Be it enacted by the Lieutenant-Governor and
House of Assembly in Legislative Session convened, as follows:
Short title
1. This
Act may be cited as the Medical Care and
Hospital Insurance Act.
Definitions
2. In
this Act
(a) "beneficiary" means a person who is
so defined under the regulations but does not include
(i) a member of the Canadian Forces,
(ii) a person serving a term of imprisonment in a
penitentiary as defined in the Corrections
and Conditional Release Act (Canada), or
(iii) a resident for whom the required waiting
period prescribed by the regulations has not elapsed;
(b) "dental association" means the Newfoundland and
Labrador Dental Association continued under the Dental Act, 2008;
(c) "department" means the department
presided over by the minister;
(d) "documentation" includes correspondence,
health records, notes, charts, documents, material and other information;
(e) "earned vehicles" means the
aggregate exposure, in car years, for automobile liability coverage derived
from all statistical experience reported and accepted by the Superintendent of
Insurance under all types of business other than type 3, miscellaneous and
fleets on an earnings, receipts or payroll basis, for those vehicle types
exhibited annually in the Actual Loss Ratio Exhibits covering the general
categories of private passenger, farmers, commercial, motor cycles, snow
vehicles and interurban trucks;
(f) "hospital" means an institution operated
by the Crown or an agent of the Crown for the care of diseased, injured or sick
people;
(g) "hospital insurance plan" means the
hospital insurance plan referred to in section 5;
(h) "hospital service" means a service
so defined under the regulations;
(i) "injury" includes a disability;
(j) "insured service" means the medical services
and hospital services so defined under the regulations;
(k) "levy year" means a calendar year in
which a levy is due from insurance companies with respect to automobile insurance
business transacted in the province;
(l) "medical association" means the Newfoundland and Labrador
Medical Association continued under the Medical
Act, 2011;
(m) "medical care insurance plan" means
the medical care insurance plan referred to in section 5;
(n) "medical service" means a service so
defined under the regulations;
(o) "minister" means the minister appointed
under the Executive Council Act to
administer this Act;
(p) "participating practitioner" means a
practitioner who is enrolled with the medical care insurance plan as a
practitioner and for whom an election under section 8 is not in effect;
(q) "practitioner" means a person who is
(i) lawfully entitled to practise medicine or
dentistry in the province, or
(ii) entitled under the regulations to provide
insured services;
(r) "professional corporation" means a
corporation
(i) permitted under the Medical Act, 2011
to provide the services of a medical practitioner,
(ii) permitted under the Dental Act, 2008 to
provide the services of a dentist, or
(iii) permitted under another statute to provide the
services of a practitioner referred to in subparagraph (q)(ii);
(s) "resident" means a person who
(i) is lawfully entitled to be or to remain in Canada,
(ii) makes his or her home in the province, and
(iii) is ordinarily present in the province,
but does not include a tourist, transient or
visitor to the province; and
(t) "Superintendent of Insurance" means
the Superintendent of Insurance appointed under the Insurance Companies Act.
PART I
RIGHTS AND CONFIDENTIALITY
Rights
3. Nothing
in this Act or the regulations shall
(a) interfere with or restrict the right of a beneficiary
to select the practitioner, or other person providing services, from whom he or
she will receive insured services;
(b) interfere with or restrict the right of a practitioner,
or other person providing services, to accept or refuse to accept a patient who
is a beneficiary; or
(c) interfere with or restrict the right of a practitioner,
or other person providing services, to charge for insured services provided to
a patient who is not a beneficiary.
Confidentiality
of information
4. (1) A
person employed in the administration of this Act shall maintain
confidentiality with respect to all matters that come to his or her knowledge
in the course of that person's employment and shall not communicate the matters
to another person, including an employee of the government, except
(a) to a person to whom an insured service is provided
about that insured service;
(b) to a practitioner for a purpose relating to insured
services that the practitioner has provided;
(c) to a professional corporation and its
directors, officers and employees for a purpose relating to insured services that
were provided through the corporation;
(d) for the purpose of the administration of this
Act;
(e) for the purpose of consultation between the
minister and the medical association or the dental association;
(f) to a person employed by the government to
enforce support orders under the Support
Orders Enforcement Act, 2006;
(g) to a professional regulatory or licensing body
for the purpose of making an allegation;
(h) to a peace officer for the purpose of
reporting a suspected offence;
(i) to a person who is empowered by a statute
which requires disclosure of information;
(j) for the purpose of releasing information,
including personal health information as
defined in the Personal Health Information
Act, to the Newfoundland and Labrador Centre for Health Information in
accordance with the Centre for Health
Information Act and regulations made under that Act; or
(k) in other circumstances that may be established
by the Lieutenant-Governor in Council.
(2) The Crown is not liable for damages caused to
a person as a result of the release of information under subsection (1).
(3) An action for defamation against the minister
or an employee of the department shall not be founded on the disclosure of information
released under subsection (1).
PART II
PLANS
Medical care and
hospital insurance plans
5. (1) The
minister shall administer a medical care insurance plan and a hospital
insurance plan for the residents of the province.
(2) Each plan shall be administered and operated
on a non-profit basis.
Duty of residents
to register
6. (1) Every
resident shall register in accordance with the regulations.
(2) A resident who wilfully gives false
information or withholds information necessary for the purpose of registration
is guilty of an offence and liable on summary conviction to a fine of not more
than $10,000.
PART III
ACCOUNTS AND PAYMENTS
Extra billing
7. (1) A
practitioner who provides insured services, whether or not he or she has made
an election under section 8 which is in effect, shall not charge or collect
from a beneficiary a fee for those insured services in excess of the amount payable
under this Act and the regulations.
(2) A practitioner or other person who contravenes
subsection (1) is guilty of an offence and liable on summary conviction to
a fine of not more than $20,000 for each contravention.
Enrollment and
election
8. (1) A
practitioner who wishes to submit accounts and collect payments directly from
the medical care insurance plan for insured services provided to beneficiaries
shall enroll with that plan as a participating practitioner in accordance with
the regulations.
