Category Archives: HST

GST/HST Dentists

A dentist whose professional practice is comprised one-third of crown, bridge and denture work, with office rent, administration and other taxable costs of $200,000 per year, may be eligible to recover an estimated $5,000 per year ongoing and a four-year “catch-up” for a total of $20,000 of immediate ITC entitlement as a result of this court decision.

This Tax Court of Canada decision reflects the first judicial review of CRA’s GST policy for dentists and indiscriminately rejects CRA’s narrow interpretation of the matter.

This decision establishes a legal precedence that, at the moment, is the highest authority with respect to this issue.  In plain terms, this Tax Court decision overrules CRA’s policy on the matter of dentists’ services with respect to crown, bridge and denture work.

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SALE OF ALL THE ASSETS OF A DENTAL PRACTICE

SAMPLE RULING

Statement of facts

A, who is a non-registrant dentist, has agreed to sell all the assets of his dental practice to dentist B who is also not registered for GST purposes. The closing of the sale will take place on March 15, 1995. The assets sold by A are as follows:

– dental supplies including various articles like crowns and caps;

– equipment and furniture;

– goodwill; and

– leasehold improvements

A previously acquired the above assets for use exclusively in the provision of exempt dental services, and in fact did not make any taxable supplies.

Ruling Requested

A is not required to collect and account for GST on the sale of the above business assets.

Ruling Given

Provided that the preceding statement constitutes a complete and accurate disclosure of all the facts, proposed transaction, and provided that the proposed transaction is completed as described above, our ruling is as follows:

The sale of dental supplies as well as equipment and furniture will not be subject to GST pursuant to paragraph 141.1(1)(b) of the Excise Tax Act. Furthermore, under section 167.1 of the Excise Tax Act, the consideration allocated to goodwill will not be included in calculating GST payable. However, A must collect and remit GST on the sale of the leasehold improvements since it is a taxable supply of real property. On the other hand, A will be eligible for a rebate under section 257 of the Excise Tax Act for the GST paid on the acquisition of, and improvements to the real property.

This ruling is given subject to the limitations and qualifications set out in GST Memoranda Series (1.4) issued by Revenue Canada and is binding provided that this proposed transaction (i.e., sale closing on March 15, 1995) is completed prior to June 15, 1995.

This ruling is based on the Excise Tax Act in its present form and do not take into account any proposed amendments to the Act which, if enacted, could have an effect on the ruling provided herein.

Due to the general nature of the bulletin, it should not be relied upon as legal or tax advice.

GST/HST to Independent Medical Evaluations

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 Supplies of health care services

DRAFT FOR DISCUSSION PURPOSES ONLY

 Introduction

 In a Tax Court of Canada decision concerning

 The Court concluded that the individuals were “patients” of the Riverfront facility because they attended the facility to be examined by a physician. The Court concluded that because Riverfront provided the examination rooms and other equipment necessary for the examinations and remunerated the physicians for the examinations and reports, Riverfront’s supplies of IMEs and reports fell within the exemption provided in section 2 of Part II of Schedule V to the ETA. This provision exempts a supply made by the operator of a health care facility of an institutional health care service rendered to a patient of the facility. Thus, for an IME to be an exempt supply, the activities that comprise the IME must fall in one of the exemptions in the ETA.

In view of the Court’s comments regarding the physicians’ examinations, we reviewed our position on the tax status of supplies made directly by physicians of IME reports, as well as evaluations supplied by other health care professionals. Our position is noted below.

Riverfront Medical Evaluations Ltd. v. Canada (“Riverfront”), the issue was whether a corporation’s supplies of independent medical evaluation (“IME”) reports to insurance companies and lawyers were “institutional health care services” supplied by the operator of a health care facility and rendered to patients of the facility. Essentially, the Court found that an IME consisted of medical care because it consisted of a physical examination of an individual by a physician. In addition, the Court found that Riverfront was a “health care facility” for purposes of the Excise Tax Act (the “ETA”) because the physical examinations were provided at Riverfront’s facility.

  Under the Excise Tax Act (the Act), exemptions from the GST/HST for supplies of medical and certain other health care services are generally limited to those made by suppliers who are engaged in the practice of a particular profession and who are licensed or certified under the laws of a province to practice the particular profession. These suppliers are defined in the Act.

