Bill 21 (Legislature 24, Session 2)

L24 S2 974

Alberta — Bills

1998 BILL 21 Second Session, 24th Legislature, 47 Elizabeth II THE LEGISLA TIVE A SSEMBLY OF A LBERTA B ILL 21 A LB ER TA H EA LTH C A R E IN SU R A N C E A M EN D M EN T A C T, 1998 THE MINISTER OF HEA LTH First Reading Second Reading Committee of the Whole Third Reading Royal A ssent

Bill 21 B ILL 21 1998 A LB ER TA H EA LTH C A R E IN SU R A N C E A M EN D M EN T A C T, 1998 (Assented to , 1998) HER MA JESTY, by and with the advice and consent of the Legislative A ssembly of A lberta, enacts as follows: Amends RSA 1980 cA-24 1 The A lberta H ealth C are Insurance A ct is am ended by this A ct. 2 Sections 5.05 and 5.1 are repealed and the follow ing is substituted: Payment of benefits 5.05(1) No physician or dental surgeon may receive the payment of benefits from the Minister for insured services provided in A lberta to a resident unless the physician or dental surgeon was opted into the Plan when the insured services were provided.

(2) No resident may receive the payment of benefits from the Minister for insured services provided in A lberta to the resident by a physician or dental surgeon unless the physician or dental surgeon who provided the insured services was opted into the Plan when the insured services were provided.

(3) Notwithstanding subsections (1) and (2), the Minister may pay benefits for insured services provided in A lberta to a resident by a physician or dental surgeon who was opted out of the Plan if the insured services were provided in an emergency. Opting in and out by dental surgeons 5.1(1) Subject to this section, every dental surgeon is deemed to have opted into the Plan.

(2) A dental surgeon may opt out of the Plan by 1

Explanatory N otes 1 A mends

chapter A -24 of the Revised Statutes of A lberta 1980. 2 Sections 5.05 and 5.1 presently read: 5 .0 5

(1) No physician or dental surgeon m ay receive the paym ent of benefits from the M inister for insured services provided in Alberta to a resident unless, (

a) in the case of insured services provided by a physician, the physician was enrolled in the Plan when the services were provided; (

b) in the case of insured services provided by a dental surgeon, the dental surgeon was opted into the Plan when the services were provided.

(2) No resident m ay receive the paym ent of benefits from the M inister for insured services provided in Alberta to the resident by a physician or dental surgeon unless (

a) the physician who provided the insured services was enrolled in the Plan when the insured services were provided, or (

b) the dental surgeon who provided the insured services was opted into the Plan when the insured services were provided.

(3) Notwithstanding subsections (1) and (2), the M inister m ay pay benefits for insured services provided in Alberta to a resident by a 1 Explanatory Notes

(

a) notifying the Minister in writing indicating the effective date of the opting out, and (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the dental surgeon practises at least 30 days prior to the effective date of the opting out.

(3) A dental surgeon who has not previously practised in A lberta may opt out of the Plan prior to commencing practice by (

a) notifying the Minister in writing indicating the date on which the dental surgeon will commence opted-out practice, and (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the dental surgeon intends to practise.

(4) A dental surgeon who has opted out of the Plan shall (

a) post a notice in a part of the dental surgeon’s office to which patients have access advising patients of the dental surgeon’s opted-out status, and (

b) ensure that each patient is advised in person of the dental surgeon’s opted-out status before any service is provided to the patient.

(5) A dental surgeon who has opted out of the Plan may opt into the Plan by notifying the Minister in writing at least 30 days prior to the effective date of the opting in. Opting in and out by physicians 5.11(1) Subject to this section, every physician is deemed to have opted into the Plan.

(2) A physician may apply to the Minister to opt out of the Plan.

(3) A n application must (

a) be in a form acceptable to and contain the information required by the Minister, and (

b) be submitted to the Minister at least 90 days before the proposed effective date of opting out.

(4) The Minister shall make a decision on an application within 60 days after receipt of the application. 2

physician who was not enrolled in the Plan or a dental surgeon who was opted out of the Plan if the insured services were provided in an em ergency. 5 .1(1) Subject to this section, every dental surgeon shall be deem ed to have opted into the Plan.

(2) A dental surgeon m ay opt out of the Plan by (

a) notifying the M inister in writing indicating the effective date of the opting out, and (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the dental surgeon practises at least 30 days prior to the effective date of the opting out.

(3) A dental surgeon who has not previously practised in Alberta m ay opt out of the Plan prior to com m encing practice, by (

a) notifying the M inister in writing indicating the date on which the dental surgeon will com m ence practice, and (

b) publishing a notice of the proposed opting out in a newspaper having general circulation in the area in which the dental surgeon intends to practise.