(2) The minister may refuse, suspend or cancel the
enrollment of a practitioner as a participating practitioner under the medical
care insurance plan in the circumstances prescribed by the regulations.
(3) A practitioner may, in writing, notify the
minister of his or her election to collect payments in respect of insured services
provided by the practitioner to beneficiaries otherwise than from the minister.
(4) An election under subsection (3) shall have
effect from the first day of the first month beginning after the expiration of
60 days after the date on which the minister receives the notice of election.
(5) A practitioner who has made an election under
subsection (3) may revoke the election by written notice to the minister.
(6) A revocation of election under subsection (5)
shall have effect from the first day of the first month beginning after the
expiration of 60 days after the date on which the minister receives the notice
of revocation.
(7) Notwithstanding subsections (4) and (6), the
minister may waive the time periods in those subsections where, in his or her opinion,
it is reasonable to do so.
Accounts
9. (1) In
order to receive payment for an insured service provided to a beneficiary, a
participating practitioner shall submit an account for the service to the
minister together with the information that is required to substantiate the
claim for payment in the form prescribed by the minister.
(2) In order to receive payment for an insured
service provided to a beneficiary by a practitioner who is not a participating
practitioner, the beneficiary shall submit an account to the minister together
with the information that is required to substantiate the claim for payment in
the form prescribed by the minister.
(3) Participating practitioners and beneficiaries shall
supply further information where the minister requires it to clarify or substantiate
his or her claim for payment.
Time to submit
account
10. (1) A
participating practitioner shall submit an account for an insured service no
later than 90 days after the practitioner provides the insured service.
(2) A beneficiary shall submit an account no later
than 2 years after the insured service is provided to him or her.
(3) Notwithstanding subsections (1) and (2), the
minister may extend the time for submitting an account where, in his or her
opinion, good cause for the extension is shown.
Payments generally
11. The minister shall not pay for an insured service
where the account for the service is not in accordance with this Act and the regulations.
Payment to participating
practitioner
12. (1) The
minister shall, under this Act and the regulations, make payment to a
participating practitioner for providing an insured service to a beneficiary according
to the terms, conditions and rates prescribed by the minister.
(2) Where a participating practitioner provides an
insured service to a beneficiary, he or she shall accept payment from the
minister in respect of that insured service, and the participating practitioner
shall accept the payment as payment in full for that service.
(3) Notwithstanding subsection (1), where a
participating practitioner performs professional services for a public
authority or body that has received the prior approval of the minister in
addition to the provision of insured services to beneficiaries, the minister
may, upon being satisfied that the participating practitioner is receiving
remuneration for the provision of those professional services, enter into an
arrangement with the public authority or body providing for the payment to it
for the insured services provided to beneficiaries, and the minister shall make
the payment in accordance with the arrangements made.
(4) A practitioner shall not receive payment from
the minister for an insured service provided to a beneficiary unless the
practitioner was a participating practitioner when the insured service was
provided.
Payments to beneficiaries
13. (1) Where
an insured service is provided in the province to a beneficiary by a
practitioner other than a participating practitioner, the minister shall, under
this Act and the regulations, make payment to the beneficiary in respect of
that insured service according to the terms, conditions and rates prescribed by
the minister.
(2) Where an insured service is provided outside
the province to a beneficiary, the minister shall make payment in accordance
with this Act and the regulations.
(3) The right of the beneficiary to receive
payment from the minister for insured services provided under subsection (1) is
a contractual right and the beneficiary is entitled to receive payment from the
minister in respect of those services in an amount equal to the amount that
would be payable to a participating practitioner by the minister under this Act
and the regulations.
Right not to be
assigned or attached
14. The
right of a beneficiary to receive payment from the minister in respect of insured
services provided to the beneficiary shall not be assigned, and an amount owing
in respect of the right shall not be charged or attached, and a transaction
purporting to assign the right or to charge or attach the amount is void.
Residents of
other jurisdictions
15. Where
an insured service is provided in the province to a person who is an insured person
of another jurisdiction in Canada
by other than a participating practitioner, the responsibility for payment will
not rest with the medical care insurance plan or the hospital insurance plan.
Exception for
emergencies
16. Notwithstanding subsection 12(4), where an insured service
is provided in the province to a beneficiary in an emergency, the minister may make
payment to a practitioner for that insured service even though the practitioner
was not a participating practitioner when the service was provided.
Professional corporation
17. (1)
Notwithstanding any other provision of this Act or the regulations, a professional
corporation may submit accounts and be paid by the minister in respect of insured
services provided by a participating practitioner through the professional
corporation to a beneficiary.
(2) A professional corporation submitting accounts
shall comply with sections 9, 10 and 12 of this Act as if it were a
participating practitioner.
(3) Where a professional corporation submits an
account for insured services, every participating practitioner whose services
are included in that account is considered to have certified that the information
provided about his or her services is true.
Non-application
of Act
18. (1) Where
a practitioner providing insured services is not a participating practitioner
and the practitioner provides an insured service to a beneficiary, the
practitioner is not subject to this Act or the regulations relating to the
provision of insured services to beneficiaries or the payment to be made for
the services except that he or she shall
(a) provide the beneficiary to whom the practitioner
has provided the insured service with the information required by the minister
to enable payment to be made under this Act to the beneficiary in respect of
the insured service; and
(b) not charge or collect from a beneficiary in respect
of an insured service an amount in excess of the amount which would be payable to
a participating practitioner by the minister under this Act or the regulations.
(2) Where a practitioner who is not a participating
practitioner provides insured services through a professional corporation, the professional
corporation is not, in relation to those services, subject to this Act or the regulations
relating to the provision of insured services to beneficiaries or the payment
to be made for the services except that the professional corporation and the
practitioner providing the insured services shall comply with paragraphs (1)(a)
and (b).
(3) Notwithstanding subsections (1) and (2), a practitioner
providing insured services who is not a participating practitioner and a professional
corporation through which a practitioner who is not a participating
practitioner provides insured services are subject to Part IV of this Act.
