27 April 2018 Ruling 185888

The Corporation provides medical repatriation services which involve arranging to transport an individual (the patient) from a foreign hospital to a health care facility in the individual’s home country. This would include transport between the medical facilities and airports via ground transportation (ambulance, taxi, or limo), and commercial airline transportation in the company of a medical escort (registered nurses, physicians and advanced cardiac life support trained paramedics). The Corporation charges a daily rate for the medical escort and a fee for the medical equipment required by the patient.

After ruling that the services supplied by the Corporation were of medical escort services rather than of international air ambulance services, so that zero-rating pursuant to Sched. VI, Pt. VII, s. 15 was not available, CRA stated:

The dictionary definition and definition in the provincial legislation suggest that the meaning of “ambulance” is a special vehicle that is used to transport injured or ill individuals who require the care of a physician, nurse or other health care provider while being transported. …

The addition of a medical escort along with medical equipment and supplies would not transform a commercial aircraft into an air ambulance.

The Corporation provides medical repatriation services which involve arranging to transport an individual (the patient) from a foreign hospital to a health care facility in the individual’s home country. This would include transport between the medical facilities and airports via ground transportation (ambulance, taxi, or limo), and commercial airline transportation in the company of a medical escort (registered nurses, physicians and advanced cardiac life support trained paramedics). The Corporation charges a daily rate for the medical escort and a fee for the medical equipment required by the patient.

CRA found that the repatriation services were a single supply, stating:

The dominant element of the supply made by the Corporation is the medical escort services. The […][recipients] come to the Corporation because their patients require a medical escort to be able to travel and their needs would not be satisfied without these services. The logistical services are inputs that are consumed in the provision of the medical escort services.

CRA found that such supply did not qualify as a zero-rated “ambulance” service. However, it could qualify as an exempt nursing supply under Sched. V, Pt, II, s. 6 or an exempt physician supply under Sched. V, Pt, II, s. 5, depending on who accompanied the patient – whereas if the attendants were paramedics it would not be exempted.

The Corporation provides medical repatriation services which involve arranging to transport an individual (the patient) from a foreign hospital to a health care facility in the individual’s home country. This would include transport between the medical facilities and airports via ground transportation (ambulance, taxi, or limo), and commercial airline transportation in the company of a medical escort (registered nurses, physicians and advanced cardiac life support trained paramedics). The Corporation charges a daily rate for the medical escort and a fee for the medical equipment required by the patient.

After finding that the repatriation services were a single supply, CRA went on to state:

[N]ursing … includes activities such as providing treatment, assessing the health care needs of […][an individual], analyzing the findings of a health assessment, and determining the appropriate service, treatment or equipment. These are activities that a nurse would be engaged in during the transport of a patient. Therefore, supplies of medical escort services made by the Corporation are exempt supplies pursuant to section 6 of Part II of Schedule V when the service is rendered to an individual by a registered nurse, a registered nursing assistant, a licensed or registered practical nurse or a registered psychiatric nurse.

The Corporation provides medical repatriation services which involve arranging to transport an individual (the patient) from a foreign hospital to a health care facility in the individual’s home country. This would include transport between the medical facilities and airports via ground transportation (ambulance, taxi, or limo), and commercial airline transportation in the company of a medical escort (registered nurses, physicians and advanced cardiac life support trained paramedics). The Corporation charges a daily rate for the medical escort and a fee for the medical equipment required by the patient.

After finding that the repatriation services were a single supply, CRA went on to state:

The activities of monitoring and caring for a patient during transfer would be activities in a health care service rendered to an individual and would fall under the exemption in section 5 when rendered to an individual by a licensed physician. …

There are no provisions … to exempt the supply of paramedical services.

… The fact that a paramedic may perform certain services on the delegated authority of a physician does not change the nature of the supply. …[D]elegated services performed by paramedics are being rendered by the paramedic not the medical practitioner who allowed the delegation.