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1997 Legislative Session: 2nd Session, 36th Parliament

FIRST READING

The following electronic version is for informational purposes only.

The printed version remains the official version.

HONOURABLE JOY K. MacPHAIL

MINISTER OF HEALTH AND

MINISTER RESPONSIBLE

FOR SENIORS

BILL 21 – 1997

MEDICARE PROTECTION AMENDMENT ACT, 1997

HER MAJESTY, by and with the advice and consent of the Legislative Assembly of the Province

of British Columbia, enacts as follows:

Section 7 of the Medicare Protection Act, R.S.B.C. 1996, c. 286, is amended

(

a) by repealing subsection (1) and substituting the following:

(1) A resident must apply to the commission in the manner required by the

commission

(

a) for enrollment as a beneficiary if not already enrolled,

(

b) for enrollment of the resident's spouse as a beneficiary if the spouse

(

i) is not living separate and apart from the resident,

(ii) is not enrolled or applying for enrollment as a beneficiary, and

(iii) has not submitted a statement under subsection (1.1),

(

c) for enrollment of each of the resident's children as a beneficiary if the child

(

i) is a resident,

(ii) is not living independently from the resident, and

(iii) is not enrolled or applying for enrollment as a beneficiary.

(1.1) Subsection (1) (

a) does not apply to a resident who submits a statement to the

commission in the manner required by the commission stating that the resident

does not want to be enrolled as a beneficiary.

(1.2) A statement under subsection (1.1) may not be submitted for the purpose of

requesting that a child described by subsection (1) (

c) not be enrolled. ,

(

b) by repealing subsection (7) and substituting the following:

(7) The commission may cancel the enrollment of a beneficiary effective

(

a) on application by the beneficiary, effective on a date subsequent to the date

of the application,

(

b) on the date the commission determines to have been the date that the

beneficiary ceased to be a resident, or

(

c) on the date of enrollment as a beneficiary, if the commission determines that

the beneficiary was not eligible for enrollment on that date.

(7.1) Subsection (7) (

a) does not apply for the purpose of requesting that the enrollment

of a child described by subsection (1) (

c) be cancelled. ,

(

c) in subsection (8) by striking out "who paid them." and substituting "who paid them

unless the commission determines that the person would be unjustly enriched by the

refund." , and

(

d) by adding the following subsection:

(9) A beneficiary must, within 14 days of the change, provide the commission with

(

a) the beneficiary's former and new addresses, if there is a change in these

addresses, or

(

b) the beneficiary's former and new names, if there is a change in the beneficiary's name.

2 The following sections are added:

Consequence to beneficiary of withdrawal from the plan

7.1 The commission must not enroll a person as a beneficiary for a prescribed period from

the date that the commission

(

a) receives a statement under

section 7 (1.1) from the person, or

(

b) cancels the enrollment of the person under

section 7 (7) (a),

the commission must not enroll a person as a beneficiary.

Cancellation of non-resident beneficiary's enrollment

7.2 The commission may cancel the enrollment of a beneficiary if the commission

believes the beneficiary has ceased to be a resident.

Interest on late payments of premiums

8.1 If payments under

section 7 (5) are not made in the prescribed manner and within the

prescribed time, the person liable to make these payments is also liable to pay the

commission interest at the prescribed rate on these payments.

Certificate of default

8.2

(1) If a person defaults in the payment of part or all of the premiums, including any

interest on premiums, payable under this Act, the commission may issue a

certificate in the prescribed form stating

(

a) that payment is in default,

(

b) the amount remaining unpaid, including interest, and

(

c) the name of the person by whom it is payable.

(2) The commission may file the certificate with a court of competent jurisdiction 30

days after the commission has served the person in default with

(

a) a copy of the certificate, and

(

b) a notice stating the location of the court where the certificate will be filed.

(3) The documents referred to in subsection (2) (

a) and (

b) sent by registered mail to

the last known address of the person in default are conclusively deemed to be

served on the person to whom they are addressed on the earlier of

(

a) the 14th day after these documents were deposited with Canada Post, or

(

b) the date on which these documents were actually received by the person,

whether by mail or otherwise.

(4) An appeal from a certificate filed under subsection (2) lies to the court at the

location where the certificate is filed and, if an appeal is commenced, the

application of subsection (7) is not stayed unless the court orders otherwise

pending the outcome of the appeal.

(5) No appeal referred to in subsection (4) shall be instituted later than 45 days after

the filing of the certificate under subsection (2).

(6) An appeal referred to in subsection (4) shall be a trial de novo and the court may

make any order it considers just, including an order that the commission amend

its certificate.

(7) On being filed, the certificate, including any amendment made under

subsection (6), has the same force and effect, and all proceedings may be taken

on it, as if it were a judgment in favour of the government of the court for the

recovery of a debt for the amount stated in the certificate against the person

named in it.

