2019-0803411I7 Medical practitioners - the METC & the DTC

Principal Issues: Whether the CRA can set up a process to consider requests to change (or expand) the categories of medical practitioners who can certify Form T2201, Disability Tax Credit Certificate.

Position: No.

Reasons: Changes to the categories of medical practitioners who can provide certification for the purpose of the disability tax credit (DTC) would require a legislative amendment to section 118.3 – this is beyond the CRA's mandate as an administrator of the Act.

Author: El-Kadi, Randa
Section: 118.4(2); 118.3(a.2) and 118.3(a.3)

                                                                                May 15, 2019

Ms. Marie Corey                                                      Income Tax Rulings Directorate
Assessment and Benefit Services Branch               Randa El-Kadi
Canada Revenue Agency                                        (613) 670-9054
750 Heron Rd., Floor 4, Room 420A
Ottawa ON  K1A 0L5
                                                                                  2019-080341

Medical practitioners who may certify Form T2201, Disability Tax Credit Certificate

We are replying to your correspondence regarding the formal process to request changes to the list of medical practitioners for the purposes of the medical expense tax credit (METC). More specifically, you ask on behalf of the Disability Advisory Committee whether the Canada Revenue Agency (CRA) can make a similar process available to request changes to (and possibly expand) the categories of medical practitioners who can certify Form T2201, Disability Tax Credit Certificate, for the purposes of the disability tax credit (DTC).

Our comments

Subsection 118.4(2) of the Income Tax Act (the Act) provides a definition of the term “medical practitioner” for the purposes of several provisions of the Act, including section 118.2 (in relation to the METC) and section 118.3 (in relation to the DTC). Namely, subsection 118.4(2) provides that a reference to an audiologist, dentist, medical doctor, medical practitioner, nurse, nurse practitioner, occupational therapist, optometrist, pharmacist, physiotherapist, psychologist or speech-language pathologist is a reference to a person authorized to practise as such,

(a)   where the reference is used in respect of a service rendered to a taxpayer, pursuant to the laws of the jurisdiction in which the service is rendered;
(b)   where the reference is used in respect of a certificate issued by the person in respect of a taxpayer, pursuant to the laws of the jurisdiction in which the taxpayer resides or of a province.

Section 118.4 of the Act seems to recognize the provincial and territorial governments’ constitutional power to govern health-related matters, including the regulation of health professionals. Therefore, in order to determine whether a particular medical practitioner qualifies as such under the Act, one must look to the relevant provincial or territorial legislation to determine whether the particular practitioner is authorized under the laws of that province or territory. (footnote 1)

The list of medical practitioners for the purposes of the METC

For the purposes of the METC, taxpayers may be eligible to claim, as a medical expense, the amounts they pay for medical services provided by authorized medical practitioners.

The CRA has made available to taxpayers a list titled “Authorized medical practitioners by province or territory for the purposes of claiming medical expenses” (the List). Although the List is not exhaustive, it assists taxpayers in determining which medical practitioners are “authorized” to practice, (footnote 2) without necessarily having to contact the CRA or their own province or territory. The process that the CRA has put in place whereby each province and territory can request changes to the List, as necessary, helps ensure a timely update any time during the year.

To that effect, the webpage titled “Requesting changes to the list of provincially/territorially authorized medical practitioners” (footnote 3) provides a vehicle specifically designed for representatives of a provincial or territorial government, or a health care profession governing body, to contact the CRA directly to request changes to the List if they believe that it is not up to date for their respective province or territory.

Medical practitioners for the purposes of the DTC

While subsection 118.4(2) describes the requirements for a person to be considered a medical practitioner for purposes of sections 118.2 and 118.3 (among others) – namely, the requirement to consider the relevant provincial legislation – specific rules in section 118.3 allow only certain categories of medical practitioners to certify that an individual has a severe and prolonged impairment in physical or mental functions for the purposes of the DTC.

