You're using an outdated browser. This website will not display correctly and some features will not work.
Learn more about the browsers we support for a faster and safer online experience.

Français

Commitment to the Future of Medicare Act, 2004

S.o. 2004, chapter 5

Consolidation Period: From December 8, 2016 to the e-Laws currency date.

Last amendment: 2016, c. 30, s. 33.

Legislative History: 2004, c. 3, Sched. A, s. 79; 2004, c. 5, s. 15 (7); 2006, c. 4, s. 44; 2007, c. 8, s. 199; 2009, c. 26, s. 1; 2009, c. 33, Sched. 18, s. 17 (2); 2010, c. 14, s. 18; 2015, c. 27, Sched. 3; 2016, c. 30, s. 33.

CONTENTS

Preamble

PART II
HEALTH SERVICES ACCESSIBILITY

8.

Definitions

9.

General Manager

10.

Persons not to charge more than OHIP

11.

Transitional

11.1

Designated services

12.

Agreement for determining amount

13.

Unauthorized payment

14.

Entitlement to review

15.

Personal information

16.

Disclosure of information to the General Manager

17.

Preferences

18.

Block fees

19.

Offence

20.

Regulations

 

Preamble

The people of Ontario and their Government:

Recognize that Medicare – our system of publicly funded health services – reflects fundamental Canadian values and that its preservation is essential for the health of Ontarians now and in the future;

Confirm their enduring commitment to the principles of public administration, comprehensiveness, universality, portability and accessibility as provided in the Canada Health Act;

Continue to support the prohibition of two-tier medicine, extra billing and user fees in accordance with the Canada Health Act;

Believe in a consumer-centred health system that ensures access is based on assessed need, not on an individual’s ability to pay;

Recognize that pharmacare for catastrophic drug costs is important to the future of the health system;

Recognize that access to community based health care, including primary health care, home care based on assessed need and community mental health care are cornerstones of an effective health care system;

Believe in public accountability to demonstrate that the health system is governed and managed in a way that reflects the public interest and that promotes efficient delivery of high quality health services to all Ontarians;

Recognize that the promotion of health, and the prevention of and treatment of disease includes mental and physical illness;

Recognize the importance of an Ontario Health Quality Council that would report to the people of Ontario on the performance of their health system to support continuous quality improvement;

Affirm that a strong health system depends on collaboration between the community, individuals, health service providers and governments, and a common vision of shared responsibility;

Therefore, Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:

Part I (ss. 1-7) Repealed:  2010, c. 14, s. 18 (1).

1. Repealed: 2010, c. 14, s. 18 (1).

Section Amendments with date in force (d/m/y)

2010, c. 14, s. 18 (1) - 08/06/2010

2. Repealed: 2010, c. 14, s. 18 (1).

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (1) - 28/03/2006

2010, c. 14, s. 18 (1) - 08/06/2010

3.-7. Repealed: 2010, c. 14, s. 18 (1).

Section Amendments with date in force (d/m/y)

2010, c. 14, s. 18 (1) - 08/06/2010

PART II
HEALTH SERVICES ACCESSIBILITY

Definitions

8. In this Part,

“Board” means the Health Services Appeal and Review Board under the Ministry of Health and Long-Term Care Appeal and Review Boards Act, 1998; (“Commission”)

Note: On a day to be named by proclamation of the Lieutenant Governor, section 8 is amended by adding the following definition:

“College” means a College within the meaning of the Regulated Health Professions Act, 1991, but does not include the College of Physicians and Surgeons of Ontario; (“ordre”)

See: 2009, c. 26, ss. 1 (1), 27 (2).

“designated practitioner” means a practitioner that is designated by the regulations as being a practitioner who may not charge an amount for the provision of insured services rendered to an insured person other than the amount payable by the Plan; (“praticien désigné”)

Note: On a day to be named by proclamation of the Lieutenant Governor, section 8 is amended by adding the following definition:

“designated service” means a service,

(a) that has been designated by the regulations as a designated service,

(b) that is not an insured service,

(c) that is rendered by a member of a prescribed College while the member is engaging in the practice of his or her health profession, or, if the regulations so provide in the case of a regulation making the dispensing of a drug a designated service, a member of the College of Physicians and Surgeons of Ontario, and

(d) that is provided under the circumstances, if any, or in accordance with the limitations and conditions, if any, that are provided for in the regulations; (“service désigné”)

See: 2009, c. 26, ss. 1 (1), 27 (2).

“General Manager” means the General Manager of the Plan appointed under the Health Insurance Act; (“directeur général”)

“insured person” means a person who is entitled to insured services under the Health Insurance Act and the regulations made under it; (“assuré”)

“insured service” means a service that is an insured service under the Health Insurance Act and the regulations made under it; (“service assuré”)

Note: On a day to be named by proclamation of the Lieutenant Governor, section 8 is amended by adding the following definition:

“Minister” means the Minister of Health and Long-Term Care; (“ministre”)

See: 2009, c. 26, ss. 1 (1), 27 (2).

