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March 4, 2020

HOUSE OF ASSEMBLY PROCEEDINGS

Vol. XLIX No. 28

The

House met at 10 a.m.

MR. SPEAKER (Reid):

Admit strangers.

Okay,

we're ready to start now.

Orders of the Day

MR. SPEAKER:

The hon. the Government House

Leader.

MS. COADY:

Good morning, welcome back

everybody.

Mr.

Speaker, I move, seconded by the Deputy Government House Leader for leave to

introduce a bill,

An Act To Amend The House Of Assembly Accountability,

Integrity And Administration Act, Bill 24, and the bill shall now be read a

first time.

MR. SPEAKER:

It is moved and seconded that

the hon. minister shall have leave to introduce Bill 24,

An Act To Amend The

House Of Assembly Accountability, Integrity And Administration Act, and that the

bill now be read a first time.

Is it

the pleasure of the House to adopt the motion?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against, 'nay.'

Carried.

CLERK (Barnes):

A bill,

An Act To Amend The

House Of Assembly Accountability, Integrity And Administration Act. (Bill 24)

MR. SPEAKER:

The bill has now been read a

first time.

When

shall the said bill be read a second time?

MS. COADY:

Now.

MR. SPEAKER:

Now?

The hon.

the Government House Leader.

MS. COADY:

Sorry, tomorrow.

AN HON. MEMBER:

No leave.

MS. COADY:

No, you're not giving me

leave on that one.

Tomorrow.

MR. SPEAKER:

Tomorrow.

motion, Bill 24 read a first time, ordered read a second time on tomorrow.

MR. SPEAKER:

The hon. the Government House

Leader.

MS. COADY:

Mr. Speaker, I move, seconded

by the Minister of Health and Community Services, for leave to introduce a bill

entitled,

An Act To Amend The Social Workers Act, Bill 25, and that that bill

shall now be read a first time.

MR. SPEAKER:

It has been moved and

seconded that the hon. minister shall have leave to introduce a bill entitled,

An Act To Amend The Social Workers Act, Bill 25, and that the said bill now be

read a first time.

Is it

the pleasure of the House to adopt the motion?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against, 'nay.'

Carried.

Motion,

the hon. the Minister of Health and Community Services to introduce a bill, “An

Act To Amend The Social Workers Act,” carried. (Bill 25)

CLERK:

A bill,

An Act To Amend The

Social Workers Act. (Bill 25)

MR. SPEAKER:

The bill has now been read a

first time.

When

shall the said bill be read a second time?

MS. COADY:

Tomorrow.

MR. SPEAKER:

Tomorrow.

motion, Bill 25 read a first time, ordered read a second time on tomorrow.

MR. SPEAKER:

The hon. the Government House

Leader.

MS. COADY:

Thank you, Mr. Speaker.

From the

Order Paper, Order 2, third reading of Bill 19.

MR. SPEAKER:

It is moved and seconded that

the said bill now be read a third time.

Is it

the pleasure of the House to adopt this motion?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against, 'nay.'

Carried.

CLERK:

A bill,

An Act To Amend The

Cannabis Control Act. (Bill 19)

MR. SPEAKER:

The bill has now been read a

third time and it is ordered that the bill do pass and that its title be as on

the Order Paper.

motion, a bill, “An Act to Amend The Cannabis Control Act,” read a third time,

ordered passed and its title be as on the Order Paper. (Bill 19)

MR. SPEAKER:

The hon. the Government House

Leader.

MS. COADY:

Thank you, Mr. Speaker.

From the

Order Paper, Order 3, second reading of Bill 20.

MR. SPEAKER:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Speaker.

I move,

seconded by the Minister of Transportation and Works that Bill 20,

An Act To

Amend The Medical Care And Hospital Insurance Act, be now read a second time.

MR. SPEAKER:

It has been moved and

seconded that Bill 20,

An Act To Amend The Medical Care And Hospital Insurance

Act, now be read a second time.

Motion,

second reading of a bill, “An Act To Amend The Medical Care And Hospital

Insurance Act.” (Bill 20)

MR. SPEAKER:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Speaker.

To add a

little bit of background for those Members who may not have been here at the

time, in 2016 I think it was actually the first piece of legislation I was in

the privileged position of bringing before this House of Assembly, which was the

Medical Care and Hospital Insurance Act, 2016. This basically revamped and

placed on a new and modern foundation the whole of the Medical Care Plan for

this province. It was the first time it had had a systematic reassessment and

overhaul in several decades.

We have

run that act now for nearly four years and over that period of time, in common

with other legislation – and I can refer back, for example, to the

Cannabis Control Act yesterday – we

have encountered some ways in which this act can be improved. So the logic, the

demand as it were for this amendment is based on experience of running the act

since October of 2016.

As I

say, the act is the legal foundation for the provincial Medical Care Plan and

the Hospital Insurance Plan, and is predicated on the five principles of the

Canada Health Act . It is in accordance

with these plans that insured medical services are recognized and hospital

services, in turn, provided to the people of the province when they need it.

includes provisions related to payments to physicians and surgical dentists for

insured services. It sets out a process for periodic audit of billings that are

submitted to MCP, how they are conducted. It sets out the authority also to

determine which medical services are to be covered by MCP and where those should

be provided. That is whether they're hospital-based or whether they can be

provided in a private medical clinic.

Again,

for background, the inception of medicare in this country brought together a

variety of desperate arrangements for compensation of physicians. Basically, the

bulk of medical services at that time was pay-as-you-go, fee-for-service, and

that model translated into the modern health care system such that about 60 per

cent of services provided in this province are provided by essentially

independent, self-employed contractors; hence, there was a need for a framework

through which these services could be identified and compensated appropriately.

The act

determines – well, it sets out the authority for the determination of rates to

be paid for those services. The actual rates themselves are subject to periodic

negotiation with the Newfoundland and Labrador Medical Association and the

Newfoundland and Labrador Dental Association, and they are set out in other

documents which I will reference as I go through the discussion of the need for

this piece of legislation to be amended.

This

bill makes amendments to

Part IV of the current act, which in that part sets out

the powers and authority of the government to conduct audits of practitioners'

billings. It also adds authority for the Lieutenant-Governor in Council to

incorporate documents by reference into the legislation. So rather than having

these documents – some of which are in excess of 350 pages – actually defined in

statute or even written into the regulations, they can be incorporated by

reference.