Penalties for
false statements
19. (1) A
practitioner providing insured services to a beneficiary who wilfully gives
false information or wilfully makes a false statement in a report, form or return
required to enable a payment to be made under this Act or the regulations is
guilty of an offence and liable on summary conviction to a fine of not less than
$10,000 and not more than $20,000.
(2) A person, other than a practitioner providing insured
services to a beneficiary, who wilfully gives false information or wilfully makes
a false statement in a report, form or return prescribed by or required for the
purpose of this Act or the regulations is guilty of an offence and liable on summary
conviction to a fine of not less than $10,000 and not more than $20,000.
(3) A professional corporation that wilfully gives
false information or wilfully makes a false statement in a report, form or
return required to enable a payment to be made under this Act or the regulations
is guilty of an offence and liable on summary conviction to a fine of not less
than $15,000 and not more than $25,000.
(4) The liability of a practitioner under subsection
(1) is not affected because the practitioner provides services through a professional
corporation.
PART IV
AUDITS
Definition
20. In
this Part, "practitioner" includes
(a) a participating practitioner;
(b) a person who was formerly a participating
practitioner under this Act or a participating physician under the Medical Care Insurance Act, 1999; and
(c) a person who was formerly a practitioner.
Audits
21. (1) The
minister may appoint auditors under this Act to audit accounts and claims for
payment by practitioners and the patterns of practice or billing followed by
practitioners including
(a) accounts and claims without proper
documentation;
(b) accounts and claims for services which are not
insured services;
(c) accounts and claims for insured services which
contain billing errors for services provided;
(d) accounts and claims for insured services which
are not medically necessary;
(e) accounts and claims in violation of this Act
or the regulations; and
(f) patterns of practice or billing that do not
follow the average pattern of practice or billing.
(2) An audit may be performed in respect of accounts
and claims for payment made and patterns of practice or billing followed by
practitioners before this Act came into force.
(3) Audits performed under this Act shall be
performed according to generally accepted auditing standards including
statistical sampling, estimation, extrapolation or those techniques prescribed
by the regulations.
(4) The minister may prepare guidelines and
criteria for the guidance of practitioners that may be applied to the patterns
of practice or billing followed by practitioners.
Powers and duties
22. (1) An
auditor performing an audit may, at reasonable times and for reasonable purposes
of the audit,
(a) without a warrant, enter and inspect premises where
insured services are provided or where documentation required for the purpose
of this Act is stored;
(b) examine documentation and make copies of it;
(c) interview or question a practitioner and his
or her employees on matters that relate to the provision of insured services;
(d) interview or question persons employed in a
hospital, clinic or other premises in which insured services are provided on
matters that relate to the provision of insured services; and
(e) interview or question a person on matters that
may be relevant to an audit.
(2) An examination of documentation referred to in
paragraph (1)(b) includes an examination of electronic records and an auditor
may make a copy of that documentation, including electronic records, in the
manner that, in his or her opinion, is necessary, including photocopying,
scanning and electronic copying of data.
(3) Notwithstanding paragraph (1)(a), an auditor
performing an audit shall not enter a dwelling-house without the consent of the
occupant except under the authority of a warrant.
(4) A person shall, on the request of an auditor,
(a) produce documentation and permit examination of
it;
(b) provide information required and answer all
questions of the auditor relating to the documentation; and
(c) supply copies of or extracts from the documentation.
(5) The minister may set time periods for
producing and examining documentation, providing information, answering
questions or supplying copies or extracts under subsection (4).
(6) Notwithstanding subsection (5), where the auditor
and the person agree, the time periods set by the minister under subsection (5)
may be extended.
(7) A person shall not hinder, obstruct or
interfere with an auditor doing anything that the auditor is authorized to do
under this section or prevent or attempt to prevent the auditor from doing any
such thing.
(8) A person shall not knowingly make a false or
misleading statement, either orally or in writing, or provide or produce false documentation
to an auditor who is carrying out duties and functions under this Act.
(9) An action shall not lie against a person for
providing documentation under this section.
(10) Paragraphs (1)(b) to (e) and subsection (4)
apply notwithstanding a provision of any other Act.
Notice to
practitioner
23. (1) Upon
completion of the audit, the auditor shall notify the practitioner in writing
of the findings of the audit and advise the practitioner of the right to alternative
dispute resolution, a review of the audit under section 26 or both.
(2) Notice under this section shall be sent by
registered mail.
(3) Notice of the findings of an audit sent by
registered mail in accordance with subsection (2) shall be considered to be received
on the fifth day following the day the notice is sent by registered mail,
unless the person to whom it is sent establishes that, acting in good faith,
the person did not receive the notice or did not receive it until a later date.
(4) Within 30 days of the auditor notifying the
practitioner of the findings of the audit under subsection (1), the minister
shall refer the findings of the audit in writing to the medical association or
the dental association which shall, where appropriate, make submissions to the
minister relating to the findings within 14 days of the referral.
(5) The practitioner may respond to the findings
of the audit in writing to the minister no more than 30 days from the receipt
of the notice of the findings of the audit under subsection (1).
(6) After reviewing the practitioner's response,
the minister may revoke one or more of the findings of the audit and notify the
practitioner accordingly.
Withholding of
payments
24. Where
an auditor notifies a practitioner of the findings of an audit under subsection
23(1), the minister may withhold from payments which would, apart from findings
of the audit to the contrary, be due to be paid to a participating practitioner
or professional corporation under section 12 for the provision of insured services,
up to the amount which, in the opinion of the minister, constitutes the value
of the subject matter raised by the audit, but only until the matter has been
finally determined, subject always to the right of permanent retention or withholding
for the purpose of compliance with an order made under section 29 or an
agreement made under paragraph 25(1)(a).
Overpayments
25. (1) Where
the findings of an audit indicate that there has been an overpayment to the
practitioner or the professional corporation, the minister may recover all or
part of the amount of the overpayment plus interest under
(a) an agreement between the minister and the
practitioner or the professional corporation; or
(b) an order of the minister made under section 29.