“non-designated practitioner” means a practitioner who is not a designated practitioner; (“praticien non désigné”)

“personal information” means any information about an identifiable individual; (“renseignements personnels”)

“physician” means a legally qualified medical practitioner who is lawfully entitled to practise medicine in Ontario; (“médecin”)

“Plan” means the Ontario Health Insurance Plan; (“Régime”)

“practitioner” means a practitioner or a health facility within the meaning of the Health Insurance Act that is prescribed as a practitioner for the purposes of this Part; (“praticien”)

“prescribed” means prescribed by the regulations made under this Part; (“prescrit”)

“unauthorized payment” means any payment accepted contrary to section 10. (“paiement non autorisé”)  2004, c. 5, s. 8; 2009, c. 33, Sched. 18, s. 17 (2).

Section Amendments with date in force (d/m/y)

2009, c. 26, s. 1 (1) - not in force; 2009, c. 33, Sched. 18, s. 17 (2) - 15/12/2009

General Manager

9. Subject to this Part and the regulations, the General Manager shall carry out any functions and duties that the General Manager considers necessary for purposes related to the administration of this Part.  2004, c. 5, s. 9.

Persons not to charge more than OHIP

10. (1) A physician or designated practitioner shall not charge more or accept payment or other benefit for more than the amount payable under the Plan for rendering an insured service to an insured person.  2004, c. 5, s. 10 (1).

Exception

(2) Subsection (1) does not apply to,

(a) a charge made to or a payment or benefit accepted from a public hospital for an insured service rendered to an insured person in that public hospital;

(b) a charge made to or a payment accepted from a prescribed facility for an insured service rendered to an insured person in that facility; or

(c) any other charge, payment, benefit or service that is prescribed, subject to any prescribed conditions or limitations.  2004, c. 5, s. 10 (2).

Physicians and designated practitioners

(3) A physician or designated practitioner shall not accept payment or benefit for an insured service rendered to an insured person except,

(a) from the Plan, including a payment made in accordance with an agreement made under subsection 2 (2) of the Health Insurance Act;

(b) from a public hospital or prescribed facility for services rendered in that public hospital or facility; or

(c) if permitted to do so by the regulations in the prescribed circumstances and on the prescribed conditions.  2004, c. 5, s. 10 (3).

Non-designated practitioners

(4) A non-designated practitioner shall not accept payment except from the Plan for that part of his or her account for any insured service rendered to an insured person that is payable by the Plan.  2004, c. 5, s. 10 (4).

Restriction on who may accept payment

(5) No person or entity may charge or accept payment or other benefit for an insured service rendered to an insured person,

(a) except as permitted under this section; or

(b) unless permitted to do so by the regulations in the prescribed circumstances and on the prescribed conditions.  2004, c. 5, s. 10 (5).

Not a payment or other benefit

(6) For the purposes of subsection (5), “payment or other benefit” does not include a salary or an amount payable under a contract of employment or a contract of services to an employee of or a person who contracts with a physician, practitioner, public hospital or prescribed facility.  2004, c. 5, s. 10 (6).

Transitional

11. (1) This section applies to physicians and designated practitioners who, on or before May 13, 2004, have rendered insured services to insured persons and who had never notified the General Manager of their intention to submit accounts for the performance of insured services rendered to insured persons directly to the Plan in accordance with subsection 15 (1) or 16 (1) of the Health Insurance Act, or had notified the General Manager under subsection 15 (4) or 16 (4) of the Health Insurance Act that they intended to cease submitting their accounts directly to the Plan.  2004, c. 5, s. 11 (1).

Notification

(2) If a physician or designated practitioner mentioned in subsection (1) notifies the General Manager by registered mail, within 90 days of the coming into force of this section, that he or she intends not to submit his or her accounts directly to the Plan, the provisions of subsection (7) apply to him or her.  2004, c. 5, s. 11 (2).

Transitional time

(3) Subsection 10 (3) does not apply to a physician or designated practitioner mentioned in subsection (1) who does not give notice under subsection (2) until the first day of the third month following the expiration of the 90-day period under subsection (2).  2004, c. 5, s. 11 (3).

Subsequent election

(4) A physician or designated practitioner who has notified the General Manager under subsection (2) may subsequently notify the General Manager by registered mail that he or she intends to submit his or her accounts directly to the Plan for the performance of insured services rendered to insured persons and in such a case, subsection 10 (3) shall apply and the physician or designated practitioner may not subsequently choose to cease submitting his or her accounts directly to the Plan.  2004, c. 5, s. 11 (4).