In order

to assure compliance with the requirements of the MCP plan, the act permits the

audits of practitioners who provide services and bill MCP. The act sets out a

process by which the billings of physicians and surgical dentists are audit,

this is educational and is predicated on that but it also is an exercise in

financial and fiscal responsibility and accountability. So, it informs the

practitioner and it also allows correction of misbillings.

The act

sets out the audit process and the manner in which disputes around those

findings are to be managed or adjudicated. It permits the Minister of Health and

Community Services – myself – to make various orders for recovery where

overpayment has been identified after such an audit. Where an order is made, the

order may be filed with the court, at which time it becomes an order of the

court and may be enforced by those mechanisms. The act also permits an appeal of

the minister's order to the court.

Audits

have been conducted under MCP for years. Since the act came into force on the

1st of October in 2016, the audits have followed a very detailed process with

very strict timelines. The process includes notification requirements, the

appointment of an audit review board where audit findings can be discussed and

disputed and the conduct of alternate dispute resolution mechanisms to allow

for, if you like, a mediated settlement rather than following a totally

quasi-legal route.

In an

attempt to provide a fair process to those wishing to dispute the audit

findings, the act contains strict timelines prescribing the time in which each

step of the process must occur. In operationalizing these provisions, however,

audit officials with my department have advised that in practice, it's very

difficult for all parties or any party to comply with those very strict

timelines, that is physicians, dentists and staff in the audit division. So they

have become a challenge for all parties to meet.

We have

seen recently where a government's timelines have been subjected to a court

process and the courts have determined that where those timelines have

established in statute, they have to be abided by. That, in turn, is a recent

decision reinforcing the need to reassess those timelines.

Therefore, taking that into account, the bill sets out a number of amendments to

the audit process. It alters and updates the time frames and the process to

allow sufficient opportunity to conduct an alternate dispute resolution

mechanism, but without prejudicing a party's right then to subsequently have a

hearing before a review panel, should that mechanism not achieve a resolution.

amends the appointment term of review panel members; as one of the challenges

there has been ensuring that there are at all times a pool of members from which

the individuals concerned can choose. The process, currently and proposed, would

be that the physician or dental party would be able to choose a member from the

pool; government would choose a member from the pool. The two would then choose

a third party and between the three of them, they would agree on who would be

the review panel chair.

So it

amends those terms to allow a sufficient pool. That has been identified by all

parties as a challenge. It increases the total number of review panel members

and it increases the number of medical members and dentists. Again, that ensures

that there's an adequate pool from which both parties can select potential

members to represent their interests before discussion.

It sets

out the process by which the chairperson of the review is determined. The

current act is silent on the matter and practice has been that it had been

mutual consent of the parties. The bill, however, proposes that the three

members would follow that where at all possible and select from amongst

themselves, but in the absence of agreement, it allows the minister to appoint a

chairperson from one of the three in the event that consensus cannot be

achieved.

Bearing

in mind the time frames and the concerns of all parties – physicians, dentists

and the audit staff – the bill extends the time frame in which a review board

must be selected and the time frame in which a hearing must be conducted in

order to accommodate the schedules of the parties and the review members,

because, again, that has been challenging.

So it

builds in a level of flexibility that currently does not exist, and it builds in

flexibility so that the process is not jeopardized where there is recourse to

the courts and particularly where direction is being sought regarding the

appointment of members. Those have been identified as issues; these amendments

deal with those issues.

addition, Mr. Speaker, to the changes to the audit provision set out in

Part IV,

the bill also amends

section 47 for clarity and ease. This is the

section which

sets out the authority of the Lieutenant-Governor in Council to make

regulations.

Mr.

Speaker, the MCP payment

schedule sets out the rates of payments to be made to

physicians and surgical dentists for listed insured services provided to MCP

beneficiaries. This is a document that is revised on a frequent basis and it's a

document that is subject to periodic negotiation with the Newfoundland and

Labrador Medical Association, Department of Finance and ourselves, and also the

Newfoundland and Labrador Dental Association. It provides guidance to physicians

and dentists in how to bill for their services. So the fee

schedule is not just

simply a list of fees – although that is the bulk of it. It contains a

preamble,

which in actual fact sets out the framework within which the fees listed

subsequently can be billed and in what way they can be billed.

Up until

2003, the MCP payment

schedule was actually appended as a

schedule to the

regulations. Consequently, each time the fees were changed – and as I say, this

is not an infrequent occurrence, even though the cycle of negotiation may be

three to four years, there is often a micro-allocation process that unfolds

within the framework of that agreement which alters fees within a particular

discipline.

So each

time the fees were updated, an amendment to the regulations was required. In

2003, however, that cumbersome mechanism was changed, the regulations were

repealed and replaced and the new regulations no longer had the MCP fee

schedule

actually appended to it. Rather, the regulations, which are still in force,

simply state that payments are to be made in accordance with the fees listed in

the fee schedule.

The fee

schedule in the act is defined in the regulations, rather, as the medical

payment

schedule and the surgical-dental payment schedule. So that specific

subsection, large as it is, but it's still a subsection of the actual MCP fee

schedule that's published and available online.

The act

permits the Minister of Health and Community Services to prescribe by reference

in regulations professional or other scales of fees, the rates of payment to be

made under the act, in respect of insured services provided to beneficiaries by

practitioner. Thereby it no longer requires appending this

schedule to the

regulations. However, Mr. Speaker, the act does not currently contain similar

provision allowing a document other than that to be so incorporated with respect

to insured services and the facilities in which those services are to be

performed.

So it's

a piecemeal approach. It lists the fee

schedule or references the fee schedule,

doesn't deal with the

preamble and it doesn't deal with facilities or location

of services. In accordance with

section 47 of the act, the Lieutenant-Governor

in Council is authorized to make regulations to prescribe which services are

insured for the purposes of the act, which services are not insured services,

which facilities in which insured services may be provided, which services are

hospital services, and which are medical services for the purposes of the act.

Up to

now some of that, however, has been left open to

interpretation and there's been

no clarity. While the Lieutenant-Governor in Council has adopted the

Medical Care Insurance Insured Services

Regulations , which set out in broad terms those services that are insured

and covered, as well as those services that are not covered, these regulations

do not contain the level of detail as the MCP payment

schedule itself, nor as in

other documents filed with the Department of Health and Community Services.

