Correspondence: Christine Elliott, Deputy Premier + Minister of Health re 2019 Funding Letter to the BOH for WDGPH with Schedules

Ministry of Health

Office of the Deputy Premier and Minister of Health

777 Bay Street, 5th Floor Toronto ON M7A 1N3 Telephone: 416 327-4300

Facsimile: 416 326-1571 www.ontario.ca/health

Ministere de la Sante

Bureau du vice-premier ministre et du ministre de la Sante

777, rue Bay, 58 etage Toronto ON M7A 1N3 Telephone: 416 327-4300

Telecopieur: 416 326-1571 www.ontario.ca/sante

AUG 20 2019

Mr. George Bridge Chair, Board of Health

Wellington-Dufferin-Guelph Health Unit

Dear Mr. Bridge:

The Ontario government is taking a comprehensive approach to modernize Ontario’s health care system which includes a coordinated public health sector that is nimble, resilient, efficient, and responsive to the province’s evolving health needs and priorities. While the broader health care system undergoes transformation, a clear opportunity has emerged for us to transform and strengthen the role of public health and its connectedness to communities.

As you are aware, the government made the decision to maintain the current cost-sharing arrangements for boards of health for 2019, to provide municipalities with additional time to find efficiencies that will ensure the sustainability of these critical shared public health services.

As a result, the Board of Health for the Wellington-Dufferin-Guelph Health Unit will be provided up to $15,742,100 in base funding and up to $21,000 in one-time funding for the 2019-20 funding year, to support the provision of public health programs and services in your public health unit. Dr. David Williams, Chief Medical Officer of Health, will write to the Wellington-Dufferin-Guelph Health Unit shortly concerning the terms and conditions governing the funding.

While the way in which we are implementing our plan to strengthen public health has changed, the need to do so has not. The current public health structure requires modernization - having 35 independent entities, all with varying capacity, does not facilitate consistent implementation of the core elements of a strong public health system.

Our government has heard that the scale and pace of change is of concern to the public health and municipal sectors. While the modernization of the public health sector remains a priority, the Ministry of Health intends to consult with public health and municipal partners throughout the fall of 2019 to inform the development of Regional Public Health Entities and to ensure that adequate time is provided for thoughtful dialogue and implementation planning.

In order to support public health unit planning for 2020, municipalities can use a planned funding change to bring the municipal share to 30% for public health programs and services effective as of January 1, 2020. However, to help provide additional stability as municipalities begin to adapt to shifting funding models, our government will also provide one-time mitigation funding to assist all public health units and municipalities to manage this increase while we work to transform the public health system across the province over the next couple of years. While final confirmation of 2020 funding will be provided through the 2020 Budget process, we expect that all municipalities will be protected from any cost increases resulting from this cost-sharing change that exceed 10% of their existing costs.

We continue to rely on your strong leadership to build a modern and sustainable public health sector. Thank you for the important service that your public health unit provides to Ontarians, and your ongoing dedication and commitment to addressing the public health needs of Ontarians.

Sincerely,

Christine Elliott

Deputy Premier and Minister of Health

c: Dr. Nicola Mercer, Medical Officer of Health, Wellington-Dufferin-Guelph Health Unit

New Schedules to the Public Health Funding and Accountability Agreement

BETWEEN THE PROVINCE AND THE BOARD OF HEALTH (BOARD OF HEALTH FOR THE WELLINGTON-DUFFERIN-GUELPH HEALTH UNIT) EFFECTIVE AS OF THE 1ST DAY OF JANUARY 2019

SCHEDULE “A” GRANTS AND BUDGET ‌

Board of Health for the Wellington-Dufferin-Guelph Health Unit

DETAILED BUDGET - MAXIMUM BASE FUNDS (FOR THE PERIOD OF JANUARY 1, 2019 TO DECEMBER 31, 2019, UNLESS OTHERWISE NOTED)
Programs/Sources of Funding		2018 Approved Allocation ($)	Increase / (Decrease) ($)	2019 Approved Allocation ($)
Mandatory Programs (Cost-Shared)		12,537,000	-	12,537,000
Enhanced Food Safety - Haines Initiative (100%)		40,300	-	40,300
Enhanced Safe Water Initiative (100%)		21,600	-	21,600
Harm Reduction Program Enhancement (100%)		150,000	-	150,000
Healthy Smiles Ontario Program (100%)		817,400	-	817,400
Infectious Diseases Control Initiative (100%)	# of FTEs: 3.00	333,400	-	333,400
MOH / AMOH Compensation Initiative (100%)(1)		91,500	-	91,500
Needle Exchange Program Initiative (100%)		61,000	-	61,000
Nursing Initiatives (100%)		392,100	-	392,100
Ontario Seniors Dental Care Program (100%)(2)		-	869,100	869,100
Smoke-Free Ontario Strategy (100%)		428,700	-	428,700
Total Maximum Base Funds(3)		14,873,000	869,100	15,742,100

DETAILED BUDGET - MAXIMUM ONE-TIME FUNDS (FOR THE PERIOD OF APRIL 1, 2019 TO MARCH 31, 2020, UNLESS OTHERWISE NOTED)
Projects / Initiatives	2019-20 Approved Allocation ($)
New Purpose-Built Vaccine Refrigerators (100%)	11,000
Public Health Inspector Practicum Program (100%)	10,000
Total Maximum One-Time Funds(3)	21,000

Cash flow will be adjusted to reflect the actual status of current MOH and AMOH positions.
Base funding for the Ontario Seniors Dental Care Program is pro-rated at $651,825 for the period of April 1, 2019 to December 31, 2019.
Maximum base and one-time funding is flowed on a mid and end of month basis. Cash flow will be adjusted when the Province provides a new Schedule “A”.