(4) A dental surgeon who has opted out of the Plan m ay opt into the Plan by notifying the M inister in writing at least 30 days prior to the effective date of the opting in. 2 Explanatory Notes

(5) The Minister may refuse an application if the Minister is of the opinion that there is a need for the type of insured services provided by the physician.

(6) If the Minister approves the application, the physician shall (

a) publish a notice of the proposed opting out at least 30 days prior to the effective date of the opting out in a newspaper having general circulation in the area in which the physician practises, (

b) post a notice in a part of the physician’s office to which patients have access advising patients of the physician’s opted-out status, and (

c) ensure that each patient is advised in person of the physician’s opted-out status before any service is provided to the patient.

(7) A physician who has been opted out of the Plan for a continuous period of at least one year may opt into the Plan by notifying the Minister in writing at least 30 days prior to the effective date of the opting in.

(8) A physician who has been opted out of the Plan for a continuous period of less than one year may apply to the Minister to opt into the Plan.

(9) A n application under subsection (8) must be in a form acceptable to and contain the information required by the Minister.

(10) The Minister may allow the application if the Minister is of the opinion that there is a need for the type of insured services provided by the physician.

(11) In making a decision on an application under subsection (2) or (8) the Minister shall take into consideration the factors, if any, that are set out in the regulations. 3

Section 5.2 is am ended (

a) in subsection (1) by striking out “No physician who is enrolled in the Plan and no dental surgeon who is opted into the Plan” and substituting “No physician or dental surgeon who is opted into the Plan”; 3

Section 5.2 presently reads in part: 5 .2(1) No physician who is enrolled in the Plan and no dental surgeon who is opted into the Plan who provides insured services to a person shall charge or collect from any person an am ount in addition to the benefits payable by the M inister for those insured services. 3 Explanatory Notes

(

b) by repealing subsection (2)(

c) and substituting the follow ing: (

c) in the case of a 3rd or subsequent contravention, order that, after a date specified in the order, the physician or dental surgeon is deemed to have opted out of the Plan for the period specified in the order. 4

Section 5.3 is am ended by striking out “If a physician who is not enrolled in the Plan or a dental surgeon who is opted out of the Plan” and substituting “If a physician or dental surgeon who is opted out of the Plan”. 5 The follow ing is added after

section 5.3: Other prohibited fees 5.31(1) No person shall charge or collect from any person (

a) an amount for any goods or services that are provided as a condition to receiving an insured service provided by a physician or dental surgeon who is opted into the Plan, or (

b) an amount the payment of which is a condition to receiving an insured service provided by a physician or dental surgeon who is opted into the Plan where the amount is in addition to the benefits payable by the Minister for the insured service. (2) Subsection (1) does not prohibit the charging or collecting of an amount paid for non-insured health or pharmaceutical goods or services where the charging or collecting of that amount is not otherwise prohibited under this A ct or the H ospitals Act and a physician or dental surgeon reasonably determines that it is necessary to provide the non-insured health or pharmaceutical goods or services before the insured service is provided. 4

(2) If a physician or dental surgeon contravenes subsection (1), the M inister m ay, (

a) in the case of a first or subsequent contravention, send a written warning to the physician or dental surgeon, (

b) in the case of a 2nd or subsequent contravention, refer the contravention to the College or The Alberta D ental Association, as the case m ay be, and (

c) in the case of a 3rd or subsequent contravention, order that, after a date specified in the order, (

i) in the case of a physician, the physician is deem ed not to be enrolled in the Plan for the period specified in the order, and (ii) in the case of a dental surgeon, the dental surgeon is deem ed to have opted out of the Plan for the period specified in the order. 4

Section 5.3 presently reads: 5 .3 If a physician who is not enrolled in the Plan or a dental surgeon who is opted out of the Plan provides insured services in Alberta in an em ergency to a resident in respect of whom benefits m ay be paid and the physician, dental surgeon or resident is paid benefits with respect to those insured services, the physician or dental surgeon shall not charge or collect from any person an am ount in addition to those benefits. 5 New provisions regarding facility fees and related benefit payments. 4 Explanatory Notes

(3) If a person receives an amount in contravention of subsection (1) the Minister may recover that amount in a civil action in debt as though that amount were a debt owing from the person to the Crown in right of A lberta.

(4) Where the Minister recovers any amount under subsection (3) the Minister shall reimburse the person who was charged the amount. Prohibition on receiving benefits 5.32(1) A physician or dental surgeon who is opted into the Plan and provides insured services to a person in circumstances where the physician or dental surgeon knows or ought reasonably to know that the person is being charged an amount in contravention of

section 5.31 shall not receive the payment of benefits from the Minister for those insured services.

