1995 Legislative Session: 4th Session, 35th Parliament
FIRST READING


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


HONOURABLE PAUL RAMSEY
MINISTER OF HEALTH AND MINISTER
RESPONSIBLE FOR SENIORS

BILL 54 -- 1995

AN ACT TO PROTECT MEDICARE

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

1 The Medical and Health Care Services Act, S.B.C. 1992, c. 76, is amended

(a) by repealing the title and substituting the following:

MEDICARE PROTECTION ACT , and

(b) by adding the following preamble:

Preamble

WHEREAS the people and government of British Columbia believe that medicare is one of the defining features of Canadian nationhood and are committed to its preservation for future generations;

WHEREAS the people and government of British Columbia wish to confirm and entrench universality, comprehensiveness, accessibility, portability and public administration as the guiding principles of the health care system of British Columbia and are committed to the preservation of these principles in perpetuity;

WHEREAS the people and government of British Columbia recognize a responsibility for the judicious use of medical services in order to maintain a fiscally sustainable health care system for future generations;

AND WHEREAS the people and government of British Columbia believe it to be fundamental that an individual's access to necessary medical care be solely based on need and not on the individual's ability to pay; .

2 Section 1 is amended by repealing the definition of "rendered by" and substituting the following:

"render" means perform personally by or under the personal supervision of the person to whom reference is being made and "personal supervision" in this context means

(a) in the case of a practitioner, personal supervision authorized by the commission in the circumstances, and

(b) in the case of a medical practitioner or health care practitioner who is not enrolled, personal supervision acceptable to the appropriate disciplinary body for the medical practitioner or health care practitioner; .

3 The following section is added:

Purpose

1.1 The purpose of this Act is to preserve a publicly managed and fiscally sustainable health care system for British Columbia in which access to necessary medical care is based on need and not an individual's ability to pay.

4 Section 12 is amended by adding the following subsection:

(9) A medical practitioner whose enrollment is cancelled under subsection (8) may not apply for enrollment under subsection (1) within 12 months of the date of the cancellation unless the commission, because it considers this to be in the public interest, allows the application.

5 Section 13 (9), (10) and (11) is repealed and the following substituted:

(9) As soon as practicable after rendering a benefit, a practitioner who has made an election under subsection (1) must give the beneficiary a claim form that is completed by the practitioner in the manner required by the commission.

6 Section 14 (1) (d) is amended by striking out "section 16," and substituting "section 17.1, 17.2 or 17.3,".

7 Sections 15 and 16 are repealed.

8 The following Part is added:

Part 3.1
Limits on Billing

General limits on direct or extra billing

17.1 (1) Except as specified in this Act or the regulations or by the commission under this Act, a person must not charge a beneficiary

(a) for a benefit, or

(b) for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of a benefit.

(2) Subsection (1) does not apply:

(a) if, at the time a service was rendered, the person receiving the service was not enrolled as a beneficiary;

(b) if, at the time the service was rendered, the service was not considered by the commission to be a benefit;

(c) if the service was rendered by a practitioner who

(i) has made an election under section 13 (1), or

(ii) is subject to an order under section 14 (2) (b);

(d) if the service was rendered by a medical practitioner who is not enrolled.

Limits on direct or extra billing by a medical practitioner who is not enrolled

17.2 (1) If a medical practitioner who is not enrolled renders a service to a beneficiary and the service would be a benefit if rendered by an enrolled medical practitioner, the medical practitioner must not charge the person for, or in relation to, the service an amount that, in total, is greater than

(a) the amount that would be payable under this Act, by the commission, for the service if rendered by an enrolled medical practitioner, or

(b) if a payment schedule or regulation permits or requires an additional charge by an enrolled medical practitioner, the total of the amount referred to in paragraph (a) and the additional charge.

(2) Subsection (1) applies only to a service rendered in

(a) a hospital as defined in section 1 of the Hospital Act,

(b) a community care facility as defined in section 1 of the Community Care Facility Act, or

(c) other circumstances specified by regulation by the Lieutenant Governor in Council.

(3) If a medical practitioner described in section 17.1

(2) (c) renders a benefit to a beneficiary, the medical practitioner must not charge the beneficiary for, or in relation to, the service an amount that, in total, is greater than

(a) the amount that would be payable under this Act, by the commission, for the service, or

(b) if a payment schedule or regulation permits or requires an additional charge, the total of the amount referred to in paragraph (a) and the additional charge.

Notice requirement

17.3 (1) Before a beneficiary is rendered a service that would be a benefit if rendered by a practitioner, the person who intends to require the beneficiary to pay all or a portion of the costs of the service must advise the beneficiary, in a manner the beneficiary can understand, of the following:

(a) that the person proposes to collect the amount directly from the beneficiary;

(b) how much the person will charge for the service;

(c) how much, if anything, the person reasonably expects that the commission will reimburse the beneficiary for the rendering of the service.