Type of Funding	Base
Source	Public Health

Enhanced Food Safety – Haines Initiative (100%)

The Enhanced Food Safety – Haines Initiative was established to augment the Board of Health’s capacity to deliver the Food Safety Program as a result of the provincial government’s response to Justice Haines’ recommendations in his report “Farm to Fork: A Strategy for Meat Safety in Ontario”.

Base funding for this initiative must be used for the sole purpose of implementing the Food Safety Program Standard under the Ontario Public Health Standards. Eligible expenses include such activities as: hiring staff, delivering additional food-handler training courses, providing public education materials, and program evaluation.

Funded projects/activities must be over and above the level of activities underway or planned based on existing mandatory programs base funding.

Enhanced Safe Water Initiative (100%)

Base funding for this initiative must be used for the sole purpose of increasing the Board of Health’s capacity to meet the requirements of the Safe Water Program Standard under the Ontario Public Health Standards.

Funded projects/activities must be over and above the level of activities underway or planned based on existing mandatory programs base funding.

Harm Reduction Program Enhancement (100%)

The scope of work for the Harm Reduction Program Enhancement is divided into three components:

Local Opioid Response;
Naloxone Distribution and Training; and,
Opioid Overdose Early Warning and Surveillance.

Local Opioid Response

Base funding must be used to build a sustainable community outreach and response capacity to address drug and opioid-related challenges in their communities. This includes working with a broad base of partners to ensure any local opioid response is coordinated, integrated, and that systems and structures are in place to adapt/enhance service models to meet evolving needs.

Local response plans, which can include harm reduction and education/prevention, initiatives, should contribute to increased access to programs and services, and improved health outcomes (i.e., decrease overdose and overdose deaths, emergency room visits, hospitalizations). With these goals in mind, the Board of Health is expected to:

Conduct a population health/situational assessment, including the identification of opioid- related community challenges and issues, which are informed by local data, community engagement, early warning systems, etc.
Lead/support the development, implementation, and evaluation of a local overdose response plan (or drug strategy). Any plan or initiative should be based on the needs identified (and/or gaps) in your local assessment. This may include building community outreach and response capacity, enhanced harm reduction services and/or education/prevention programs and services.
Engage stakeholders - identify and leverage community partners to support the population health/situational assessment and implementation of local overdose response plans or initiatives. This should include First Nations, Métis and Inuit communities where appropriate.
Adopt and ensure timely data entry into the Ontario Harm Reduction Database, including the Transition to the Ontario Harm Reduction Database and ensure timely collection and entry of minimum data set as per direction from the Province (to be provided).

Naloxone Kit Distribution and Training

The Board of Health (or their Designate) must be established as a naloxone distribution lead/hub for eligible community organizations, as specified by the Province, which will increase dissemination of kits to those most at risk of opioid overdose.

To achieve this, the Board of Health is expected to:

Ordering of naloxone kits as outlined by the Province; this includes naloxone required by eligible community organizations distributing naloxone.
Coordinate and supervise naloxone inventory, including managing supply, storage, maintaining inventory records, and distribution of naloxone to eligible community organizations, and ensuring community organizations distribute naloxone in accordance with eligibility criteria established by the ministry.
With the exception of entities (organizations, individuals, etc.) as specified by the Province:
- Train community organization staff on naloxone administration, including how to administer naloxone in cases of opioid overdose, recognizing the signs of overdose and ways to reduce the risk of overdose. Board of Health staff would also instruct agency staff on how to provide training to end-users (people who use drugs, their friends and family).
- Train community organization staff on naloxone eligibility criteria, including providing advice to agency staff on who is eligible to receive naloxone and the recommended quantity to dispense.
- Support policy development at community organizations, including providing consultation on naloxone-related policy and procedures that are being developed or amended within the eligible community organizations.
- Promote naloxone availability and engage in community organization outreach, including encouraging eligible community organizations to acquire naloxone kits for distribution to their clients.

Use of NARCAN® Nasalspray

The Board of Health will be required to submit orders for Narcan to the Province in order to implement the Harm Reduction Program Enhancement. By receiving Narcan, the Board of Health acknowledges and agrees that:

Its use of the Narcan is entirely at its own risk. There is no representation, warranty, condition or other promise of any kind, express, implied, statutory or otherwise, given by her Majesty the Queen in Right of Ontario as represented by the Ministry of Health, including Ontario Government Pharmaceutical and Medical Supply Service in connection with the Narcan.
The Province takes no responsibility for any unauthorized use of the Narcan by the Board of Health or by its clients.
The Board of Health also agrees:
- To not assign or subcontract the distribution, supply or obligation to comply with any of these terms and conditions to any other person or organization without the prior written consent of the Province.
- To comply with the terms and conditions as it relates to the use and administration of Narcan as specified in all applicable federal and provincial laws.
- To provide training to persons who will be administering Narcan. The training shall consist of the following: opioid overdose prevention; signs and symptoms of an opioid overdose; and, the necessary steps to respond to an opioid overdose, including the proper and effective administration of Narcan.
- To follow all provincial written instructions relating to the proper use, administration, training and/or distribution of Narcan.
- To immediately return any Narcan in its custody or control at the written request of the Province at the Board of Health’s own cost or expense
- That the Province does not guarantee supply of Narcan, nor that Narcan will be provided to the Board of Health in a timely manner.

Opioid Overdose Early Warning and Surveillance

Base funding must be used to support the Board of Health in taking a leadership role in establishing systems to identify and track the risks posed by illicit synthetic opioids in their jurisdictions, including the sudden availability of illicit synthetic opioids and resulting opioid overdoses. Risk based information about illicit synthetic opioids should be shared in an ongoing manner with community partners to inform their situational awareness and service planning. This includes:

Surveillance systems should include a set of “real-time” qualitative and quantitative indicators and complementary information on local illicit synthetic opioid risk. Partners should include, but are not limited to: emergency departments, first responders (police, fire and ambulance) and harm reduction services.
Early warning systems should include the communication mechanisms and structures required to share information in a timely manner among health system and community partners, including people who use drugs, about changes in the acute, local risk level, to inform action. They should also include reporting to the province through a mechanism currently under development.

