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An Act to Amend the Medical Services Payment Act

Legislature :
54
Session :
5
Bill No. :
52
Member :
Hon. Elvy Robichaud
First Reading :
2003-3-26
Second Reading :
2003-3-27
Committee of the Whole :
2003-3-28
Amended :
Third Reading :
2003-4-1
Royal Assent :
2003-4-11
Download PDF :
Bill 52

Text of Bill :
Her Majesty, by and with the advice and consent of the Legislative Assembly of New Brunswick, enacts as follows:



1                           Section 1 of the Medical Services Payment Act, chapter M-7 of the Revised Statutes, 1973, is amended



(a)               by repealing the definition "entitled services" and substituting the following:



"entitled services" means



(a)               all services rendered by medical practitioners or oral and maxillofacial surgeons that are medically required and includes any other services provided by a person other than a medical practitioner or an oral and maxillofacial surgeon that are specified by the Lieutenant-Governor in Council except



(i)         services that a person is eligible for or entitled to under any Act of the Parliament of Canada or under a law of any jurisdiction relating to workers' compensation,



(ii)       services that a person receives under the Hospital Services Act and the regulations made thereunder,



(iii)    ambulance services and other forms of transportation of patients,



(iv)      travelling expenses incurred by a medical practitioner unless incurred under circumstances specified in the regulations,



(v)       travelling expenses incurred by an oral and maxillofacial surgeon, and



(vi)      any other services deemed by the Lieutenant-Governor in Council not to be entitled services; and



(b)               those materials and supplies which the provincial authority has agreed to provide payment for under an agreement entered into under section 4.1; and



(c)                those materials and supplies in hospital facilities which the provincial authority has determined to provide payment for under the tariff         or system of payment established under section 4.11;



(b)               by adding the following definitions in alphabetical order:



"New Brunswick Dental Society" means the New Brunswick Dental Society continued under section 3 of the New Brunswick Dental Act, 1985;



"oral and maxillofacial surgeon" means a dental practitioner whose name is entered in the specialists register and who is the holder of a specialist's licence in oral and maxillofacial surgery issued pursuant to the New Brunswick Dental Act, 1985, or a dental practitioner who practises outside of New Brunswick and who is recognized as an oral and maxillofacial surgeon by the licensing body of the jurisdiction in which that dental practitioner practises oral and maxillofacial surgery;



2                           Section 2 of the French version of the Act is amended



(a)               in paragraph (1)a)



(i)         in subparagraph (iii.1) by striking out "dispensés" and substituting "fournis";



(ii)       in subparagraph (iv) by striking out "dispensés" and substituting "fournis";



(b)               in subsection (2)



(i)         in the portion preceding paragraph a) by striking out "dispensés" and substituting "fournis";



(ii)       in paragraph a) by striking out "dispensés" and substituting "fournis";



(c)               in subsection (3) by striking out "dispensés" and substituting "fournis";



(d)               in subsection (4) by striking out "dispensés" and substituting "fournis".



3                           Section 2.01 of the Act is repealed and the following is substituted



2.01                  Notwithstanding any other provision of this Act, the medical services plan shall not provide payment for



(a)               entitled services furnished in the Province if those services are provided by a medical practitioner or an oral and maxillofacial surgeon who is, at the time the services are provided, practising outside the provisions of this Act and the regulations,



(b)               entitled services furnished in a private hospital facility in the Province, or



(c)                entitled services provided by an oral and maxillofacial surgeon to a patient other than an in-patient in a hospital facility approved by the jurisdiction in which the hospital facility is located.



4                           Subsection 2.1(1) of the French version of the Act is amended



(a)               in paragraph a) by striking out "dispensés" and substituting "fournis";



(b)               in paragraph b) by striking out "dispensés" and substituting "fournis".



5                           Section 3 of the Act is amended



(a)               in paragraph (a) by striking out "the medical practitioner" and substituting "the medical practitioner or oral and maxillofacial surgeon";



(b)               in paragraph (b) by striking out the portion preceding subparagraph (i) and substituting the following:



(b)               the right of a medical practitioner or an oral and maxillofacial surgeon



6                           The Act is amended by adding after section 4.1 the following:



4.11(1)          The provincial authority may determine, with the approval of the Lieutenant-Governor in Council, the amount to be paid for entitled services rendered on a fee for service basis in accordance with a tariff or a system of payment that provides reasonable compensation to oral and maxillofacial surgeons.



4.11(2)          The terms of the determination under subsection (1) are subject to any regulations under subparagraphs 12(h.1)(iii) and paragraph 12(h.21).



