Acts and Regulations

M-7 - Medical Services Payment Act

Full text
Document at 10 October 2019
CHAPTER M-7
Medical Services Payment Act
Definitions
1In this Act
“beneficiary” means a beneficiary as defined in the regulations;(bénéficiaire)
“cost of the entitled services” includes the cost of future entitled services;(coût des services assurés)
“entitled person” means an entitled person as defined in the regulations;(personne admissible)
“entitled services” means(services assurés)
(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;
“fiscal year” means the period commencing on April 1 in one year and ending on March 31 in the next year;(année financière)
“full time equivalent” means a unit of measurement of the workload of a medical practitioner in providing entitled services during a fiscal year, where one unit represents a workload that is typical of a full time medical practitioner during the fiscal year;(équivalent à plein temps)
“medical practitioner” means a person lawfully entitled to practise medicine in the place in which such practice is carried on by him;(médecin)
“medical services plan” means a plan established pursuant to this Act and the regulations;(régime de services médicaux)
“medicare number” means the number assigned to an entitled person under the regulations;(numéro d’assurance-maladie)
“Minister” means the Minister of Health;(ministre)
“New Brunswick Dental Society” means the New Brunswick Dental Society continued under section 3 of the New Brunswick Dental Act, 1985;(Société dentaire du Nouveau-Brunswick)
“New Brunswick Medical Society” means the New Brunswick Medical Society continued under section 74 of the Medical Act;(Societé médicale du Nouveau-Brunswick)
“non-identifying medical information” means all information acquired with respect to an entitled person except the name, residence, date of birth, sex and medicare number of an entitled person;(renseignement personnel médical non identificateur)
“non-resident” means a person(non-résident)
(a) who resides in a province or territory of Canada with which the provincial authority has entered an agreement under section 2.1, and
(b) who is eligible and entitled to receive services under a plan that is similar to the medical services plan;
“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;(chirurgien buccal et maxillo-facial)
“personal non-medical information” means the name, residence, date of birth, sex and medicare number of an entitled person;(renseignement personnel non médical)
“practitioner number” means a practitioner number as defined in the regulations;(numéro de médecin)
“private hospital facility” means a hospital facility established, operated or maintained by a person other than a regional health authority as defined in the Regional Health Authorities Act;(établissement hospitalier privé)
“provincial authority” means the Minister of Health and includes persons designated by the Minister to act on behalf of the Minister;(autorité provinciale)
“resident” means a person lawfully entitled to be or to remain in Canada, who makes his home and is ordinarily present in New Brunswick, but does not include a tourist, transient or visitor to the Province.(résident)
1968, c.85, s.1; 1971, c.31, s.1; 1975, c.35, s.1; 1986, c.8, s.72; 1988, c.22, s.1; 1989, c.22, s.1; 1991, c.16, s.1; 1992, c.79, s.1; 1992, c.82, s.1; 1993, c.60, s.1; 1994, c.57, s.1; 2000, c.26, s.186; 2002, c.1, s.13; 2003, c.20, s.1; 2006, c.16, s.107; 2014, c.18, s.1; 2019, c.12, s.20
Medical services plan
2(1)The provincial authority shall take such action as is necessary
(a) to establish a medical services plan
(i) that is subject in respect of its accounts and financial transactions to audit by such person as is charged by law with the audit of the accounts of the Province,
(ii) that provides payment for the furnishing of entitled services upon uniform terms and conditions to all beneficiaries in the Province,
(iii) that does not impose a waiting period in excess of three months before persons who become residents of the Province are eligible for entitled services,
(iii.1) that provides for the payment of amounts in respect of the cost of entitled services furnished to a non-resident in the Province, in accordance with an agreement entered into under section 2.1,
(iv) that provides for the payment of amounts in respect of the cost of entitled services furnished to a beneficiary outside the Province or while temporarily absent from the Province, and
(v) that, in the case of persons who move from this Province to become residents of another province, provides for such persons to be deemed to be temporarily absent for any period not exceeding three months that is required to obtain medical care insurance coverage in that other province; and
(b) to establish a division within the Department of Health to administer and operate the medical services plan.
2(2)Notwithstanding subparagraph (1)(a)(iv), the medical services plan shall not provide payments of amounts in respect of the cost of entitled services provided to a beneficiary outside Canada unless the services
(a) are rendered in an emergency, or
(b) are not available in Canada and the provincial authority has authorized the payment.
