Please note that the following document, although correct at the time of issue, may not represent the current position of the Canada Revenue Agency. / Veuillez prendre note que ce document, bien qu'exact au moment émis, peut ne pas représenter la position actuelle de l'Agence du revenu du Canada.
Excise and GST/HST Rulings Directorate
Place de Ville, Tower A, 15th floor
320 Queen Street
Ottawa ON K1A 0L5
[Addressee]
Case Number: 128607
August 8, 2012
Dear [Client]:
Subject: GST/HST RULING
HST and Nursing Footcare Services
Thank you for your letter of [mm/dd/yyyy], concerning the application of the Goods and Services Tax (GST)/Harmonized Sales Tax (HST) to your supply of foot care services. We apologize for the delay in responding.
HST applies at the rate of 15% in Nova Scotia, 13% in Ontario, New Brunswick, and Newfoundland and Labrador, and 12% in British Columbia. GST applies at the rate of 5% in the remaining provinces and territories.
All legislative references are to the Excise Tax Act (ETA) unless otherwise specified.
STATEMENT OF FACTS
We understand the following:
1. You are a Registered Nurse registered with the […] [provincial entity]. […].
2. You have completed the Basic and Advanced Foot Care courses at […]. These courses are specially designed for nurses, and may only be completed by registered nurses and registered practical nurses.
3. You are currently […], providing services to clients in their homes, whether that is their house, apartment, group home, retirement home or long term care facility.
4. Your services are primarily related to foot care. […]
5. The foot care services you provide include assessing and treating foot problems such as sores, calluses, hammer toes, ingrown toenails, thickened nails, and other foot conditions. You refer the client to his or her doctor or recommend a podiatrist if the condition is beyond the scope of your practice.
6. You do not advertise your services directly. You obtain clients through word-of-mouth referrals from your existing clients. […].
7. […].
8. Your clients, or their […], are billed directly.
RULING REQUESTED
You would like to know if your supplies of foot care services are exempt services for purposes of the GST/HST.
RULING GIVEN
Based on the facts set out above, we rule that your supply of nursing services, specifically foot care services, is an exempt supply pursuant to section 6 of Part II of Schedule V to the ETA.
This ruling is subject to the qualifications in GST/HST Memorandum 1.4, Excise and GST/HST Rulings and Interpretations Service. We are bound by this ruling provided that none of the above issues are currently under audit, objection, or appeal, that no future changes to the ETA, regulations or our interpretative policy affect its validity, and all relevant facts and transactions have been fully disclosed.
EXPLANATION
Generally, most supplies of property and services made in Canada are taxable for GST/HST purposes, unless they are exempt supplies. Exempt supplies are listed in Schedule V. Part II of Schedule V provides that certain health care services are exempt from GST/HST. In order for a supply of property or a service to be exempt from GST/HST under Part II of Schedule V, a specific exempting provision included in Part II must apply to that particular supply.
In addition, it should be noted that the GST/HST is a transactional tax and as such, the exempting provisions in Part II of Schedule V apply on a supply-by-supply basis. These provisions set out specific criteria that must be met in order for a particular supply of a service to fall within those provisions. For every supply or transaction, the supplier must determine whether these criteria are met or whether the tax is applicable. Because of these criteria it is possible for a supplier to make a mix of taxable and exempt supplies and for the tax status of a supply to differ depending on the supplier. Thus, regardless of the manner in which nursing services may be defined, the tax status of a particular supply of nursing services is also conditional on whether the supply meets all of the criteria set out in the exempting provision, as explained below.
Section 6 of Part II of Schedule V exempts a supply of a nursing service rendered to an individual by a registered nurse, a registered nursing assistant, a licensed or registered practical nurse or a registered psychiatric nurse, if the service is rendered within a nurse-patient relationship. Given the preceding, there are three criteria that the supply must meet to be exempt; i.e., it must be a service that:
* is rendered by a registered or licensed nurse;
* falls within the scope of nursing services; and
* is rendered to an individual within a nurse-patient relationship.
The Canada Revenue Agency (the “CRA”) considers that the supply of a “nursing service” is an activity described as the skilled practice of nursing involving procedures, treatments, medication, administration, and other interventions, performed on patients under a nursing care plan or on the order of a medical practitioner.
The CRA also considers a “nurse-patient relationship” to mean nursing services that involve personal interaction between a nurse and an individual who is a patient where there is an established or ongoing relationship between the nurse and the patient and the nurse is a direct care provider of the patient.
Accordingly, when a registered nurse, a registered nursing assistant, a licensed or registered practical nurse or a registered psychiatric nurse, renders nursing services to an individual in the capacity of a care provider, i.e., in a professional nurse-patient therapeutic relationship, these nursing services will be exempt.
Although foot care is traditionally provided by chiropodists or podiatrists in […] [province A], preventative or restorative quality foot care nursing services use nursing knowledge, skills, and judgement to assess the patient as a whole. In addition foot care performed by registered nurses involves the performance on a patient of a controlled act listed in the […] [relevant Acts]. Foot care services provided by registered nurses are supportive, preventative, therapeutic, and rehabilitative in nature.
Foot care is a service that is recognized by various nursing associations in Canada as a specialty of nursing practice and there are foot care nursing programs offered by various educational institutions. In some provinces registered nurses may have special recognition as a certified foot care nurse by a nursing association. Accordingly, we accept that there are situations where foot care may be a nursing service rendered to an individual within a nurse-patient relationship.
In the present circumstances, the fact that you are a Registered Nurse, that the specialized foot care training you received is only available to nurses and is recognized by the nursing profession and that you utilize this training in performing foot care services for your clients in their home indicates that the foot care you supply is a nursing service rendered within a nurse-patient relationship and is therefore exempt pursuant to section 6 of Part II of Schedule V to the ETA.
If you require clarification with respect to any of the issues discussed in this letter, please call me directly at 613-954-4395. Should you have additional questions on the interpretation and application of GST/HST, please contact a GST/HST Rulings officer at 1-800-959-8287.
Yours truly,
Art Blommesteijn
Health Care Sectors Unit
Public Service Bodies and Governments Division
Excise and GST/HST Rulings Directorate
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