7                           Section 4.3 of the Act is repealed and the following is substituted:



4.3                      The provincial authority may make special arrangement to pay for the furnishing of entitled services by medical practitioners or oral and maxillofacial surgeons in accordance with a tariff or system of payment that provides reasonable compensation to medical practitioners or oral and maxillofacial surgeons where the services are provided on other than a fee for service basis.



8                           Section 5.1 of the Act is amended



(a)               in subsection (1) by striking out "A medical practitioner" and substituting "A medical practitioner or an oral and maxillofacial surgeon";



(b)               in subsection (2) by striking out "A medical practitioner" and substituting "A medical practitioner or an oral and maxillofacial surgeon".



9                           Section 5.2 of the Act is amended



(a)               in subsection (1) by striking out "A medical practitioner" and substituting "A medical practitioner or an oral and maxillofacial surgeon";



(b)               in subsection (4) by striking out "a medical practitioner" and substituting "a medical practitioner or an oral and maxillofacial surgeon".



10                        Section 5.3 of the Act is amended by striking out "A medical practitioner" and substituting "A medical practitioner or an oral and maxillofacial surgeon".



11                        Subsection 5.4(3) of the Act is repealed and the following is substituted:



5.4(3)             The provincial authority may deduct from any amount payable to a medical practitioner or an oral and maxillofacial surgeon under the medical services plan an amount equal to the amount of any overpayment under the plan to the medical practitioner or oral and maxillofacial surgeon, as assessed by the provincial authority.



12                        Section 5.5 of the Act is amended



(a)               in subsection (1)



(i)         by striking out the portion preceding paragraph (a) and substituting the following:



5.5(1)             Nothwithstanding any action taken by the provincial authority under section 5.4, the provincial authority may refer to the Professional Review Committee for review, and the committee shall review, patterns of billing of medical practitioners and oral and maxillofacial surgeons under the medical services plan in order to identify, in respect of a medical practitioner or an oral and maxillofacial surgeon,



(ii)       in paragraph a) of the French version of the Act by striking out "dispensés" and substituting "fournis";



(iii)    in paragraph b) of the French version by striking out "dispensés" and substituting "fournis".



(b)               by repealing subsection (2) and substituting the following:



5.5(2)             Where, after conducting a review under subsection (1), the Professional Review Committee finds in respect of a medical practitioner or an oral and maxillofacial surgeon that the level of service was in excess of what could be considered to be medically required or that there has been misuse of the fee schedule, the Professional Review Committee shall, in addition to any other recommendation it may make to the provincial authority, recommend to the provincial authority an amount of overpayment to be recovered from the medical practitioner or the oral and maxillofacial surgeon, as the case may be, and may recommend the terms, conditions and schedule for the recovery of the overpayment.



(c)               in subsection (3) by striking out "the medical practitioner" and substituting "the medical practitioner or oral and maxillofacial surgeon";



(d)               by repealing subsection (4) and substituting the following:



5.5(4)             The provincial authority shall recover from a medical practitioner or an oral and maxillofacial surgeon in respect of whom a recommendation for recovery of an overpayment has been made under subsection (2), the amount recommended for recovery by the Professional Review Committee and may deduct the amount of the overpayment from any payments that are or become payable to the medical practitioner or oral and maxillofacial surgeon, as the case may be, under the medical services plan.



(e)               in subsection (6)



(i)         in paragraph (a) by striking out "a medical practitioner" and substituting "a medical practitioner or an oral and maxillofacial surgeon";



(ii)       by repealing paragraph (b) and substituting the following:



(b)               refuse to enter into any agreement with a medical practitioner or an oral and maxillofacial surgeon which would permit the medical practitioner or oral and maxillofacial surgeon, as the case may be, to practise his profession within the provisions of this Act and the regulations.



13                        Section 5.6 of the Act is repealed and the following is substituted:



5.6                      No medical practitioner or oral and maxillofacial surgeon shall challenge an amount recommended under section 5.5 by the Professional Review Committee by reason only that the amount was determined from a random sample of the medical practitioner's or oral and maxillofacial surgeon's accounts and by the application of statistical methodology to the account from which the sample was drawn as opposed to a case by case examination of the account in respect of which the recommendation is made.



14                        Section 7 of the Act is amended by striking out "against a medical practitioner or other person providing entitled services" and substituting "against a medical practitioner, an oral and maxillofacial surgeon or other person providing entitled services".