2(3)Notwithstanding subsection (2), the medical services plan may pay amounts in respect of entitled services furnished to a beneficiary outside Canada if the provincial authority considers it reasonable and appropriate in the circumstances and authorizes the payment.
2(4)Notwithstanding subsection (2), the provincial authority may enter into an agreement with medical facilities in the State of Maine to provide entitled services to beneficiaries who reside in a prescribed geographic area within New Brunswick, and the medical services plan may provide payments of amounts in respect of entitled services furnished to those beneficiaries at those medical facilities at the rate negotiated by the provincial authority.
1968, c.85, s.2; 1971, c.31, s.1; 1986, c.8, s.72; 1988, c.22, s.2; 1997, c.20, s.1; 2000, c.26, s.186; 2003, c.20, s.2; 2006, c.16, s.107
Services not paid for by medical services plan
2.01Notwithstanding 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, or
(b) entitled services furnished in a private hospital facility in the Province.
(c) Repealed: 2011, c.51, s.1
1993, c.60, s.2; 2003, c.20, s.3; 2005, c.28, s.1; 2011, c.51, s.1; 2019, c.12, s.20
Reciprocal agreements with representative of a province or territory
2.1(1)The provincial authority may enter into and amend from time to time reciprocal agreements with a representative of a province or territory of Canada relating to
(a) the payment of amounts in respect of the cost of entitled services furnished to a beneficiary outside the Province or while temporarily absent from the Province, and
(b) the payment of amounts in respect of the cost of entitled services furnished to a non-resident in the Province.
2.1(2)A reciprocal agreement entered into under subsection (1) may specify the entitled services that are not to be considered to be entitled services for the purposes of the agreement.
1988, c.22, s.3; 2003, c.20, s.4
Full time equivalents
2.2(1)The provincial authority may, in respect of a fiscal year, establish maximum desirable levels of full time equivalents for the Province or for one or more areas of the Province specified by the provincial authority for various types of practices engaged in by medical practitioners in the Province or in the area or areas.
2.2(2)Repealed: 1993, c.60, s.3
2.2(3)The provincial authority may adjust a maximum desirable level of full time equivalents established under subsection (1) and the adjustment shall be effective as of the date specified by the provincial authority.
2.2(4)Where the provincial authority has established maximum desirable levels of full time equivalents under subsection (1) in respect of a fiscal year, the provincial authority shall calculate, before the first day of July in that fiscal year, in accordance with a formula provided in the regulations, the full time equivalent for each medical practitioner engaged in a type of practice in the Province or in the area during the preceding fiscal year and the actual number of full time equivalents in the Province or in the area for each type of practice engaged in by medical practitioners in the Province or in the area during the preceding fiscal year.
2.2(5)The actual number of full time equivalents in the Province or in an area for each type of practice engaged in by medical practitioners as calculated under subsection (4) shall be deemed to be the actual number of full time equivalents in the Province or in the area for each type of practice engaged in by medical practitioners in the Province or in the area commencing the first day of April of the fiscal year in which the calculations under subsection (4) are made.
2.2(6)The provincial authority shall adjust the actual number of full time equivalents referred to in subsection (5) in accordance with a formula provided in the regulations and such adjustment is effective as of the date specified by the provincial authority.
2.2(6.1)An adjustment in accordance with subsection (6) shall continue to be applied during the first quarter of the succeeding fiscal year, with such modifications to the formula provided in the regulations as are necessary.
2.2(6.2)Notwithstanding subsection (5), during the first quarter of a fiscal year, the actual number of full time equivalents to be used for the purposes of this Act shall be the actual number of full time equivalents for the previous fiscal year as adjusted in accordance with subsections (6) and (6.1).
2.2(6.3)During the last three quarters of a fiscal year, the actual number of full time equivalents to be used for the purposes of this Act are those calculated under subsection (4), as adjusted during the entire fiscal year in accordance with subsection (6).
2.2(7)An adjustment by the provincial authority under subsection (6) or (6.1) may be retroactive.
1992, c.79, s.2; 1993, c.60, s.3; 2019, c.12, s.20
Determination of area and type of practice for full time equivalents
2.3The provincial authority shall, for the purposes of section 2.2, determine in which area and type of practice or practices a medical practitioner is engaged and the determination of the provincial authority is final.
1992, c.79, s.2
Non-application of Regulations Act
2.4The Regulations Act does not apply to an order, decision, calculation, determination or adjustment made by the provincial authority under section 2.2.
