Acts and Regulations

2010-106 - Medical Services Payment Act

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NEW BRUNSWICK
REGULATION 2010-106
under the
Medical Services Payment Act
(O.C. 2010-373)
Filed July 5, 2010
1Paragraph 15(3)(a) of New Brunswick Regulation 84-20 under the Medical Services Payment Act is amended by striking out “Medical Assessment Advisory Committee” and substituting “Professional Review Committee”.
2Section 17 of the Regulation is amended
(a) by repealing subsection (1);
(b) by repealing subsection (2).
3Section 18 of the Regulation is repealed.
4Section 26 of the Regulation is amended by striking out “committee” and substituting “Professional Review Committee”.
5Section 28 of the Regulation is amended
(a) in the portion preceding paragraph (a) by striking out “committee” and substituting “Professional Review Committee”;
(b) in paragraph (d) by striking out “and” at the end of the paragraph;
(c) in paragraph (e) by striking out the period at the end of the paragraph and substituting a comma;
(d) by adding after paragraph (e) the following:
(f) review and make recommendations to the provincial authority on the method of assessing accounts for payment for entitled services provided to beneficiaries by medical practitioners or oral and maxillofacial surgeons,
(g) review the assessment of accounts for payment for entitled services to beneficiaries by medical practitioners or oral and maxillofacial surgeons that are referred to it by the provincial authority and make recommendations concerning the assessment of such accounts to the provincial authority, and
(h) to make recommendations to the provincial authority on any matter referred to it concerning the planning of structured audits, the findings of audits in process and the conclusions of audit processes.
6Section 30 of the Regulation is amended by striking out “committee” and substituting “Professional Review Committee”.
7Section 31 of the Regulation is amended by striking out “committee” and substituting “Professional Review Committee”.
8Section 32 of the Regulation is amended
(a) by repealing paragraph (a) and substituting the following:
(a) make available to the Professional Review Committee all information possessed by the provincial authority which is relevant and necessary for the attainment of the Committee’s objectives, and
(b) in paragraph (b) by striking out “committee and the provincial authority” and substituting “Professional Review Committee and the provincial authority”.
9Section 33 of the Regulation is amended in the portion preceding paragraph (a) by striking out “committee” and substituting “Professional Review Committee”.
10The Regulation is amended by adding after section 33 the following:
33.001Where a medical practitioner or an oral and maxillofacial surgeon and the provincial authority disagree on the assessment of accounts with respect to entitled services rendered or with respect to audit findings, the parties shall engage in discussions in order to resolve the dispute.
33.002Where a medical practitioner or an oral and maxillofacial surgeon is not satisfied with the assessment of accounts with respect to entitled services rendered or with respect to audit findings, the medical practitioner or the oral and maxillofacial surgeon may make a request to the provincial authority to refer the matter to the Professional Review Committee for a recommendation concerning the assessment of such accounts.
33.003(1)Where a medical practitioner or an oral and maxillofacial surgeon is not satisfied with the assessment of accounts with respect to entitled services rendered or with respect to audit findings, the medical practitioner or oral and maxillofacial surgeon may appeal the assessment or the audit findings to an adjudicator.
33.003(2)An adjudicator shall be appointed by mutual agreement between the Department of Health and the New Brunswick Medical Society.
33.003(3)An adjudicator shall be appointed for a term of one year which may be renewed and his or her name shall be placed on a list maintained by the provincial authority.
33.004(1)A medical practitioner or an oral and maxillofacial surgeon who wishes to make an appeal under subsection 33.003(1) shall file with the provincial authority a notice of appeal within 60 days after receipt of the final notice of assessment issued by the provincial authority.
33.004(2)The notice of appeal shall include the reasons for the appeal and the official language chosen by the appellant.
33.004(3)If a medical practitioner or an oral and maxillofacial surgeon has made full payment of the amount specified in the final notice of assessment or has agreed to a repayment schedule, the provincial authority shall refer the notice of appeal to an adjudicator within 30 days after receipt of the notice of appeal.
33.004(4)Within 30 days after receiving the notice of appeal, the adjudicator shall set out the time and place for the hearing of the appeal, and shall advise the appellant and the provincial authority in writing of the time and place of the hearing.
33.004(5)With the consent of both parties, the adjudicator may determine the appeal based on the written representations of the parties without a hearing.
33.004(6)Only non-identifying medical information shall be contained in written or oral representations.
33.004(7)For the purposes of a hearing, an adjudicator has all the powers, privileges and immunities of a commissioner under the Inquiries Act.
33.004(8)Within 30 days after the hearing or the receipt of written representations, the adjudicator shall render a written decision in which he or she may affirm, vary or reverse the amount specified in the final notice of assessment.
33.004(9)The decision of the adjudicator is final and binding on both parties.
33.004(10)The decision of the adjudicator must be implemented within 30 days after the decision is rendered.
33.004(11)If the decision of the adjudicator affirms the amount specified in the final notice of assessment and the medical practitioner or the oral and maxillofacial surgeon has agreed to a repayment schedule with the provincial authority, the decision shall be deemed to have been implemented.
33.005The expenses related to the appeal shall be equally shared between the Department of Health and the New Brunswick Medical Society.