In order

to avoid any confusion, Mr. Speaker, among practitioners and their patients, it

is imperative that a document exist which clearly sets out those insured

services that must be performed in a hospital and those that are permitted to be

provided in a private setting. The reasons for this have become more acute,

given the desire of government and the Newfoundland and Labrador Medical

Association to look at, for operational reasons and access reasons,

transitioning services from regional health authority facilities into private

clinics. That is where this particular move has been given further impetus.

The

current MCP payment

schedule may serve this function because it does contain a

certain level of detail, albeit in the billing context, as to where insured

services are permitted to be provided. The MCP payment

schedule is currently in

excess of 300 pages, making it impractical to reproduce it in regulations. It's

readily available to all physicians and dentists and is accessible on the Health

and Community Services website where we update it regularly. It is a go-to

document for fee-for-service practitioners and it is accessed frequently and

regularly.

Bill 20

includes authority for the Lieutenant-Governor in Council, via regulations, to

incorporate a document by reference without requiring it to be reproduced in its

entirety in the regulations. So you can see where I'm going joining these dots.

This drafting technique is not unusual, for the benefit of people who may not

have experienced it before, given we do have new Members in the House.

As I've

already indicated, the act already permits incorporation of the fee

schedule

part by reference. Other examples of documents incorporated by reference can be

found in recent legislation adopted by this hon. House; for example, the

Public Health Protection and Promotion Act

which came last sitting and the

Prescription Monitoring Act from the previous session which contains similar

provisions. It allows for due process and it allows clinical and association

input and makes it flexible.

Mr.

Speaker, the provision of this bill will come into force, it's proposed, on

Royal Assent; however, the other provisions will be proclaimed at a later date.

These would allow sufficient time to appoint additional members to the review

board panel. That process is not something that can be done overnight.

This

bill will provide more clarity for practising health care professionals as to

what medical services are insured and covered by MCP, a topic that has recently

come to the floor again with inquiries to our department about whether or not

certain procedures are covered. This would be clearly laid out and clearly

available to the public as well as the practitioner.

The

amendments will extend the timelines related to alternate dispute resolution

mechanisms. This is seen as beneficial by all parties. It supports a more fair

process for those wishing to dispute the findings without going to court, yet

does not prejudice their right to a full panel hearing. They will not affect the

practice of physicians or dentists, nor will they affect the availability of

services for patients or access for patients.

Mr.

Speaker, to loop right back to the intent of this act, originally, in 2016, we

have to have legislation that is current, that is up to date and is true to the

original intent of the bill. I would argue that the amendments that I propose

remain true to the spirit of the original act. They help clarify and they help

confirm the purpose of the act. They allow for revision of processes that were

originally put in and found to be cumbersome and difficult for all parties. It's

not one particular group or another that finds themselves particularly

disadvantaged. It was an equal opportunity disadvantage to everybody the way

things were written before.

I would

conclude, Mr. Speaker, by asking that all Members of this hon. House join me – I

would be happy to deal with any particular detailed questions during the

Committee stage of this bill, but I would commend this bill to the House for its

support.

Thank

you very much.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Opposition House

Leader.

MR. BRAZIL:

Thank you, Mr. Speaker.

It's

indeed an honour again to stand in this House and speak to legislation. We've

only been back a couple of days, but we're into our second piece of legislation.

No doubt, in some cases, some of it is just ensuring that logistically we've got

everything covered. In some other cases, it's a little bit more encompassing to

ensure that not only is the legislation fluent, but that it also moves to

improve whatever work and purpose that it serves to ensure people have better

access to services and that the services themselves are being provided in the

most economically and supportive manner possible.

In this

case here, Bill 20, as the minister has taken us through – and I'll note some

parts of it to outline some of the things that we'd like in a change, some of

the things that may be concerns, and, no doubt, there will be other Members

speak to what we heard yesterday in the briefing. I do thank the minister's

staff for the briefing yesterday. We had some good dialogue about some of the

issues and even some of the challenges around why the changes are necessary and

what facilitated those particular changes.

So the

gist, in a general context, would be – at a high level here – is we're changing

some of the time frames to ensure the process for auditing and the billing

process is done in a more equitable way to ensure that the proper outcomes are

in the best interest of everybody involved; keeping in mind, we're dealing with

physicians and oral surgeons for the most part here.

It's

about coming up with a mechanism that best fits our way of – I say

self-policing, but self-policing with all the entities that are involved here,

which would be the government partnership, the MCP who actually do the paying,

the physicians themselves and any process there that may be in dispute –

ensuring that everything is in a proper flow mechanism and that what is supposed

to be done, is done in a proper fashion and what is supposed to be paid out,

would be paid out in a timely fashion also, so that it's not a hindrance to

anyone providing a service, being paid for that service or being able to have

access to those type of services.

The bill

makes changes to the review board timelines, the review board takes place and

the audit is completed on a practitioners' MCP listings. As we've known in the

past, every so often there are some red flags that come up about the billing

process, and we need to have safeguards in play. We do have them through our

auditing process.

Now, are

there times that there are some who slip through the cracks just because of

errors in administrative processes? Are there some who, unfortunately,

deliberately mislead in some of the billings? Are there other ones who their

misinterpretation of what's acceptable or what would be paid under a particular

billing process comes into play?

So what

we allow then is the process for our auditors, having our trained individuals

who would go in, assess what would be acceptable and what's allowable under the

legislation and the process, and what would have been explained to the

physicians in play, in this particular case, of what would be paid under a

particular procedure for a particular service.

What

would happen then as part of the process, in the auditing process, would be

either an acknowledgement that something is not acceptable and it will not be

paid for or an acknowledgement that something has been paid for that

inadvertently shouldn't have been – for various number of reasons that the

auditors themselves would have picked up. Then it would be given back to the

physicians who had put it forward – or their administrative responsible

individuals, their auditors or their accountants, whoever deal with those type

of things – to have the dispute around what the issue was in how this either got

paid or got billed.

Then, if

you can't come to a consensus that this indeed was a mistake or if, no, they

feel they should be paid for, that there's a dispute over it or what the issues

may be around the ramifications, the penalties and that which may be there, that

there would be a dispute mechanism.

The

issue here is around changing the timelines for a number of reasons. To be able

to expedite things in a timely fashion, but expedite them so that you have all

the players in play with all the information necessary to be able to either

dispute a particular challenge from an auditor's point of view, or from the

auditors themselves being able to have all the information necessary to clarify

in that particular dispute.

