Acts and Regulations

84-115 - General

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Current to 13 December 2023
NEW BRUNSWICK
REGULATION 84-115
under the
Health Services Act
(O.C. 84-447)
Filed June 1, 1984
Under section 13 of the Health Services Act, the Lieutenant-Governor in Council makes the following Regulation:
2018-38
1This Regulation may be cited as the General Regulation - Health Services Act.
2In this Regulation
“beneficiary” means(bénéficiaire)
(a) a person in need, other than a dependent of a beneficiary, to whom a valid health services card has been issued under the Family Income Security Act and regulations,
(b) a child or youth under the Minister’s care as defined in the Child and Youth Well-Being Act and regulations to whom a valid health services card has been issued,
(c) a person who is blind or disabled as defined in the Family Income Security Act and regulations to whom a valid health services card has been issued, or
(d) a person in need who is a resident of a licenced nursing home, a community residence or a special care home and to whom the Minister of Social Development has issued a valid health services card;
“cosmetic drug” Repealed: 92-40
“dental practitioner” means a dental practitioner duly registered and licensed in the jurisdiction in which entitled services were provided;(dentiste)
“denturist” means a denturist duly registered and licensed in the jurisdiction in which entitled services were provided;(prothésiste dentaire)
“dependent” means(personne à charge)
(a) a spouse of a beneficiary or a dependent child under eighteen years who is not self supporting, or
(b) a person eighteen years or older who is solely dependent on a beneficiary;
“diagnostic services” means the following services performed by a dental practitioner:(service de diagnostic)
(a) oral examination,
(b) single periapical or bitewing film,
(c) each additional film, and
(d) panorex X-ray;
“Director” means the person designated by the Minister to perform the duties, functions, tasks and to assume the responsibilities allocated to the Director by this Regulation;(Directeur)
“dispensing physician” means a medical practitioner who dispenses drugs as designated from time to time;(médecin pro-pharmacien)
“emergency services” means the following services performed by a dental practitioner:(services d’urgence)
(a) extractions as a result of pain,
(b) temporary treatment of abscesses, acute necrotic ulcerative gingivitis and post-extraction complications including hemorrhage or dry socket,
(c) temporary treatment for teeth fractured as the result of an accidental injury including light cured and acid etched restorations,
(d) palliative treatment for conditions causing pain including temporary restorations, and
(e) denture repairs;
“entitled services” means and includes(services assurés)
(a) those goods or services for which a rate of payment is set out in Schedule II of this Regulation, and
(b) such other goods and services as the Minister may in sole discretion deem advisable to include within the health services plan,
but excludes those goods and services which by virtue of the Health Services Act and this Regulation and Schedule I hereto are specified as not being entitled services;
“hospital facility” means a hospital facility that is licensed or approved to provide in-patient or out-patient treatment services by the governmental licensing authority in whose jurisdiction the hospital facility is situated;(établissement hospitalier)
“medical practitioner” means a medical practitioner duly registered and licensed in the jurisdiction in which entitled services were provided;(médecin)
“nursing service” means the Victorian Order of Nurses or the Red Cross nursing service or any other nursing service which in the opinion of the Director provides a similar service;(service infirmier)
“optician” means an optician duly registered and licensed in the jurisdiction in which services were provided;(opticien)
“optometrist” means an optometrist duly registered and licensed in the jurisdiction in which entitled services were provided;(optométriste)
“pharmacist” means a pharmacist duly registered and licensed in the jurisdiction in which entitled services were provided;(pharmacien)
“prosthetic services” means the following services performed by a dental practitioner or denturist:(services de prothèse)
(a) complete dentures,
(b) removable partial dentures, and
(c) denture repairs and relines;
“special educational facility” means an institution which in the opinion of the Director provides training and rehabilitation facilities not otherwise available in New Brunswick;(établissement de rééduction spéciale)
“suppliers of prostheses” means retail or wholesale suppliers of prosthetic appliances;(fournisseurs de prothèses)
“wholesale optical company” means a wholesale supplier of vision goods and services.(grossiste en produits optiques)
84-235; 85-61; 87-27; 89-18; 92-40; 93-26; 96-23; 2000, c.26, s.152; 2008, c.6, s.25; 2016, c.37, s.84; 2019, c.2, s.68; 2023-19; 2023, c.36, s.15
3(1)Every beneficiary or dependent is eligible to receive payment or have payment made on behalf of the beneficiary or dependent at the applicable rate established in Schedule II hereof, or at the amount charged, whichever is lesser, for or with respect to entitled services received in the Province.