 For instance, a supply of a consultative, treatment, diagnostic or other health care service rendered to an individual is exempt for GST/HST purposes when a medical practitioner makes the supply. A medical practitioner is defined as a person who is licensed under the laws of a province to practice the profession of medicine or dentistry

 In addition, a supply of an optometric, chiropractic, physiotherapy, podiatric, osteopathic, audiological, speech-language pathology, occupational therapy, or psychological service rendered to an individual is exempt when a practitioner supplies the service. A practitioner is defined in the Act as a person who practices the profession relevant to one of these services and who is licensed or otherwise certified to practice that profession (if required in the province where the service is supplied) or has the qualifications equivalent to those necessary to be so licensed or certified in another province (if not required in the province where the service is supplied). Please note that it is possible for a corporation to qualify as a medical practitioner or practitioner.

GST HST basics

HST basics: five things you must know

 Here are five fundamentals that businesses in Ontario and B.C. need to know about the new tax:

  1. HST combines the federal Goods and Services Tax (GST) with the provincial sales tax (PST) into a single tax.
  2. Ontario businesses will charge 13 per cent.
  3. B.C. businesses will charge 12 per cent (the lowest HST rate in Canada).
  4. HST applies to both goods and services, adding the provincial sales tax to services that would previously only have had GST applied.
  5. As of May 1, 2010 businesses that sell goods or services to be delivered, installed or performed on or after July 1, 2010 are required charge HST.

Which businesses will need to charge HST?

HST will apply to goods, services, real property and intangible property, such as contractual rights and patents. (We’ve included two charts below to show how the tax status of many goods and services will change.)

You will need to charge HST if:

  • you have sales over $30,000 in the calendar year or any four consecutive quarters;
  • your business is registered for the GST already.

Current GST registrants won’t need to apply for a new number. The business number (BN) you use for your GST account number will be the same number you will use for your HST account and your filing frequency stays the same.

Why harmonize?

In both Ontario and British Columbia, the HST is being introduced to help businesses cut red tape and save money. The purpose of harmonization is to make businesses more competitive and to stimulate the economy.

Here’s how this works.

Under the current tax system, you can claim back the GST you’ve paid on all of your business expenses, but you can’t do the same for PST. As a result, goods have a “tax history” that has PST added at every step of the supply chain. These hidden PST costs are included in the final price, with consumers paying tax on the embedded tax.

As a value-added tax, GST is different. There is no hidden tax, because businesses can use the GST they pay out as an input tax credit. The business only remits the difference between the GST it has collected and the GST it has paid.

Harmonization brings the same system and advantages to the collection of the retail sales tax portion. Every business expense that includes HST, from phone services to office supplies, will help reduce the total amount of tax remitted to the government.

Claiming input tax credits

Not all businesses will be able to claim input tax credits on the PST portion of the HST right away.

Small and medium-sized companies with annual taxable sales under $10 million will be able to claim input tax credits for the sales tax paid out after July 1, 2010. However, financial institutions and large businesses with annual taxable sales of more than $10 million will have to wait five years to claim input tax credits paid on the provincial portion of the HST for certain expenses. Then, full input tax credits will be phased in over a three-year period.

Once the HST is fully phased in, the estimated savings for business are substantial.

In B.C., it’s estimated that businesses will save $1.9 billion in input costs. In Ontario, the HST will slash about $4.5 billion annually in hidden sales taxes once it’s fully phased in.

Lessons learned from other provinces

The HST is not new to Canada. Already, Quebec and the Atlantic provinces have tax harmonization. And around the world, more than 130 countries have adopted value-added taxes.

Interestingly, prices actually dropped slightly in the eastern provinces after the HST was introduced. According to the C.D. Howe Institute, lessons from the implementation of HST in the eastern provinces suggest that harmonization in Ontario and B.C. will not lead to higher consumer prices.

In Ontario, businesses can expect to save more than $500 million annually in compliance costs while B.C. businesses can expect to save $150 million a year.

“Sales tax harmonization will simplify tax compliance for businesses since they will only have to manage one sales tax system,” says Ted Wigdor, vice-president, government and corporate affairs, with Certified General Accountants of Ontario. That means one harmonized tax base, one set of sales tax returns and one consistent reporting period, all of which will benefit small- and medium-sized enterprises.

HST implementation checklist

The following checklist will help you identify the systems you will need to change to be ready for the introduction of the HST on July 1, 2010.