(2) Subsection (1) does not apply if the medical condition or incapacity of the beneficiary makes compliance with that subsection impractical but, if the service would be a benefit if rendered by a practitioner, the beneficiary must not be charged for the service an amount that, in total, is greater than

(a) the amount that would be payable under this Act, by the commission, for the service, or

(b) if a payment schedule or regulation permits or requires an additional charge, the total of the amount referred to in paragraph (a) and the additional charge.

(3) If a beneficiary is not advised, as required by subsection (1), the beneficiary is not liable to pay for the service unless the service was rendered in an emergency situation that made it impractical to comply with that subsection.

Refunds required

17.4 (1) If a beneficiary pays for a service described in section 17.2, the person who charged for, or in relation to, the service must refund to the beneficiary any amount paid for the service that is in excess of the amount allowed for that service by section 17.2.

(2) If a beneficiary pays for a service but was not liable to pay for it because of section 17.3 (3), the person who charged for, or in relation to, the service must refund to the beneficiary the amount paid for the service.

(3) If a person pays all or part of a private clinic fee that a regulation under section 45 (3) directs not be charged or accepted, the person who charged or accepted payment of the private clinic fee must refund the amount paid in contravention of the regulation.

Civil action

17.5 An amount that is to be refunded under this Part is a debt due to the person who paid the amount, recoverable by action in any court of competent jurisdiction.

Agreements

17.6 The minister, or a person designated by the minister for the purpose, may enter into an agreement to pay an amount to offset all or part of the cost for materials, consultations, use of an office, clinic or other place or for any other matter that relates to the rendering of a benefit.

 
Consequential Amendments

 
Guaranteed Available Income for Need Act

9 Sections 11 (1) (a) and 12 (2) (a) of the Guaranteed Available Income for Need Act, R.S.B.C. 1979, c. 157, are amended by striking out "under the Medical and Health Care Services Act;" and substituting "under the Medicare Protection Act;".

 
Hospital Act

10 The Hospital Act, R.S.B.C. 1979, c. 176, is amended by adding the following section:

Facility and professional fee limits

4.1 A hospital must take all reasonable measures to ensure that the limits on direct or extra billing established by Part 3.1 of the Medicare Protection Act are complied with in respect of a service rendered to a beneficiary, as defined in section 1 of the Medicare Protection Act, by a medical practitioner at the hospital.

 
Medical and Health Care Services Special Account Act

11 Sections 1 and 3 of the Medical and Health Care Services Special Account Act, S.B.C. 1994, c. 10, are amended by striking out "Medical and Health Care Services Act" wherever it appears and substituting "Medicare Protection Act".

 
Social Service Tax Act

12 Section 1 (3) (c) of the Social Service Tax Act, R.S.B.C. 1979, c. 388, is amended by striking out "Medical and Health Care Services Act." and substituting "Medicare Protection Act."

Short Title

13 This Act may be cited as the Medical and Health Care Services Amendment Act, 1995.

Commencement

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

 
Explanatory Notes

SECTION 1: [Medical and Health Care Services Act], changes the title of the Act to "Medicare Protection Act", and adds a Preamble which establishes the general principles underlying British Columbia's health care system and confirms the fundamental requirement that necessary medical services be available without regard to ability to pay.

SECTION 2: [Medical and Health Care Services Act, amends section 1] revises the definition of "rendered by" .

SECTION 3: [Medical and Health Care Services Act, adds section 1.1] adds a purpose section to the Act to establish as the Act's fundamental purpose the preservation of a publicly managed and financially sustainable health care system, under which access to necessary medical care is based on need and not on a person's ability to pay.

SECTION 4: [Medical and Health Care Services Act, amends section 12] requires a medical practitioner who voluntarily cancels his or her enrollment under the Act to wait one year before being eligible to apply again for enrollment, unless the public interest justifies a reduction in this waiting period.

SECTION 5: [Medical and Health Care Services Act, amends section 13 ] requires a practitioner who is direct billing to provide the beneficiary with a properly completed claim form as soon as possible after rendering a benefit.

SECTION 6: [Medical and Health Care Services Act, amends section 14] amends a reference to section 16 of the Act as a consequence of sections 7 and 8 of this Bill.

SECTION 7: [Medical and Health Care Services Act, repeals sections 15 and 16] repeals sections 15 and 16 of the Act as a consequence of the new limits on direct and extra billing provisions in the new Part 3.1 of the Act set out in section 8 of this Bill.

SECTION 8: [Medical and Health Care Services Act, adds sections 17.1 to 17.6] enacts a new Part 3.1 of the Act consisting of requirements and limitations in relation to direct and extra billing. It specifies that advance notice must be given by a practitioner if a person will have to pay for a service in any circumstances and that no practitioner may charge a beneficiary for a benefit unless the practitioner has made an election under section 13 (1) of the Act or is the subject of an order under section 14 (2) (b) of the Act.

Part 3.1 provides that an enrolled medical practitioner is not permitted to charge in excess of the amount payable by the commission for a similar benefit in like circumstances and that a medical practitioner who is not enrolled may not impose extra charges if the procedure is rendered in a hospital, continuing care facility or in other prescribed circumstances. In either case, the medical practitioner must refund any amount charged in excess of the amount that would have been payable by the commission for that procedure.


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