1992, c.79, s.2
Duty of provincial authority to inform
2.5The provincial authority shall inform the New Brunswick Medical Society and each regional health authority under the Regional Health Authorities Act forthwith of any maximum desirable levels of full time equivalents established under subsection 2.2(1), any increases under subsection 2.2(3) and the date of such increases, the actual number of full time equivalents in the Province or in an area for each type of practice calculated under subsection 2.2(4) and any adjustments under subsections 2.2(6) and (6.1) and the effective date of such adjustments.
1992, c.79, s.2; 1993, c.60, s.4; 2002, c.1, s.13
Right of medical practitioner, oral maxillofacial surgeon and patient respecting entitled services
2019, c.12, s.20
3Subject 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 or oral and maxillofacial surgeon from whom he will receive entitled services, or
(b) the right of a medical practitioner or an oral and maxillofacial surgeon
(i) to accept or refuse to accept a patient who is a beneficiary, except in cases of medical emergency,
(ii) to make charges for services to a patient who is not a beneficiary,
(iii) to choose his method of remuneration in accordance with the regulations, or
(iv) to elect in accordance with the regulations to practise his profession outside the provisions of this Act and the regulations.
1968, c.85, s.3; 1985, c.15, s.1; 1986, c.53, s.1; 1993, c.60, s.5; 1996, c.49, s.1; 2003, c.20, s.5; 2019, c.12, s.20
Duty of Minister to consult the New Brunswick Medical Society
4Before recommending regulations to the Lieutenant-Governor in Council under paragraph 12(d), (e), (f), (g), (h.3), (h.4), (h.5), (j), (k), (l) or (n), the Minister shall consult with the New Brunswick Medical Society, and no such regulations shall be made or amended until the advice and recommendations of the Society have been received by the Minister or until the period within which the Society was requested by the Minister to furnish advice and make recommendations has expired whichever is the earlier.
1968, c.85, s.4; 1985, c.15, s.2; 1989, c.22, s.2; 1990, c.41, s.2; 1996, c.49, s.2; 2014, c.18, s.3
Agreement with New Brunswick Medical Society
4.1(1)The provincial authority, with the approval of the Lieutenant-Governor in Council, may enter into an agreement with the New Brunswick Medical Society respecting the payment for furnishing entitled services on a fee for service basis in accordance with a tariff or a system of payment that provides reasonable compensation to medical practitioners.
4.1(2)An agreement entered into under subsection (1) remains in force until it is replaced by another agreement.
4.1(3)Where the regulations provide for the resolution by binding arbitration of differences that arise in the negotiation of an agreement referred to in subsection (1), any award on arbitration shall be deemed a term of the agreement to which it relates.
4.1(4)The terms of an agreement under subsection (1) are subject to any regulations under paragraphs 12(h.1) and (h.2).
1989, c.22, s.3; 1990, c.41, s.2; 1996, c.48, s.1
Repealed
4.101Repealed: 2010, c.15, s.1
2009, c.45, s.1; 2010, c.15, s.1
Payment for entitled services rendered by oral and maxillofacial surgeons
2019, c.12, s.20
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).
2003, c.20, s.6; 2019, c.12, s.20
Payment for service not covered in agreement
4.2The provincial authority may determine the amount to be paid for an entitled service on a fee for service basis if the service is not set out in an agreement under section 4.1 or the amount to be paid for the service is not determined in the agreement.
1989, c.22, s.3; 1996, c.48, s.1
Special arrangements for furnishing of entitled services
4.3The 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.
1989, c.22, s.3; 1996, c.48, s.1; 2003, c.20, s.7
Repealed
5Repealed: 1993, c.60, s.6
1968, c.85, s.5; 1993, c.60, s.6
Obligation of medical practitioner to inform
5.1(1)A medical practitioner or an oral and maxillofacial surgeon 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.
5.1(2)A medical practitioner or an oral and maxillofacial surgeon 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.
1993, c.60, s.7; 2003, c.20, s.8; 2019, c.12, s.20
Practitioner numbers
5.2(1)A medical practitioner or an oral and maxillofacial surgeon 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.
5.2(2)A medical practitioner who is practising in the Province within the provisions of this Act and the regulations immediately before the commencement of this section is not required to apply for a practitioner number.
5.2(3)Subsection (2) includes a medical practitioner who, on the commencement of this section, is being replaced on a locum tenens basis if the medical practitioner was practising in the Province within the provisions of this Act and the regulations immediately before being so replaced.