  • Do you need to modify your cash registers or point-of-sale systems?
  • Do you need to update automatic payments to include HST?
  • Do you need to update your e-commerce website to add the HST? (Remember, your business might be closed for the July 1 holiday, but your website is not!)
  • Do you need to update your accounting software to accommodate the new tax?
  • Do you need to update your accounts receivable / accounts payable / invoicing software?
  • Do you need to make adjustments to the way you do your input tax/taxable benefits calculations?
  • Are there any other aspects of your business that will be affected by the new tax?

Sample HST remittance calculation

To better understand how value-added tax works, let’s take a British Columbia accounting firm as an example.

Scenario: The firm hires an independent contractor to work on an accounting project. The contractor bills the accounting firm $1,000 and the accounting firm, after reviewing the work and managing the project, bills its client $2,000.

As of July 1, 2010: calculating the “value-added”

Contractor’s fee to accounting firm $ 1,000
+ 12% HST $ 120
Total invoice $ 1,120
Accounting firm’s fee to client $ 2,000
+ 12% HST $ 240
Total invoice $ 2,240

 

Total HST remitted to government: $240.

Even though $360 of HST is collected between the two companies, only $240 is remitted to the government. That’s because while the accounting firm collected $240 in HST, it keeps $120 of the funds collected to cover the money paid out to the contractor and only remits the remaining $120 to the government.

In reality, each business will likely have other qualifying HST deductions as well from the tax paid on other business expenses, so the amount paid to the government would likely be reduced even further.

Special rules for transactions that staddle the implementation date

Service businesses that have not charged provincial sales tax may need to charge both taxes on work that overlaps the July 1 implementation date.

If over 90 per cent of the work is done before July 1, the business will charge GST only. However: If more than 10 per cent of the work is done after July 1, the business will need to charge GST on the pre-transition portion of their work and charge HST on the remaining portion. These rules apply to the taxable supplies of personal property and services made in Ontario or B.C.

Consider a design firm that creates a brochure a client. Work begins in May and the brochure is completed at the end of July. Seventy per cent of the work is performed in May and June, while the remaining 30 per cent is performed in the month of July.

Since more than 10 per cent of the work overlaps the HST implentation date, the firm must charge both GST and HST. Here is an example of how the company would invoice both taxes:

Invoice for services rendered

Brochure design (pre-July1) $ 7000
GST (5% of $7000) $ 350
Brochure design (post-July1) $ 3000
HST (12% of $3000 using the BC rate) $ 360
Total amount owing $ 10,710

 

How goods & services will be taxed as of July 1, 2010

Wondering which products and services will see a change in their tax status as of July 1? Here’s a run-down of some of the key ones:

Goods & services that will have the HST added in both provinces

 

Affected goods & services Up to June 30 After July 1
Advertising services GST only HST
Cleaning services GST only HST
Commissions GST only HST
Custom software* GST only HST
Electricity GST only HST
Gasoline GST only HST
Goods for resale and raw materials GST only HST
Heating fuels GST only HST
Magazines* GST only HST
Manufacturing equipment* GST only HST
Membership fees (fitness, golf) GST only HST
Office rent GST only HST
Personal services (manicures, hair cutting, etc.) GST only HST
Professional services (accounting, legal, graphic design, etc.) GST only HST
Real property contracts (home improvements, office renovations) GST only HST
Safety clothing* GST only HST
Taxi and limousine fares GST only HST
Trade show admissions and conferences GST only HST
Training seminars GST only HST
* These items may be subject to certain conditions or, as in the case of safety clothing, be defined by the province.

 

Goods and services with variable PST/HST status in Ontario and B.C.

 

Goods/services Current PST tax status Current PST tax status Tax status with HST
  Ontario British Columbia  
Legal services Non-taxable Taxable Taxable
Admissions under $4 Exempt Non-taxable Taxable
Footwear under $30 Exempt Taxable Taxable
Basic groceries Exempt Exempt Zero-rated
Restaurant and catered meals Taxable (under $4, exempt) Exempt Taxable in B.C.; In ON over $4 is taxable, under $4 has a point-of-sale rebate on the provincial portion*.
Snack foods and soft drinks Taxable Exempt Taxable
Internet access fees Non-taxable Taxable Taxable
Newspapers Exempt Exempt Taxable in B.C.; in Ontario, there is a point-of-sale rebate on the provincial portion of HST
Software services (subject to certain conditions) Taxable Exempt Taxable
Adult-sized clothing for children under 15 Taxable Exempt Taxable

 

* While the Ontario tax rate for prepared foods and beverages under $4 is often said to be tax exempt, that is not correct. According to a GST/HST bulletin GI-064, businesses will get an instant point-of-sale rebate on the 8 per cent provincial portion of the HST. There are strict guidelines for qualifying products as well as how the HST must be shown on the sales receipt.

