File No. 11865-6(lgd)
This is in response to your letter of May 15, 1995, in which you asked for our review and confirmation with respect to your ruling of April 25, 1995 . This ruling was provided to XXXXX regarding the application of the GST to their services, including, nursing services. XXXXX is now appealing your ruling.
In their letter to you of May 3, 1995, XXXXX has provided eight additional explanations to support their view that the occupational services provided on a contractual basis to companies and organizations are exempt pursuant to section 6 of Part II of Schedule V to the Excise Tax Act (ETA). To facilitate this response, each area cited by XXXXX is addressed numerically in the order presented in their letter.
1. The Department recognizes the fact Occupational Health Nursing is one of the specialty areas recognized by the XXXXX
2. The Department recognizes that Canadian Certified Health Nurses practice their profession under governing standards.
3. The Department recognizes occupational health nursing as a qualified area of nursing practice as defined by the XXXXX . However, recognizing a nursing practice does not translate into a "nursing service rendered" under section 6.
4. The Department recognizes the long history of occupational health nursing in occupational environments.
5. It appears Fact 2 in your ruling is in error. XXXXX maintains it does not provide "private duty nursing". The services provided to companies and organizations are occupational health nursing.
6. For purposes of the ETA, the definition of "health care facility" includes only those facilities where medical (i.e., medical practitioner) or hospital care is provided. Accordingly, such facilities which provide only first aid or rehabilitative care which is not considered to be hospital or medical care would not come within the definition of "health care facility". It is our understanding the services that are being provided to employees and/or clients are occupational nursing services.
7. Registered nurses, registered nursing assistants or a licensed practical nurse may render nursing services directly to patients, they may be hired by employment agencies who specialize in the provision of health care providers or provide their services on a contractual basis . Accordingly, if the nursing services are provided pursuant to section 6 of Part II of the ETA, the charge for such services is exempt. XXXXX contends medical practices providing occupational medical services in various cities in XXXXX do not charge or remit GST on their services. This may in fact be true if the services are rendered to individuals by a medical practitioner of a consultative, diagnostic, treatment or other health care service (other than a surgical or dental service that is performed for cosmetic purposes and not for medical or reconstructive purposes). Such services are exempt pursuant to section 5 of Part II of Schedule V to the ETA.
8. The Department maintains that the teaching of first aid, CPR or other related emergency response/disaster training does not meet the exempting provisions of section 6 of Part II of the ETA. "Worker Compensation Case Management" which may include liaising with other health care providers to enhance employee rehabilitation does not meet the exempting provisions of section 6 of Part II of Schedule V to the ETA. However, services provided to Workers' Compensation Boards which have been identified as a "provincial entity" are not subject to the GST.
Based on the information provided, we concur with and support the GST Application Ruling of April 25, 1995 provided to XXXXX .
Also, as stated in our letter of February 20, 1995 addressed to XXXXX , services described as occupational health services do not meet the exempting provisions set out in section 6 of Part II of Schedule V because occupational nursing is not considered nursing pursuant to this provision. However, it should be kept in mind that a supply of a nursing service rendered by a registered nurse, registered nursing assistant or licensed practical nurse will meet the provisions of section 6, Part II Schedule V where:
(a) the service is rendered to an individual in a health care facility or in the individual's place of residence;
(b) the service is a private-duty service; or
(c) the service is made to a public sector body.
As you are aware, Part II of Schedule V to the ETA provides exemption from the GST for a number of health care services. Section 7 of that Part lists ten specific practitioners' services for which exemption from the GST is unconditionally provided. During her conversation with Lance Dixon, XXXXX expressed an interest in how an amendment could be made to the ETA to include "occupational health nurse" within the exempting provision of section 7 of Part II of Schedule V to the ETA. XXXXX was advised that the Department of National Revenue is responsible for administering the Excise Tax Act as approved by Parliament. She was advised that a change to provide exemption for the services provided by occupational health nurses would require an amendment to the "Health Care Services (GST) Regulations. Since such changes are a matter of tax policy and, as such, fall within the purview of the Department of Finance, she was advised to make formal representation to that Department at the following address.
Mr. S. Watson
Director
Personal Income Tax & Sales Tax Divisions
L'Esplanade Laurier
140 O'Connor Street
16th Floor, East Tower
Ottawa, Ontario
K1A 0G5
If you have any questions or require any further clarification please contact either myself at (613) 954-5127 or Lance Dixon at (613) 952-9264.
Yours truly,
Enikö Vermes
A/Manager
Health Care, Goods and Services
Special Sectors
GST Rulings and Interpretations
| c.c.: |
Enikö Vermes
Lance Dixon |
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