(2) Where there is an agreement under paragraph (1)(a),
the minister shall not make an order under section 29 unless the practitioner
or professional corporation does not comply with the agreement.
Review
26. (1) A
practitioner, either personally or through another person acting on his or her
behalf with his or her written consent, may request a review by a review board of
the findings of an audit performed under this Act.
(2) A request for a review under this section
shall be made in writing to the minister no more than 30 days from the receipt
of the notice of the findings of the audit provided under subsection 23(1).
(3) A request for review may be included in a
response submitted under subsection 23(5).
(4) A review board shall be appointed within 60
days of receipt of the request for a review.
(5) The review board shall conduct a hearing
within 60 days of its appointment.
(6) The review board shall make a written report of
its findings and recommendations to the minister within 30 days of the
completion of the hearing.
(7) Notwithstanding subsections (2), (4), (5) and
(6), where the parties to the hearing agree, the time periods referred to in those
sections may be extended.
(8) The parties to the hearing are the
practitioner, the professional corporation and the minister.
(9) A practitioner shall not request a review of
an amount identified as owing under an audit conducted in accordance with this
Act by reason only that the amount was determined from a random sample of the
practitioner's accounts or claims for payment and by the application of
statistical methodology to the account or claim for payment from which the
sample was drawn as opposed to a case by case examination of the accounts and claims
for payment in respect of which the audit is made.
(10) Only non-identifying personal health
information shall be disclosed in written or oral representations to the review
board.
Review board
27. (1) A
review board appointed under subsection 26(4) shall consist of the following persons,
all of whom shall first be appointed to the panel established under section 28:
(a) one member appointed by the minister;
(b) one member appointed by the practitioner or professional
corporation; and
(c) one member appointed jointly by the minister
and the practitioner or professional corporation.
(2) Where an appointment to the review board under
paragraph (1)(b) is not made within 30 days of the request to review, the
minister shall appoint a member to the review board on behalf of the
practitioner or professional corporation from the panel established under
section 28.
(3) Where the minister and the practitioner or professional
corporation are not able to agree on the appointment of a member under paragraph
(1)(c), the members appointed under paragraphs (1)(a) and (b) shall appoint the
third member of the review board.
(4) Where the members appointed under paragraphs
(1)(a) and (b) are not able to agree on the appointment of the third member under
subsection (3), the minister or the practitioner or professional corporation
may apply to the Trial Division for an order appointing the third member of the
review board.
(5) The review board shall determine the procedure
for the hearing.
(6) Notwithstanding subsection (5), the procedure
adopted for the hearing shall permit the parties to be represented by a
solicitor or other person, to lead evidence from witnesses and to produce documents.
(7) For the purpose of this Act, the review board
has the powers that are or may be conferred on a commission under the Public Inquiries Act, 2006.
Panel
28. (1) The
Lieutenant-Governor in Council shall appoint a panel of not more than 15
persons to act as members of review boards and
(a) at least 5 of those persons shall be medical
practitioners selected from a list of nominees provided by the medical association;
and
(b) at least 2 of those persons shall be dentists
selected from a list of nominees provided by the dental association.
(2) The members of the panel shall be appointed
for a term of up to 3 years and are eligible for reappointment.
(3) Where the term of a member of the panel
expires, he or she continues to be a member until reappointed or replaced.
Orders
29. (1) The
minister may make a written order after reviewing
(a) the audit findings;
(b) the submissions made by the medical
association or the dental association, where the association made submissions under
subsection 23(4);
(c) the practitioner's response, where the
practitioner responded to the audit findings under subsection 23(5);
(d) the report of the review board, where a hearing
is held by a review board appointed under subsection 26(4); and
(e) the advice of the advisory committee, where the
minister referred the matter to a committee under subsection 33(1).
(2) In an order under subsection (1), the minister
may do one or more of the following:
(a) order the practitioner or the professional
corporation to pay to the minister, within the time period specified in the
order, an amount determined to have been overpaid to the practitioner or the professional
corporation and where the minister makes such an order, he or she shall also
order the practitioner or professional corporation to pay interest on the
amount of the overpayment;
(b) where the minister makes an order under paragraph
(a), also order that all or part of the amount of the overpayment and interest be
deducted from an amount payable to the practitioner or the professional
corporation under the medical care insurance plan;
(c) order the practitioner or the professional
corporation to adopt an appropriate pattern of practice or billing, as specified
by the minister in the order;
(d) order the practitioner or professional
corporation to pay a penalty totalling an amount not greater than the amount estimated
to be the loss sustained by the Crown because of a payment to the practitioner,
professional corporation or beneficiary for insured services which relate to
the subject of the audit plus 10% of that amount and, for the purpose of this paragraph,
the estimated amount shall, subject to proof to the contrary or appeal in
accordance with section 32, be considered to be the loss sustained;
(e) strike the name of the practitioner from the
list of participating practitioners under the medical care insurance plan for the
time period specified in the order;
(f) reduce an amount payable to a practitioner or professional
corporation under the medical care insurance plan by a percentage for the time
period specified in the order; or
(g) order the practitioner or professional
corporation to pay all or part of the costs of either or both of the audit or
the review board hearing.
(3) The minister may base an order on any relevant
source of information, including a source created on a statistical basis or by
a comparison between insured services provided by the practitioner and
corresponding insured services provided by other practitioners, but the
minister is not required to review a particular insured service the practitioner
provided.
(4) Notwithstanding subsection 27(5) or (6), the
minister may make an order where the practitioner or professional corporation does
not appear at the review board hearing after having been given written notice
of the review board hearing.
(5) The minister shall provide a copy of an order
made under this section to
(a) the practitioner or the professional
corporation; and
(b) the medical association or the dental
association.
(6) Where the minister makes an order, he or she may
advise the appropriate professional regulatory or licensing body that an order
has been made respecting the practitioner or the professional corporation.
(7) An order made by the minister may be filed with
the Trial Division and, upon filing, is enforceable in the same manner as an order
or a judgment of that court.