When decision takes effect

(5) A decision to submit accounts directly to the Plan under subsection (4) takes effect as of the first day of the third month following the month in which the General Manager received the notification.  2004, c. 5, s. 11 (5).

Deemed election

(6) Unless the General Manager is satisfied that the account was submitted in error, if a physician or designated practitioner who has notified the General Manager under subsection (2) subsequently submits an account directly to the Plan for the performance of insured services rendered to an insured person, he or she shall be deemed to have notified the General Manager under subsection (4) that he or she intends to submit his or her accounts directly to the Plan, except in respect of any prescribed accounts or classes of accounts, and subject to any prescribed circumstances or conditions.  2004, c. 5, s. 11 (6).

Where notification given

(7) The following apply to a physician or designated practitioner who has notified the General Manager under subsection (2), except in respect of any prescribed accounts or classes of accounts, and subject to any prescribed circumstances or conditions:

1. Subsection 10 (3) does not apply to the physician or designated practitioner and, despite subsection 10 (5), he or she may accept payment for the rendering of insured services to insured persons from a source not mentioned in clause 10 (3) (a), (b) or (c), if he or she complies with all other relevant provisions of this Part.

2. Subject to subsection 10 (2), the physician or designated practitioner shall not accept payment for rendering an insured service to an insured person until after he or she receives notice that the patient has been reimbursed by the Plan unless the insured person consents to make the payment on an earlier date. 

3. All other applicable provisions of this Part apply to the physician or designated practitioner.  2004, c. 5, s. 11 (7).

Note: On a day to be named by proclamation of the Lieutenant Governor, the Act is amended by adding the following section:

Designated services

11.1 (1) Where a service has been designated as a designated service, no person or entity may charge or accept payment or other benefit for a designated service rendered to an insured person, except as permitted by and in accordance with the regulations.  2009, c. 26, s. 1 (2).

Determination

(2) A prescribed person may make a determination that a charge, payment or other benefit was made or accepted contrary to subsection (1).  2009, c. 26, s. 1 (2).

Application to Board

(3) Any person or entity with standing may apply to the Board,

(a) for a review to determine whether a charge, payment or other benefit was made or accepted contrary to subsection (1); or

(b) for a review of a determination made under subsection (2).  2009, c. 26, s. 1 (2).

Standing

(4) For the purposes of subsection (3), “person or entity with standing” means,

(a) in clause (3) (a),

(i) a person or entity that charged or may have charged or accepted or may have accepted payment or other benefit for a designated service rendered to an insured person,

(ii) an insured person to whom a designated service was rendered or may have been rendered or who was charged or may have been charged for a designated service or who paid for or provided a benefit or may have paid for or provided a benefit for a designated service,

(iii) a prescribed person referred to in subsection (2), or

(iv) any other person or entity provided for in the regulations; and

(b) in clause (3) (b),

(i) a person or entity that has been determined to have charged or accepted payment or other benefit for a designated service rendered to an insured person,

(ii) an insured person to whom a designated service was rendered who has been determined to have been charged or determined to have paid for or provided a benefit for the designated service, or

(iii) any other person or entity provided for in the regulations.  2009, c. 26, s. 1 (2).

Appeal

(5) Any party to a matter before the Board under this section may in the circumstances provided for in the regulations appeal from the Board’s determination or order to the Divisional Court in accordance with the rules of the court.  2009, c. 26, s. 1 (2).

Evidence

(6) Section 23 of the Health Insurance Act applies to the matter before the Board as if it were a hearing under section 21 of the Health Insurance Act.  2009, c. 26, s. 1 (2).

Filing with court

(7) A copy of a determination or order made by the Board under this section may be filed with the Superior Court of Justice after the time in which an appeal may be made has passed, and once filed shall be entered in the same way as a judgment or order of the Superior Court of Justice and is enforceable as an order of that court.  2009, c. 26, s. 1 (2).

Regulations

(8) The Lieutenant Governor in Council may make regulations governing designated services, and without restricting the generality of the foregoing, may make regulations,

(a) designating services as designated services and, for the purposes of the definition of “designated service”,

(i) providing for the circumstances under which a service is a designated service,

(ii) providing for limitations and conditions on the provision of a designated service,

(iii) prescribing Colleges for the purposes of the definition of “designated service”;

(b) limiting any charges or payments for rendering a designated service to an insured person to charges made to or payments accepted from the Crown in right of Ontario and providing for audits and for the recovery and reimbursement of amounts received contrary to this Act or the regulations;

(c) defining “charge”, “payment”, “benefit”, “dispensing” or “drug” for the purposes of this section;