Consumers will normally receive the rebate by being paid by the retailer at the point of sale. The consumer can file a rebate claim with CRA using Form GST189 within four years of the purchase if the vendor does not pay or credit the rebate amount at the point of sale. Be sure to visit the link in the further reading section below to learn more about which products qualify for this instant rebate.

Further reading

For more on how transitional rules for the HST may affect your business, go to http://www.cra-arc.gc.ca/tx/pstr/trnstnl/menu-eng.html.

For more information on the HST and how to get registered, go to “Demystifying the GST / HST” at http://www.canadaone.com/ezine/oct03/gst.html.

For more information on qualifying products for Ontario’s Point-of-Sale rebate on Prepared Foods and Beverages http://www.crfa.ca/pdf/cra_pos_rebates.pdf.

For more information on point-of-sale rebates for Ontario newspapers visit http://www.cra-arc.gc.ca/E/pub/gi/gi-060/gi-060-e.pdf.

For more information on transition rules for services and personal property, visit http://www.cra-arc.gc.ca/E/pub/gi/notice247/notice247-e.html#P1.2

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Health care professionals

  

 

On July 1, 2010, the provincial sales tax (PST) will be harmonized with the federal goods and service tax (GST), resulting in a federally administered single sales tax imposed at 12%. The proposed harmonization will impose significant additional costs on the health care industry.

Now is the time for medical and health care professionals to consider the implications of harmonization on their costs, compliance systems and customers. Medical and health care professionals are persons licensed or otherwise certified to provide such services and include doctors, dentists, nurses, and other health care providers (e.g., chiropractors, orthopedists, optometrists, physiotherapists, podiatrists, chiropodists, osteopaths, audiologists, pathologists, occupational therapists, psychologists and midwives).

Most services provided by medical and health care professionals are not currently subject to either the GST or the PST. Under B.C.’s proposed harmonization with the GST, these services should remain exempt from B.C. HST with no direct impact to the consumer. However, where supplies made by a medical or health care professional are taxable (e.g., therapeutic massages, cosmetic surgery, sales of certain goods such as toothbrushes, etc.) these supplies will be subject to the B.C. HST. This represents a significant increase to the price of these supplies to consumers, and it is recommended that the tax status of these items be reviewed in detail prior to the introduction of the B.C. HST.

Impact on purchases made by medical and health care professionals

Currently, the PST applies to a relatively narrow base of goods and services used by medical and health care professionals in their practices. The B.C. HST will apply to a much broader base of goods and services. As a result, medical and health care professionals will be required to pay additional non-recoverable tax on the purchase of goods and services that are not currently subject to the PST. Consequently, their overhead costs will likely increase, and these professionals may be forced to pass on the additional costs to their customers.

The following table highlights a number of typical expenses that are currently subject to the GST but not the PST. Acquiring these items under the B.C. HST will become more expensive than under the current regime.

Other issues to consider

With the implementation of the B.C. HST fast approaching, medical and health care professionals should  consider a number of strategic planning activities:

  • Timing of purchases – stocking up on purchases of goods that do not currently attract the PST but that will attract the B.C. HST on July 1, 2010, will assist in reducing overall costs.
  • Real estate issues – consider purchasing real property prior to the implementation of the B.C. HST to minimize the taxes due on the purchase (i.e., 5% GST instead of 12% B.C. HST on the purchase of real property).
  • Corporate structure – consider reviewing the structure to determine the optimal treatment for income tax and B.C. HST purposes.
  • Current contracts – discussing the impact of the B.C. HST on suppliers will assist in determining whether a supplier’s costs will be positively affected by the implementation the B.C. HST and, as such, allow the medical or health care professional to purchase these products at a lower price.

Farmers in BC

Currently, farmers are exempt from paying PST on the cost of many items purchased for use in the farming business.  If a farmer is registered to collect GST/HST, any HST paid on costs for the farming business are recoverable as input tax credits. As most agricultural products are zero-rated (they are considered taxable, but the HST rate is zero), very little or no HST would be collected.  Many farmers are small suppliers, so registering to collect GST/HST is not mandatory, but would probably be to their advantage.  See Who has to register to collect GST/HST?