5.2(4)A practitioner number shall be issued to a medical practitioner or an oral and maxillofacial surgeon, subject to and in accordance with the regulations.
1993, c.60, s.7; 2003, c.20, s.9; 2019, c.12, s.20
Practise outside the Act
5.3A medical practitioner or an oral and maxillofacial surgeon 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.
1993, c.60, s.7; 2003, c.20, s.10; 2019, c.12, s.20
Assessment of accounts and recovery of overpayment
5.4(1)The provincial authority shall approve and assess accounts for entitled services, determine the amounts to be paid for the services and authorize the payment for the services in accordance with this Act and the regulations.
5.4(2)An assessment of an account for an entitled service may be made either before or after the account has been paid by the provincial authority.
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.
1996, c.49, s.3; 2003, c.20, s.11; 2019, c.12, s.20
Review of billing patterns and recovery of overpayment
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 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,
(a) whether the quality of service provided was below a minimum acceptable level,
(b) whether the level of service provided was in excess of what could be considered to be medically required, and
(c) whether there has been misuse of the fee schedule under the medical services plan or under an agreement entered into under section 4.1,
and based on such review the committee shall make recommendations for action to the provincial authority.
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.
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 or oral and maxillofacial surgeon with an opportunity to make a representation to the committee respecting the matter under review.
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.
5.5(5)Notwithstanding subsection (4), the provincial authority may, where it considers it appropriate to do so, recover less than the amount recommended for recovery by the Professional Review Committee or may recover the amount recommended on terms, conditions or schedule that is less onerous than that recommended by the Professional Review Committee, or both.
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 or an oral and maxillofacial surgeon for such period as it considers appropriate, or
(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.
1996, c.49, s.3; 2003, c.20, s.12; 2019, c.12, s.20
Use of random sampling
5.6No 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.
1996, c.49, s.3; 2003, c.20, s.13
Professional Review Committee
5.7(1)The provincial authority shall establish the Professional Review Committee, which shall consist of five members who are medical practitioners appointed by the provincial authority in accordance with the regulations.
5.7(2)The Professional Review Committee shall
(a) conduct reviews and make recommendations to the provincial authority on any matter referred to it under subsection 5.5(1),
(b) examine and study all matters and material forwarded by the provincial authority and make recommendations related to such matters, and
(c) perform such other duties as are prescribed by regulation.
5.7(3)Notwithstanding subsection (1), those persons who are members of the Professional Review Committee, as continued under the General Regulation - Medical Services Payment Act, immediately before the commencement of this section, constitute the members of the Professional Review Committee established under this Act on the commencement of this section, in accordance with the terms of their appointments under the Regulation.
5.7(4)The Professional Review Committee as continued under the General Regulation - Medical Services Payment Act is dissolved on the commencement of this section.
5.7(5)After the commencement of this section, the Professional Review Committee established under this Act may deal with and complete any review, matter or thing commenced by the Professional Review Committee under the General Regulation - Medical Services Payment Act.
1996, c.49, s.3
Non-assignability of beneficiary’s interest
6Notwithstanding section 44 of the Financial Administration Act, the interest of any beneficiary in a payment under this Act is not assignable.
1968, c.85, s.6; 2011, c.20, s.12
Immunity
7Subject to section 11, no action lies against a medical practitioner, an oral and maxillofacial surgeon or other person providing entitled services in respect of information furnished to the provincial authority under this Act or the regulations.