15                        Section 8 of the Act is amended



(a)               in subsection (1)



(i)         by repealing paragraph (b) and substituting the following:



(b)               to a medical practitioner or an oral and maxillofacial surgeon for any purpose relating to entitled services that the medical practitioner or oral and maxillofacial surgeon has provided,



(ii)       by repealing paragraph (d) and substituting the following:



(d)               information relating to entitled services that an entitled person has received may be released to a medical practitioner or an oral and maxillofacial surgeon if that entitled person is a patient of the medical practitioner or oral and maxillofacial surgeon, as the case may be,



(iii)    by adding after paragraph (g) the following:



(g.1)          information relating to oral and maxillofacial surgeon registration may be released to the New Brunswick Dental Society;



(b)               by repealing subsection (1.1) and substituting the following:



8(1.1)             Notwithstanding paragraph (1)(b), a person employed in the administration of this Act shall not release to a medical practitioner or an oral and maxillofacial surgeon the name of any person who has complained to the provincial authority about the billing practices or provision of entitled services by the medical practitioner or oral and maxillofacial surgeon or the nature of the complaint, except as required by law or where the matter complained of is referred to the Professional Review Committee under section 5.5.



16                        Subsection 8.1(1) of the Act is amended by striking out "maintained in offices of medical practitioners" and substituting "maintained in offices of medical practitioners or oral and maxillofacial surgeons".



17                        Subsection 8.3(1) of the Act is repealed and the following is substituted:



8.3(1)             The Minister may, for the purposes of verifying the accuracy of accounts for services submitted by medical practitioners or oral and maxillofacial surgeons for payment under the medical services plan, require any person to provide to the Minister all documentation and records in the possession of that person in respect of medical services provided by medical practitioners or oral and maxillofacial surgeons for or on behalf of that person, including all patient and other records, accounts, reports, data and information that relates to such services.



18                        Section 10.01 of the French version of the Act is amended by striking out "dispensés" and substituting "fournis";



19                        Subsection 11(3) of the Act is amended by striking out "A medical practitioner or other person providing entitled services" and substituting "A medical practitioner, an oral and maxillofacial surgeon or other person providing entitled services".



20                        Section 12 of the Act is amended



(a)               in paragraph (b.2) by striking out "medical practitioners" and substituting "medical practitioners or oral and maxillofacial surgeons";



(b)               in paragraph (c) by striking out "a medical practitioner" and substituting "a medical practitioner or an oral and maxillofacial surgeon";



(c)               in paragraph (c.1) by striking out "who is not a medical practitioner" and substituting "who is not a medical practitioner or an oral and maxillofacial surgeon";



(d)               in paragraph (e) by striking out "a medical practitioner" and substituting "a medical practitioner or an oral and maxillofacial surgeon";



(e)               in paragraph (h.1)



(i)         in the portion proceeding subparagraph (i) of the French version by striking out "dispensés" and substituting "fournis";



(ii)       by repealing subparagraph (ii) of the French version and substituting the following:



(ii)       les totaux des montants payés au titre des services assurés fournis par un médecin; et



(iii)    by repealing subparagraph (iii) and substituting the following:



(iii)    totals of amounts paid for entitled services rendered by medical practitioners and oral and maxillofacial surgeons,



(f)                by adding after paragraph (h.2) the following:



(h.21)       respecting circumstances in which, periods for which and percentages by which amounts payable for all or some entitled services rendered by all or some oral and maxillofacial surgeons may be, in light of totals of amounts paid for entitled services rendered by medical practitioners and oral and maxillofacial surgeons, greater than or smaller than the amounts that would otherwise be payable;



(g)               in paragraph (j.1) by striking out "medical practitioners" and substituting "medical practitioners and oral and maxillofacial surgeons".



21                        This Act or any provision of it comes into force on a day or days to be fixed by proclamation.



EXPLANATORY NOTES



Section 1



(a)               The existing definition is as follows:



"entitled services" means



(a)               all services rendered by medical practitioners that are medically required and includes any other services provided by a person other than a medical practitioner that are specified by the Lieutenant-Governor in Council except



(i)         services that a person is eligible for or entitled to under any Act of the Parliament of Canada or under a law of any jurisdiction relating to workers' compensation,



(ii)       services that a person receives under the Hospital Services Act and the regulations made thereunder,



(iii)    ambulance services and other forms of transportation of patients,



(iv)      travelling expenses incurred by a medical practitioner unless incurred under circumstances specified in the regulations, and



(v)       any other services deemed by the Lieutenant-Governor in Council not to be entitled services; and



(b)               those materials and supplies which the provincial authority has agreed to provide payment for under an agreement entered into under section 4.1;



(b)               New definitions are added.



Section 2



(a)(i)         For reasons of consistency of vocabulary, a word is changed in the French version.