Healthy Smiles Ontario Program (100%)

The Healthy Smiles Ontario (HSO) Program provides preventive, routine, and emergency and essential dental treatment for children and youth, from low-income families, who are 17 years of age or under.

HSO builds upon and links with existing public health dental infrastructure to provide access to dental services for eligible children and youth.

The HSO Program has the following three (3) streams (age of ≤ 17 years of age and Ontario residency are common eligibility requirements for all streams):

Preventive Services Only Stream (HSO-PSO):
- Eligibility comprised of clinical need and attestation of financial hardship.
- Eligibility assessment and enrolment undertaken by boards of health.
- Clinical preventive service delivery in publicly-funded dental clinics and through fee-for- service providers in areas where publicly-funded dental clinics do not exist.
Core Stream (HSO-Core):
- Eligibility correlates to the level at which a family/youth’s Adjusted Net Family Income (AFNI) is at, or below, the level at which they are/would be eligible for 90% of the Ontario Child Benefit (OCB), OR family/youth is in receipt of benefits through Ontario Works, Ontario Disability Support Program, or Assistance for Children with Severe Disabilities Program.
- Eligibility assessment undertaken by the Ministry of Finance and Ministry of Community and Social Services; enrolment undertaken by the program administrator, with client support provided by boards of health as needed.
- Clinical service delivery takes place in publicly-funded dental clinics and through fee-for- service providers.
Emergency and Essential Services Stream (HSO-EESS):
- Eligibility comprised of clinical need and attestation of financial hardship.
- Eligibility assessment undertaken by boards of health and fee-for-service providers, with enrolment undertaken by the program administrator.
- Clinical service delivery takes place in publicly-funded dental clinics and through fee-for- service providers.

Base funding for this program must be used for the ongoing, day-to-day requirements associated with delivering services under the HSO Program to eligible children and youth in low-income families. It is within the purview of the Board of Health to allocate funding from the overall base funding amount across the program expense categories.

HSO Program expense categories include:

Clinical service delivery costs, which are comprised of:
- Salaries, wages, and benefits of full-time, part-time, or contracted staff that provide clinical dental services for HSO;
- Salaries, wages, and benefits of full-time, part-time, or contracted staff that undertake the following ancillary/support activities for HSO: management of the clinic(s); financial and programmatic reporting for the clinic(s); and, general administration (i.e., receptionist) at the clinic(s); and,
- Overhead costs associated with HSO clinical service delivery services such as: clinical materials and supplies; building occupancy costs; maintenance of clinic infrastructure; staff travel associated with portable and mobile clinics; staff training and professional development associated with clinical staff and ancillary/support staff, if applicable; office equipment, communication, and I & IT.
Oral health navigation costs, which are comprised of:
- Salaries, wages, and benefits of full-time, part-time, or contracted staff that are engaged in:
  - Client enrolment for all streams of the program;
  - Promotion of the HSO Program (i.e., local level efforts at promoting and advertising the HSO Program to the target population);
  - Referral to services (i.e., referring HSO clients to fee-for-service providers for service delivery where needed);
  - Case management of HSO clients; and,
  - Oral health promotion and education for HSO clients.
- Salaries, wages, and benefits of full-time, part-time, or contracted staff that undertake the following ancillary/support activities related to oral health navigation: management, financial and programmatic reporting, and general administration (if applicable).
- Overhead costs associated with oral health navigation such as: materials and supplies; building occupancy costs incurred for components of oral health navigation; staff travel associated with oral health navigation, where applicable; staff training and professional development associated with oral health navigation staff and ancillary/support staff, if applicable; office equipment, communication, and I & IT costs associated with oral health navigation.

The Board of Health is responsible for ensuring promotional/marketing activities have a direct and positive impact on meeting the objectives of the HSO Program.

The Board of Health is reminded that HSO promotional/marketing materials approved by the Province and developed provincially are available for use by the Board of Health in promoting the HSO Program.

The overarching HSO brand and provincial marketing materials were developed by the Province to promote consistency of messaging, and “look and feel” across the province. When promoting the HSO Program locally, the Board of Health is requested to align local promotional products with the provincial HSO brand. When the Board of Health uses the HSO brand, it is required to liaise with the Ministry of Health’s Communications and Marketing Division to ensure use of the brand aligns with provincial standards.

Operational expenses not covered within this program include: staff recruitment incentives, billing incentives, and client transportation. Other expenses not included within this program include other oral health activities required under the Ontario Public Health Standards, including the Oral Health Protocol, 2018.

Other requirements of the HSO Program include:

