1992 Legislative Session: 1st Session, 35th Parliament
FIRST READING


The following electronic version is for informational purposes only.
The printed version remains the official version.


MINISTER OF FINANCE AND
CORPORATE RELATIONS

BILL 13 -- 1992

MEDICAL PRACTITIONER FEE FOR SERVICE APPORTIONMENT ACT

HER MAJESTY, by and with the advice and consent of the Legislative Assembly of the Province of British Columbia, enacts as follows:

Interpretation

1 (1) In this Act

"available amount" means $1 271 031 823;

"category" means a category of medical practitioner established under section 4 (1) (a);

"category maximum" means, for a category, the portion of the available amount that is established under section 4 (1) (b) as the total amount that may be paid under all payment schedules to medical practitioners in the category;

"fiscal year" means the fiscal year ending March 31, 1993;

"payment schedule" means a payment schedule established under section 7 (3) of the Medical Service Act to pay medical practitioners on a fee for services basis.

(2) On the report of the minister charged with the administration of the Medical Service Act that sound management of the plan requires a change in the available amount, the Lieutenant Governor in Council may, by order, change the available amount and, on the making of the order, "available amount" for the purposes of this Act becomes this new amount.

(3) Words and phrases used in this Act have the meanings given to them in the Medical Service Act.

Application

2 (1) If this Act conflicts with the Medical Service Act, with the Financial Administration Act, with the plan or with an agreement, payment schedule or regulation made under the Medical Service Act, this Act applies.

(2) This Act does not apply to a northern or isolation allowance established under the Medical Service Act and the northern or isolation allowance must not be included in any calculation of any reduction made under this Act.

Available amount for the 1992/93 fiscal year

3 The total amount that may be paid under all payment schedules by the commission to all medical practitioners for services rendered in the fiscal year must not be greater than the available amount.

Categories for payment purposes

4 (1) For the purposes of section 3 the commission may establish

(a) categories of medical practitioner, and

(b) the portion of the available amount that may be paid under all payment schedules to medical practitioners in a category.

(2) A category may be based on

(a) the nature of medical practice and whether it is a specialist practice,

(b) the area of British Columbia where the medical practice is conducted, or

(c) the level of payments medical practitioners within the category would receive under all payment schedules if this Act did not apply.

(3) If the commission considers that payments in the fiscal year under all payment schedules to the medical practitioners in a category will be greater than or less than the category maximum, the commission may adjust its payments to the medical practitioners in the category under the payment schedules to a level that the commission considers appropriate to achieve the category maximum.

Payment adjustment by projected
fee for service income level

5 (1) In this section

"estimated total fiscal year payment" means the greater of

(a) the amount calculated as follows:

amount

 

payment schedule amount x 12

number of months

where

"payment schedule amount" equals, for payments made to the medical practitioner under all payment schedules in the fiscal year as of the date of the estimation, the total amount the medical practitioner would have received if this Act did not apply;

"number of months" equals the number of months as of the date of the estimation for which payments have been made to the medical practitioner under a payment schedule in the fiscal year;

or

(b) the amount equaling, for payments made to the medical practitioner under all payment schedules for services rendered during a year, the total amount the medical practitioner would have received if this Act did not apply;

"rendered during a year" means rendered during the 12 months commencing

(a) on October 1, 1990 if the estimation is made respecting payments made in April of the fiscal year,

(b) on November 1, 1990 if the estimation is made respecting payments made in May of the fiscal year,

(c) on December 1, 1990 if the estimation is made respecting payments made in June of the fiscal year,

(d) on January 1, 1991 if the estimation is made respecting payments made in July of the fiscal year,

(e) on February 1, 1991 if the estimation is made respecting payments made in August of the fiscal year,

(f) on March 1, 1991 if the estimation is made respecting payments made in September of the fiscal year,

(g) on April 1, 1991 if the estimation is made respecting payments made in October of the fiscal year,

(h) on May 1, 1991 if the estimation is made respecting payments made in November of the fiscal year,

(i) on June 1, 1991 if the estimation is made respecting payments made in December of the fiscal year,

(j) on July 1, 1991 if the estimation is made respecting payments made in January of the fiscal year,

(k) on August 1, 1991 if the estimation is made respecting payments made in February of the fiscal year, or

(l) on September 1, 1991 if the estimation is made respecting payments made in March of the fiscal year.

(2) If the commission has reason to believe that the payments to a medical practitioner under all payment schedules in a month in the fiscal year would be reduced if the reduction factor described in subsection (3) or (4) for the month was calculated and applied to the payments, the commission must calculate and apply the reduction factor to those payments.

