The Transparent and Accountable Health Care Act, 2023 deems certain health-sector entities that receive $1 million or more in public funds to be subject to existing Ontario public-sector accountability regimes. Major health sector organizations that get at least $1 million from the Ministry of Health, and privately contracted suppliers that receive at least $1 million (directly or indirectly) from those organizations, are treated as designated employers under the Broader Public Sector Executive Compensation Act, as employers under the Public Sector Salary Disclosure Act, and as governmental organizations under the Ombudsman Act.
The Auditor General is given authority to audit any aspect of their operations for fiscal years in which they meet the threshold.
The bill matters because it pulls a wide array of providers and suppliers—explicitly including for-profit entities—into the province's public disclosure and oversight framework. That changes compliance obligations for hospitals, long-term care homes, independent health facilities, group purchasing organizations and contractors; it also creates new transparency around executive pay and salaries and expands routes for public complaints and provincial audit scrutiny.
At a Glance
What It Does
The Act deems entities meeting a $1 million annual public-funds threshold to fall under three existing transparency regimes: the Broader Public Sector Executive Compensation Act, the Public Sector Salary Disclosure Act and the Ombudsman Act. It also authorizes the Auditor General to audit any aspect of their operations for fiscal years in which they meet the threshold.
Who It Affects
Directly affected are organizations that receive $1 million+ from the Ministry of Health (hospitals, long‑term care homes, Ontario Health bodies, air ambulance providers, independent health facilities and similar entities) and suppliers that receive $1 million+ in aggregate from those organizations, including for‑profit contractors and group purchasing organizations.
Why It Matters
The bill extends public-sector pay and disclosure rules and provincial oversight into parts of the health sector previously outside those regimes, increasing transparency of executive compensation and opening entities to Ombudsman complaints and Auditor General audits—shifting compliance, reporting and potential reputational risk across the health system.
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What This Bill Actually Does
The Act sets a monetary trigger and then applies existing transparency laws to whoever crosses it. For ‘major health sector organizations’ the trigger is receiving at least $1 million in public funds from the Ministry of Health in a provincial fiscal year beginning on or after April 1, 2024.
For ‘publicly-funded suppliers’ the Act aggregates funds received directly or indirectly from major health sector organizations or other publicly-funded suppliers, and counts grants, contracts for goods or services, fee-for-service arrangements, loans and loan guarantees when calculating the $1 million threshold.
Once an entity meets the threshold, the bill uses a deeming approach rather than creating new standalone obligations. Entities that would not otherwise be covered are treated as ‘designated employers’ under the Broader Public Sector Executive Compensation Act, as employers for the purposes of Ontario’s sunshine-pay law (Public Sector Salary Disclosure Act, 1996), and as ‘governmental organizations’ under the Ombudsman Act.
The timing of coverage differs slightly across instruments: the executive-compensation deeming takes effect in the first fiscal year the threshold is met and continues thereafter, while salary-disclosure and Auditor General powers apply only in fiscal years in which the $1 million threshold is reached.The bill explicitly includes for‑profit bodies that carry on business for profit, so private clinics and contractors are swept in when their public-funded receipts meet the numerical test. It also empowers the Auditor General to audit “any aspect” of the operations of covered entities, subject to the same $1 million-per-fiscal-year limitation.
Finally, the Lieutenant Governor in Council may make regulations to implement the Act, and the law comes into force on Royal Assent.
The Five Things You Need to Know
Major health sector organizations are defined by receipt of at least $1 million in public funds from the Ministry of Health in a fiscal year beginning on or after April 1, 2024.
Publicly-funded suppliers reach the $1 million threshold on an aggregate basis from payments received directly or indirectly from major health sector organizations or other publicly-funded suppliers, and the bill counts grants, contracts, fee-for-service, loans and loan guarantees.
The bill deems covered entities to be designated employers under the Broader Public Sector Executive Compensation Act beginning in the first fiscal year they meet the threshold and for every fiscal year thereafter.
The Auditor General gains explicit authority to audit any aspect of operations of covered entities, but that authority is limited to fiscal years in which the entity receives at least $1 million in public funds.
The legislation expressly includes entities that carry on business for profit, bringing private providers and contractors within the scope when their public-funded receipts meet the $1 million trigger.
Section-by-Section Breakdown
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Purpose—what the Act is trying to achieve
This short section states that the Act’s goal is to improve transparency and accountability in health‑care funding by ensuring that persons and entities receiving public funds are covered by existing legislative accountability tools. Practically, it frames the rest of the statute as a targeted expansion of coverage rather than as a set of new regulatory rules.