The Board of Health is required to bill back relevant programs for services provided to non- HSO clients using HSO resources. All revenues collected under the HSO Program, including revenues collected for the provision of services to non-HSO clients such as Ontario Works adults, Ontario Disability Support Program adults, municipal clients, etc., with HSO resources must be reported as income in the Standards Activity Reports, Annual Reports, and Annual Service Plan and Budget Submission. Revenues must be used to offset expenditures of the HSO Program.
For the purposes of reporting and monitoring for the HSO Program, the Board of Health must use the following provincial approved systems or mechanisms, or other as specified by the Province.
- Aggregate screening, enrolment, and utilization data for any given month must be submitted by the 15th of the following month to the ministry in the ministry-issued template titled Dental Clinic Services Monthly Reporting Template.
- Client-specific clinical data must be recorded in either dental management software (e.g., ClearDent, AbelDent, etc.) or in the template titled HSO Clinic Treatment Workbook that has been issued by the ministry for the purposes of recording such data.
The Board of Health must enter into Service Level Agreements with any partner organization (e.g., Community Health Centre, Aboriginal Health Access Centre, etc.) delivering services as part of the HSO Program. The Service Level Agreement must set out clear performance expectations, clearly state funding and reporting requirements between the Board of Health and local partner, and ensure accountability for public funds.
Any significant change to previously approved HSO business models, including changes to plans, partnerships, or processes, must be approved by the Province before being implemented.
Any contract or subcontract entered into by the Board of Health for the purposes of implementing the HSO Program must be conducted according to relevant municipal procurement guidelines.
The Board of Health is responsible for ensuring value-for-money and accountability for public funds.
The Board of Health must ensure that funds are used to meet the objectives of the HSO Program with a priority to deliver clinical dental services to HSO clients.

Infectious Diseases Control Initiative (100%)

Base funding for this initiative must be used solely for the purpose of hiring infectious diseases control positions and supporting these staff (e.g., recruitment, salaries/benefits, accommodations, program management, supplies and equipment, other directly related costs) to monitor and control infectious diseases, and enhance the Board of Health’s ability to handle and coordinate increased activities related to outbreak management, including providing support to other boards of health during infectious disease outbreaks. Positions eligible for base funding under this initiative include physicians, inspectors, nurses, epidemiologists, and support staff.

The Board of Health is required to remain within both the funding levels and the number of FTE positions approved by the Province.

Staff funded through this initiative are required to be available for redeployment when requested by the Province, to assist other boards of health with managing outbreaks and to increase the system’s surge capacity.

MOH / AMOH Compensation Initiative (100%)

The Province committed to provide boards of health with 100% of the additional base funding required to fund eligible Medical Officer of Health (MOH) and Associate Medical Officer of Health (AMOH) positions within salary ranges initially established as part of the 2008 Physician Services Agreement and continued under subsequent agreements.

Base funding must be used for costs associated with top-up for salaries and benefits, and for applicable stipends to eligible MOH and AMOH positions at the Board of Health and cannot be used to support other physicians or staffing costs. Base funding for this initiative continues to be separate from cost-shared base salaries and benefits.

The maximum base allocation approved for the Board of Health includes criteria for potential MOH and AMOH positions such as: additional salary and benefits for 1.0 FTE MOH position and 1.0 FTE or more AMOH positions where applicable, potential placement at the top of the MOH/AMOH Salary Grid, and inclusion of stipends. Some exceptions will apply to these criteria.

The maximum base allocation in Schedule A of the Agreement does not necessarily reflect the cash flow that the Board of Health will receive. Cash flow will continue to be adjusted regularly by the Province based on up-to-date application data and information provided by the Board of Health during a funding year. The Board of Health is required to notify the Province if there is any change in the eligible MOH and/or AMOH(s) base salary, benefits, FTE and/or position status as this may impact the eligibility amount for top-up.

The Board of Health must comply and adhere to the eligibility criteria for the MOH/AMOH Compensation Initiative as per the Policy Framework on Medical Officer of Health Appointments, Reporting, and Compensation.

Needle Exchange Program Initiative (100%)

Base funding for this initiative must be used for the purchase of needles and syringes, and their associated disposal costs, for the Board of Health’s Needle Exchange Program.

Nursing Initiatives (100%)

The Province provides base funding to the Board of Health for the following nursing initiatives and positions:

Chief Nursing Officer;
Infection Prevention and Control Nurses; and,
Social Determinants of Health Nurses.

Chief Nursing Officer Initiative

Base funding must be must to support up to or greater than one full-time equivalent (FTE) Chief Nursing Officer and/or nurse practice lead to enhance the health outcomes of the community at individual, group, and population levels through contributions to organizational strategic planning and decision making; by facilitating recruitment and retention of qualified, competent public health nursing staff; by enabling quality public health nursing practice; and, by articulating, modeling, and promoting a vision of excellence in public health nursing practice, which facilitates evidence-based services and quality health outcomes in the public health context.

The following qualifications are required for designation as a Chief Nursing Officer:

Registered Nurse in good standing with the College of Nurses of Ontario;
Baccalaureate degree in nursing;
Graduate degree in nursing, community health, public health, health promotion, health administration or other relevant equivalent OR be committed to obtaining such qualification within three (3) years of designation;
Minimum of 10 years nursing experience with progressive leadership responsibilities, including a significant level of experience in public health; and,
Member of appropriate professional organizations (e.g., Registered Nurses’ Association of Ontario, Association of Nursing Directors and Supervisors in Official Health Agencies in Ontario-Public Health Nursing Management, etc.).

Infection Prevention and Control Nurses

Base funding must be used to support up to or greater than one FTE infection prevention and control nursing services at the Board of Health.

The position(s) is required to have a nursing designation (Registered Nurse, Registered Practical Nurse, or Registered Nurse in the Extended Class); and, Certification in Infection Control (CIC), or a commitment to obtaining CIC within three (3) years of beginning of employment.

Social Determinants of Health Nurses

Base funding must be used to support nursing activities of up to or greater than two FTE public health nurses with specific knowledge and expertise in social determinants of health and health inequities issues, and to provide enhanced supports internally and externally to the Board of Health to address the needs of priority populations impacted most negatively by the social determinants of health.

These positions are required to be to be a registered nurse; and, to have or be committed to obtaining the qualifications of a public health nurse as specified in section 71(3) of the Health Protection and Promotion Act (HPPA) and section 6 of Ontario Regulation 566 under the HPPA.