3(2)Every beneficiary or dependent who is temporarily absent from the Province is eligible to receive payment or have payment made on behalf of the beneficiary or dependent at the rate established in Schedule II hereof, or at the amount charged, whichever is the lesser, for or with respect to the entitled services received, provided that the entitled services
(a) are required for treatment of an emergency condition due to a sudden attack of illness or for emergency treatment of an accidental injury during temporary absence from the Province,
(b) are defined by the Director as not available in the Province,
(c) have received prior approval in accordance with section 6,
(d) are supplied to a person who fulfills the requirements of paragraph (3)(b),
(e) are supplied to a person who fulfills the requirements of paragraph (3)(c), or
(f) are provided in areas of provinces and states bordering on New Brunswick designated by the Director.
3(3)For the purpose of this section a person is “temporarily absent from the Province” where that person is absent from New Brunswick for the purpose of a vacation or a visit but not where the period of absence exceeds three consecutive months, except
(a) where the beneficiary or dependent is unable to return to the Province within three months due to continued hospitalization or medical treatment of illness,
(b) where the beneficiary or dependent is living with foster parents who reside outside New Brunswick, or
(c) where the beneficiary or dependent of a beneficiary is attending a special educational facility outside New Brunswick.
3(4)Repealed: 2023-19
2023-19
4Notwithstanding section 3, the entitled dental services available to social assistance beneficiaries and dependents who are eighteen years of age or older and who are not in receipt of social assistance benefits as a blind or disabled person under the Family Income Security Act or are not children or youth under the Minister's care as defined in the Child and Youth Well-Being Act shall be limited to
(a) diagnostic services;
(b) emergency services;
(c) prosthetic services; and
(d) restorative services.
84-235; 85-61; 96-23; 2008-77; 2023-19; 2023, c.36, s.15
4.1Repealed: 87-93
87-27; 87-93
5Notwithstanding sections 3 and 4, a person referred by the Department of Social Development to the Dental Advisory Committee may be approved by it as a beneficiary entitled to dental services.
87-27; 94-152; 2000, c.26, s.152; 2008, c.6, s.25; 2023-19
5.1Notwithstanding sections 3, 4 and 5, prior approval of the Dental Advisory Committee shall be required in the following instances:
(a) where the total fee for diagnostic services together with preventative and restorative treatment services will exceed two hundred dollars, and
(b) before effecting
(i) a full mandibular or maxillary extraction,
(ii) crowns,
(iii) complete or partial dentures,
(iv) root canal therapy,
(v) multiple extractions involving in excess of four teeth where the patient is 18 years or older, or
(vi) orthodontic services including diagnostic services and X-rays, provided that such diagnostic services and X-rays may be compensated although approval is not given for orthodontic treatment where the Committee requests the Director to do so.
84-235
6Every beneficiary or dependent who travels outside New Brunswick specifically for the purpose of receiving health services must have the prior approval of the Director for the receipt of such health services in order to receive payment therefor.
7The following persons are not beneficiaries:
(a) persons serving a term of imprisonment in a penitentiary maintained by Canada;
(b) persons serving a term of imprisonment in a jail maintained by New Brunswick or any other jurisdiction; and
(c) persons held in the New Brunswick Training School or the Nova Scotia Training School for Girls at Truro, Nova Scotia.
2023-19
8A beneficiary or dependent requesting entitled services shall produce and show to the supplier of such services a valid health services card identifying the person receiving the services.
9The health services plan established by this Regulation shall be administered and operated by the Department of Social Development and such other persons as are, in the opinion of the Minister, required.
87-27; 94-152; 2000, c.26, s.152; 2008, c.6, s.25; 2023-19
10(1)Where a person provides an entitled service to a beneficiary or dependent and desires payment from the Director therefor, that person shall submit an account for the service.
10(2)Where a beneficiary pays for an entitled service and seeks reimbursement therefor, the beneficiary shall, in order to receive payment, submit such information as the Director may require to determine the validity of the claim.
2023-19
11(1)Fees not specified in the Schedules to this Regulation with respect to entitled services shall be reasonable and just and may be so determined by the Director and authorized for payment.
11(2)The rates of payment for entitled services not listed in the Schedules to this Regulation and the descriptions of those entitled services are negotiated through contracts with the professional associations that provide those services to beneficiaries.
2023-19
12Where a person submits an account for entitled services in accordance with section 10, and is paid an amount under the health services plan, such payment is, except as provided in this Regulation, payment in full of the account and no other claim shall be made by the person supplying the service against any other person with respect to such account or any part thereof.
