agreement survive the termination or expiration of this Agreement.

12.0 Notice

12.1 Any notice, information or document provided for under this Agreement will be effectively given if delivered or sent by letter, postage or other charges prepaid. Any notice that is delivered will have been received upon delivery; and, except in periods of postal disruption, any notice mailed will be deemed to have been received eight calendar days after being mailed.

The address for notice or communication to Canada will be:

Health Canada
70 Colombine Drive
11th Floor, Brooke Claxton Building
Ottawa, Ontario, K1A 0K9
Attention: Marcel Saulnier, Assoc. Assistant Deputy Minister

Email: marcel.saulnier@canada.ca

The address for notice or communication to Ontario will be:

Ministry of Health
12th Flr Suite 1200, 1075 Bay St,
Toronto, ON M5S 2B1
Attention: Greg Hein, Assistant Deputy Minister

Email: Greg.Hein@ontario.ca

13.0 General

13.1 This Agreement comprises the entire Bilateral Agreement for Pan-Canadian Virtual Care Priorities in Response to COVID-19 entered into by the Parties with respect to the subject matter hereof.

13.2 This Agreement will be governed by and interpreted according to the laws of Canada and Ontario.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Ontario will be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

13.4 If for any reason a provision of this Agreement that is not a fundamental term is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

13.5 This Agreement may be executed in counterparts, in which case (i) the counterparts together will constitute one agreement, and (ii) communication of execution by fax transmission or emailed in PDF will constitute good delivery.

13.6 This Agreement is drafted in English at the request of the Parties.

Signed on behalf of Canada by the Minister of Health this 26th day of March, 2021.

The Honourable Patty Hajdu, Minister of Health

Signed on behalf of Ontario by the Minister of Health at Toronto, Ontario this 12th day of March, 2021.

The Honourable Christine Elliott, Deputy Premier and Minister of Health

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