Ontario Seniors Dental Care Program (100%)

The Ontario Seniors Dental Care Program (OSDCP) provides comprehensive dental care to eligible low-income seniors to help reduce unnecessary trips to the hospital, prevent chronic disease and increase quality of life for seniors. The program will be implemented through a staged implementation approach as follows:

STAGE 1: Late Summer 2019 – Dental care provided to eligible low-income seniors through public health units, Community Health Centres, and Aboriginal Health Access Centres based on increasing public health unit operational funding and leveraging existing infrastructure.

STAGE 2: This coming Winter (i.e., Winter 2019-20) – Program expanded by investing in new dental services in underserviced areas, including through mobile dental buses and an increased number of dental suites in Public Health Units, Community Health Centres, and Aboriginal Health Access Centres.

Eligibility

Clients will be eligible for the OSDCP if they:

Are 65 years of age or older;
Are residents of Ontario;
Meet the Ministry of Health-specified income eligibility thresholds i.e., single seniors with annual incomes of $19,300 or less after taxes, or senior couples (one or both people aged 65 or older), with a combined annual income of $32,300 or less after taxes; and,
Have no access to any other form of dental benefits, including through government programs such as the Ontario Disability Support Program, Ontario Works, or the Non- Insured Health Benefits Program.

Eligible clients will be enrolled for up to one benefit year at a time with eligibility re-determined on an annual basis. The benefit year for the OSDCP will align with the benefit year for the Healthy Smiles Ontario Program (i.e., from August 1st until July 31st of the following calendar year).

Basket of Services

The basket of dental services under this Program will be consistent with the Ministry of Children, Community, and Social Services Schedule of Dental Services and Fees, but with the inclusion of certain essential prosthodontics (e.g., dentures) in the basket of services. Eligible clients will be required to pay a 10% co-payment on the total cost of the prosthodontic to the Board of Health.

In addition to prosthodontics, key examples of services included are as follows:

Examinations/assessments: new patient exam; check-up exam; specific exam; emergency exam.
Preventive services: polishing; fluoride; sealants; scaling.
Restorative services: services to repair cavities or broken teeth such as temporary fillings, permanent fillings, crowns.
Radiographs.
Oral surgery services to remove teeth or abnormal tissue.
Anaesthesia.
Endodontic services: services to treat infections and pain with root canals being the most common service.
Periodontal services to treat gum disease and other conditions.

Program Enrolment

Program enrolment will be managed centrally and will not be a requirement of the Board of Health. The Board of Health will be responsible for local oversight of dental service delivery to eligible clients under the program within the Public Health Unit area.

Program Delivery

The OSDCP will be delivered through Public Health Units, Community Health Centres, and Aboriginal Health Access Centres across the province with care provided by salaried dental providers. These service delivery partners are well positioned to understand the needs of priority populations and provide high quality dental care to low-income seniors in their communities.

With respect to Public Health Unit service delivery under the OSDCP, Public Health Units may enter into partnership contracts on a salaried basis with other entities / organizations or providers/specialists as needed (e.g., to address potential access issues) to provide services to enrolled clients in accordance with the OSDCP schedule of services on behalf of the Public Health Unit.

Base funding for the OSDCP must be used by the Board of Health in accordance with the OSDCP-related requirements of the Oral Health Protocol, 2018 (or as current) for the ongoing, day-to-day requirements associated with oral health navigation and delivering eligible dental services to enrolled clients through public health unit service delivery and/or through local service delivery partners. The Board of Health can allocate base funding for this Program across the program expense categories, with every effort to be made to maximize clinical service delivery and minimize administrative costs.

The official start of the Program (i.e., Stage 1 program launch with the commencement of clinical service delivery to clients) is anticipated for late Summer 2019. Beginning April 1, 2019, the Board of Health can begin ramp-up activities in preparation for the late summer 2019 launch of the Program. Eligible ramp-up expenses (staff and/or overhead) effective

April 1, 2019 are:

Costs associated with program outreach for the purpose of identifying clients in the community;
Costs associated with community outreach for the purpose of identifying and liaising with potential service delivery partners;
Costs associated with project management to ensure readiness by late summer 2019;
Information and information technology in accordance with Ministry of Health direction;
Clinical and office equipment, materials, and supplies; and,
Planning costs associated with Ministry of Health-approved capital projects in support of the OSDCP, in accordance with any terms and conditions identified through the capital approval process.

As part of implementation, eligible expense categories under this Program also include:
Clinical service delivery costs, which are comprised of:
- Salaries, wages, and benefits of full-time, part-time, or contracted staff of the Public Health Unit or local service delivery partner which provide clinical dental services for the Program;
- Salaries, wages, and benefits of full-time, part-time, or contracted staff of the Public Health Unit or local service delivery partner which undertake ancillary/support activities for the Program, including: management of the clinic(s); financial and programmatic data collection and reporting for the clinic(s); and, general administration (e.g., reception services) at the clinic(s); and,
- Overhead costs associated with the Program’s clinical service delivery such as: clinical materials and supplies; building occupancy costs; maintenance of clinic infrastructure; staff travel associated with clinical service delivery (e.g., portable clinics, mobile clinics, long-term care homes, if applicable); staff training and professional development associated with clinical staff and ancillary/support staff, if applicable; office equipment, communication, and information and information technology.
Oral health navigation costs, which are comprised of:
- Salaries, wages, and benefits of full-time, part-time, or contracted staff engaged in: client enrolment assistance for the Program’s clients (i.e., assisting clients with enrolment forms); program outreach (i.e., local-level efforts for identifying potential clients); and, oral health education and promotion to the Program’s clients.
- Salaries, wages, and benefits of full-time, part-time, or contracted staff that undertake the following ancillary/support activities related to oral health navigation: management, financial and programmatic reporting, and general administration (if applicable); and,
- Overhead costs associated with oral health navigation such as: materials and supplies; building occupancy costs incurred for components of oral health navigation; staff travel associated with oral health navigation, where applicable; staff training and professional development associated with oral health navigation and ancillary/support staff, if applicable; office equipment, communication, and information and information technology costs associated with oral health navigation.
  