1968, c.85, s.7; 2003, c.20, s.14; 2019, c.12, s.20
Release of information
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
(a) for purposes relating to the administration of this Act or as required by law,
(a.1) as required under section 11.1 of the Family Services Act,
(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,
(c) upon the request or with the written approval of the person to whom the information relates,
(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,
(d.1) information may be released to the College of Physicians and Surgeons of New Brunswick for the purpose of regulating the quality or standards of professional services provided by medical practitioners who are members of the body, including for the purpose of an investigation,
(e) non-identifying medical information may be released,
(f) personal non-medical information may be released to departments, agencies and commissions designated under subsection (2) for the purpose of the planning of services, health research and epidemiological studies,
(f.1) information relating to an account of a medical practitioner or an oral and maxillofacial surgeon for entitled services provided may be released to a regional health authority, as defined in the Regional Health Authorities Act, for the purpose of the efficient delivery of health services,
(g) information relating to medical practitioner registration may be released to the New Brunswick Medical Society and to the College of Physicians and Surgeons of New Brunswick,
(g.01) personal information relating to a medical practitioner may be released to
(i) an agent of the provincial authority for the purpose of administering programs for the benefit of medical practitioners under an agreement referred to in subsection 4.1(1), and
(ii) the New Brunswick Medical Society for the purpose of negotiating an agreement referred to in subsection 4.1(1),
(g.1) information relating to oral and maxillofacial surgeon registration may be released to the New Brunswick Dental Society,
(g.2) information relating to the remuneration of a medical practitioner or an oral and maxillofacial surgeon for entitled services provided may be released for the purpose of public reporting,
(g.3) Repealed: 2019, c.18, s.5
(h) information may be released by the provincial authority, while acting in the capacity of the Minister, for the purpose of enabling the Minister to carry out the Minister’s statutory duties under any Act, or
(h.1) Repealed: 2013, c.46, s.1
(i) information may be released to an employee of the Department of Health who is charged with a statutory duty for the purpose of carrying out that statutory duty.
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.
8(2)The provincial authority may designate departments, agencies and commissions for the purposes of paragraph (1)(f).
8(3)If this section is inconsistent with or in conflict with a provision of the Right to Information and Protection of Privacy Act, other than the provisions of that Act relating to the collection, use or disclosure of personal information in the context of the agreements entered into under section 47.1 of that Act, this section prevails.
1968, c.85, s.8; 1994, c.57, s.3; 1999, c.32, s.10; 2000, c.12, s.1; 2000, c.26, s.186; 2003, c.20, s.15; 2006, c.16, s.107; 2012, c.46, s.1; 2013, c.46, s.1; 2014, c.18, s.3; 2015, c.40, s.1; 2017, c.29, s.5; 2019, c.12, s.20; 2019, c.18, s.5
Inspection of records
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 or oral and maxillofacial surgeons 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.
8.1(2)The Minister shall furnish every inspector with a certificate of the inspector’s appointment and, on entering any place for the purposes of inspection, an inspector shall, on demand, produce the certificate to the person in charge of the place.
8.1(3)A certificate that purports to be an appointment under this section is admissible in evidence without proof of signature and is prima facie evidence that its holder has been duly appointed under subsection (1).
8.1(4)For the purpose of enforcing this Act and the regulations, an inspector may
(a) at any reasonable time, enter and inspect premises described in subsection (1),
(b) request information or production for inspection, examination and audit any books, accounts, reports and medical records that may be relevant to the carrying out of an inspection, and
(c) remove books, accounts, reports and medical records produced as a result of a request under paragraph (b) or discovered during the inspection for the purpose of making copies or taking extracts.
8.1(5)An inspector removing a book, account, report or medical record from premises under subsection (4) shall first provide a receipt for it to the person in charge of the premises and shall promptly return the book, account, report or medical record to the premises after completion of the making of copies or taking of extracts, as the case may be.
8.1(6)Copies of or extracts from books, accounts, reports or medical records removed from premises under this Act and certified by the person making the copies or taking the extracts as being true copies of or extracts from the originals are admissible in evidence to the same extent as, and have the same evidentiary value as, the books, accounts, reports or medical records of which they are copies or from which they are extracts.
1994, c.79, s.1; 2003, c.20, s.16; 2014, c.18, s.3
Obstruction of inspector
8.2(1)Every person shall give all reasonable assistance to the inspector to enable the inspector to exercise powers given under section 8.1 and shall furnish the inspector with such information, books, accounts, reports and medical records as the inspector may reasonably request within the time period specified by the inspector.
8.2(2)No person shall hinder, obstruct or otherwise interfere with an inspector who is carrying out the inspector’s duties and functions under this Act.
8.2(3)No person shall knowingly make a false or misleading statement, either orally or in writing, or provide or produce a false book, account, report or medical record to an inspector who is carrying out the inspector’s duties and functions under this Act.
1994, c.79, s.1; 2013, c.46, s.2
Requirement to produce
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.
8.3(2)A person to whom the Minister has made a request under subsection (1) shall provide all documentation or records required under subsection (1) within the time period specified by the Minister.
8.3(3)No action lies against any person who provides any documentation or records under this section.
8.3(4)Subsection (2) applies notwithstanding any provision of any other Act.