Major health sector organizations—definition and examples
Section 3 sets the $1 million-per-fiscal-year threshold for entities that get public funds from the Ministry of Health and lists representative examples (boards of health, hospitals, Ontario Health, long‑term care homes, independent health facilities, air ambulance providers, out‑of‑hospital premises, group purchasing organizations). It also clarifies that the threshold applies to funding received as grants, transfer payments or other funding arrangements and that for‑profit entities are included.
Publicly-funded suppliers—aggregating direct and indirect funding
Section 4 captures suppliers and subcontractors by aggregating payments received from major health sector organizations or other publicly-funded suppliers. It specifies what counts as public funds for this test—grants, contracts for goods or services, fee‑for‑service payments and loans or loan guarantees—so an entity need not receive Ministry money directly to be covered. The aggregation language is the mechanism that brings supply chains under the Act.
Deeming to existing accountability statutes
Sections 5 through 7 use deeming clauses to make covered entities subject to three existing laws. Section 5 deems them designated employers under the Broader Public Sector Executive Compensation Act (with effect in the first fiscal year meeting the threshold and thereafter). Section 6 treats them as governmental organizations for the Ombudsman Act, and Section 7 deems them employers under the Public Sector Salary Disclosure Act; the salary-disclosure deeming applies only in fiscal years where the $1 million threshold is met. The practical effect is that existing compliance, reporting and disclosure rules attach to these entities without drafting a parallel new regime.
Auditor General authority
Section 8 authorizes the Auditor General to audit any aspect of the operations of a covered entity. That is a broad auditing grant, but it is bounded by the same fiscal-year threshold: auditing authority applies only in years the entity receives at least $1 million in public funds. The provision expands the Auditor General’s reach into private providers and suppliers when they are materially funded by public dollars.
Regulations, commencement and short title
Section 9 allows the Lieutenant Governor in Council to make regulations necessary to carry out the Act, providing flexibility for implementation details (for example, defining aggregation rules or administrative processes). Section 10 says the Act comes into force on Royal Assent, and Section 11 provides the short title.
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Explore this topic in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Ontario taxpayers and the public — they gain broader visibility into executive pay and public‑funded salaries across more parts of the health system, improving capacity to evaluate use of public funds.
- Patients and patient advocates — expansion of Ombudsman jurisdiction creates additional channels for complaints and independent review of systemic or institution‑level issues at entities that were formerly outside provincial complaint oversight.
- Auditor General and oversight bodies — the Auditor General and Ombudsman obtain formal authority to examine and investigate a wider set of organizations and funding relationships, strengthening systemic audit capacity and complaint handling.
Who Bears the Cost
- Major health institutions and their governance boards (hospitals, long‑term care homes, Ontario Health bodies) — they face new reporting and compensation‑governance requirements that could require policy changes, additional HR reporting, and potential limits on pay agreements.
- Private and not‑for‑profit suppliers and contractors — firms that previously operated under commercial confidentiality may need to disclose salaries and submit to oversight and audit, increasing compliance costs and possibly affecting contract negotiations.
- Ministry of Health and agencies — implementing, monitoring and enforcing the expanded regime will require administrative effort; the Auditor General’s expanded audit activity may increase workload and coordination demands across government and providers.
Key Issues
The Core Tension
The central tension is between achieving broader public accountability—bringing more of the health system under pay disclosure, Ombudsman review and audit—and imposing new administrative, commercial and disclosure burdens that may disrupt procurement, contract structures and service delivery; the Act substitutes a clear monetary trigger for harder judgment calls, but that clarity comes at the cost of potentially blunt and uneven outcomes.
The Act solves a visibility gap by tying an objective monetary test to existing accountability frameworks, but that approach raises practical and policy questions. The $1 million threshold is administratively simple but arbitrary: it will capture a mix of large public entities and smaller private contractors that happen to cross the threshold, producing uneven compliance burdens across similar service providers.
Aggregation rules for indirect payments and the inclusion of loans and guarantees broaden scope but also create calculation complexity that will require detailed regulatory or administrative guidance.
The deeming strategy minimizes legislative drafting but creates potential friction with contractual confidentiality, proprietary commercial information and collective‑bargaining arrangements. Entities may resist disclosure on commercial or privacy grounds, and providers could restructure payment flows or contract chains to avoid the threshold.
The Auditor General’s authority to audit “any aspect” is expansive, but the statutory restriction to fiscal years in which the $1 million threshold is met means multi‑year contracts that dip below the trigger in some years could escape continuous oversight. Finally, the effectiveness of the change depends on resourcing: oversight bodies will need capacity to manage more audits and disclosures, and the Lieutenant Governor in Council’s regulation‑making power will likely be crucial to resolve calculation, timing and confidentiality questions.
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