(8) Section 32 (2) to (4) applies to the amount referred to in subsection (1) (

b) stated

in a certificate as though that amount were the premiums referred to in

section 32 (2) collected under an agreement referred to in

section 32 (1).

Section 9 is repealed and the following substituted:

Payments for benefits

9 Subject to sections 10 (1), 11, 14 and 15, a beneficiary is entitled to have payment

made in accordance with amounts in a payment

schedule for a benefit that the

beneficiary has received and this payment will be

(

a) at a reduced rate, if applicable, as provided for under this Act, and

(

b) less any applicable patient visit charge.

Section 11 (4) is amended by striking out "cancellation under

section 7 (7) (b)," and substituting "cancellation under

section 7 (7) (

b) or (c)," .

Section 13 is amended by adding the following subsections:

(3.1) The commission may establish one or more formulae under which

(

a) one or more categories of medical practitioners are specified by

(

i) the lengths of their periods of enrollment or practice as medical

practitioners,

(ii) the benefits to which this regulation applies, and

(iii) the area of British Columbia where this regulation applies, and

(

b) the rate or rates at which medical practitioners in a category established

under paragraph (

a) are eligible to be paid, less any reduction made under

section 24 (2), for rendering benefits specified under paragraph (a) (ii) in the

area specified under paragraph (a) (iii).

(3.2) Despite subsection (3), a medical practitioner in a category established under

subsection (3.1) (

a) who renders a benefit specified under subsection (3.1) (a) (ii)

to a beneficiary in an area specified under subsection (3.1) (a) (iii) is, if this Act

and the regulations made under it are complied with, eligible to be paid for his or

her services in accordance with the applicable rate established under

subsection (3.1) (b), less any reduction made under

section 24 (2), rather than as

provided for under the applicable payment schedule.

6 The following

section is added:

Disqualification from enrollment as a medical practitioner

13.1

(1) Despite

section 13 (2), no person may be enrolled as a medical practitioner if the

person is 75 years of age or older.

(2) The enrollment of a medical practitioner is cancelled on December 31 of the

calendar year in which the medical practitioner becomes 75 years of age.

(3) Despite subsection (2), in the calendar year in which this

section comes into

force, the enrollment of a medical practitioner is cancelled on December 31 of

that calendar year if the medical practitioner is 75 years of age or older.

(4) Despite subsections (1) to (3), if the commission is satisfied that beneficiaries

may be denied access to necessary benefits if subsections (1) to (3) were to apply

to a person, the commission may suspend the application of subsections (1) to

(3) 7 S ection 15 (2) is amended by striking out "or" at the end of paragraph (

a) and by adding

the following paragraph:

(a.1) order that the practitioner, for a period fixed by the commission, be paid for

rendering benefits at a rate specified by the commission that is less than the

rate under the applicable payment schedule, or .

Section 18 is amended

(

a) in subsection (1) by striking out "the medical practitioner must not charge

the person" and substituting "a person must not charge the beneficiary" ,

and

(

b) in subsection (3) by striking out "the medical practitioner" and substituting "a person" .

9 The following

section is added:

Persons acting for beneficiaries

20.1

(1) A person requesting a benefit for a beneficiary must not be charged for the benefit

in place of the beneficiary if this Part requires that the beneficiary not be charged

for the benefit.

(2) A person requesting a benefit for a beneficiary must receive advice concerning a

requirement to pay for the benefit if this Part requires that the beneficiary receive

advice concerning the requirement to pay for the benefit.

Section 32 is amended

(

a) by adding the following subsection:

(1.1) If the payment of another person's premiums referred to in subsection (1) (

a) is

in arrears, including arrears arising before the making of an agreement referred

to in subsection (1) respecting the other person, the person making the agreement,

if requested by the commission, must collect and remit the arrears, including

applicable interest on these arrears, by payment to the commission as specified

by the commission under subsection (1). , and

(

b) in subsection (2) by striking out "subsection (1)" and substituting "subsection (1) and

arrears collected under subsection (1.1)" .

Section 36 is amended

(

a) in subsection (1) by adding the following definition:

"prescribed agency" means a body that is prescribed for the purposes of this Part. ,

and

(

b) by adding the following subsections:

(2.1) If the commission, on behalf of a prescribed agency, pays a practitioner, an owner

of a diagnostic facility or a representative of a professional corporation for

services rendered, or claimed to have been rendered, this Part applies to the

services as though these services were benefits.

(2.2) The claims and patterns of practice or billing concerning a prescribed agency

(

a) need not be under this Act, and

(

b) can have arisen at any time since July 24, 1992.

Section 37 (1) is amended

(

a) in paragraph (

b) by striking out "by a practitioner" , and

(

b) in paragraph (

c) by striking out "by the practitioner" .

Section 43 is repealed and the following substituted:

Appeals – practitioners and diagnostic facilities

(1) A practitioner, an owner of a diagnostic facility or a representative of a professional corporation in respect of whom an order was made under

section 15 (2)

or 37 (1) may appeal the order to the Supreme Court not more than 30 days after

the date of the order or cancellation.

