NP Independent Practice and Entrepreneurship

Vocabulary and key regulatory concepts regarding independent Nurse Practitioner practice, health legislation, and business entrepreneurship in nursing.

Independent Practice

The state of being self-employed for nursing services or operating an independent nursing business, such as consulting, primary care clinics, virtual care, psychotherapy, or medical aesthetics.

Bill 60 (Your Health Act, 2023)

Legislation that expanded the use of Independent Health Facilities (IHFs) and allows more private/for-profit organizations to deliver publicly funded health services in Ontario to reduce wait times.

Canada Health Act (CHA) Principles

The five core principles protecting equitable access to medically necessary care: public administration, comprehensiveness, universality, portability, and accessibility.

Physician-Equivalent Services (PES)

Medically necessary health services that, according to the 2025 CHA Services Policy, cannot result in patient charges simply because they are provided by an NP instead of a physician.

Extra-billing

The practice where a health care provider charges extra fees for insured services beyond what is covered by the public healthcare system.

User charges

Direct payments required to access insured services, such as a mandatory membership fee.

Block fees

Annual or bundled administration fees for access to certain uninsured services or practice conveniences, though patients cannot be declined insured services for refusing these optional fees.

Preferred access fees

Charges for expedited appointments or preferential treatment based on payment status, which creates a risk of a two-tier healthcare system.

OHIP Podiatry Coverage

The Ontario Health Insurance Plan covers $\$7-16$ for each visit up to $\$135$ per patient per year, plus $\$30$ for x-rays, but does not cover surgeries.

PSA (Prostate-Specific Antigen) Coverage

OHIP covers this test only if the patient has prostate cancer and is receiving treatment, or if an HCP suspects prostate cancer based on history or physical exam.

CNPS Professional Liability Coverage

Provides up to $\$10,000,000$ per claim for professional negligence relating to nursing care for the individual nurse, but does not cover the incorporated business entity or employees.

Health Information Custodian (HIC)

The individual (e.g., an independent NP) responsible for the collection, storage, disclosure, retention, destruction, and breach management of health information under PHIPA.

PHIPA Record Retention (Minors)

A recommendation to keep health documents for $10$ years after a minor turns $18$, or $10$ years after the termination of the nurse-client relationship.

Agents

Employees of an independent NP who become representatives of the NP if the NP is the designated Health Information Custodian.

CNO Advertising Prohibitions

Nurses are prohibited from using the CNO logo, making guarantees or sensational claims, using comparative superiority claims, or using client testimonials in direct care ads.

Health Professional Corporation

An optional business structure for independent Nurse Practitioners as per CNO standards.

BC Primary Care Networks

Clinical networks of primary care providers in a geographical area that focus on longitudinal attachment, team-based care, and ten core attributes including indigenous and culturally safe care.

Alberta NP Independent Clinics

A formalized model where the government supports NP-led clinics with patient panel expectations of $900$ patients, mentorship funding, and after-hours access requirements.

Vitamin D OHIP Coverage

Covered only for patients with osteoporosis, rickets, osteopenia, malabsorption syndromes, renal disease, or those on drugs affecting vitamin D metabolism.

Commitment to the Future of Medicare Act (2004)

The Ontario legislation used to operationalize the five principles of the Canada Health Act and prohibit extra billing and user charges.