Interest
30. Interest
ordered to be paid to the minister under paragraph 29(2)(a) or agreed to be
paid under an agreement under paragraph 25(1)(a) shall be calculated in accordance
with the regulations.
Joint and individual
liability
31. Where
an order is made under section 29 against a professional corporation, a
practitioner who provided services which are, or are related to, the subject of
the audit in respect of which the order was made, is jointly and individually
liable with the professional corporation for the order imposed on the professional
corporation.
Appeal
32. (1) A
practitioner or professional corporation aggrieved by an order of the minister
under section 29 may, within 60 days from the date of the order, appeal against
the order to a judge of the Trial Division by filing a notice of appeal with
the court, and by serving a copy of the notice of appeal on the minister.
(2) Notwithstanding a
rule or practice to the contrary, the notice of appeal shall
(a) set out in detail the allegations of the
appellant and the grounds upon which the order is appealed; and
(b) be signed by the appellant or his or her solicitor.
(3) The appellant shall, within 14 days after serving
the notice of appeal on the minister under this section, apply to a judge for
the appointment of a day for the hearing of the appeal and shall, not less than
30 days before the hearing, serve upon the minister a written notice of the day
appointed for the hearing of the appeal.
(4) The minister shall produce to the judge hearing
the appeal all papers and documents in his or her possession relevant to the
subject matter of the appeal.
(5) The judge shall hear the appeal and the evidence
presented by the appellant and the minister in a summary manner and, after reviewing
all aspects which the judge, in his or her discretion believes to be appropriate
in the interests of justice, equity and fairness, decide the appeal by
(a) upholding, amending or revoking the order; or
(b) making another order or decision which he or
she believes to be appropriate in the circumstances.
(6) The judge may order costs for or against the
appellant or the Crown and fix the amount.
(7) An appeal may be taken from an order or decision
of the judge to the Court of Appeal upon a point of law raised on the hearing
of the appeal, and the rules governing appeals to that court from an order or
decision of a judge of the Trial Division apply to appeals under this subsection.
(8) The filing of a notice of appeal under this section
or the appeal itself shall not affect the order of the minister which shall remain
in force pending the outcome of the appeal.
Advisory committee
33. (1) The
minister may, in accordance with the regulations, appoint a committee to review
and advise upon matters relating to audits performed under this Act that are
referred to it by the minister.
(2) The minister shall, by regulation, prescribe
the terms of reference for the committee, the composition of the committee and
the duties of the committee.
Alternative
dispute resolution
34. Notwithstanding
any other provision of this Part, the minister may employ alternative dispute resolution
mechanisms in resolving the matters related to audit reviews and appeals in the
manner prescribed by the regulations.
PART V
LEVY
Levy generally
35. (1) This
Part applies where insured services are provided with respect to an injury and the
injury is caused by, or contributed to by, or results from, a motor vehicle
accident in which the person, whose negligence, act or omission caused,
contributed to or resulted in the injury, is insured at the date of the
accident by a policy of insurance through a licensed insurer on whom a levy was
imposed under this Act for the levy year in which the accident occurred.
(2) The minister shall impose a levy to be paid by
every licensed motor vehicle insurer with respect to each vehicle insured by
that insurer for the purpose of recovering the cost of insured services received
by beneficiaries as a result of injuries where the injuries were caused by, or contributed
to by, or result from, motor vehicle accidents.
Calculation and
payment
36. (1) Every
licensed insurer who carries on the business of automobile insurance in the
province shall, in respect of each levy year, pay to the minister a levy
determined by multiplying the base rate per vehicle by the number of earned
vehicles at the end of each levy year.
(2) Every licensed insurer liable to pay a levy
under subsection (1) shall before the last day of March, June, September and December
in each levy year pay one quarter of the levy estimated to be payable as
calculated by the minister or his or her representative by reference to the
number of earned vehicles and the base rate per vehicle for the immediately
preceding levy year.
(3) Where a licensed insurer provides the minister
with satisfactory proof that the actual earned vehicle count will vary
significantly from the previous year on which the estimated levy is based, the
minister may adjust the estimated levy.
Report and adjustment
37. (1) The
Superintendent of Insurance shall provide annually to the minister a report
detailing actual automobile experience including the number of earned vehicles
and the number of claims for every licensed insurer as provided under the Insurance Companies Act.
(2) Based on the report in subsection (1), the minister
shall issue an adjustment invoice or credit as applicable to licensed insurers
in respect of the immediately preceding levy year payable or refundable within
30 days of issuance.
Interest
38. Where
the levy is not paid in full on the due date, the licensed insurer shall pay to
the minister interest on the unpaid portion from the due date at an annual rate
equal to the sum of the prime lending rate of the bank holding the province's
general revenue fund plus 4 percentage points.
Unpaid levy
39. An
amount payable under sections 35 to 38 constitutes a debt due the Crown and the
minister may bring an action for its recovery in a court in the province.
Effect on licence
40. The
insurer shall pay a levy payable under sections 35 to 38 before the issuance or
renewal of a licence under the Insurance
Companies Act.
PART VI
RECOVERY OF COSTS FOR SERVICES
Recovery by injured
person generally
41. (1) This Part applies where
insured services are provided with respect to an injury and the injury is
caused by, contributed to by or results from
(a) the negligence, act or omission of a person;
or
(b) a motor vehicle accident in which the person
whose negligence, act or omission caused, contributed to or resulted in the
injury is not insured at the date of the accident by a policy of insurance
through a licensed insurer liable to pay a levy under this Act.
(2) For the purpose of this Part,
(a) the amount paid for insured hospital services that
are received by a beneficiary shall be an amount equal to the charges of the hospital
in which the services were provided, calculated in accordance with this Act and
the regulations, that the beneficiary would have been required to pay if he or
she was not entitled to receive the services as insured hospital services under
this Act; and
(b) the cost of insured medical services provided
is the cost as established in this Act and the regulations.
(3) In this
Part, "insured services" includes any services for which an amount has
been or may in the future be paid by the minister in relation to negligence or
an act or omission including medical and hospital services and any services prescribed
by the regulations as insured services for the purpose of this Part.