For example, pursuant to paragraph 118.3(1)(a.2) of the Act, only the following categories of medical practitioners may certify that an individual is markedly restricted in their ability to perform a basic activity of daily living:

*     a sight impairment may be certified by either a medical doctor, a nurse practitioner or an optometrist;
*     a speech impairment may be certified by either a medical doctor, a nurse practitioner or a speech-language pathologist;
*     a hearing impairment may be certified by either a medical doctor, a nurse practitioner or an audiologist;
*     an impairment with respect to an individual’s ability in feeding or dressing themselves may be certified by either a medical doctor, a nurse practitioner or an occupational therapist;
*     an impairment with respect to an individual’s ability in walking may be certified by either a medical doctor, a nurse practitioner, an occupational therapist or a physiotherapist; and
*     an impairment with respect to an individual’s ability in mental functions necessary for everyday life may be certified by either a medical doctor, a nurse practitioner or a psychologist.

Given that the reference to “medical practitioners” in paragraph 118.3(1)(a.2) of the Act in respect of DTC certification is subject to the definition of this term in paragraph 118.4(2)(b), there is a requirement that the certifying medical doctor, nurse practitioner, optometrist, speech-language pathologist, audiologist, occupational therapist, physiotherapist or psychologist (as the case may be) listed in section 118.3 be authorized to practice as such pursuant to the laws of the jurisdiction in which the taxpayer (for whom Form T2201 is completed) resides or the laws of a province.

Conclusions

Change requests to the List are initiated by provincial and territorial authorities with jurisdiction over health professions. Where the CRA receives such requests along with the supporting documentation (such as legislative references, regulations or decrees), it updates the List as necessary to reflect provincial and territorial laws and regulations relating to health professions.

On the other hand, the categories of medical practitioners who can certify Form T2201 for the purposes of the DTC are provided for in section 118.3 of the Act. Therefore, any changes to these categories would require an amendment to that provision. The Department of Finance Canada (Finance) is responsible for tax policy and legislative changes to the Act, while the CRA is responsible for administering the tax system and applying the legislation as enacted by Parliament. Any proposal to change section 118.3 of the Act will be a change in tax policy and therefore, will be the responsibility of Finance.

In brief, the CRA has neither the authority to expand the categories of medical practitioners who can certify form T2201, nor the authority to consider such requests. The CRA, however, can revise its forms and publications (such as Form T2201) to reflect legislative amendments to the Act, as initiated by Finance.

We trust our comments will be of assistance.

Unless exempted, a copy of this memorandum will be severed using the Access to Information Act criteria and placed in the Canada Revenue Agency’s electronic library. After a 90-day waiting period, a severed copy will also be distributed to the commercial tax publishers for inclusion in their databases. You may request an extension of this 90-day period. The severing process removes all content that is not subject to disclosure, including information that could reveal the identity of the taxpayer. The taxpayer may ask for a version that has been severed using the Privacy Act criteria, which does not remove taxpayer identity. You can request this by e-mailing us at: ITRACCESSG@cra-arc.gc.ca. A copy will be sent to you for delivery to the taxpayer.

Lita Krantz, CPA, CA
Manager
Tax Credits and Ministerial Issues
Business and Employment Division
Income Tax Rulings Directorate
Legislative Policy and Regulatory Affairs Branch

FOOTNOTES

Note to reader:  Because of our system requirements, the footnotes contained in the original document are shown below instead:

1  See wording in E 2012-0462011E5.
2  For alternative wording, see E 2012-0462011E5 where we state that: “The Canada Revenue Agency Web site provides a summary chart identifying those health care professionals authorized to practice as medical practitioners by province or territory for the purposes of claiming medical expenses.”
3  See the following link: https://www.canada.ca/en/revenue-agency/services/tax/tax-professionals/income-tax-rulings-interpretations/requesting-changes-list-provincially-territorially-authorized-medical-practitioners.html.

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