(a)(ii)       The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(b)(i)         The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(b)(ii)       The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(c)                The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(d)               The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



Section 3



The existing provision is as follows:



2.01                  Notwithstanding any other provision of this Act, the medical services plan shall not provide payment for



(a)               entitled services furnished in the Province if those services are provided by a medical practitioner who is, at the time the services are provided, practising outside the provisions of this Act and the regulations, or



(b)               entitled services furnished in a private hospital facility in the Province.



Section 4



(a)               The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(b)               The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



Section 5



(a)               The existing provision is as follows:



3                           Subject to sections 2.01, 5.1 and 5.3 and subsection 5.5(6), nothing in this Act or the regulations interferes with



(a)               the right of a beneficiary to select the medical practitioner from whom he will receive entitled services, or



(b)               The existing provision is as follows:



3                           Subject to sections 2.01, 5.1 and 5.3 and subsection 5.5(6), nothing in this Act or the regulations interferes with…



(b)               the right of a medical practitioner



Section 6



New provision.



Section 7



The existing provision is as follows:



4.3                      The provincial authority may make special arrangements to pay for the furnishing of entitled services by medical practitioners in accordance with a tariff or system of payment that provides reasonable compensation to medical practitioners where the services are provided on other than a fee for service basis.



Section 8



(a)               The existing provision is as follows:



5.1(1)             A medical practitioner who is practising in the Province outside the provisions of this Act and the regulations shall inform any person to whom entitled services are provided that he or she is practising outside the provisions of this Act and the regulations, and that the person is not entitled to payment under the medical services plan.



(b)               The existing provision is as follows:



5.1(2)             A medical practitioner who renders entitled services in a private hospital facility in the Province shall inform the person to whom the services are rendered that the person is not entitled to payment under the medical services plan.



Section 9



(a)               The existing provision is as follows:



5.2(1)             A medical practitioner who wishes to practise in the Province within the provisions of this Act and the regulations shall apply for a practitioner number, in accordance with the regulations.



(b)               The existing provision is as follows:



5.2(4)             A practitioner number shall be issued to a medical practitioner, subject to and in accordance with the regulations.



Section 10



The existing provision is as follows:



5.3                      A medical practitioner who practises in the Province and who does not hold a practitioner number issued under this Act and the regulations is practising outside the provisions of this Act and the regulations.



Section 11



The existing provision is as follows:



5.4(3)             The provincial authority may deduct from any amount payable to a medical practitioner under the medical services plan an amount equal to the amount of any overpayment under the plan to the medical practitioner, as assessed by the provincial authority.



Section 12



(a)(i)         The existing provision is as follows:



5.5(1)             Notwithstanding any action taken by the provincial authority under section 5.4, the provincial authority may refer to the Professional Review Committee for review, and the committee shall review, patterns of billing of medical practitioners under the medical services plan in order to identify, in respect of a medical practitioner,



(a)(ii)       The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(a)(iii)      The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(b)               The existing provision is as follows:



5.5(2)             Where, after conducting a review under subsection (1), the Professional Review Committee finds in respect of a medical practitioner that the level of service was in excess of what could be considered to be medically required or that there has been misuse of the fee schedule, the Professional Review Committee shall, in addition to any other recommendation it may make to the provincial authority, recommend to the provincial authority an amount of overpayment to be recovered from the medical practitioner and may recommend the terms, conditions and schedule for the recovery of the overpayment.



(c)                The existing provision is as follows:



5.5(3)             Before the Professional Review Committee makes a recommendation to the provincial authority in respect of an action under this section, it shall provide the medical practitioner with an opportunity to make a representation to the committee respecting the matter under review.



(d)               The existing provision is as follows:



5.5(4)             The provincial authority shall recover from a medical practitioner in respect of whom a recommendation for recovery of an overpayment has been made under subsection (2), the amount recommended for recovery by the Professional Review Committee and may deduct the amount of the overpayment from any payments that are or become payable to the medical practitioner under the medical services plan.



(e)(i)         The existing provision is as follows:



5.5(6)             The provincial authority may, upon the recommendation of the Professional Review Committee,



(a)               suspend any agreement entered into with a medical practitioner for such period as it considers appropriate, or



(e)(ii)       The existing provision is as follows:



5.5(6)             The provincial authority may, upon the recommendation of the Professional Review Committee,…



(b)               refuse to enter into any agreement with a medical practitioner which would permit the medical practitioner to practise his profession within the provisions of this Act and the regulations.