(d) governing when, to whom, by whom, in what circumstances and in what amounts, charges may be made or payments may be accepted for rendering designated services, including establishing maximum amounts that may be charged, and prohibiting charges and payments, in full or in part;

(e) governing the making of payments, including governing the information that must be maintained in support of such payments and the information that must be furnished in connection with them, and governing the manner in which payments must be made and the times within which they must be made;

(f) governing the information that must be provided to a person who is charged for a designated service;

(g) specifying services that are not designated services;

(h) where the dispensing of a drug is designated as a designated service, clarifying the relationship between this Act and the Drug Interchangeability and Dispensing Fee Act or any other Act or law, including specifying which Act or law prevails in the case of a conflict;

(i) prescribing persons for the purposes of subsection (2);

(j) governing any matter before the Board under this section, including providing for,

(i) applications and the giving of notice,

(ii) the parties to the proceedings,

(iii) the manner in which the proceedings shall be conducted and the conduct of proceedings,

(iv) when the Minister or another prescribed person is entitled to be heard or otherwise make submissions,

(v) the powers of the Board upon making a determination,

(vi) the circumstances in which an appeal of the determination or order of the Board may be made to the Divisional Court,

(vii) the powers of the Divisional Court upon the appeal.  2009, c. 26, s. 1 (2).

Public consultation

(9) Section 7 applies to the making of regulations under this section, with necessary modification.  2009, c. 26, s. 1 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (9) is repealed and the following substituted:

Public consultation

(9) Subsections 16 (2) to (9) of the Excellent Care for All Act, 2010 apply to the making of regulations under this section, with necessary modification.  2010, c. 14, s. 18 (2).

See: 2010, c. 14, ss. 18 (2), 21 (2).

See: 2009, c. 26, ss. 1 (2), 27 (2).

Section Amendments with date in force (d/m/y)

2009, c. 26, s. 1 (2) - not in force

2010, c. 14, s. 18 (2) - not in force

Agreement for determining amount

12. (1) The Minister of Health and Long-Term Care may enter into agreements with the associations mentioned in subsection (2), as representatives of physicians, dentists and optometrists, to provide for methods of negotiating and determining the amounts payable under the Plan in respect of the rendering of insured services to insured persons.  2004, c. 5, s. 12 (1).

Associations

(2) The associations representing physicians, dentists and optometrists are,

(a) the Ontario Medical Association, in respect of physicians;

(b) the Ontario Dental Association, in respect of dentists; and

(c) the Ontario Association of Optometrists, in respect of optometrists.  2004, c. 5, s. 12 (2).

No liability

(2.1) No cause of action arises and no civil proceedings may be brought or maintained against a director, officer, member, employee or agent of the Ontario Medical Association for anything done in good faith with respect to,

(a) any agreement entered into between the Ontario Medical Association and the Minister of Health and Long-Term Care or the Crown in right of Ontario respecting,

(i) insured services under the Plan,

(ii) the amounts payable under the Plan in respect of the rendering of insured services to insured persons, or

(iii) other amounts payable to physicians by the Minister or the Crown; or

(b) any recommendation made to the Minister of Health and Long-Term Care or the Crown in right of Ontario concerning anything related to,

(i) insured services under the Plan,

(ii) the amounts payable under the Plan in respect of the rendering of insured services to insured persons, or

(iii) other amounts payable to physicians by the Minister or the Crown. 2015, c. 27, Sched. 3, s. 1.

Same

(3) The Lieutenant Governor in Council may make a regulation providing that the Minister may enter into an agreement under subsection (1) with a specified person or organization other than an association mentioned in subsection (2).  2004, c. 5, s. 12 (3).

Definitions

(4) In this section,

“dentist” means a member of the Royal College of Dental Surgeons of Ontario; (“dentiste”)

“optometrist” means a member of the College of Optometrists of Ontario. (“optométriste”)  2004, c. 5, s. 12 (4).

Section Amendments with date in force (d/m/y)

2015, c. 27, Sched. 3, s. 1 - 03/12/2015

Unauthorized payment

13. (1) If the General Manager is of the initial opinion that a person has paid an unauthorized payment, the General Manager shall promptly serve on the physician, practitioner, other person or entity that is alleged to have received the unauthorized payment notice of the General Manager’s intent to reimburse the person who is alleged to have made the unauthorized payment, together with a brief statement of the facts giving rise to the General Manager’s initial opinion.  2004, c. 5, s. 13 (1).

Providing information

(2) The physician, practitioner, other person or entity that is alleged to have received the unauthorized payment may, not later than 21 days after receiving the notice described in subsection (1), provide the General Manager in writing with any information that he, she or it believes is relevant to determining whether an unauthorized payment has been paid.  2004, c. 5, s. 13 (2).