1994, c.79, s.1; 2003, c.20, s.17; 2013, c.46, s.3; 2014, c.18, s.3; 2019, c.12, s.20
Immunity of Minister
9No action lies against the Minister with respect to any act or omission relating to the providing of entitled services under this Act or the regulations.
1968, c.85, s.9; 2014, c.18, s.3
Immunity of committee or committee member
9.1No action for damages or other proceeding shall be taken against any committee established under this Act or the regulations, or any member of such committee, with respect to anything done or purported to be done in good faith by the committee or as a member of the committee, or with respect to anything omitted to be done in good faith by the committee or as a member of the committee, under this Act or the regulations.
1998, c.9, s.1
Recovery of costs of entitled services, subrogation, sharing insufficient recovery, release or settlement, liability insurer
10(1)Where, as a result of the negligence or wrongful act of another, a person suffers personal injuries for which he receives entitled services under this Act or the regulations, he
(a) shall have the same right to claim and to recover the cost of the entitled services against the person who was negligent or who did the wrongful act as he would have had if he, himself, had been required to pay for the entitled services, and
(b) if he makes any claim for the personal injuries suffered against the person who was negligent or who did the wrongful act, shall claim and seek to recover the cost of the entitled services.
10(2)Where under subsection (1), a person either acting for himself or on behalf of another person, recovers a sum in respect of entitled services received under this Act or the regulations, he shall as soon as practicable pay such sum recovered to the provincial authority.
10(3)Where, as a result of the negligence or wrongful act of another, a person suffers personal injuries for which he receives entitled services under this Act or the regulations and he does not claim against the person who was negligent or who did the wrongful act, Her Majesty the Queen in right of the Province may maintain an action in her own name or in the name of the injured person for recovery of the cost of the entitled services.
10(4)Where, as a result of the negligence or wrongful act of another, a person suffers personal injuries for which he receives entitled services under this Act or the regulations and a claim is made against the person who was negligent or who did the wrongful act but the person making the claim, either acting on his own behalf or on behalf of another person, does not
(a) claim for the cost of the entitled services,
(b) if a release is given or the claim is settled, obtain a written approval of the release or settlement in accordance with subsection (9) or (10), or
(c) pay any sum recovered in respect of the entitled services to the provincial authority in accordance with subsection (2),
Her Majesty the Queen in Right of the Province may maintain an action in her own name against the person making the claim, whether acting on his own behalf or on behalf of another person, for recovery of the cost of the entitled services.
10(5)It shall not be a defence to an action brought by Her Majesty under subsection (4) that a release has been given, a claim has been settled or a judgment obtained unless
(a) the claim included a claim for the cost of the entitled services, and
(b) if a release is given or the claim is settled, the provincial authority has under subsection (9) or (10) approved the release or settlement.
10(6)Where the provincial authority or a person designated by him approves in writing a release or settlement under subsection (10), Her Majesty the Queen in right of the Province may continue the action or maintain an action in her own name for recovery of the cost of the entitled services.
Sharing insufficient recovery
10(7)Subject to subsection (10), where, as a result of a claim under this section
(a) the claim is settled or a judgment is obtained, and
(b) insufficient funds are available to provide complete recovery to the injured person for his losses and injuries and to pay the cost of the entitled services,
the injured person and Her Majesty the Queen in right of the Province shall share pro rata in proportion to their respective losses in any recovery in accordance with the terms and conditions prescribed by regulation.
10(8)No person, acting for himself or on behalf of another person, shall, without the approval in writing under subsection (9) or (10) of the provincial authority make a settlement of a claim based upon a cause of action for damages for personal injuries in a case where the injured person has received entitled services under this Act or the regulations unless at the same time he makes a settlement to recover the same pro rata proportion in respect of the cost of the entitled services as the injured person is to recover in respect of his losses and injuries.
10(9)No release or settlement of a claim or judgment based upon a cause of action for damages for personal injuries in a case where the injured person has received entitled services under this Act or the regulations is binding upon Her Majesty unless the provincial authority or a person designated by him has approved the release or settlement in writing.
10(10)Notwithstanding subsection (9), where a person who makes a claim under subsection (1) has obtained an offer for a settlement whereby the same pro rata proportion of the cost of entitled services would be recovered as the injured person would recover in respect of his losses and injuries but, in the opinion of the provincial authority or a person designated by him, the offer would not provide sufficient recovery in respect of the entitled services, the provincial authority or a person designated by him may approve in writing a release or settlement whereby the person making a claim under subsection (1) makes a settlement of a claim in respect of his injuries or losses without making a settlement in respect of the cost of the entitled services but the written approval is not binding on Her Majesty in relation to a claim made under subsection (6) in respect of the cost of the entitled services.