(2) Section 5.2(2) applies where a physician or dental surgeon contravenes subsection (1). 6

Section 5.4 is repealed and the follow ing is substituted: Minister’s right to recover amounts 5.4(1) If a physician or dental surgeon (

a) in contravention of

section 5.2 or 5.3, receives an amount in addition to the benefits payable by the Minister, or (

b) receives the payment of benefits in contravention of

section 5.32, the Minister may recover the additional amount and the benefits in a case referred to in clause (a), or the benefits in a case referred to in clause (b), by one or more of the following means: (

c) by withholding those amounts from any benefits payable to the physician or dental surgeon; (

d) by civil action as though those amounts were a debt owing to the Crown in right of A lberta; (

e) pursuant to any agreement between the Minister and the physician or dental surgeon that provides for the repayment of those amounts.

(2) The Minister shall reimburse a person in respect of whom benefits may be paid for any amounts recovered under subsection (1) that were paid by the person and have not been previously reimbursed. 5

Section 5.4 presently reads: 5 .4(1) If a physician or dental surgeon, in contravention of

section 5.2 or 5 .3, receives an am ount in addition to the benefits payable by the M inister, the M inister m ay recover that additional am ount and the am ount of the benefits by one or m ore of the following m eans: (

a) withholding those am ounts from any benefits payable to the physician or dental surgeon; (

b) civil action as though those am ounts were a debt owing to the Crown in right of Alberta; (

c) pursuant to an agreem ent between the M inister and the physician or dental surgeon that provides for the repaym ent of those am ounts.

(2) The M inister shall reim burse a resident in respect of whom benefits m ay be paid or his personal representatives for any am ounts recovered under subsection (1) that were paid by the resident and with respect to which the resident did not receive benefits. 5 Explanatory Notes

7 The follow ing is added after

section 5.4: Offence 5.41 A person who contravenes

section 5.2, 5.3, 5.31 or 5.32 is guilty of an offence and liable to a fine of not more than (a) $1000 for the first offence, and (b) $2000 for the 2nd and each subsequent offence. 8

Section 5.5(1) is am ended by striking out “a physician who is not enrolled in the Plan and a dental surgeon who is opted out of the Plan” and substituting “a physician or dental surgeon who is opted out of the Plan”. 9 Sections 5.6 to 5.9 are repealed. 10

Section 6 is am ended (

a) in clause (h.1) by adding “or 5.11(7)” after “section 5.1”; (

b) by repealing clause (h.2) and substituting the follow ing: (h.2) respecting the factors to be taken into consideration by the Minister in dealing with applications under

section 5.11(2) and (8); (

c) by repealing clauses (h.3) to (h.7). 6

7 Offences respecting unlawful fees. 8

Section 5.5(1) presently reads: 5 .5

(1) Prior to providing insured services in Alberta to a resident in respect of whom benefits m ay be paid, a physician who is not enrolled in the Plan and a dental surgeon who is opted out of the Plan shall advise the resident of that fact and that the resident is not entitled to be reim bursed from the Plan for the cost of any insured services provided by the physician or dental surgeon. 9 Repeal of enrolment provisions for physicians. 10

Section 6 presently reads in part: 6 The Lieutenant G overnor in Council m ay m ake regulations (h.1) governing notifications under

section 5 .1; (h.2) respecting the application procedures and requirem ents for physicians to be enrolled in the Plan; (h.3) respecting the determ ination of need for the purposes of physicians ’ eligibility for enrolm ent in the Plan; (h.4) establishing additional eligibility criteria for the enrolm ent of physicians in the Plan; (h.5 ) respecting the term s and conditions that m ay be im posed on a physician’s enrolm ent in the Plan; (h.6) respecting the suspension and cancellation of a physician’s enrolm ent in the Plan; (h.7) respecting the procedures and requirem ents for physicians who wish to have their enrolm ent in the Plan term inated; 6 Explanatory Notes

Section 13(2)(

b) is repealed and the following is substituted: (

b) to any committee established to advise the Minister in respect of matters under

section 8. 12 A physician who immediately before the coming into force of this

section was enrolled in the Alberta Health Care Insurance Plan is deemed to be opted into the Plan. 13 This Act comes into force on Proclamation. 7

Section 13(2) presently reads:

(2) The Minister or a person employed in the administration of this Act and authorized by the Minister may disclose or communicate information pertaining to the date on which health services were provided, a description of those services, any diagnosis given by a person who provided the services, the name and address of the person who provided the services, the benefits paid for those services and the person to whom they were paid, the name and address of the person to whom the services were provided and any other information pertaining to the nature of the health services provided (

b) to the Medical Practice Audit Committee established by the College. 12 Transitional. 13 Coming into force. 7 Explanatory Notes Title: 1998 (24th, 2nd) Bill 21, Alberta Health Care Insurance Amendment Act, 1998

Document details

Collection	Alberta — Bills
Citation	L24 S2 974
Type	bill
Volume / chapter	L24 S2 974
Language	en
Format	json
Source	PROVINCIAL
Identifier	d668a8e8c29f2260da48b26dd77de5e3b13e093e

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