Payment by General Manager

(3) If, after reviewing any information provided in accordance with subsection (2), the General Manager is satisfied that a person has paid an unauthorized payment, the General Manager shall pay to the person the amount of the unauthorized payment.  2004, c. 5, s. 13 (3).

Debt

(4) Where a person has paid an unauthorized payment and the General Manager has paid the person under subsection (3), the physician, practitioner, other person or entity to whom the unauthorized payment was made is indebted to the Plan for the amount of the unauthorized payment and the amount of the administrative charge prescribed by the regulations.  2004, c. 5, s. 13 (4).

General Manager to recover money

(5) The General Manager may recover from the physician, practitioner, other person or entity a part or all of any amount he, she or it is indebted to the Plan under subsection (4) by set-off against any money payable by the Plan or under the Independent Health Facilities Act to him, her or it.  2004, c. 5, s. 13 (5).

Applies despite SPPA

(6) Despite section 25 of the Statutory Powers Procedure Act, a request for a review under section 14 or any application for judicial review of a review under section 14 does not stay the General Manager from exercising any right of set-off under subsection (5).  2004, c. 5, s. 13 (6).

Notice of recovery

(7) Following a payment under subsection (3), the General Manager shall promptly serve on the physician, practitioner, other person or entity notice of the amount of his, her or its indebtedness to the Plan, the account in respect of which the indebtedness arose and his, her or its right under section 14 to request a review of the issue.  2004, c. 5, s. 13 (7).

Service of notice

(8) The notice under subsection (1) or (7) shall be served upon the physician, practitioner, other person or entity to whom the notice is required to be given in accordance with the regulations, and shall be deemed to have been given on a date determined in accordance with the regulations.  2004, c. 5, s. 13 (8).

Entitlement to review

14. (1) A physician, practitioner, other person or entity is entitled to a review of the issue of whether he, she or it has received an unauthorized payment if within 15 days after receiving the notice under subsection 13 (7) he, she or it mails or delivers to the General Manager written notice requesting a review.  2004, c. 5, s. 14 (1).

Referral for review

(2) The General Manager, upon receiving a request for a review in accordance with subsection (1), shall refer the matter to the Board’s chair.  2004, c. 5, s. 14 (2).

Persons to review

(3) The Board’s chair may from time to time appoint a member of the Board to conduct a review under this Part.  2004, c. 5, s. 14 (3).

Terms of reference

(4) A member of the Board conducting a review shall inquire into whether the physician, practitioner, other person or entity has received an unauthorized payment.  2004, c. 5, s. 14 (4).

Right to representations

(5) The General Manager, the physician, practitioner, other person or entity to which notice must be given under subsection 13 (7) and the insured person have the right to make written representations to the member of the Board conducting the review.  2004, c. 5, s. 14 (5).

Non-application of SPPA

(6) Despite any provision of the Statutory Powers Procedure Act, the written representations to the member of the Board are the only representations that may be made under this section.  2004, c. 5, s. 14 (6).

Decision in writing

(7) The member of the Board conducting a review shall provide to the parties who made representations in accordance with subsection (5) a decision in writing as to whether, in the Board’s opinion, an unauthorized payment was paid and, if so, the amount of that payment.  2004, c. 5, s. 14 (7).

Filing of notice or decision

(8) Where a physician, practitioner, other person or entity has not requested a review in accordance with subsection (1) or where a member of the Board has conducted a review and determined that the physician, practitioner, other person or entity has received an unauthorized payment, the General Manager may file with the Superior Court of Justice a copy of the notice given by the General Manager to the physician, practitioner, other person or entity, or of the decision of the Board, as the case may be, and the notice or decision shall be entered in the same way as a judgment or order of the Superior Court of Justice and is enforceable as an order of that court.  2004, c. 5, s. 14 (8).

General Manager to pay

(9) If the member of the Board conducting a review advises the General Manager that the General Manager recovered more from the physician, practitioner, other person or entity than the sum of the unauthorized payment, if any, and the administrative charge, the General Manager shall pay the physician, practitioner, other person or entity,

(a) if the member finds there was no unauthorized payment, the total amount recovered; or

(b) if the member finds there was an unauthorized payment, the difference between the amount recovered and the amount that should have been recovered.  2004, c. 5, s. 14 (9).

Personal information

15. (1) The General Manager may directly or indirectly collect personal information, subject to such conditions as may be prescribed, for purposes related to the administration of this Part, the Health Insurance Act or the Independent Health Facilities Act.  2004, c. 5, s. 15 (1).

Use of personal information

(2) The General Manager may use personal information, subject to any conditions that may be prescribed, for purposes related to the administration of this Part, the Health Insurance Act or the Independent Health Facilities Act.  2004, c. 5, s. 15 (2).