 Proposed General Transitional Rules for BC HST

Transitional rules are required to determine which tax – the existing PST (Social Services Tax) or the BC component of the HST – would apply to transactions that straddle the July 1, 2010 implementation date.

November 18, 2009 – New home sales – Grandparenting

Where written agreements of purchase and sale are entered into on or before November 18, 2009, and both ownership and possession of the homes are transferred under the agreement after June 2010, the sales will be subject to the federal component of the HST, but not the provincial component.  This would apply to sales of newly constructed or substantially renovated single-unit homes to individuals, and to sales of residential condominiums to all persons including individuals.

Sales of these grandparented homes would not be eligible for the new housing rebate or new rental housing rebate.

October 14, 2009

Certain purchasers that are non-consumers may have to self-assess the BC component of the HST on consideration that becomes due, or is paid, after October 14, 2009 and before May 1, 2010 for goods and services provided on or after July 1, 2010.  This would not apply if the non-consumer is a GST registrant and would therefore be entitled to an input tax credit.

Note:  Consumer means an individual who acquires goods or services for the individual’s personal consumption or use or for the personal consumption or use of another individual.  See the detailed information in Canada Revenue Agency’s Notice 247 regarding this topic.

A GST registrant in BC or Ontario should not be collecting the provincial portion of the HST prior to May 1, 2010, for goods or services provided in BC or Ontario, even if the goods or services are to be provided on or after July 1, 2010.  Prior to May 1, only the 5% GST should be collected for these goods or services.

May 1, 2010

The HST would generally apply to consideration that becomes due or is paid on or after this date, for property and services provided on or after July 1, 2010.

Some items addressed in the proposed HST transitional rules:
 
 
 
 
 
 

 

  

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Funeral services – HST will not apply to funeral services where the contract is entered into before July 1, 2010.    
 
 

 
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Transitional PST inventory rebate for residential real property contracts – A rebate will be available for PST embedded in construction materials purchased before July 1, 2010, but used in residential property contracts on or after July 1, 2010.    
 
 

 
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Subscriptions to newspapers, magazines and other periodical publications – HST will not apply to subscriptions paid before July 1, 2010.    
 
 

 
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Passenger transportation services – HST will generally not apply to the cost of continuous journeys that commence before July 1, 2010.    
 
 

 
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Freight transportation services – HST will generally not apply to the cost of a freight transportation service performed on or after July 1, 2010 if the service is part of a continuous freight movement of goods that begins before July 2010.     
 
 

 

 

For further information on the BC HST and the proposed transitional rules, see the following on the BC Ministry of Finance website

  

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News Release    
 
 

 
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Canada Revenue Agency information:
 
 
 
 
 
 

 

  

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Notice247 Harmonized Sales Tax for Ontario and BC – Questions and Answers on General Transitional Rules for Personal Property and Services    
 
 

 
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Notice246  Harmonized Sales Tax for BC – Questions and Answers on Housing Rebates and Transitional Rules for Housing and Other Real Property Situated in BC.    
 
 

 
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GST/HST Information Sheets:  Transition to the Harmonized Sales Tax
 

 
  

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GI-056 Services    
 
 

 
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GI-057 Memberships    
 
 

 
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GI-058 Admissions    
 
 

 
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GI-070 Goods    
 
 

 

 

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GST/HST Information Sheets:  Harmonized Sales Tax:
 
  

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  Due to the general nature of the bulletin, it should not be relied upon as legal or tax advice. 

Supplies of health care services

Supplies of health care services

 Under the Excise Tax Act (the Act), exemptions from the GST/HST for supplies of medical and certain other health care services are generally limited to those made by suppliers who are engaged in the practice of a particular profession and who are licensed or certified under the laws of a province to practise the particular profession. These suppliers are defined in the Act.

 For instance, a supply of a consultative, treatment, diagnostic or other health care service rendered to an individual is exempt for GST/HST purposes when a medical practitioner makes the supply. A medical practitioner is defined as a person who is licensed under the laws of a province to practice the profession of medicine or dentistry

 In addition, a supply of an optometric, chiropractic, physiotherapy, chiropodic, podiatric, osteopathic, audiological, speech-language pathology, occupational therapy, or psychological service rendered to an individual is exempt when a practitioner supplies the service. A practitioner is defined in the Act as a person who practises the profession relevant to one of these services and who is licensed or otherwise certified to practise that profession (if required in the province where the service is supplied) or has the qualifications equivalent to those necessary to be so licensed or certified in another province (if not required in the province where the service is supplied). Please note that it is possible for a corporation to qualify as a medical practitioner or practitioner.