Claim for
recovery
42. (1) Where
a beneficiary suffers an injury caused by, contributed to by or resulting from
the negligence, act or omission of a person for which the beneficiary received insured
services, including the costs of future insured services, the beneficiary
(a) has the same right to
recover the amount paid for the insured services against the person whose
negligence, act or omission caused, contributed to or resulted in the injury as
the beneficiary would have had if the beneficiary had been required to pay for
the insured services; and
(b) shall claim and seek to
recover the costs of the insured services if the beneficiary makes a claim for
the injury suffered against the person whose negligence, act or omission
caused, contributed to or resulted in the injury.
(2) Where a beneficiary recovers an amount in respect of insured
services under subsection (1), he or she shall without delay pay the amount recovered
to the minister.
(3) Where a beneficiary does not pay the amount to
the minister under subsection (2) within a reasonable time, the minister may recover
the amount from the beneficiary as a debt due the Crown.
(4) The
minister shall be subrogated to the rights of a beneficiary under this section to recover any amount paid by the minister
for insured services provided to that beneficiary and an action may be brought by the minister, either in his or her name
or in the name of the beneficiary, for the
recovery of that amount.
(5) It is not a defence to an action brought by the minister
under subsection (4) that a claim for damages has been adjudicated upon unless
the claim included a claim for the amount paid for insured services and it is
not a defence to an action for damages for an injury brought by a beneficiary who has received insured services that an action taken by
the minister under subsection (4) has been adjudicated upon.
(6) Where an action has not been brought by or on
behalf of that beneficiary under subsection (1) for the recovery of damages
arising out of the injury, the minister upon service of notice on the beneficiary
may bring an action in his or her own name or in the name of the beneficiary
for the recovery of the cost of the insured services, and before trial of the
action that beneficiary may join in the action another claim arising out of the
same occurrence upon the conditions as to costs or otherwise that to the court
may seem just and may in that case effect settlement of that claim.
(7) A
beneficiary and the minister shall share in proportion to their respective
losses in any recovery in accordance with the terms and conditions prescribed
by the regulations where, as a result of a claim under
this section,
(a) the claim is settled or
a judgment is obtained; and
(b) insufficient funds are
available to provide complete recovery to the beneficiary for his or her losses
and injuries and to pay the costs of the insured services referred to in section
41,
but nothing in this subsection prevents
the minister from waiving in whole or in part the minister's share of an amount
recovered where, in the opinion of the minister, the circumstances warrant.
(8) Where a person whose
negligence, act or omission caused, contributed to or resulted in injury to a beneficiary is
insured by a liability insurer, the liability insurer may pay to the minister
any amount referable to a claim for recovery of the cost of insured services
that would otherwise be paid to the beneficiary and payment of that amount to
the minister discharges the liability of the insurer to pay that amount to the
beneficiary or to any person claiming on behalf of the beneficiary.
Proof of amount
43. In an action under section 42, a
certificate of a person designated by the minister as to the amount paid for or
cost of insured services provided to a beneficiary is admissible in evidence
and is, in the absence of evidence to the contrary, proof of that amount.
Settlement of
claim
44. (1) A release or settlement of a claim
or judgment based upon a cause of action for damages for an injury where the beneficiary
has received insured services shall not be binding upon the Crown unless the minister
has approved the release or settlement in writing.
(2) A
beneficiary acting on his or her own behalf or a
person acting on behalf of a beneficiary shall not make a settlement of a claim
based upon a cause of action for damages for an injury where the beneficiary has received insured services without the approval of the
minister in writing.
(3) Notwithstanding anything in this section, the
approval of the minister in writing is required under subsections (1) and (2)
even where the beneficiary or a person acting on his or her behalf has not made
a claim.
Fees
45. Notwithstanding any other
provision of this Act, the minister may, in accordance with the regulations,
authorize the payment of a fee to a barrister or solicitor who makes a claim and
recovers an amount in respect of the cost of insured services that are received
by the beneficiary.
PART VII
GENERAL
Consultation with
associations
46. The
medical association and the dental association shall be consulted by the
minister with reference to the rates of payments to be made under this Act in respect
of insured services provided to beneficiaries by practitioners, the manner and
form in which the payments to practitioners shall be made and changes in
connection with payments and, where in the opinion of the minister it is necessary,
with reference to general questions of principle concerning the practices of
medicine and dentistry.
Regulations
47. The
Lieutenant-Governor in Council may make regulations
(a) prescribing which services are insured services
for the purpose of this Act;
(b) prescribing which services are not insured
services for the purpose of this Act;
(c) prescribing the facilities in which insured
services may be provided;
(d) prescribing which services are hospital services
for the purpose of this Act;
(e) prescribing which services are medical services
for the purpose of this Act;
(f) prescribing to what extent and under what
circumstances insured services shall be paid for by the minister where the insured
services are received by beneficiaries while they are out of the province;
(g) prescribing a procedure for reviewing decisions
relating to whether, under this Act and the regulations,
(i) a person is a resident,
(ii) a person is a beneficiary, and
(iii) a beneficiary is entitled to payment;
(h) respecting the techniques that may be used
during an audit;
(i) respecting the calculation of interest for the
purpose of section 30;
(j) defining the term "policy of
insurance" for the purpose of subsections 35(1) and 41(1);
(k) prescribing the fees that may be paid to
barristers or solicitors in accordance with section 45 and any terms and conditions
respecting the payment of those fees;
(l) providing for the investigation of complaints
of violations of this Act or regulations or of an order made under this Act or
the regulations;
(m) providing for the holding of inquiries into a
complaint referred to in paragraph (l) or into the operation of this Act or
into a charge or complaint that a person has contravened this Act or the
regulations, or has wilfully made a false statement in a form, return, account
or statement required to be completed or made under this Act, or into another
matter arising in the administration of this Act, and providing that the person
holding the inquiry shall have the powers that may be conferred upon a commission
under the Public Inquiries Act, 2006 including
the power to take evidence under oath or affirmation;
(n) notwithstanding any other provision of this
Act, adapting, modifying, qualifying or altering the provisions of this Act to
meet the requirements of the Canada
Health Act for the purpose of rendering the medical care insurance plan one
in respect of which a contribution is payable by Canada under the Canada Health Act;
(o) defining a word or phrase used but not defined
in this Act; and
(p) generally, to give effect to the purpose of
this Act.