Disclosure

(3) The General Manager shall disclose personal information if all prescribed conditions have been met and if the disclosure is necessary for purposes related to the administration of this Part, the Health Insurance Act, the Independent Health Facilities Act, the Regulated Health Professions Act, 1991 or a health profession Act as defined in that Act, but shall not disclose the information if, in his or her opinion, the disclosure is not necessary for those purposes.  2004, c. 5, s. 15 (3).

Limitation

(4) The General Manager shall not collect, use or disclose more information than is reasonably necessary for the purposes of the collection, use or disclosure.  2004, c. 5, s. 15 (4).

Obligation

(5) Before disclosing personal information obtained under this Part, the person who obtained it shall delete from it all names and identifying numbers, symbols or other particulars assigned to individuals unless,

(a) disclosure of the names or other identifying information is necessary for the purposes described in subsection (3); or

(b) disclosure of the names or other identifying information is otherwise authorized under the Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, 2004.  2004, c. 5, s. 15 (5), (7).

(6) Spent:  2004, c. 5, s. 15 (6).

(7) Spent:  2004, c. 5, s. 15 (7).

Section Amendments with date in force (d/m/y)

2004, c. 5, s. 15 (7) - 23/09/2004

Disclosure of information to the General Manager

16. (1) The General Manager may require that any person or entity submit information to the General Manager for the purposes of determining whether there has been a contravention of or a failure to comply with any of the following provisions, if the General Manager is of the opinion that such a contravention or failure may have taken place:

1. Section 10, 13, 17 or 18 of this Act.

2. Section 15 or 15.1 of the Health Insurance Act.

3. Section 3 of the Independent Health Facilities Act.  2004, c. 5, s. 16 (1).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is repealed and the following substituted:

Disclosure of information

(1) The General Manager or, in the case of a determination regarding section 11.1 and if the regulations so provide, another prescribed person may require that any person or entity submit information to the General Manager or the prescribed person for the purposes of determining whether there has been a contravention of or a failure to comply with any of the following provisions, if the General Manager or prescribed person is of the opinion that such a contravention or failure may have taken place:

1. Section 10, 11.1, 13, 17 or 18 of this Act.

2. Section 15 or 15.1 of the Health Insurance Act.

3. Section 3 of the Independent Health Facilities Act.  2009, c. 26, s. 1 (3).

See: 2009, c. 26, ss. 1 (3), 27 (2).

Same

(2) The information mentioned in subsection (1) may be any information that the General Manager reasonably considers is necessary for the purposes mentioned in subsection (1).  2004, c. 5, s. 16 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is repealed and the following substituted:

Same

(2) The information mentioned in subsection (1) may be any information that the General Manager or prescribed person reasonably considers is necessary for the purposes mentioned in subsection (1).  2009, c. 26, s. 1 (3).

See: 2009, c. 26, ss. 1 (3), 27 (2).

Time and form

(3) Subject to the regulations, the information shall be submitted and disclosed,

(a) in the form required by the General Manager; and

(b) within 21 days of the receipt by the person or entity of the request by the General Manager.  2004, c. 5, s. 16 (3).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (3) is repealed and the following substituted:

Time and form

(3) Subject to the regulations, the information shall be submitted and disclosed,

(a) in the form required by the General Manager or prescribed person; and

(b) within 21 days of the receipt by the person or entity of the request by the General Manager or prescribed person.  2009, c. 26, s. 1 (3).

See: 2009, c. 26, ss. 1 (3), 27 (2).

Extension of time

(4) The General Manager may extend the period of time mentioned in clause (3) (b) for a time that the General Manager believes is reasonable in the circumstances, if the General Manager believes that the person or entity cannot submit or disclose the information within the period of time for reasons that he, she or it cannot control.  2004, c. 5, s. 16 (4).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (4) is repealed and the following substituted:

Extension of time

(4) The General Manager or prescribed person may extend the period of time mentioned in clause (3) (b) for a time that he or she believes is reasonable in the circumstances, if the General Manager or prescribed person believes that the person or entity cannot submit or disclose the information within the period of time for reasons that he, she or it cannot control.  2009, c. 26, s. 1 (3).

See: 2009, c. 26, ss. 1 (3), 27 (2).

Suspension of payments

(5) The Minister or the General Manager may suspend payments under the Plan or under the Independent Health Facilities Act to a person or entity during any period when he, she or it fails to comply with subsection (1) without just cause, whether or not the person or entity is convicted of an offence.  2004, c. 5, s. 16 (5).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (5) is repealed and the following substituted:

Suspension of payments

(5) The Minister, the General Manager or a prescribed person may suspend payments under the Plan or under the Independent Health Facilities Act or under any other Act, law or system of payments to a person or entity during any period when the person or entity fails to comply with subsection (1) without just cause, whether or not the person or entity is convicted of an offence.  2009, c. 26, s. 1 (3).