 Health care services supplied by corporations that are not medical practitioners or practitioners. The exemptions for supplies of the above-noted health care services do not apply to persons who do not qualify as medical practitioners or practitioners. Thus, the tax status of a health care service can vary depending on the supplier.

 Corporations may supply health care services through their employees or through independent contractors they engage to perform services on their behalf. However, corporations who do not meet the definition of medical practitioner or practitioner should be aware that their supplies may not fall within the exemptions in the Act. Although an employee or subcontractor engaged by a corporation may hold a licence to practise a particular health care profession, this licence does not confer any benefit on the corporation for purposes of the Act. A corporation is a separate legal entity from its owners, directors, subcontractors and employees. The tax status of a corporation’s supplies is evaluated separately from the activities of its owners, directors, subcontractors and employees.

 Corporations and independent contractors

In the health care field, corporations established to provide health care services to individuals often subcontract with independent contractors to provide these services. Because the GST/HST is a multistage tax, each transaction is a supply. This means that when a corporation enters into a contract to obtain the services of an independent contractor, the result is that the contractor has made a supply to the corporation, not to the individual. The provision of the health care service to the individual is made by the corporation.

 It is important to note that if the independent contractor’s supply to the corporation is exempt, this exemption does not flow through to the corporation’s supply. The tax status of the corporation’s supply to its client is determined independently of the contractor’s supply to the corporation because for purposes of the GST/HST, the corporation’s supply to its client is a distinct supply from the independent contractor’s supply to the corporation.

Due to the general nature of the bulletin, it should not be relied upon as legal or tax advice.

Medical Clinic Contracting with Associates

This policy clarifies the application of the GST/HST to payments made between parties within a medical practice organization with respect to the organization’s operating expenses.

Sample Ruling 7: Medical Clinic Contracting with Associates
 Statement of Facts

1. Practitioner A is a sole proprietor operating a medical practice under the name Clinic XYZ. The sole proprietor owns the practice and all related assets of the practice.

2. Practitioner A contracts with independent contractor associates whereby the associates will render health care services to individuals at Clinic XYZ and agree to pay Clinic XYZ for the use of the facility, medical equipment, and supplies of administrative services.

3. Clinic XYZ does not invoice the associates specifically for the use of the clinic, medical equipment, or administrative services. Rather, the associates and Practitioner A enter into an arrangement whereby the associates will assign to Clinic XYZ the fees payable to them by the provincial health insurance plan. Pursuant to this arrangement, Clinic XYZ will forward the associates’ billings to the provincial health insurance plan for the health care services the associates rendered using their billing numbers for this purpose. Clinic XYZ will collect these fees, remit 60% of the fees to the associates and withhold the remaining 40% in exchange for providing the use of the clinic, medical supplies, and administrative services.

Ruling Requested

The 40% of the associates’ fees that Clinic XYZ withholds is not consideration for a taxable supply and accordingly, no GST/HST applies to this portion of the associates’ fees not remitted to the associates.

Ruling Given

Based on the facts set out above, we rule that the 40% portion of the associates’ fees that Clinic XYZ does not remit to the associates is consideration paid by the associates for a taxable supply consisting of the use of the facility and medical equipment and administrative services. This supply by Clinic XYZ is a commercial activity and if Clinic XYZ is registered or is required to be registered (i.e., is not a small supplier), the GST/HST applies to the consideration paid by the associates for this supply (i.e., the portion of the associates’ fees withheld by Clinic XYZ).

While Clinic XYZ collected the fees payable by the provincial health insurance plan, it did not provide health care services to patients. Clinic XYZ is collecting the amount from the provincial health insurance plan on behalf of the associates. The associates and Practitioner A have an agreement that the associates will pay Clinic XYZ for the use of its facilities. Therefore, the amount of the associates’ fees withheld by Clinic XYZ is not consideration for a supply of health care services; rather the amount withheld is consideration for a taxable supply made by Clinic XYZ to the associates.