There

are some issues here around the physicians themselves. Normally, we're talking

here of oral surgeons and physicians in billing the MCP which provides the

payment process. The others there, there are a little over a thousand, close to

1,100 practitioners who would fall under this particular category here. There's

a fair financial implication here to the people of Newfoundland and Labrador and

to those physicians who provide the services. They still have to ensure that

their bills are paid and that they have all the equipment and that necessary.

That comes with ensuring that their revenue streams are viable.

But we –

and I say we collectively as the House of Assembly and those who are elected –

have to ensure that all the stopgaps are in play, that only monies we pay out

are monies that were justifiably necessary to provide a particular service. It's

a service that is very necessary to have in play. The issue becomes about

slowing the process down so that government doesn't get its due diligence to

ensure the taxpayers' money is protected, and that the physicians are not slowed

down in being able to do their administrative parts to receive the monies they

need to be able to provide the particular services.

There

are a number of sections here. I'll just touch on a few of them and explain a

little bit more, add a little bit more detail to what the minister himself has

added. Subsection 26(4) allows for the appointment of a review board when a

doctor wishes to have the findings of an audit reviewed. The process there is

that there's an audit done – and we periodically pick. We don't have enough

auditors to do every billing submission that we have there.

So it's

a process where, periodically, there are ones selected. It could be for a

particular area where there's a lot of billing. It could be that a particular

physician is billing more than the norm of other physicians. That's not saying

there's anything untoward here. It's just saying that may be an indication to

say, well, let's look at that. There may be 100 reasons, but a particular one

might be this individual provides a service that recently there's been a big

uptake. It could be in a particular community or a particular clinic or a

particular new piece of technology or a new approach that they use that draws

more clients or more patients to be able to provide that service.

The

review board now presently has 60 days of receipt of a request to do the review.

The review is to ensure that full disclosure was made and put in place and the

whole process was done in a fluent manner to ensure the outcome was the most

active that could be possibly done. The changes now would be to 120 days of the

request. Personally, I wouldn't have a problem with that.

While I

do know maybe on a day-to-day basis the time frame for being able to justify or

argue for monies that you would've been entitled to might be a little bit more

stringent. But noting – and going back on what I said earlier –the career paths

that we're in here now and the industry we're talking about, they do have, in

most cases, a little bit more of an opportunity to be able to continue their

business going while they're challenging a particular decision that's been made

here.

So,

originally, when the legislation was written it was envisioned that this could

be done very quickly, that it would go through. But as things become more

complex, as recruitment of staff or vacant positions, for example, or challenges

in training, or changes in technology occur, then obviously we found in the last

number of years that process, that timelines haven't been met, to the detriment

of everybody involved. So the process here was to move that along to ensure that

the 60-day went to 120, so it would be a timely fashion, things wouldn't be

rushed and all players involved would know the time frames they had to look at

their whole review process.

Subsection 26(5) requires the hearing to be conducted within a specific time

frame from appointment of the board. Again, that was in a 60-day time frame

originally. That was, as I mentioned earlier, the same as 26(4), thought that

that would be an equitable time frame to be able to do it. Unfortunately,

experience has dictated it doesn't work that way. It doesn't work for the

benefit of anybody involved. So the suggestion here again is the same thing,

120-day change for the appointments. I personally concur with that for the same

argument that I just gave for 26(4).

Subsection 26(6) requires that the report be done within a specific time frame.

As we do in any legislation, particularly around regulations, there are time

frames attached to it so people would know when to expect their ability to have

influence or a hearing and their ability to understand when a decision is going

to be rendered. In this case, the review board shall make a written report

within 30 days.

Again,

as we said earlier, the 60, the 30, we're doubling that now because, as was

noted, the time frame for someone to actually not only get all the evidence –

keeping in mind if we're doubling it, there are probably going to be more

presentations, more witnesses, more dialogue, more information shared – that you

would need a more timely process so people could analyze it all before the

report is written. So we have gone to the 60-day process on that for the same

reason, that we need to do the best job for everybody involved. This is arguably

an issue that people may agree or disagree, that this particular industry has

the ability for that extra period of time to still be able to function

efficiently and economically.

Subsection 27(4) describes the process for appointment to the review board.

We've talked about the process that has gone on previously, from each appointing

an individual and then a minister being engaged in helping with the appointment.

When the minister and the practitioners, the professional corporation cannot

agree – this is the key thing here – they can apply to a Trial Division for an

order appointing the third member of the review board.

So the

process is the physician or their representative selects an individual to be on

the review panel. The government would appoint somebody, and then a third,

impartial individual would be appointed. If, indeed, they can't come to a

consensus as to who that individual would be, then there is a process here

through the Trial Division, through our legal system, that would make that

decision. It's a fairly professional system and a fairly – play on words – fair

system where everybody would get to ensure that the best individuals would be

part and there would be proper representation.

The bill

is making a number of changes from the Trial Division to the Supreme Court, and

that's particularly only because – and we will probably mention this a dozen

times as the Legislature goes through changes to the legislation – Trial

Division is no longer part of our, I guess, legal

definitions anymore, or legal

terminology. Now it's the Supreme Court. It's just changing that process as to

who would be responsible for deciding on the third individual who will be part

of that process.

Subsection 27(4) is new and allows for a suspension to the time limits as

prescribed in subsection 26(4), which we had talked about earlier. This allows

for suspension of a time limit in subsection 26(4) when an application is made

to the Supreme Court. Meaning because we imposed our 60s, that now we're going

to change to 120, but all of a sudden we couldn't agree on who the third party

member of the review panel would be, then now we're going to the Supreme Court.

And the court system, for whatever reason, may not be able to get you in on the

timely fashion that fits within the 120-day time frame that has been outlined,

so that would be suspended until it's determined exactly when that can be done

and then you will reconvene with the three-member panel to do the full review

itself.

Subsection 27(4) is new – and I should have noted at the beginning that while

this is updating some of the old legislation, there is also some new sections in

here to make it relevant to today's operation and more efficient for all parties

involved as part of the process. “The members of the review board shall

unanimously choose a chairperson ….” That's standard in a lot of organizational

processes, but obviously that can't be done until you have your full panel in

place. That's where the process gets slowed down a little bit, if we're indeed

going to the Supreme Court for the selection of that other individual.

Subsection 27(4), again another new

section – and this is all about if the

member of the review board cannot agree on a chairperson within seven days, one

will be appointed by the minister. There are times here where I'm 100 per cent

adverse to the minister having carte blanche to make decisions and then there

are other times when I 100 per cent agree with why the minister needs to have

it. In this case, I do agree with the minister having the ability because you

can't slow down the process. There has to be somewhere at the end of the day an

end result.