  Operational expenses that are not eligible under this Program include:
Staff recruitment incentives;
Billing incentives;
Client transportation unless otherwise approved by the Ministry of Health; and,
Costs associated with any activities required under the Ontario Public Health Standards, including the Oral Health Protocol, 2018 (or as current), which are not related to the OSDCP.

Other Requirements

Marketing
When promoting the OSDCP locally, the Board of Health is requested to align local promotional products with the provincial Program brand and messaging. The Board of Health is required to liaise with the Province to ensure use of the brand aligns with provincial standards.

Revenue
The Board of Health is required to bill-back relevant programs for services provided to non- OSDCP clients using resources under this Program. All revenues collected under the OSDCP, including revenues collected for the provision of services to non-Program clients such as Ontario Works adults, Ontario Disability Support Program adults, Non-Insured Benefits clients, municipal clients, Healthy Smiles Ontario clients, etc., with resources under this Program must be reported as an offset revenue to the Province. Priority must always be given to clients eligible under this Program. The Board of Health is required to closely monitor and track revenue from bill-back for reporting purposes to the Province.
The Board of Health is required to collect a 10% co-payment from clients receiving prosthodontics. The client is responsible for reimbursing the Board of Health for 10% of the total cost of the prosthodontic with the Board of Health paying for the remainder (90%) through base funding under this Program. The revenue received from the co-payment is to be used to offset the expenditures of the Program. The Board of Health must report the aggregate amount of the co-payment to the Province. The Board of Health is required to closely monitor and track revenue from co-payments for reporting purposes to the Province.

Community Partners
The Board of Health must enter into discussions with all Community Health Centres and Aboriginal Health Access Centres in their catchment area to ascertain the feasibility of a partnership for the purpose of delivering this Program.
The Board of Health must enter into Service Level Agreements with any partner organization (i.e., Community Health Centres, Aboriginal Health Access Centres) delivering services under this Program. The Service Level Agreement must set out clear performance expectations, clearly state funding and reporting requirements between the Board of Health and the local partner, and ensure accountability for public funds.

The Board of Health must ensure that base funding is used to meet the objectives of the Program, with a priority to deliver clinical dental services to clients, while staying within the base funding allocation.

Smoke-Free Ontario Strategy (100%)

The Smoke-Free Ontario Strategy is a multi-level comprehensive tobacco control strategy aiming to eliminate tobacco-related illness and death by: preventing experimentation and escalation of tobacco use among children, youth and young adults; increasing and supporting cessation by motivating and assisting people to quit tobacco use; and, protecting the health of Ontarians by eliminating involuntary exposure to second-hand smoke. These objectives are supported by crosscutting health promotion approaches, capacity building, collaboration, systemic monitoring and evaluation.

The Province provides base funding to the Board of Health to implement tobacco control activities that are based in evidence and best practices, contributing to reductions in tobacco use rates.

Base funding for the Smoke-Free Ontario Strategy must be used in the planning and implementation of comprehensive tobacco control activities across prevention, cessation, prosecution, and protection and enforcement at the local and regional levels.

The Board of Health must comply and adhere to the Smoke-Free Ontario Strategy: Public Health Unit Tobacco Control Program Guidelines and the Directives: Enforcement of the Smoke-Free Ontario Act. Operational expenses not covered within this program include information and information technology equipment.

TYPE OF FUNDING: ONE-TIME
SOURCE: PUBLIC HEALTH

New Purpose-Built Vaccine Refrigerators (100%)

One-time funding must be used for the purchase of one (1) new 51.1 cubic foot (approximate) purpose-built vaccine refrigerators used to store publicly funded vaccines. The purpose-built refrigerators must meet the following specifications:

plug type, voltage and wattage rating, and the recommended breaker size for the circuit connection.

Public Health Inspector Practicum Program (100%)

One-time funding must be used to hire the approved Public Health Inspector Practicum position(s). Eligible costs include student salaries, wages and benefits, transportation expenses associated with the practicum position, equipment, and educational expenses.

The Board of Health must comply with the requirements of the Canadian Institute of Public Health Inspectors Board of Certification for field training for a 12-week period; and, ensure the availability of a qualified supervisor/mentor to oversee the practicum student’s term.

Vaccine Programs

Funding on a per dose basis will be provided to the Board of Health for the administration of influenza, meningococcal, and human papillomavirus (HPV) vaccines.

In order to claim the vaccine administration fees, the Board of Health is required to submit, as part of the Standards Activity Reports or other reports as requested by the Province, the number of doses administered. Reimbursement by the Province will be made on a quarterly basis based on the information.

The Board of Health is required to ensure that the vaccine information submitted on the Standards Activity Reports, or other reports requested by the Province, accurately reflects the vaccines administered and reported on the Vaccine Utilization database.