10(11)Where a person whose negligent or wrongful act resulted in personal injuries to another is insured by a liability insurer carrying on business in the Province and a claim made in respect of those personal injuries does not include a claim for the cost of the entitled services received by the injured person under this Act or the regulations, the liability insurer shall pay to the provincial authority the cost of the entitled services and payment of that amount to the provincial authority discharges the liability of the insurer to pay the cost of the entitled services in any subsequent claim to the insured person or any person claiming under or on behalf of the insured person.
10(12)Every liability insurer carrying on business in the Province shall provide the provincial authority, when requested to do so, information relating to
(a) a claim made against an insured person by a person who received entitled services under this Act or the regulations, or
(b) the terms and conditions of any settlement entered into by an insured person and a person who received entitled services under this Act or the regulations.
10(13)In an action under this section a certificate signed or purporting to be signed by or on behalf of the provincial authority shall be accepted by all courts
(a) as conclusive proof
(i) that the person named in the certificate has received entitled services,
(ii) that the amount recorded in the certificate is the cost of the entitled services received by the person named in the certificate, and
(iii) of the office, authority and signature of the person signing or purporting to sign the certificate, without proof of his appointment, authority or signature, and
(b) as prima facie proof that the entitled services were received in respect of the personal injuries suffered.
10(14)This section applies except where the personal injuries occurred as a result of the use or operation of a motor vehicle registered in the Province.
1968, c.85, s.10; 1975, c.35, s.2; 1985, c.15, s.3; 1986, c.53, s.2; 1988, c.22, s.4; 1992, c.82, s.2
Levy
10.01The provincial authority may, in accordance with the Insurance Act, impose a levy for the purpose of recovering the cost of the entitled services provided to beneficiaries under this Act as a result of personal injuries arising out of the use or operation of a motor vehicle registered in the Province.
1992, c.82, s.3; 2003, c.20, s.18
Payment of fee to barrister and solicitor
10.1Notwithstanding any other provision of this Act, the provincial authority or a person designated by him may, in accordance with the regulations, authorize the payment of a fee to a barrister and solicitor who makes a claim on behalf of an injured person and recovers a sum in respect of the cost of entitled services in accordance with section 10.
1988, c.22, s.5
Offences and penalty
11(1)A person who violates or fails to comply with any provision of the regulations commits an offence punishable under Part II of the Provincial Offences Procedure Act as a category B offence.
11(2)A person who violates or fails to comply with subsection 2.02(2), section 8, subsection 8.2(2) or (3), subsection 8.3(2) or subsection 11.1(1), 11.1(2) or 11.1(2.1) commits an offence punishable under Part II of the Provincial Offences Procedure Act as a category F offence.
11(3)A medical practitioner, an oral and maxillofacial surgeon 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.
1968, c.85, s.11; 1985, c.15, s.4; 1990, c.61, s.78; 1994, c.57, s.4; 1994, c.79, s.2; 1998, c.9, s.2; 2003, c.20, s.19; 2019, c.12, s.20
Prohibitions
11.1(1)No person shall knowingly obtain or receive entitled services that he is not entitled to obtain or receive under this Act or the regulations.
11.1(2)No person shall knowingly aid or abet another person to obtain or receive entitled services that such other person is not entitled to obtain or receive under this Act or the regulations.
11.1(2.1)No person shall use information released under subsection 2.02(2) or section 8 for a purpose other than that for which it was released.