Now, I

would think that would be very rare that the minister would have to intervene in

those cases, but you need to have a stop mechanism that says we're going to stop

this whole dialogue and debate to go into what it is the issue is here, and that

would be around reviewing the appeal and making a decision based on that. So I

understand that and it's a new one.

Again,

you'll notice whenever I do get to speak to pieces of legislation, I may jump in

and out of when I think the minister may have or should have that authority to

when I think he may not. In this case, reviewing the piece of legislation and

understanding that it's not uncommon when there's a decision that can't be made

on an agreement on a particular makeup of a committee, in this case the

chairperson, that somebody has to make that from a neutral point of view.

While

the minister may not be 100 per cent neutral in this, it's far enough removed

because it's MCP, which I know is part of the Department of Health and the

government's process, but it's independent enough to be able to make that, so I

don't have a big problem with that at this point.

Subsection 28(1) describes how the Lieutenant-Governor in Council appoints the

panel. This is an existing one. There's a total of 15 persons and at least five

shall be medical practitioners provided by the Newfoundland and Labrador Medical

Association. At least two shall be dentists provided by the Dental Association.

The term of up to three years, that's the present, what we have now. That's

fine, that was set up based on the conversation of the day a number of years ago

when the legislation was put in place and the last changes that were made.

Now

looking at the ability to having proper representation, having more experience

on it and being able to have the committee come together, then the panel itself,

it's been proposed here that it would expand. So it would expand now to 18

members, of which that's increasing to eight members now for medical

practitioners, four would be dentists and increasing up to five-year terms from

a three-year term. I'm not averse to that. I understand you want some stability

and you need to have numbers so you can draw down. Personally, from the

conversation we had in the briefing yesterday, I don't really have a problem

with that.

There

was some concern on the numbers and the questioning around would it all be

people – too many on one side who are making decisions. The quick answer is the

individual, the physician, gets to appoint their representative, the government

gets to put theirs there, MCP, and then the third is agreed neutrally. You do

have an impartial as much as possible, or at least a proper open dialogue, so I

don't have big concerns about that. I just want to ensure that it isn't one

particular side of this equation that's favoured over based on the numbers. I

understand why it would be that because the number of practising physicians

would be higher than the number of practising dentists, from that perspective.

The time

frames, the five-year terms, when you get somebody to commit to that and they

can become knowledgeable, it's good to keep that expertise there for a period of

time. Five-year appointments are not beyond the norm now when it comes to having

appeal boards, panels, foundations and stuff, people who make decisions based on

a bit of longevity for some subsequent planning processes and historic

knowledge. I think that works fairly well.

Subsection 29(7) describes the various orders that may be made by the minister

in relationship to the finding of the audit review board, et cetera. This is a

simple change to replace Trial Division with Supreme Court. As I mentioned

earlier, this is just about bringing this back to what now is the Supreme Court

versus the Trial Division processes.

What I

will also note here, there are a number of other nuances here, none that are

dramatically changing the process. What they do is add another dimension to it.

Some might say there are some drawbacks to it. I challenge some of that. One of

the biggest fears we have is having the proper resources available to ensure we

do this in the manner that was noted and the expectation, when we put it

forward, by all parties involved.

That's

going to become, I think, a bit of a challenge if we don't find the proper

mechanism to ensure the resources are readily available and the expertise that's

necessary is at your fingertips on a moment's notice. That's no doubt – I

suspect some of my colleagues will speak to that in the coming hour or so that

we're going to have here.

There

are a couple of other new clauses here: adding a new clause that the alternative

dispute resolution process shall be considered to be concluded 30 days after the

notice is provided. We're talking here, there is a limit to describe the period

of time for a dispute process to be concluded. So we're trying to conclude it.

You need to have a timely fashion to ensure this comes to a resolution, one way

or the other, because everybody involved need to move on to whatever the next

issue is. If it's the business owner, the physician themselves, they need to

move on to whatever issue they feel needs to be dealt with or any other process

they feel they need to take to do that, and government needs to move on so they

can move on to the next file to ensure the auditing process moves in the manner

it was set to do.

looking at this, I think the changes are needed. It modernizes it. It's not just

a housekeeping one, because every change made from a time-related fashion also

has implications when it comes to resources that are necessary, the selections

of the proper individuals and the mechanisms that are going to come to a

resolution at the end itself.

I just

wanted to note some of those things here. In Committee, no doubt, we'll have

some questions around clarification on how we move it, on some of the selection

processes. My understanding is some of this is tied to the Independent

Appointments Commission, so I may have some more clarification on how that fits

with everything else; but, at this point, I'm glad to see we're modernizing and

changing the time frames based on the dialogue that had taken place,

particularly from those in the industry and those who are engaged in this whole

process.

Mr.

Speaker, we'll have an opportunity to speak to this a little bit more in

Committee.

Thank

you, Mr. Speaker.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for Mount

Scio.

MS. STOODLEY:

Thank you, Mr. Speaker.

I want

to say, this gives me an opportunity to go through a lot of the legislation. I

wasn't familiar with the Medial Care and

Hospital Insurance Act , but this has been a very helpful exercise and I find

it very helpful preparing to speak on the changes that we put forward to

legislation.

I do

support the changes to this bill,

An Act to Amend the Medical Care and Hospital

Insurance Act. I really like the ongoing legislative review process that

happens. I believe this particular act gets looked at yearly. I think it's an

excellent process that's very important.

In the

act, which I was very pleased to read, auditors audit accounts and claims for

payment and patterns of practice or billing, and that includes claims and

accounts to make sure that the correct documentation was submitted; claims for

services that are not insured services – also very important; billing errors;

insured services which are not medically necessary; accounts and claims in

violation of the act; patterns of practice or billing that do not follow the

average pattern.

This

made me remember, I went to see a dentist once and the dentist recommended that

I have this device. So I got the device and then my insurer wouldn't cover it

because they said the price was exorbitant, and I didn't think to go back and

challenge it. I know that wasn't MCP covered, but I think it is important for

consumer protection and taxpayer protection that auditors do go back and audit

MCP claims and services just to make sure that taxpayers are getting appropriate

value for their money for MCP coverage.

Audit

processes are extremely important and, obviously, then if the audit findings –

if there's a result or something for a practitioner, if there's a negative

finding, contrary to the act and the regulation, then a practitioner may request

a review by a review board of the findings of the audit which is an excellent,

fair process. So I certainly support this.