13(1)In this section, “assessment”, with respect to accounts submitted for payment under the health services plan, means
(a) the evaluation of such accounts,
(b) the investigation of such accounts to determine their correctness or validity, and
(c) the application and interpretation of the payment Schedules, by the Director to permit a determination as to whether payment should be made under the health services plan with respect to the accounts so submitted,
and “to assess” has a corresponding meaning.
13(2)The Director may, in his sole discretion, require any person who has submitted an account for payment under the health services plan to supply such additional information within such time as in the opinion of the Director is necessary to enable an assessment to be made under this section.
13(3)The Director may
(a) develop rules applicable to assessment under this section,
(b) assess accounts submitted for payment under the health services plan, and
(c) take such action with respect to the payment of accounts so assessed, including the making of orders
(i) denying payment of an account, or
(ii) providing that payment with respect to any entitled service for which payment is claimed in an account be made at a rate less than that provided in the payment Schedule for the entitled service,
which, in the Director’s opinion, will give effect to assessments made under this section.
13(4)No payment shall be made or authorized under the health services plan with respect to services which, in the opinion of the Director, are not entitled services under this Regulation.
14The Director may deduct, for late submission of accounts, five percent per month of each account rendered
(a) more than ninety days after the provision of the entitled service, or
(b) more than ninety days after the end of every three month period of entitled service for cases requiring services over a long period of time.
15(1)Notwithstanding section 14, no payment shall be made by the Director for entitled dental services requiring prior approval by the Dental Advisory Committee if the claim for payment is submitted beyond a period of six months after receiving approval by the Dental Advisory Committee.
15(2)If more than one account for dental services is rendered for the same patient within a six month period and the total of the accounts exceeds two hundred dollars, the Director shall not pay the accounts unless the services were approved by the Dental Advisory Committee, or are considered to be emergency services.
15(3)No payment shall be made for dental services approved by the Dental Advisory Committee until all services have been rendered including examination and radiographs.
15(3.1)A dentist providing an entitled dental service is authorized to collect from a beneficiary or dependent a participation fee, which applies only to the dentist’s own fees.
15(4)Repealed: 2023-19
84-235; 2023-19
16A person receiving services or a prosthesis for which payment is requested or has been made may be required to undergo examination by an independent examiner named by the Director and approved by the advisory committee established under section 19.
17(1)A person, being a beneficiary or a supplier of entitled services who has submitted an account for payment under the health services plan, who has any complaint concerning the assessment of accounts with respect to entitled services rendered or received, may request that the Director review or refer the matter complained of to the advisory committee established under section 19.
17(2)The time for making the request under subsection (1) shall be limited to forty days from the date the matter complained of arose, but the Director may, in his sole discretion, enlarge the time for making the request.
84-235
18The Director shall provide to the professional or trade association representing a group of suppliers any requested relevant information with respect to the payment of their accounts under this Regulation provided that
(a) the Director may charge an amount to cover the cost of supplying the information, and
(b) no information shall be communicated which would disclose an individual account or cause a violation of section 6 of the Act.
2018-38
19(1)There is hereby constituted an advisory committee for dental services which shall be known as the Dental Advisory Committee and shall consist of the following:
(a) three members and an alternate appointed by the Board of the New Brunswick Dental Society each of whom shall be members in good standing of that Society, and
(b) an employee of the Department of Social Development who shall be appointed by the Minister and who shall be the Secretary.
19(2)Any three of the persons appointed under paragraph (1)(a) together with the person appointed under paragraph (1)(b) shall constitute a quorum.
19(3)The advisory committee shall advise the Minister at the Minister’s request in all matters relating to dental services and shall discharge, carry out and perform such duties to assist in all matters pertaining to an effective and efficient dental program.
19(4)Except for the member from the Department of Social Development, members shall be
(a) reimbursed for those accommodation, meal and travel expenses reasonably incurred in connection with their duties on the advisory committee in accordance with the Treasury Board travel policy guidelines, as amended, and
(b) remunerated for attendance at meetings at the rate of $450 per day which time shall include travelling time.
84-235; 87-27; 94-152; 2000, c.26, s.152; 2008, c.6, s.25; 2023-19
20Regulation 71-123 under the Health Services Act is repealed.
SCHEDULE I
The following are not entitled services under Health Services:
DENTAL SERVICES
1Orthodontic services, except treatment performed by an orthodontist.
2Self-curing relines to dentures.
3Goods or services for cosmetic purposes.
VISION SERVICES
4Contact lenses.