Regulations by
minister
48. (1) The
minister may make regulations
(a) to prevent unnecessary use or abuse of insured
services;
(b) prescribing the waiting period that is
required to elapse before a resident becomes a beneficiary and the other conditions
to be observed by a resident in order that he or she may qualify as a beneficiary;
(c) prescribing the conditions to be observed by a
resident to continue to qualify as a beneficiary;
(d) respecting the registration of residents for
the purpose of this Act, including the information required and the form of
proof of that information;
(e) respecting the expiry of registration of
residents;
(f) defining which residents are beneficiaries for
the purpose of this Act;
(g) respecting the manner in which persons may be
identified as beneficiaries including the use, return, replacement or destruction
of identification issued by the minister;
(h) defining
(i) the terms and conditions relating to the
provision of dental and other health related services, and
(ii) to what extent and under what circumstances
dental and other health related services shall be paid for by the minister;
(i) prescribing for the purpose of subparagraph 2(q)(ii) which persons are entitled to provide insured
services;
(j) establishing the procedure by which practitioners
enroll as participating practitioners;
(k) following consultation with the medical
association and the dental association, prescribing the circumstances under
which the minister may refuse, suspend or cancel the enrollment of a
practitioner as a participating practitioner under the medical care insurance plan;
(l) respecting the manner and form in which accounts
and claims for payment shall be submitted;
(m) respecting the information that shall be
submitted with accounts and claims for payment including the manner and form of
that information;
(n) prescribing, by
reference to professional or other scales of fees, the rates of payments to be
made under this Act in respect of insured services provided to beneficiaries by
practitioners;
(o) respecting the manner and form in which
payments to practitioners, professional corporations and other persons shall be
made under this Act;
(p) governing the method of assessing accounts and
claims for payment submitted by practitioners, professional corporations and
other persons;
(q) prescribing the manner in which alternative
dispute resolution mechanisms may be employed in resolving matters related to
audits including reviews and appeals of audits;
(r) respecting the application of this Act to a professional
corporation;
(s) following consultation with the medical
association and the dental association, prescribing a formula for the determination
of the average pattern of practice for the whole or an area of the province and
defining the words "pattern of practice" for the purpose of sections
21 and 29;
(t) establishing an advisory committee under section
33;
(u) establishing a formula for the determination
of the base rate for each vehicle under section 36;
(v) prescribing the terms and conditions with respect
to the minister and a beneficiary sharing in proportion their respective losses
under subsection 42(7);
(w) for the provision by hospitals of insured
services upon uniform terms and conditions to beneficiaries of the province
under the conditions specified in the Canada
Health Act and regulations made under that Act;
(x) for the payment of amounts to hospitals from
funds voted by the Legislature in respect of the cost of insured services, and
the payment of those amounts that may be specified in an agreement when insured
services are provided to beneficiaries of the province, who are eligible for
them and entitled to them by hospitals that are owned or operated by Canada or
are situated outside the province;
(y) providing for the furnishing to the Minister
of Health for Canada
of the information and at the times that the minister may require for the
purpose of the Canada Health Act;
(z) defining a word or phrase used but not defined
in this Act; and
(aa) generally, to give effect to the purpose of
this Act.
(2) Regulations made under paragraph (1)(n) do not
constitute subordinate legislation for the purpose of the Statutes and Subordinate Legislation Act.
Offence and penalty
49. The
Lieutenant-Governor in Council may, in regulations made under section 47, and
the minister may, in regulations made under section 48, provide that a person
who contravenes a specified provision of the regulations is guilty of an
offence and may prescribe penalties to which the person is liable, on summary
conviction, for failing to comply with or otherwise contravening the provisions
of the regulations.
Date and effect
of regulations
50. Regulations
made under section 47 or 48 may be made with retroactive effect.
Offence
51. (1) Unless
otherwise provided, a person who contravenes this Act or the regulations,
except those regulations made under paragraph 48(1)(n), is guilty of an offence
and where no penalty is specifically provided in this Act or the regulations,
liable on summary conviction in the case of a first conviction to a fine not more
than $10,000 and in the case of a second or subsequent conviction for a similar
offence to a fine not more than $20,000.
(2) For the purpose of subsection (1) a conviction
is not a second or subsequent conviction unless it is in respect of an offence
committed within 12 months after a prior offence.
Actions barred
52. An
action shall not lie against practitioners or professional corporations
providing insured services, or an employee of those practitioners and
professional corporations, relating to information provided to the minister
with respect to an insured service provided to a beneficiary.
Non-liability
53. (1) An
action relating to providing insured services under this Act shall not lie
against the minister or a person employed in the department with respect to the
negligence, act or omission of a practitioner, professional corporation or
other person providing the services or of an employee or a person acting on
behalf of a practitioner, professional corporation or other person.
(2) An action shall not lie against a member of a
medical or other committee serving the minister in a consultative or advisory capacity
in respect of anything done or omitted to be done in good faith in the
performance of the duties of the member.
Practitioner liability
54. It
is not a defence to a prosecution of a practitioner for an offence under this
Act that insured services were provided through a professional corporation or
that a claim for payment in respect of services provided by that practitioner was
submitted by a professional corporation.
PART VIII
TRANSITIONAL, CONSEQUENTIAL, REPEAL AND COMMENCEMENT
Transitional
55. (1) Where
a person is registered with the medical care insurance plan in relation to the Medical Care Insurance Act, 1999 or the
hospital insurance plan in relation to the Hospital
Insurance Agreement Act immediately before the coming into force of this
Act, he or she is considered to be registered in the equivalent plan under this
Act.