The

panel of not more than 18 people to act as members of the review boards, I think

that makes sense – although 18 is probably a lot. Hopefully they would be

smaller than 18, but I do appreciate the fact that eight shall be medical

practitioners selected from a list provided by the medical association, and that

is up from five. Four of these shall be dentists selected from a list of

nominees provided by the dental association, and that's up from two.

It's

very important that members of these review boards are professionals that have

been recommended by industry associations. Obviously, that increases everyone's

confidence in the system, and the reliability and the transparency. That's

incredibly important.

Then one

change was around choosing the chairperson of the review board. Board members

will be able to vote for the chairperson of the review board, which is very

important; but, if there's an extenuating circumstance where they're unable to

do that, I like the idea that the minister can appoint a member as chairperson

just to make sure that all bases are covered. So I like that kind of catch-all,

and I understand that covers some scenarios in other jurisdictions where there

have been issues before choosing a chairperson. What if there's a tie, I like

that – just to improve the efficiency of the process.

I really

like the idea of having more members of the panel that are recommended from the

medical association and the dental association. I think that's very important to

have those important industry associations on board with the legislation.

Then

extending the term of appointment for panel members – currently at three years,

up to five years – again, I think is beneficial to the system. Three years is

not unsuitable, but I think by the time once you get your feet wet, you get

involved, you understand the process and you get comfortable with the role, then

your three years are up and then someone new has to come in. So I think adding

the extra two years will hopefully reduce the administration appointing new

people, and hopefully make it a bit smoother.

I know

when I was on the Memorial University board, some of the challenges we used to

have – because students graduate – the process to appoint a student to the board

took six or eight months. So by the time the student was appointed to the board,

in many cases they had a month or two left of school. They could participate for

a few months and then we had a new student – which was excellent. But I like the

idea of extending the term from three years to five years. I think it helps add

continuity and increase the level of expertise.

Also,

the time frames for audit reviews and appeals are suspended when the alternative

dispute resolution mechanism is employed. I think that's very important to

ensure a fair process for the practitioners and for all those involved, so

they're not held to timelines. If they go down an alternative dispute resolution

mechanism, they have ample time and aren't constrained by these timelines.

I think

giving the review board more time to make their decisions and meet is very

important. Having the review board be appointed within 120 days and then the

hearing conducted within 120 days, I think is not unreasonable. When you're

looking at a board of potentially more than 10 people, up to 18 people, a review

board getting their schedules to align is very challenging. So I think having

the hearing within 120 days is certainly reasonable, but hopefully all groups,

all parties would want to conclude that as soon as possible. I'm confident that

that would happen.

I do

think, overall, that audit processes are extremely important. I'm very pleased

to learn and read about them now in the

Medical Care and Hospital Insurance Act . I think the audit processes protect

taxpayers, protect the users, the practitioners, and it helps make sure that

taxpayers have a high degree of confidence in a system that they're paying for,

essentially.

So I

believe that these changes are very positive. The fact that they came out of an

ongoing legislation review is excellent. They increase fairness of the process.

I think they improve the process for practitioners and for taxpayers and

safeguard our investment through the

Medical Care and Hospital Insurance Act . So I'm very pleased to support this

bill today.

Thank

you, Mr. Speaker.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for

Stephenville - Port au Port.

MR. WAKEHAM:

Thank you, Mr. Speaker.

I want

to start off as well by thanking the minister's staff who provided us with the

technical briefing yesterday, and took the time to answer all of our questions.

I really appreciate that.

While on

the surface this simply seems like a straightforward change, when you dig a

little deeper you find that there's a little more to it and some of it is a bit

concerning. I want to reference a couple of things that I found out yesterday

from the staff, and one of those relates to this change from 60 to 120 days.

In the

past, most of these reviews did not need to take place. There was a settlement

process between the practitioner and the department. What we found out yesterday

is that there appears to be less of a settlement process now and a move towards

wanting to go to a review process. So moving the dates from 60 days to 120 days

is obviously necessary in order to accommodate, if we're going to start having a

lot more reviews. I guess one of the questions we will have at the Committee

stage is why are more practitioners now not agreeing with the audit findings and

wanting to go to a review process. That was one of the things we found out

yesterday, Mr. Speaker.

Another

one that highlighted for me was the fact that they do between 20 and 25 audits

per year. Now, there are approximately 1,100 practitioners that require

auditing, so that works out to about 1 to 2 per cent a year. So if you do

straightforward math, that would mean it would take you anywhere from 44 to 55

years to do an audit on every single one just once. That's a significant period

of time.

The

other thing that stood out, again, for me was that at the end of the day there

is – significant accounts receivable – still roughly $2 million outstanding in

this process, set up as an accounts receivable for the province, to be collected

yet. There are approximately, as I said, 1,100 practitioners and we do somewhere

between 20 and 25 audits. Now, these audits normally occur, often occur, if a

practitioner, for example, has billings that are not in line with his

colleagues, his or her peer group, if a complaint is received or if there is an

anomaly picked up by the department.

Again,

as has been highlighted, once the audit is completed, the findings are presented

to the practitioner and there's a reconciliation process and, again, it appears

that the reconciliation process is now not being reconciled and more people are

going to be opting for a review. In the past, the government has collected

approximately $700,000 each year as result of these audits and now it's gone

down to around $200,000. I don't know if it's because the practitioners are more

in line with the billing process.

That's

another point that audits are not always a bad thing if you're a practitioner.

They're actually quite good, because it can help prevent you from making

mistakes that you might continue to make if you weren't audited. That's an

important part. I spent a couple of years working for the Internal Audit

Division of the Department of Finance and I know the value of internal auditing

in government, so having an audit done is not necessarily a bad thing.

One of

the other things that stood out yesterday was the fact they have a staff of

eight people. Two of those positions have been vacant for eight months, and I'm

not sure why. These are not highly sought after positions, in the sense that

there are lots of people that could actually fill these positions. With the high

unemployment rate we have in the province and the need for more audits to be

done, I don't really understand why two of those eight positions would be vacant

for eight months. I understand from the department officials yesterday that one

of those positions is now being forwarded for hiring.

Similarly, it reminded me then, is this part of a bigger problem? Last year when

we did Estimates, the Department of Finance had $1.9 million in salaries vacant

for over a year. Part of the hiring process was blamed as the reason for it. We

need to get to the bottom of that; we need to understand why. I'd also suggest

that if this particular audit group had more resources, perhaps more audits

would be done on an annual basis, and maybe there would be less opportunity or

less likelihood of any material findings if more people were audited.