5Major or minor eye examinations by an optometrist
(a) for persons who are less than nineteen years of age unless such examinations have been approved by the Director, and
(b) that are more frequent than once in twenty-four months for persons who are nineteen years of age or older unless such examinations have been approved by the Director.
87-27
NURSING SERVICES
6Private duty nursing.
7Nursing service other than that provided in the patient’s home by the Victorian Order of Nurses or provided by the Red Cross nursing service.
PHARMACEUTICAL SERVICES
Repealed: 92-40
8Repealed: 92-40
85-115; 92-40
9Repealed: 92-40
89-18; 92-40
10Repealed: 92-40
89-162; 92-40
11Repealed: 92-40
85-115; 87-27; 89-18; 89-162; 92-40
SCHEDULE II
The rates of payment for entitled services are as follows:
Dental Services
Repealed: 2023-19
2023-19
1Repealed: 2023-19
85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84; 2019, c.2, s.68; 2023-19
2Repealed: 2023-19
85-61; 86-77; 87-138; 88-219; 89-182; 94-152; 2000, c.26, s.152; 2008, c.6, s.25; 2023-19
3Repealed: 2023-19
85-61; 86-77; 87-138; 88-219; 89-182; 2023-19
4Repealed: 2023-19
85-61; 86-77; 87-138; 88-219; 89-182; 2023-19
5Repealed: 2023-19
85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84; 2019, c.2, s.68; 2023-19
6Repealed: 2023-19
84-235; 85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84; 2019, c.2, s.68; 2023-19
7Repealed: 2023-19
86-77; 87-138; 88-219; 89-182; 93-26; 2023-19
8Repealed: 2023-19
86-77; 87-138; 88-219; 89-182; 2023-19
PHARMACEUTICAL SERVICES
87-27; 92-40
9(1)A beneficiary or dependent is eligible to receive as entitled services
(a) drugs for which prescriptions are required by law, and
(b) other drugs and services
that form part of the New Brunswick Therapeutic Drug Formulary and Interchangeable Products List.
9(2)Notwithstanding subsection (1), only a beneficiary and a dependent child under the age of 18 years who is not self-supporting are eligible to receive the following:
(a) single entity vitamins;
(b) fluoride preparations;
(c) anti-parasitic applications;
(d) antifungal agents; and
(e) allergy sera.
85-115; 92-40
10Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a pharmacy shall be that set out in section 16 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11 which may be collected from the person.
84-235; 92-40
11(1)The participation fee for each entitled service under section 9 is
 
(a)for a social assistance adult beneficiary or dependent (person 18 years of age or older)..............
$4.00
 
(b)for a social assistance child dependent (persons who have not reached their 18th birthday)..............
$2.00
11(2)Notwithstanding subsection (1), a pharmacy or dispensing physician who dispenses an entitled service under section 9 may collect an additional participation fee from a social assistance adult beneficiary or dependent as permitted under section 12.1.
11(3)No beneficiary is required to pay more than a total of two hundred and fifty dollars in participation fees under subsection (1) in respect of the beneficiary and his or her dependants in any fiscal year.
11(4)For the purposes of subsection (3), “fiscal year” means the period commencing the first day in April in any year to the thirty-first day of March in the next year, inclusive.
92-40; 96-23
12Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a dispensing physician shall be that set out in section 22 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11, which may be collected from the person.
92-40
12.1(1)Subject to subsection (2), sections 16.1, 20.1, 20.2, 20.3 and 22.1 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act apply with the necessary modifications in respect of an entitled service referred to in section 9.
12.1(2)A reference to an authorized charge in sections 20.1, 20.2 and 20.3 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act shall be deemed to be a reference to a participation fee.
92-40
13(1)Repealed: 92-40
13(2)Repealed: 92-40
13(3)For prescriptions filled by provincial regional health authority pharmacies and provincial mental health clinics payment will be made at cost plus an administrative fee to be determined by the Director.
85-124; 92-40; 93-26; 2002-32
14VISION SERVICES
Repealed: 2023-19
87-27; 2023-19
14Repealed: 2023-19
84-235; 85-61; 85-90; 87-27; 88-220; 89-138; 92-41; 2016, c.37, s.84; 2019, c.2, s.68; 2023-19
15Repealed: 2023-19
84-235; 85-61; 87-27; 89-138; 92-41; 92-42; 2016, c.37, s.84; 2019, c.2, s.68; 2023-19
16Repealed: 2023-19
2023-19
17Repealed: 2023-19
85-61; 89-139; 2016, c.37, s.84; 2019, c.2, s.68; 2023-19
N.B. This Regulation is consolidated to December 13, 2023.