Section 13



The existing provision is as follows:



5.6                      No medical practitioner shall challenge an amount recommended under section 5.5 by the Professional Review Committee by reason only that the amount was determined from a random sample of the medical practitioner's accounts and by the application of statistical methodology to the accounts from which the sample was drawn as opposed to a case by case examination of the accounts in respect of which the recommendation is made.



Section 14



The existing provision is as follows:



7                           Subject to section 11, no action lies against a medical practitioner or other person providing entitled services in respect of information furnished to the provincial authority under this Act or the regulations.



Section 15



(a)(i)         The existing provision is as follows:



8(1)                   Every person employed in the administration of this Act shall preserve secrecy with respect to all matters that come to the person's knowledge in the course of that person's employment, and no such person shall release any information acquired in the course of that person's employment, except…



b)                  to a medical practitioner for any purpose relating to entitled services that the medical practitioner has provided,



(a)(ii)       The existing provision is as follows:



8(1)                   Every person employed in the administration of this Act shall preserve secrecy with respect to all matters that come to the person's knowledge in the course of that person's employment, and no such person shall release any information acquired in the course of that person's employment, except…



(d)               information relating to entitled services that an entitled person has received may be released to a medical practitioner if that entitled person is a patient of the medical practitioner,



(a)(iii)      New provision.



(b)               The existing provision is as follows:



8(1.1)             Notwithstanding paragraph (1)(b), a person employed in the administration of this Act shall not release to a medical practitioner the name of any person who has complained to the provincial authority about the billing practices or provision of entitled services by the medical practitioner or the nature of the complaint, except as required by law or where the matter complained of is referred to the Professional Review Committee under section 5.5.



Section 16



The existing provision is as follows:



8.1(1)             The Minister may appoint in writing inspectors to inspect, examine and audit books, accounts, reports and medical records maintained in offices of medical practitioners respecting persons who are receiving or have received services and in respect of which services claims for payment have been submitted under the medical services plan.



Section 17



The existing provision is as follows:



8.3(1)             The Minister may, for the purposes of verifying the accuracy of accounts for services submitted by medical practitioners for payment under the medical services plan, require any person to provide to the Minister all documentation and records in the possession of that person in respect of medical services provided by medical practitioners for or on behalf of that person, including all patient and other records, accounts, reports, data and information that relates to such services.



Section 18



The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



Section 19



The existing provision is as follows:



11(3)               A medical practitioner or other person providing entitled services who wilfully makes a false statement in any report, form or return required for the purposes of this Act or the regulations commits an offence punishable under Part II of the Provincial Offences Procedure Act as a category I offence.



Section 20



(a)               The existing provision is as follows:



12                        The Lieutenant-Governor in Council may make regulations…



(b.2)          respecting applications by medical practitioners for practitioner numbers;



(b)               The existing provision is as follows:



12                        The Lieutenant-Governor in Council may make regulations…



(c)                deeming certain services rendered by a person who is not a medical practitioner to be entitled services;



(c)                The existing provision is as follows:



12                        The Lieutenant-Governor in Council may make regulations…



(c.1)            respecting the payment to a person who is not a medical practitioner for providing entitled services to beneficiaries;



(d)               The existing provision is as follows:



12                        The Lieutenant-Governor in Council may make regulations…



(e)                prescribing the procedure for a medical practitioner to elect to practise his profession outside the provisions of this Act and the regulations;



(e)(i)         The amendment is consequential on the amendment made in subparagraph 2(a)(i) of the amending Act.



(e)(ii)       The existing provision in the French version is as follows:



12                        Le lieutenant-gouverneur en conseil peut établir des règlements…



h.1)            concernant les circonstances dans lesquelles, les périodes au cours desquelles et les pourcentages auxquels les montants payables pour la totalité ou certains des services assurés dispensés par la totalité ou certains des médecins peuvent être supérieurs ou inférieurs aux montants qui seraient autrement payables, selon l'un quelconque ou la totalité des éléments suivants :…



(ii)       totaux des montants payés au titre des services assurés dispensés par un médecin; et



(e)(iii)      The existing provision is as follows:



12                        The Lieutenant-Governor in Council may make regulations…



(h.1)          respecting circumstances in which, periods for which and percentages by which amounts payable for all or some entitled services rendered by all or some medical practitioners may be, in the light of any or all of …



(iii)    totals of amounts paid for entitled services rendered by medical practitioners,



greater than or smaller than the amounts that would otherwise be payable;



(f)                New provision.



(g)               The existing provision is as follows:



12                        The Lieutenant-Governor in Council may make regulations…



(j.1)            respecting notices to be given by medical practitioners to the provincial authority or a person designated by the provincial authority and the form, manner, time and content of such notices;



Section 21



Commencement provision.

 

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