See: 2009, c. 26, ss. 1 (3), 27 (2).

Reporting

(6) Any person shall report to the General Manager any information relating to the administration or enforcement of this Part or the regulations, the Health Insurance Act or the Independent Health Facilities Act if the person believes it to be in the public interest to do so.  2004, c. 5, s. 16 (6).

(7) Repealed:  2004, c. 3, Sched. A, s. 79 (3).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (6) is repealed and the following substituted:

Reporting

(6) Any person shall report to the General Manager or to a prescribed person any information relating to the administration or enforcement of this Part or the regulations, the Health Insurance Act or the Independent Health Facilities Act if the person believes it to be in the public interest to do so.  2009, c. 26, s. 1 (3).

Regulations

(7) The Lieutenant Governor in Council may make regulations defining “system of payments” for the purposes of this section.  2009, c. 26, s. 1 (3).

See: 2009, c. 26, ss. 1 (3), 27 (2).

Protection from liability

(8) No proceeding for reporting, providing or disclosing information under this section shall be commenced against a person unless he or she acts maliciously and the information is not true.  2004, c. 5, s. 16 (8).

No retaliation

(9) No person or entity shall discipline or penalize any person for reporting, providing or disclosing information under this section unless he or she acts maliciously and the information is not true.  2004, c. 5, s. 16 (9).

Exception: solicitor-client privilege

(10) Nothing in this section abrogates any privilege that may exist between a solicitor and his or her client.  2004, c. 5, s. 16 (10).

Interpretation

(11) In this section,

“information” includes personal information.  2004, c. 5, s. 16 (11).

Section Amendments with date in force (d/m/y)

2004, c. 3, Sched. A, s. 79 (3) - 01/11/2004

2009, c. 26, s. 1 (3) - not in force

Preferences

17. (1) No person or entity shall,

(a) pay or confer a benefit upon any person or entity in exchange for conferring upon an insured person a preference in obtaining access to an insured service;

(b) charge or accept payment or a benefit for conferring upon an insured person a preference in obtaining access to an insured service;

(c) offer to do anything referred to in clause (a) or (b).  2004, c. 5, s. 17 (1).

Mandatory reporting

(2) A prescribed person who, in the course of his or her professional or official duties, has reason to believe that anything prohibited by subsection (1) has occurred shall promptly report the matter to the General Manager.  2004, c. 5, s. 17 (2).

(3) Repealed:  2004, c. 3, Sched. A, s. 79 (4).

Protection from liability

(4) No proceeding for making a report under subsection (2) or for providing information in connection with the report shall be commenced against a person unless he or she acts maliciously and the information on which the report is based is not true.  2004, c. 5, s. 17 (4).

No retaliation

(5) No person or entity shall discipline or penalize any person for making a report under subsection (2) or for providing information in connection with the report unless the person who reported or provided the information acted maliciously and the information is not true.  2004, c. 5, s. 17 (5).

Defence

(6) Where an employer or contractor is charged with contravening subsection (1) as a result of an act committed by an employee, subcontractor or person with whom the employer or contractor contracted, it is a defence to the charge that the employer or contractor took all reasonable steps in the circumstances to prevent such a contravention.  2004, c. 5, s. 17 (6).

Exception: solicitor-client privilege

(7) Nothing in this section abrogates any privilege that may exist between a solicitor and his or her client.  2004, c. 5, s. 17 (7).

Section Amendments with date in force (d/m/y)

2004, c. 3, Sched. A, s. 79 (4) - 01/11/2004

Block fees

18. (1) If regulations have been made under this section, a person or entity may charge a block or annual fee only in accordance with those regulations.  2004, c. 5, s. 18 (1).

Non-discrimination

(2) A physician, practitioner or hospital shall not refuse to render an insured service to an insured person or refuse to continue rendering insured services to an insured person for any reason relating to an insured person’s choice not to pay a block or annual fee.  2004, c. 5, s. 18 (2).

Regulations

(3) For the purposes of this section, the Lieutenant Governor in Council may make regulations governing block or annual fees, including the circumstances under which they may be charged and the information that must be provided to the person who is charged, but may not regulate the amount of such a fee.  2004, c. 5, s. 18 (3).

Definition

(4) In this section,

“block or annual fee”,

(a) means a fee charged in respect of one or more health services that are not insured services as defined in section 1 of the Health Insurance Act, or a fee for an undertaking not to charge for such a service or to be available to provide such a service or services if,

(i) the service or services are or would be rendered by a physician, practitioner or hospital, or the service or services are or would be necessary adjuncts to services rendered by a physician, practitioner or hospital, and

(ii) at the time the fee is paid it is not possible for the person paying the fee to know with certainty how many, if any, of the services covered by the block or annual fee the patient will require during the period of time covered by the block or annual fee, or

(b) has any other meaning that may be provided for in regulations made under subsection (3).  2004, c. 5, s. 18 (4).