Influenza

1. Interior
  - Fully adjustable, full extension stainless steel roll-out drawers;
  - Optional fixed stainless steel shelving;
  - Resistant to cleaning solutions;
  - Ongoing positive forced fan air circulation to ensure temperature uniformity at all shelf levels;
  - Fan is either encased or removed from the chamber. Fan auto shut-off when door is opened; and,
  - Walls are smooth, scratch and corrosion resistant painted interior and exterior surfaces.
2. Refrigeration System
  - Heavy duty, hermetically sealed compressors;
  - Refrigerant material should be R400 or equivalent;
  - Advanced defrost sensor(s) to manage the defrost cycle and minimize trace amounts of frost build-up; and,
  - Evaporator operates at +2°C, preventing vaccine from freezing.
3. Doors
  - Full view non-condensing, glass door(s), at least double pane construction;
  - Spring-loaded closures include ≥90º stay open feature and <90º self-closing feature;
  - Door locking provision;
  - Option of left or right hand opening; and,
  - Interior cabinet lights with door activated on/off switch, as well as, an independent external on/off.
4. Tamper Resistant Thermostat
  - The thermostat should be set at the factory to +5oC with a control range between +2ºC to +8ºC but this could be done at the time of delivery/installation at no additional cost.
5. Thermometer
  - A automatic temperature recording and monitoring device with battery backup;
  - An external built-in visual digital display thermometer independent of the temperature recording and monitoring device which has a digital temperature display in Celsius and temperature increment readings of 0.1ºC;
  - The external built-in digital thermometer must also be able to record and display the maximum, minimum and current temperatures and allow the user to easily check and reset these recordings as required; and,
  - The automatic temperature recording and monitoring device and digital display thermometer must be calibrated/accurate within +/- 0.5ºC or better.
6. Alarm Condition Indicator
  - Audible and visual warnings for over-temperature, under-temperature and power failure;
  - Remote alarm contacts;
  - Door ajar enunciator; and,
  - Alarm testing system.
7. Top or Bottom Mounted Compressors/Condensers
  - Compressor mounted at top or bottom but not in rear.
8. Noise Levels
  - The noise produced by the operation of the refrigerator shall not exceed 85 decibels at one metre. Specifications of the refrigerator must include the noise level measured in decibels of sound at one metre from the refrigerator.
9. Locking Plug
  - Power supply must have a locking plug.
10. Castors
  - Heavy duty locking castors either installed at the factory or upon delivery.
11. Voltage Safeguard
  - Voltage safeguard device capable of protecting against power surges related to the resumption of power to the refrigerator.
12. Warranty
  - The warranty should include, from date of acceptance, a five year comprehensive parts and labour warranty with the stipulation that a qualified service representative shall be on-site no later than 12 hours after the service call was made. Software upgrades provided free of charge during the warranty period.
13. Electrical Equipment
  - All electrically operated equipment must be UL, CSA and/or Electrical Safety Authority approved and bear a corresponding label. The equipment should specify the electrical

The Province will continue to pay $5.00/dose for the administration of the influenza vaccine.
All doses administered by Public Health Units to individuals aged 6 months or older who live, work or attend school in Ontario.

Meningococcal
The Province will continue to pay $8.50/dose for the administration of the meningococcal vaccine.
Routine immunization program: Doses administered as part of the grade 7 school-based or catch-up program for eligible students up to grade 12.

o Men-C-C doses if given in substitution of Men-C-ACYW135 for routine doses Note: Doses administered through the high-risk program are not eligible for reimbursement.

Human Papillomavirus (HPV)
The Province will continue to pay $8.50/dose for the administration of the HPV vaccine.
Routine immunization program: Doses administered as part of the grade 7 school-based or catch-up program for eligible students up to grade 12.

High-risk program: MSM <26 years of age.

SCHEDULE “C” REPORTING REQUIREMENTS

The reports mentioned in this Schedule are provided for every Board of Health Funding Year unless specified otherwise by the Province.

The Board of Health is required to provide the following reports/information in accordance with direction provided in writing by the Province (and according to templates provided by the Province):

Name of Report	Reporting Period	Due Date
1. Annual Service Plan and Budget Submission	For the entire Board of Health Funding Year	March 1 of the current Board of Health Funding Year
2. Quarterly Standards Activity Reports
Q1 Standards Activity Report	For Q1	April 30 of the current Board of Health Funding Year
Q2 Standards Activity Report	For Q2	July 31 of the current Board of Health Funding Year
Q3 Standards Activity Report	For Q3	October 31 of the current Board of Health Funding Year
Q4 Standards Activity Report	For Q4	January 31 of the following Board of Health Funding Year
3. Annual Report and Attestation	For the entire Board of Health Funding Year	April 30 of the following Board of Health Funding Year
4. Annual Reconciliation Report	For the entire Board of Health Funding Year	April 30 of the following Board of Health Funding Year
5. MOH/AMOH Compensation Initiative Application	For the entire Board of Health Funding Year	As directed by the Province
6. Other Reports and Submissions	As directed by the Province	As directed by the Province

Definitions

For the purposes of this Schedule, the following words shall have the following meanings:

“Q1” means the period commencing on January 1st and ending on the following March 31st.

“Q2” means the period commencing on April 1st and ending on the following June 30th.

“Q3” means the period commencing on July 1st and ending on the following September 30th.

“Q4” means the period commencing on October1st and ending on the following December 31st.

Report Details

Annual Service Plan and Budget Submission

The Board of Health shall provide its Annual Service Plan and Budget Submission by March 1st of the current Board of Health Funding Year.
The Annual Service Plan and Budget Submission Template sets the context for reporting required of the Board of Health to demonstrate its accountability to the Province.
When completed by the Board of Health, it will: describe the complete picture of programs and services the Boards of Health will be delivering within the context of the Ontario Public Health Standards; demonstrate that Board of Health programs and services align with the priorities of its communities, as identified in its population health assessment; demonstrate accountability for planning – ensure the Board of Health is planning to meet all program requirements in accordance with the Ontario Public Health Standards, and ensure there is a link between demonstrated needs and local priorities for program delivery; demonstrate the use of funding per program and service.

Quarterly Standards Activity Reports
The Quarterly Standards Activity Reports will provide financial forecasts and interim information on program achievements for all programs governed under the Agreement.
Through these Standards Activity Reports, the Board of Health will have the opportunity to identify risks, emerging issues, changes in local context, and programmatic and financial adjustments in program plans.