Again,

there's no real issue here with the changes to the date, other than the fact

that one of the reasons appears to be because of the potential for more reviews

to take place. So I would like to find out what that anticipated is.

The

issue on the numbers, again, as my colleague talked about, the representation

from the physicians is chosen by the NLMA and the representation for the oral

surgeons are chosen by the dentists, so the minister will pick from the names of

those submitted, so no issue there.

understand the issue with the naming of – we no longer have a Trial Division and

we were told yesterday that we're going to see that change coming to all of the

legislation brought to us. We're going to see anything that refers to a Trial

Division will just go to a Supreme Court naming. The other part, on the end of

it, was the minister – the comments that related to

section 47. Those, again,

relate to the actual billings, the MCP billings piece.

I look

forward to discussion in Committee. Of course, we all look forward to the update

on the negotiations with the NLMA, because there are significant changes that

will be necessary if we are to move forward to a different model of health care

delivery. We all look forward to that happening.

Overall,

Mr. Speaker, we support this bill and thank you for your time.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for Mount

Pearl - Southlands.

MR. LANE:

Thank you, Mr. Speaker.

I'm not

going to take very long to speak to this Bill 20. I also attended the briefing

yesterday. I want to thank the staff of the Department of Health and Community

Services for the very informative briefing and, quite frankly, for answering a

lot of questions, which I and others tend to do. Of course, it's all part of our

due diligence to make sure that whatever is going through this House is good

legislation and makes sense. That's what we're all elected to do.

I'm not

going to get into all the details that have already come forward. I think the

minister did a good job in going through it. I do concur with some of the

comments that have been made. Generally speaking, I think it's a good bill. I

think it makes sense to make sure that the timelines – because what's happening

in this bill, there are a few other little things, but I think the primary focus

on this bill is basically extending timelines for the review committee process

to come more in line with what's required by all parties to make the system and

to make the process work better.

I think

by extending the timelines as well, it does give a greater opportunity to reach

settlements before it ever gets to the review committee process. I think that

can be a positive thing as well, the fact that there is only a very small

percentage of physicians and – I want to say dentists, but it's not dentists.

They are dentists, but dental surgeons, I think. If you go to see your dentist

up at Pearlgate somewhere, Pearlgate Plaza or wherever the case might be, this

doesn't govern them, but dental surgeons certainly it does. There is only a very

small percentage of those individuals that are being audited yearly.

Now, I

realize as well that when we're talking about that, it's not as if nobody is

analyzing the bills or the trends or whatever unless they actually do an audit.

That's not the case. As staff said, they are always analyzing the billing and

the billing codes and so on that are coming through and when they see anomalies

that sort of stand out, that this particular physician or this particular dental

surgeon, what he or she is billing for is not necessarily consistent with the

larger group, then those are the individuals that generally get chosen to be

audited.

understand there's kind of a balance. I also sort of understand where my

colleague from Stephenville is coming about the eight positions and only six

being filled, two not being filled for eight months. Again, I believe there has

to be sort of a cost-benefit analysis to some of this as well, because when we

look at our province overall, we look at the tremendous amount of debt that we

have and we look at the year-over-year deficits that we're experiencing,

somewhere along the way we have to try to find efficiencies in savings.

While

one might argue, well, these positions are actually bringing money in, they're

paying for themselves, I would like to understand the cost benefit of that.

Because, really, if you look at eight people and you look at $400,000 in

savings, if you have eight employees, by the time you pay salaries, benefits and

everything else, that probably equals a lot more than $400,000 for eight people.

appreciate there has to be a balance to making sure we're auditing where

anomalies exist, keeping everybody on their toes, making sure that it's being

done properly, but at the same token we can't on the one hand stand in the House

of Assembly and complain about our debt and our deficit while on the other hand

be saying we need to fill more positions and how come they're not filled and

they're not filled and so on.

So I do

appreciate where my colleague is coming from, but I think there has to be a

balance and a discussion around the benefit derived on one end compared to the

cost to put those measures in place as well. I guess we would differ a little

bit perhaps in that view, but other than that, I do get where he's coming from.

Mr.

Speaker, with that said, the only other thing I got from the briefing that sort

of raised a little bit of a point in my mind is they indicated that when they go

back and if they find anomalies with a particular physician and so on, they go

back two years. They will audit for two years; even though, based on the

legislation we were told, they can actually go back five years.

So if

you see somebody who's billing for something and it's way out of whack with

everybody else, and then you go in and you audit and sure enough, this year they

were not consistent with the others; you go back the year before, they were not

consistent with the others and now you're recovering this money. Because of

policy, not legislation or the practice they've been following, they will cut it

off at two years.

theory, five years ago – and not two years ago – they were doing the same thing

and we were being over billed. The taxpayers were being over billed for five

years, in theory, and we don't recover that money. I think that's something that

needs to be looked at, because I've actually had people – and I'm sure other

Members have as well – who may have received an overpayment for some reason.

Someone who was in receipt of government assistance or some government program,

and for some reason they got paid more money than they were supposed to. Perhaps

there was some confusion, perhaps they might have worked somewhere for a couple

of months that didn't get reported or whatever and then at some point in the

future they realize you owe the Department of AES.

I've had

people owe like $1,000, and they're only getting $300 or $400 a month is all

they're getting. Now you owe us $1,000, so we're going to cut you off for the

next three months. You're going to get nothing to live on because we overpaid

you last year, as an example.

If we

are so diligent in getting back every last cent and every bit of overpayment for

someone at the very lowest end of the financial spectrum, then I think it's

important that when we look at these types of situations, if there is evidence

to point to the fact that there has been consistent over billing for an extended

period of time, if the legislation allows you to go back for five years, I don't

know why the department would say: no, no, we're only going to go back for two,

we'll forget the other three.

I just

throw that out there as a point. It has nothing to do with this legislation, per

se, but it is all connected because it was discussed at the briefing and it does

tie into what's happening here.

So other

than that, I have no issue with the bill. As I said, I think it makes sense to

put mechanisms in place that make things run more smoothly, more efficiently,

that work for all parties involved.

I did

ask if the NLMA and the group that represent the dentists, if they were on board

and consulted. We were told they were absolutely consulted, and nobody from

either of those organizations made any representation to say they had an issue

with what was happening here. So I'm going to assume they're on board or they

have no problem with it. That's a good thing as well.