Offence

19. (1) Every one who contravenes a provision of this Part or the regulations is guilty of an offence.  2004, c. 5, s. 19 (1).

Penalty, individual

(2) Subject to subsection (3), an individual who is convicted of an offence under this section is liable to a fine of not more than $10,000.  2004, c. 5, s. 19 (2).

Same, s. 17 (2)

(3) An individual who is convicted of an offence under this section for contravening subsection 17 (2) is liable to a fine not exceeding $1,000.  2004, c. 5, s. 19 (3).

Penalty, corporation

(4) A corporation that is convicted of an offence under this section is liable to a fine not exceeding $25,000.  2004, c. 5, s. 19 (4).

Compensation or restitution

(5) The court that convicts a person of an offence under this section may, in addition to any other penalty, order that the person pay compensation or make restitution to any person who suffered a loss as a result of the offence.  2004, c. 5, s. 19 (5).

Limitation

(6) A prosecution for an offence under this section shall not be commenced after two years after the date on which the offence was, or is alleged to have been, committed.  2004, c. 5, s. 19 (6).

Regulations

20. (1) The Lieutenant Governor in Council may make regulations,

(a) prescribing practitioner and health facilities for the purposes of the definition of “practitioner” in this Part;

(b) designating practitioners as practitioners who may not charge an amount for the provision of insured services rendered to insured persons other than the amount payable by the Plan;

(c) governing circumstances and prescribing conditions for the purposes of subsection 10 (5);

(d) prescribing an administrative charge for the purpose of subsection 13 (4), and for that purpose may set out a formula to determine the charge;

(e) governing service for the purposes of subsection 13 (8);

(f) prescribing conditions and purposes for the purposes of section 15;

(g) governing the information that must be provided under section 16, including its content and the form in which it must be provided;

(h) prescribing persons for the purposes of section 17;

(i) prescribing conditions and limitations for the purposes of this Part;

(j) prescribing anything that must or may be prescribed under this Part or anything that is required or permitted to be done in accordance with the regulations or as provided in the regulations.  2004, c. 5, s. 20 (1).

Same

(2) A regulation under this Part may be general or specific in its application, may create different categories or classes, and may make different provisions for different categories, classes or circumstances.  2004, c. 5, s. 20 (2).

Exemptions

(3) A regulation under this Part may provide for exemption from the application of any provision of this Part.  2004, c. 5, s. 20 (3).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (3) is repealed and the following substituted:

Exemptions

(3) The Lieutenant Governor in Council may make regulations exempting any person or entity or class of persons or entities from the application of any provision of this Part, and may make such an exemption subject to any condition that may be provided for in the regulations.  2009, c. 26, s. 1 (4).

See: 2009, c. 26, ss. 1 (4), 27 (2).

Retroactivity

(4) A regulation under this Part is effective with respect to a period before it was filed if the regulation so provides.  2004, c. 5, s. 20 (4).

Restriction

(5) A regulation made for the purposes of this Part shall not include a provision that is contrary to a provision of the Canada Health Act.  2004, c. 5, s. 20 (5).

Section Amendments with date in force (d/m/y)

2009, c. 26, s. 1 (4) - not in force

PART III (ss. 21-35) Repealed: 2016, c. 30, s. 33.

21. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (2-5) - 18/07/2007

2007, c. 8, s. 199 (1) - no effect - see 2006, c. 4, s. 44 (3) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

22. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (6, 7) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

23. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (8-13) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

24. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (13-22) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

25. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (13, 18, 23-26) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

26. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (27) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

27. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (18, 28-35) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

28. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (36-46) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

29. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (47) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

30. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (48) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

31. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (49) - 18/07/2007

2007, c. 8, s. 199 (2) - 01/07/2010

2016, c. 30, s. 33 - 8/12/2016

32. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (50) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

33. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (51, 52) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

34. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2006, c. 4, s. 44 (53, 54) - 18/07/2007

2016, c. 30, s. 33 - 8/12/2016

35. Repealed: 2016, c. 30, s. 33.

Section Amendments with date in force (d/m/y)

2016, c. 30, s. 33 - 8/12/2016

36.-44. Omitted (amends or repeals other Acts).  2004, c. 5, ss. 36-44.

45. Omitted (provides for coming into force of provisions of this Act).  2004, c. 5, s. 45.

46. Omitted (enacts short title of this Act).  2004, c. 5, s. 46.

______________

 

Français