(2) Where a practitioner is enrolled with the
medical care insurance plan in relation to the Medical Care Insurance Act, 1999 or the hospital insurance plan in
relation to the Hospital Insurance
Agreement Act immediately before the coming into force of this Act, he or
she is considered to be enrolled in the equivalent plan under this Act.
(3) Where an election of a practitioner to collect
payments in respect of insured services provided by the practitioner to
beneficiaries other than from the minister is in effect immediately before the
coming into force of this Act, that election is considered to be an election
under section 8 of this Act and continues to be in effect.
(4) Where an account for an insured service was
submitted to the minister for payment but had not yet been paid immediately
before the coming into force of this Act, that account is considered to be an
account submitted under this Act.
(5) Where an arrangement under subsection 10(2) of
the Medical Care Insurance Act, 1999
is in effect immediately before the coming into force of this Act, that
arrangement is considered to be an arrangement made under subsection 12(3) of
this Act.
(6) Where a notice under subsection 15(1) of the Medical Care Insurance Act, 1999 was
sent in relation to an audit, investigation or inquiry under that Act before
the coming into force of this Act, the Medical
Care Insurance Act, 1999 shall apply to the audit, investigation or inquiry
as though that Act were still in force.
(7) Notwithstanding subsection (6), subsections
27(2) and 29(4) of this Act shall apply to all audits, investigations and
inquiries regardless of when and whether a notice under subsection 15(1) of the
Medical Care Insurance Act, 1999 has
been sent.
(8) Where a notice under subsection 15(1) of the Medical Care Insurance Act, 1999 was not
sent in relation to an audit, investigation or inquiry under that Act before
the coming into force of this Act and the audit, investigation or inquiry is ongoing
on the coming into force of this Act, this Act shall apply to the audit,
investigation or inquiry.
(9) Persons who are members of a review board
appointed under subsection 15(5) of the Medical
Care Insurance Act, 1999 immediately before the coming into force of this
Act shall continue to be members of that review board.
(10) Persons who are members of the panel referred
to in subsection 15(7) of the Medical
Care Insurance Act, 1999 immediately before the coming into force of this
Act shall continue to be members of the panel referred to in section 28 of this
Act.
(11) Orders made under section 15 of the Medical Care Insurance Act, 1999 and
agreements between the minister and a physician after an audit, investigation
or inquiry which are in effect immediately before the coming into force of this
Act continue to be in effect as though they were orders and agreements made
under this Act.
(12) Where a retainer agreement or contingency fee
agreement signed by the minister was in effect immediately before the coming
into force of this Act, the provisions of that agreement relating to the minister's
claim for recovery under the Medical Care Insurance Act, 1999 continue
to be in effect and shall not be subject to this Act but shall be subject to
the Medical Care Insurance Act, 1999 as though that Act were still in
force.
(13) A person shall only claim for the cost of future
insured services under this Act where the cause of action on which the claim is
based arises after this Act comes into force.
(14) Persons who are members of the Medical
Consultants Committee under section 15 of the Physicians and Fees Regulations under the Medical Care Insurance Act, 1999 immediately before the coming into
force of this Act shall continue to be members of that committee for the purposes
of this Act.
RSNL1990 cA-22
Amdt.
56. (1) Subsection 45.1(8) of the Automobile Insurance Act is repealed and
the following substituted:
(8) For the purpose of this section a person shall
not be considered to have insurance coverage or inadequate insurance coverage
only because he or she receives or is entitled to receive compensation or
benefits under the Medical Care and
Hospital Insurance Act, the Income
and Employment Support Act or the Workers'
Compensation Act for injuries or damages arising out of an accident
involving an automobile.
(2) Subsection 45.20(2) of the Act is repealed and
the following substituted:
(2) Subsection (1) shall not apply to applications
under the Medical Care and Hospital
Insurance Act, the Income and
Employment Support Act or the Workers'
Compensation Act.
SNL2004 cC-5.1
Amdt.
57. Subparagraph 16(d)(iv) of the Centre for Health Information Act is
repealed and the following substituted:
(iv) the Medical
Care and Hospital Insurance Act,
RSNL1990 cI-10
Amdt.
58. Subsection 14(10) of the Insurance Companies Act is repealed and the following substituted:
(10) Effective July 1, 1994, after notification by
the Department of Health to the superintendent of any unpaid levy due under the
Medical Care and Hospital Insurance Act,
the superintendent shall prohibit the insurer from entering into new contracts
of insurance or renewing existing contracts of insurance until the levy is
paid.
SNL1991 c16 Amdt.
59. Paragraph 11(4)(c) of the Jury Act, 1991 is repealed and the following substituted:
(c) the names, addresses and dates of birth of
beneficiaries under the Medical Care and
Hospital Insurance Act, but no other information respecting beneficiaries
shall be provided; and
SNL2008 cP-7.01
Amdt.
60. Paragraph 2(1)(m) of the Personal Health Information Act is repealed and the following
substituted:
(m) "MCP" means the Newfoundland and Labrador Medical Care Plan
administered under the Medical Care and
Hospital Insurance Act;
SNL1992 cR-17
Amdt.
61. Subsection 59(3) of the Royal Newfoundland Constabulary Act, 1992 is repealed and the
following substituted:
(3) Paragraph (1)(b) does not apply to expenses
for which provision is made for recovery by the minister under sections 41 to 45
of the Medical Care and Hospital Insurance
Act.
SNL2001 cT-4.2
Amdt.
62. Subparagraph 2(d)(ii) of the Tobacco Health Care Costs Recovery Act
is repealed and the following substituted:
(ii) insured services as defined under the Medical Care and Hospital Insurance Act,
and
Repeal
63. (1) The following Acts are repealed:
(a) Hospital
Insurance Agreement Act; and
(b) Medical
Care Insurance Act, 1999.
(2) The Medical
Care Insurance Release of Information Order, Newfoundland
and Labrador Regulation 132/97, published
under the Medical Care Insurance Act,
1999, is repealed.
Commencement
64. This Act comes into force on October 1, 2016.
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