(2) An appeal from a decision of the Supreme Court on appeal under subsection

(1) lies to the Court of Appeal with leave of a justice of the Court of Appeal.

(3) An appeal under this

section does not operate to stay the order appealed from

unless the court to which the appeal is made otherwise orders.

Section 51 (2) is amended by adding the following paragraphs:

(c.1) prescribing the period for the purposes of

section 7.1;

(c.2) establishing the manner and time for the making of payments of premiums;

(c.3) prescribing the rate for the purposes of

section 8.1;

(c.4) prescribing the form of certificate under

section 8.2;

(h.1) prescribing bodies for the purposes the definition of prescribed agencies in

Part 7; .

Commencement

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

Explanatory Notes

[This Bill amends the Revised Statutes of British Columbia,

1996. The Revised Statutes of British Columbia, 1996 came into force on April

21, 1997.]

SECTION 1: [Medicare Protection Act, amends

section 7]

requires all residents as defined in the Act to enroll as beneficiaries unless

they elect not to be enrolled by submitting a statement to the commission;

provides that an election not to be enrolled can not be made by or on behalf

of a dependent child;

requires beneficiaries to keep the commission advised of their current

names and addresses;

clarifies that a beneficiary will not qualify for a refund of premiums through

voluntary cancellation of enrollment if this would result in an unjust enrichment of the beneficiary.

SECTION 2: [Medicare Protection Act, enacts sections 7.1, 7.2, 8.1 and 8.2]

creates a waiting period for enrollment as a beneficiary for persons who

voluntarily cancel their enrollments, or elect not to be enrolled, as beneficiaries;

allows the commission to cancel the enrollment of a beneficiary if the

commission believes the beneficiary has ceased to be a resident;

allows interest to be charged at a prescribed rate on overdue premium

payments;

allows the commission to file with a court a certificate setting out the

amount owed by a beneficiary in arrears and to enforce payment of this

amount through that court as though the court had issued a judgment for that

amount.

SECTION 3: [Medicare Protection Act, re-enacts

section 9] is only to make this similar to

other Bills consequential to the amendments made to

section 13 of the Act by

section 5 of this Bill.

SECTION 4: [Medicare Protection Act, amends

section 11 (4)] is a consequential

amendment to the amendments made to

section 7 (7) of the Act by this Bill.

SECTION 5: [Medicare Protection Act, adds

section 13 (3.1) and (3.2)] allows the commission to establish formulae for increasing or decreasing its payments to

specified medical practitioners from those established by payment schedules

established under

Part 5 of the Act for rendering specified benefits. The

increase or decrease would be based on the area of British Columbia where the

benefit is rendered and the length of time of enrollment of the medical practitioner.

SECTION 6: [Medicare Protection Act, enacts

section 13.1] disqualifies persons 75 years

of age or older from being, or remaining, enrolled under the Act as medical

practitioners except in special cases where the commission is satisfied that

beneficiaries may otherwise be denied access to necessary benefits.

SECTION 7: [Medicare Protection Act, amends

section 15 (2)] allows the commission, as

a penalty for contravention of the rules governing the plan, to reduce for a time

the rate at which a practitioner can bill for benefits rendered.

SECTION 8: [Medicare Protection Act, amends

section 18] clarifies that the prohibition on

extra billing applies not only to medical practitioners but also to any person

billing on behalf of a medical practitioner.

SECTION 9: [Medicare Protection Act, enacts

section 20.1] clarifies that a relative or other

person aiding a benefit to obtain a beneficiary can not be billed for charges that

the Act specifies can not be billed directly to or on behalf of the beneficiary.

SECTION 10: [Medicare Protection Act, amends

section 32] facilitates the collection under

section 32 of premiums in arrears.

SECTION 11: [Medicare Protection Act, amends

section 36] allows

Part 7 of the Act, which

provides for the inspection and audit of claims by a practitioner, an owner of a

diagnostic facility or a representative of a professional corporation for

payments under the plan, to be applied for the inspection and audit of claims

for payments from the commission acting as a payments agent on behalf of the

prescribed agencies.

SECTION 12: [Medicare Protection Act, amends

section 37 (1)] clarifies the intent of

section

37 (1) of the Act which is that the

section apply generally to the actions of a

practitioner, owner of a diagnostic facility or a representative of a professional

corporation. The amendments to

section 36 of the Act extend the application

section 37 to corresponding actions of those acting for prescribed agencies.

SECTION 13: [Medicare Protection Act, re-enacts

section 43] allows a practitioner, an

owner of a diagnostic facility or a representative of a professional corporation

to appeal directly to the Supreme Court in circumstances where, under the

current

section 43, the appeal would be to the Medical and Health Care

Services Appeal Board.

SECTION 14: [Medicare Protection Act, amends

section 51 (2)] allows regulations to be

made to prescribe matters that this Bill requires be prescribed.

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