(3) If, in calculating payment in a month in the fiscal year to a medical practitioner who is not in a category established under section 4 for specialist practice, the commission estimates that its estimated total fiscal year payment, including retroactive payments, to the medical practitioner will exceed $300 000, the commission must reduce its payments to the medical practitioner under all payment schedules in the month by a reduction factor calculated as follows:

reduction factor

discounts

estimated total fiscal year payment to the medical practitioner

where "discounts" equals the sum of

(a) 33% of that part of the estimated total fiscal year payment to the medical practitioner that falls between $300 000 and $340 000, and

(b) 50% of that part of the estimated total fiscal year payment to the medical practitioner that exceeds $340 000.

(4) If, in calculating payment in a month in the fiscal year to a medical practitioner who is in a category established under section 4 for specialist practice, the commission estimates that its estimated total fiscal year payment, including retroactive payments, to the medical practitioner will exceed $360 000, the commission must reduce its payments to the medical practitioner under all payment schedules in the month by a reduction factor calculated as follows:

reduction factor

discounts

estimated total fiscal year payment to the medical practitioner

where "discounts" equals the sum of

(a) 33% of that part of the estimated total fiscal year payment to the medical practitioner that falls between $360 000 and $400 000, and

(b) 50% of that part of the estimated total fiscal year payment to the medical practitioner that exceeds $400 000.

(5) If the commission considers that the estimated total fiscal year payment calculated under this section for a medical practitioner is too high, the commission may increase the payment it makes for the month to the medical practitioner from that calculated under subsection (3) or (4) for the purposes of that month.

Pro rata payment premium

6 (1) The commission must pay a premium at a prescribed rate to each medical practitioner on payments made to the medical practitioner under all payment schedules in the fiscal year and this Act, except for this section, does not apply to the premium.

(2) The total of premiums paid under subsection (1) to a medical practitioner must not exceed a prescribed amount for any month in the fiscal year.

(3) The Lieutenant Governor in Council may make regulations

(a) prescribing the rate under subsection (1), and

(b) prescribing the amount under subsection (2).

(4) In calculating a premium to be paid under this section, payments made to a medical practitioner under a payment schedule will be valued at the amount that would have applied for payment purposes if this Act did not apply to the payment.

Exemption

7 If the Lieutenant Governor in Council considers that the special circumstances of a medical practitioner's patients so warrant, the Lieutenant Governor in Council may order that a reduction calculated under section 4 or 5 or a debt owing under section 9

(1) does not apply, or applies only to a limited extent.

Fiscal year reconciliation

8 (1) In this section

"difference" means, for a medical practitioner,

(a) the preliminary reduction less the proper reduction, if the preliminary reduction is greater than the proper reduction, or

(b) the proper reduction less the preliminary reduction, if the proper reduction is greater than the preliminary reduction;

"payment schedule amount" means, for a medical practitioner, the total of payments that, if this Act did not apply, would have been made to the medical practitioner under all payment schedules for services rendered in the fiscal year;

"preliminary reduction" means, for a medical practitioner, the total amount by which payments made in the fiscal year to the medical practitioner were reduced under sections 4 and 5;

"proper reduction" means, for a medical practitioner, the total amount by which payments to the medical practitioner should be reduced for services rendered in the fiscal year if

(a) the reduction level, if any, applicable to the medical practitioner on March 31, 1993 under section 4 (3) is applied to the payment schedule amount, and

(b) the discounts described in section 5 (3) or (4), whichever is applicable, are applied to the payment schedule amount in place of estimated total fiscal year payment as defined in section 5.

(2) A premium paid under section 6 must not be included for the purpose of a calculation under this section.

(3) If the commission ascertains that a difference exists for a medical practitioner, the commission must,

(a) if the preliminary reduction is greater than the proper reduction, pay the amount of the difference to the medical practitioner, or

(b) if the proper reduction is greater than the preliminary reduction, advise the medical practitioner by registered mail addressed to the medical practitioner at the medical practitioner's last known business address that the difference is due and owing to the government.

(4) No interest is payable by the government, the commission or a medical practitioner on a difference.

(5) The commission need not act under subsection (3) before November 1, 1993.

Effect of payment at an adjusted rate

9 (1) If the commission advises a medical practitioner under section 8 (3) (b) that a difference is due and owing, the amount of the difference is a debt due and owing to the government by the medical practitioner and may be deducted from amounts that later become payable to the medical practitioner under the Medical Service Act or may be recovered from the medical practitioner by civil action.

(2) If the amount of a payment made under a payment schedule for services rendered in the fiscal year has been reduced under this Act, the obligation of the commission or the government to make the payment is correspondingly reduced.

 
Consequential Amendment

 
Medical Service Act

10 Section 7 (3) of the Medical Service Act, R.S.B.C. 1979, c. 255, is amended by striking out "Subject to the approval of the Lieutenant Governor in Council, the" and substituting "The".

Commencement

11 This Act comes into force by regulation of the Lieutenant Governor in Council.


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