Annual Report and Attestation
The Annual Report and Attestation will provide a year-end summary report on achievements on all programs governed under the Agreement, in all accountability domains under the Organizational Requirements, and identification of any major

changes in planned activities due to local events.
The Annual Report will include a narrative report on the delivery of programs and services, fiduciary requirements, good governance and management, public health practice, and other issues, year-end report on indicators, and a board of health attestation on required items.

Annual Reconciliation Report
The Board of Health shall provide to the Province an Annual Reconciliation Report (as part of the Annual Report and Attestation) for funding provided for public health programs governed under the Accountability Agreement.
The Annual Reconciliation Report must contain: Audited Financial Statements; and, Auditor’s Attestation Report in the Province’s prescribed format.

MOH/AMOH Compensation Initiative Application
The Board of Health shall complete, sign, and submit an annual application in order to participate in this Initiative and be considered for funding.
Application form templates and eligibility criteria/guidelines shall be provided by the Province.

SCHEDULE “D”

BOARD OF HEALTH FINANCIAL CONTROLS

Financial controls support the integrity of the Board of Health’s financial statements, support the safeguarding of assets, and assist with the prevention and/or detection of significant errors including fraud. Effective financial controls provide reasonable assurance that financial transactions will include the following attributes:
- Completeness – all financial records are captured and included in the Board of Health’s financial reports;
- Accuracy – the correct amounts are posted in the correct accounts;
- Authorization – the correct levels of authority (i.e., delegation of authority) are in place to approve payments and corrections including data entry and computer access;
- Validity – invoices received and paid are for work performed or products received and the transactions properly recorded;
- Existence – assets and liabilities and adequate documentation exists to support the item;
- Error Handling – errors are identified and corrected by appropriate individuals;
- Segregation of Duties – certain functions are kept separate to support the integrity of transactions and the financial statements; and,
- Presentation and Disclosure – timely preparation of financial reports in line with the approved accounting method (e.g., Generally Accepted Accounting Principles (GAAP)).

The Board of Health is required to adhere to the principles of financial controls, as detailed above. The Board of Health is required to have financial controls in place to meet the following objectives:

Controls are in place to ensure that financial information is accurately and completely collected, recorded, and reported.

Examples of potential controls to support this objective include, but are not limited to:
- Documented policies and procedures to provide a sense of the organization’s direction and address its objectives.
- Define approval limits to authorize appropriate individuals to perform appropriate activities.
- Segregation of duties (e.g., ensure the same person is not responsible for ordering, recording, and paying for purchases).
- An authorized chart of accounts.
- All accounts reconciled on a regular and timely basis.
- Access to accounts is appropriately restricted.
- Regular comparison of budgeted versus actual dollar spending and variance analysis.
- Exception reports and the timeliness to clear transactions.
- Electronic system controls, such as access authorization, valid date range test, dollar value limits, and batch totals, are in place to ensure data integrity.
- Use of a capital asset ledger.
- Delegate appropriate staff with authority to approve journal entries and credits.
- Trial balances including all asset accounts that are prepared and reviewed by supervisors on a monthly basis.
Controls are in place to ensure that revenue receipts are collected and recorded on a timely basis.

Examples of potential controls to support this objective include, but are not limited to:
- Independent review of an aging accounts receivable report to ensure timely clearance of accounts receivable balances.
- Separate accounts receivable function from the cash receipts function.
- Accounts receivable sub-ledger is reconciled to the general ledger control account on a regular and timely basis.
- Original source documents are maintained and secured to support all receipts and expenditures.
Controls are in place to ensure that goods and services procurement, payroll and employee expenses are processed correctly and in accordance with applicable policies and directives.

Examples of potential controls to support this objective include, but are not limited to:
- Policies are implemented to govern procurement of goods and services and expense reimbursement for employees and board members.
- Use appropriate procurement method to acquire goods and services in accordance with applicable policies and directives.
- Segregation of duties is used to apply the three (3) way matching process (i.e., matching 1) purchase orders, with 2) packing slips, and with 3) invoices).
- Separate roles for setting up a vendor, approving payment, and receiving goods.
- Separate roles for approving purchases and approving payment for purchases.
- Processes in place to take advantage of offered discounts.
- Monitoring of breaking down large dollar purchases into smaller invoices in an attempt to bypass approval limits.
- Accounts payable sub-ledger is reconciled to the general ledger control account on a regular and timely basis.
- Employee and Board member expenses are approved by appropriate individuals for reimbursement and are supported by itemized receipts.
- Original source documents are maintained and secured to support all receipts and expenditures.
- Regular monitoring to ensure compliance with applicable directives.
- Establish controls to prevent and detect duplicate payments.
- Policies are in place to govern the issue and use of credit cards, such as corporate, purchasing or travel cards, to employees and board members.
- All credit card expenses are supported by original receipts, reviewed and approved by appropriate individuals in a timely manner.
- Separate payroll preparation, disbursement and distribution functions.
Controls are in place in the fund disbursement process to prevent and detect errors, omissions or fraud.

Examples of potential controls include, but are not limited to:
- Policy in place to define dollar limit for paying cash versus cheque.
- Cheques are sequentially numbered and access is restricted to those with authorization to issue payments.
- All cancelled or void cheques are accounted for along with explanation for cancellation.
- Process is in place for accruing liabilities.
- Stale-dated cheques are followed up on and cleared on a timely basis.
- Bank statements and cancelled cheques are reviewed on a regular and timely basis by a person other than the person processing the cheques / payments.
- Bank reconciliations occur monthly for all accounts and are independently reviewed by someone other than the person authorized to sign cheques.

File Attachments

Correspondence: Christine Elliott, Deputy Premier + Minister of Health re 2019 Funding Letter to the BOH (PDF, 21 pages, 626 KB)