Definitions and Interpretations

EXEMPT SUPPLIES OF HEALTH CARE SERVICES

1. Under Part II of Schedule V to the Act, supplies of many health care services are exempt. In general terms, health care services have to promote physical and mental health, and the protection against disease. These services must be performed by health care professionals who are entitled to provide the health care services listed below.

Services Provided by Medical Practitioners and Practitioners

2. A supply of a prescribed diagnostic, treatment or other health care service (e.g., a laboratory testing service) when made on the order of a medical practitioner or practitioner is exempt.

3. A supply made by a medical practitioner of a consultative, diagnostic, treatment or other health care service rendered to an individual (other than a surgical or dental service that is performed for cosmetic purposes and not for medical or reconstructive purposes) is exempt.

4. A supply of any of the following services when rendered to an individual, where the supply is made by a practitioner of the service, is exempt:

(a) optometric services;
(b) chiropractic services;
(c) physiotherapy services;
(d) chiropodic services;
(e) podiatric services;
(f) osteopathic services;
(g) audiological services;
(h) speech-therapy services;
(i) occupational therapy services; and
(j) psychological services when provided by a practitioner who is registered in the Canadian Register of Health Service Providers in Psychology.

5. Only health care services that promote physical and mental health and protection against disease are exempt; other professional services provided by medical practitioners and practitioners (e.g., witness fees for court appearances) are taxable unless exempted by some other provision of the Act. For example, when such supplies are made by hospital authorities that are also charities, the supplies are likely to be exempted by virtue of section 2 of Part VI of Schedule V.

Institutional Health Care Services

6. Institutional health care services made by the operator of a health care facility to a patient or resident of the facility are exempt. [When a medical or prosthesis is installed in a health care facility in conjunction with an exempt institutional health care service, the supply of the prosthesis is also exempt. For example, when medical treatment in a hospital involves the installation of a prosthesis such as an artificial hip, the supply of the prosthesis by the hospital is exempt.] Exempt institutional health care services do not include medical or dental services performed for purely cosmetic purposes.

7. A supply of food and beverages, including the services of a caterer, made to an operator of a health care facility under a contract to provide, on a regular basis, meals for the patients or residents of the facility is exempt.

8. Fees charged by health care facilities to their patients or residents to cover accommodation and other institutional health care services are exempt. However, separate charges for other services, provided on a commercial basis by these facilities, that are not health related (e.g., parking and meals served in a cafeteria to visitors), are taxable.

9. The definition of “health care facility” under Part II (Health Care Services) of Schedule V to the Act includes a facility operated for the purpose of providing residents of the facility who have limited physical or mental capacity for self-supervision and self-care with:

(a) nursing and personal care under the direction or supervision of qualified medical and nursing care staff or other personal and supervisory care (other than domestic services of an ordinary household nature);

(b) assistance with the activities of daily living and social, recreational and other related services to meet the psycho-social needs of residents; and

(c) meals and accommodation.

Cosmetic Surgery for Medical or Reconstructive Purposes

10. Surgical and dental procedures that alter or enhance a patient’s appearance but have no medical or reconstructive purpose, are considered to be cosmetic surgery and, generally, are taxable. Refer to paragraph 6 of this memorandum for more information on this subject.

11. However, cosmetic surgery that is performed for medical or reconstructive reasons is exempt. An example of this type of surgery is skin grafting performed on a burn victim.

12. In certain circumstances, provincial and territorial health insurance plans consider cosmetic surgery to be medically necessary and therefore an insured service. In these cases, the service is exempt. Such surgery is usually evaluated on a case-by-case basis. The criteria for finding cosmetic surgery to be medically necessary include:

(a) the surgery is to alter a significant defect in appearance caused by disease, trauma, or congenital deformity; and
(b) it is recommended by a mental health facility, or
(c) the patient is less than eighteen years of age and the defect is in an area of the body which normally and usually would not be clothed.

Nursing Services

13. A supply of a nursing service provided by a registered nurse, a registered nursing assistant or a licensed practical nurse is exempt where:

(a) the service is provided to an individual in a health care facility or in the individual’s place of residence;
(b) the service is a private-duty nursing service; or
(c) the supply is made to a public sector body (for example, a school authority, a hospital authority or a municipality).

14. Nurses may provide their services directly to patients or they may be hired by employment agencies who specialize in the provision of health care providers. In either case, the charge for their services is exempt.

Dental Hygienist Services

15. A supply of a dental hygienist service is exempt regardless of whether the hygienist is self-employed or is an employee of a management corporation or a medical practitioner.