11.1(3)Repealed: 1990, c.61, s.78
1985, c.15, s.5; 1990, c.61, s.78; 1994, c.57, s.5; 1998, c.9, s.3
Regulations
12The Lieutenant-Governor in Council may make regulations
(a) establishing a medical services plan;
(a.1) prescribing geographic areas for the purposes of subsection 2(4);
(b) providing for the administration and operation of the medical services plan;
(b.01) prescribing fees to be paid by beneficiaries to replace cards issued under the medical services plan that have been lost, damaged, destroyed or stolen;
(b.02) authorizing the Minister to waive fees to be paid under paragraph (b.01) where, in the Minister’s opinion, the payment of the fee would constitute a hardship;
(b.1) defining “practitioner number”;
(b.2) respecting applications by medical practitioners or oral and maxillofacial surgeons for practitioner numbers;
(b.3) respecting the issuance, classification, suspension, cancellation, reinstatement, surrender and revocation of practitioner numbers;
(b.4) respecting the terms, conditions and circumstances upon which practitioner numbers may be issued, classified, refused, held, used, suspended, cancelled, reinstated, surrendered and revoked;
(c) deeming certain services rendered by a person who is not a medical practitioner or an oral and maxillofacial surgeon to be entitled services;
(c.1) respecting the payment to a person who is not a medical practitioner or an oral and maxillofacial surgeon for providing entitled services to beneficiaries;
(d) deeming certain services not to be entitled services;
(e) prescribing the procedure for a medical practitioner or an oral and maxillofacial surgeon to elect to practise his profession outside the provisions of this Act and the regulations;
(f) respecting the time, manner and form in which accounts shall be rendered and in which any other information required in connection with the accounts shall be submitted;
(g) respecting the assessment and review of accounts with respect to the provision and cost of entitled services and the determination of the amount payable therefor;
(g.1) prescribing the terms and conditions under which Her Majesty the Queen in right of the Province and a person who has suffered personal injuries as a result of the negligence or wrongful act of another shall share the proceeds of any recovery under subsection 10(7);
(g.2) respecting the payment of a fee to a barrister and solicitor who makes a claim on behalf of an injured person and recovers a sum in respect of the cost of entitled services in accordance with section 10;
(g.3) respecting formulas for the purposes of calculations and adjustments under subsections 2.2(4) and (6) respectively;
(h) Repealed: 1989, c.22, s.4
(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
(i) the location of a medical practitioner’s practice,
(i.1) the type of practice engaged in by a medical practitioner,
(i.2) the percentage by which the actual number of full time equivalents for a type of practice engaged in by a medical practitioner in the Province or in an area exceeds the maximum desirable level of full time equivalents established by the provincial authority for that type of practice in the Province or in that area,
(ii) totals of amounts paid for entitled services rendered by a medical practitioner, and
(iii) 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;
(h.2) respecting relief, in whole or in part, from the effect of regulations under subparagraph (h.1)(ii);
(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;
(h.3) respecting procedures to be followed by the provincial authority and the New Brunswick Medical Society in relation to the negotiation of an agreement under section 4.1 or an amendment to such an agreement;
(h.4) respecting the means, procedures and persons or bodies by which differences arising in the negotiation of an agreement under section 4.1, or an amendment to such an agreement, may be resolved;
(h.5) respecting the powers, duties and remuneration of persons or bodies referred to in paragraph (h.4);
(i) respecting the amounts to be paid with respect to the cost of entitled services
(i) in another province or territory of Canada, or
(ii) outside Canada;
(j) specifying circumstances under which travelling expenses incurred by a medical practitioner are deemed to be entitled services;
(j.1) respecting notices to be given by medical practitioners and oral and maxillofacial surgeons to the provincial authority or a person designated by the provincial authority and the form, manner, time and content of such notices;
(k) respecting the manner in which persons may be identified as entitled persons;
(k.1) authorizing the Minister to provide a declaration of residency form;
(l) respecting the appointment of committees and prescribing the duties, powers, objects and procedures of committees, including the Professional Review Committee;
(l.1) Repealed: 1996, c.49, s.4
(m) fixing the remuneration for members of committees while attending meetings and otherwise carrying out their prescribed duties;
(m.1) respecting requests to the provincial authority for a review of calculations and adjustments done in accordance with subsections 2.2(4), (6) and (6.1) and the procedure for conducting a review upon receipt of such a request;
(m.2) defining words and expressions used but not defined in this Act;
(n) respecting appeals from anything done under this Act or the regulations and the procedure therefor; and
(o) generally for the administration of this Act.
1968, c.85, s.12; 1985, c.15, s.6; 1988, c.22, s.6; 1989, c.22, s.4; 1990, c.41, s.3; 1990, c.42, s.1; 1992, c.79, s.3; 1993, c.60, s.8; 1996, c.49, s.4; 1997, c.20, s.2; 2003, c.20, s.20; 2010, c.29, s.1; 2011, c.51, s.2; 2014, c.18, s.2; 2014, c.18, s.3; 2019, c.12, s.20
Retroactivity of regulations under paragraph 12(g.3)
12.1Regulations made under paragraph 12(g.3) may be retroactive in their operation.
1992, c.79, s.4
N.B. This Act is consolidated to June 14, 2019.