Acts and Regulations

84-20 - General

Section 14.4
Disposition versions

Full text
14.4(1)For the twelve month period beginning on April 1 of any year, the Lieutenant-Governor in Council may determine the sum that is available to the Medicare Branch for payments for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons.
14.4(2)A determination under subsection (1) may be made at any time before or during the twelve month period to which it relates.
14.4(3)Notwithstanding any other provision of this Regulation, where a determination has been made under subsection (1) and the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons exceeds
(a) by June 30 of the period to which the determination relates, twenty-seven per cent of the sum determined,
(b) by September 30 of the period to which the determination relates, forty-eight per cent of the sum determined,
(c) by December 31 of the period to which the determination relates, seventy-four per cent of the sum determined, or
(d) by March 31 of the period to which the determination relates, one hundred per cent of the sum determined,
the amount payable for ordinary entitled services rendered by every medical practitioner or oral and maxillofacial surgeon shall be, if the Director so directs, for the three months immediately following a period in which an excess occurred, a percentage below the amount that would be payable apart from this section.
14.4(4)Where during part or all of any period referred to in subsection (2) the amounts payable for ordinary entitled services have been set under that subsection, and at the end of that period the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners and oral and maxillofacial surgeons has not reached the level set by subsection (2) for the end of that period, the amount payable during the three months that immediately follow for ordinary entitled services rendered by any medical practitioner or oral and maxillofacial surgeon shall be, if the Director so directs, a percentage above the amount that would be payable apart from this section.
14.4(5)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections the Director shall have regard to the following principles:
(a) that the levels stated in subsection (2) should not be exceeded, and
(b) that subject to paragraph (a), the total of all amounts actually paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons should be, at the end of each period referred to in subsection (2), as close as possible to the total of the amounts that would have been paid for those entitled services if the amounts payable had not been affected by subsection (2).
14.4(6)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections in relation to payments to be made in the three months immediately following the end of the twelve month period to which a determination under subsection (1) relates, the Director may assume, unless a further determination has already been made under subsection (1), that for the twelve month period that is about to begin a determination will be made under subsection (1) in the same terms as the determination that was made for the twelve month period that is ending.
90-83; 2003-51; 2019, c.12, s.21
14.4(1)For the twelve month period beginning on April 1 of any year, the Lieutenant-Governor in Council may determine the sum that is available to the Medicare Branch for payments for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons.
14.4(2)A determination under subsection (1) may be made at any time before or during the twelve month period to which it relates.
14.4(3)Notwithstanding any other provision of this Regulation, where a determination has been made under subsection (1) and the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons exceeds
(a) by June 30 of the period to which the determination relates, twenty-seven per cent of the sum determined,
(b) by September 30 of the period to which the determination relates, forty-eight per cent of the sum determined,
(c) by December 31 of the period to which the determination relates, seventy-four per cent of the sum determined, or
(d) by March 31 of the period to which the determination relates, one hundred per cent of the sum determined,
the amount payable for ordinary entitled services rendered by every medical practitioner or oral and maxillofacial surgeon shall be, if the Director so directs, for the three months immediately following a period in which an excess occurred, a percentage below the amount that would be payable apart from this section.
14.4(4)Where during part or all of any period referred to in subsection (2) the amounts payable for ordinary entitled services have been set under that subsection, and at the end of that period the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners and oral and maxillofacial surgeons has not reached the level set by subsection (2) for the end of that period, the amount payable during the three months that immediately follow for ordinary entitled services rendered by any medical practitioner or oral and maxillofacial surgeon shall be, if the Director so directs, a percentage above the amount that would be payable apart from this section.
14.4(5)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections the Director shall have regard to the following principles:
(a) that the levels stated in subsection (2) should not be exceeded, and
(b) that subject to paragraph (a), the total of all amounts actually paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons should be, at the end of each period referred to in subsection (2), as close as possible to the total of the amounts that would have been paid for those entitled services if the amounts payable had not been affected by subsection (2).
14.4(6)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections in relation to payments to be made in the three months immediately following the end of the twelve month period to which a determination under subsection (1) relates, the Director may assume, unless a further determination has already been made under subsection (1), that for the twelve month period that is about to begin a determination will be made under subsection (1) in the same terms as the determination that was made for the twelve month period that is ending.
90-83; 2003-51
14.4(1)For the twelve month period beginning on April 1 of any year, the Lieutenant-Governor in Council may determine the sum that is available to the Medicare Branch for payments for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons.
14.4(2)A determination under subsection (1) may be made at any time before or during the twelve month period to which it relates.
14.4(3)Notwithstanding any other provision of this Regulation, where a determination has been made under subsection (1) and the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons exceeds
(a) by June 30 of the period to which the determination relates, twenty-seven per cent of the sum determined,
(b) by September 30 of the period to which the determination relates, forty-eight per cent of the sum determined,
(c) by December 31 of the period to which the determination relates, seventy-four per cent of the sum determined, or
(d) by March 31 of the period to which the determination relates, one hundred per cent of the sum determined,
the amount payable for ordinary entitled services rendered by every medical practitioner or oral and maxillofacial surgeon shall be, if the Director so directs, for the three months immediately following a period in which an excess occurred, a percentage below the amount that would be payable apart from this section.
14.4(4)Where during part or all of any period referred to in subsection (2) the amounts payable for ordinary entitled services have been set under that subsection, and at the end of that period the total of all amounts paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners and oral and maxillofacial surgeons has not reached the level set by subsection (2) for the end of that period, the amount payable during the three months that immediately follow for ordinary entitled services rendered by any medical practitioner or oral and maxillofacial surgeon shall be, if the Director so directs, a percentage above the amount that would be payable apart from this section.
14.4(5)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections the Director shall have regard to the following principles:
(a) that the levels stated in subsection (2) should not be exceeded, and
(b) that subject to paragraph (a), the total of all amounts actually paid by the Medicare Branch for ordinary entitled services rendered by medical practitioners or oral and maxillofacial surgeons should be, at the end of each period referred to in subsection (2), as close as possible to the total of the amounts that would have been paid for those entitled services if the amounts payable had not been affected by subsection (2).
14.4(6)In acting under subsections (2) and (3) and in determining percentages for the purpose of those subsections in relation to payments to be made in the three months immediately following the end of the twelve month period to which a determination under subsection (1) relates, the Director may assume, unless a further determination has already been made under subsection (1), that for the twelve month period that is about to begin a determination will be made under subsection (1) in the same terms as the determination that was made for the twelve month period that is ending.
90-83; 2003-51