I will

conclude, Mr. Speaker, by saying – because we're on the topic of billing MCP and

so on. I will just say that I really believe – I did ask this question, it's not

related to what's in this bill, per se, this change, but I was told it could be

part of this actual piece of legislation because it has to be put in somewhere

and maybe this would have been the place, maybe it wouldn't have.

I think

the fact that we are now giving nurse practitioners the ability to open up

clinics to fill the gap where there may not necessarily be physicians and so on,

I really think, and I say to the minister, there has to be consideration given,

needs to happen, to give nurse practitioners – as well as pharmacists, by the

way, as well as pharmacists – the ability to bill MCP. It's no good to expand

the scope of practice to fill gaps that exist if nobody's going to go to them,

because they're not going to pay out of pocket. They can't afford to pay out of

pocket, whatever the case might be.

I just

throw that out there as an aside, that when we're looking at this legislation

and billing of MCP, I certainly encourage the minister and the government to

include nurse practitioners and pharmacists and allow them to start billing MCP

for services, I think would make our system a lot better.

Thank

you, Mr. Speaker.

MR. SPEAKER:

The hon. the Member for Lake

Melville.

MR. TRIMPER:

Thank you very much, Mr.

Speaker.

It's an

honour to speak to this bill, the Medical

Care and Hospital Insurance Act and the proposed amendments. I want to also

echo, as my colleagues have done on the floor, it was a very, very good

technical briefing provided by – and I wanted to enter their names into the

record, Gerard Power and Gerrie Smith yesterday that the minister arranged,

because having attended several technical briefings – and many of them are very

good – but the particular combination yesterday of Mr. Power, who is actually

involved in the audit process, so the technical understanding of it, along with

Ms. Gerrie Smith, who is responsible for drafting a lot of the legislation that

we are working with, it really was very most appropriate for where we are with

this process of the bill through the House because we are in second reading.

This is

all about the rationale of the bill, not a clause by clause, are we changing

this number to another number, but really an understanding of why we are doing

this. As the minister outlined in his remarks, he spoke very effectively to the

rationale of the bill. When we get into Committee, we'll deal with the specifics

of the clauses and so on, but I want to speak more to the rationale of it and I,

again, compliment those two individuals for their focus on that.

I have

some numbers here; I am going to follow my way around. What I did and I think

it's important, because this may seem rather dry to people perhaps in the House

but perhaps watching, but I wanted to underline why this is so important. When

you consider that our single, greatest line item in our provincial budget is

health care, some 40 per cent of our total budget, it's extremely important to

know that there are very good, comprehensive processes such as this audit

function that are in place.

What I

wanted to do was just enter into the record – I'm looking at my colleague there,

the Minister of Health and Community Services – some reference from the Canadian

Medical Protective Association which explains exactly what the role of the audit

function is. So I just would like to read the following couple of paragraphs.

“An

audit is most often triggered because a physician's billing profile is

inconsistent with the average for the peer group, or a particular fee code is

being used in a manner that does not meet a provincial or territorial billing

agency's or health ministry's expectations.” So, as we've said, we're looking

for anomalies. It's kind of interesting that on the day of the PMR where we're

looking at artificial intelligence and the ability to use technology to help

detect ways that we can improve society and how we do things – anyway finding

the interesting juxtaposition in technology and practical governance.

“Provincial and territorial governments are obligated to ensure that the

physician billings comply with the federal Canada Health Act” – so that's the

overarching national piece of legislation that this particular act certainly has

to complement and support – “and these governments may face penalties if

irregularities are found.”

The

particular audit function, it “generally includes a review of the physician's

records” – so you're dealing with hundreds if not thousands of files – “and the

physician has an opportunity to respond to the concerns raised or demands for

any proposed payback.”

As some

have indicated there are some $2 million worth of outstanding identified

recoverables right now from the audits that have occurred. To work that way

through the process, that was also part of the justification for why you're

going to see some of the changes in this act.

“The

audit usually focuses on issues such as whether the service was performed” at

all, “whether it was medically indicated, and whether the appropriate fee code

was used.” Several of my colleagues have spoken about fee codes and whether or

not they were properly entered and/or being used appropriately. In fact, some of

the codes need to be changed, so that flexibility in being able to change them.

As my colleague for Mount Pearl - Southlands had just indicated and the idea of

nursing practitioners, as they get into some of these responsibilities we need

to understand if they're now providing their services, how they can now code and

recover appropriately.

“Inadequate, missing, illegible or otherwise deficient record keeping often

hinders physicians' ability to effectively explain and defend their billings.

For example, a psychiatrist's billings were audited during which it was found

that he did not document the start or end times for psychotherapy sessions.

Without documentation supporting the length of each session, the audit resulted

in a significant payback being demanded of the psychiatrist's billings for

psychotherapy sessions, despite the fact that he provided testimonials from

patients, office staff, and colleagues that these services were in fact

rendered.”

It's all

about properly documenting and being able to recover. Again, when you're dealing

with 40 per cent of the provincial budget, it's important that we do have these

safeguards in place.

My next

little element that I wanted to introduce into the discussion is just a little

look at our own provincial situation. I'm understanding that we have something

like 268 full-time equivalent family physicians, for example, and they are

handling a big load. They're handling some 1,900 patients each, so there's a

tremendous volume of entries and recoverables; hence, the need for very

sophisticated people who can understand data, work with data, work with

statistics and work with technology, such as are in Mr. Power's shop.

Back on

the rationale and exactly why we're here. Really, what we're doing is there is a

process in place but recent decisions, recent revelations, have indicated some

changes are needed and they mostly come around timelines. With, frankly,

millions of dollars potentially at stake and at debate right now, lawyers get

involved; therefore, you're looking very carefully to ensure that the process

and the appeals that are done are followed very carefully and that you do not

miss those deadlines.

What's

been asked of us, of this government, of this House of Assembly is to provide

both transparency and greater flexibility in terms of time frames to be able to

meet the expectations of working your way through this – so everything from

appointments through to review periods. Some of my colleagues have indicated

there are extensions, and when we get to Committee we will be discussing each of

them in detail I would assume. But that's really what we're doing, is dealing

with time frames.

Again,

my recent colleague just spoke before me. He talked about some 20 to 25 audits

are being done a year, but with some $2 million in outstanding recoverables

there is a need to do some catching up. As we go through the bill and in

Committee, you'll see a lot of reference to some administrative catch-ups, but

also, again, on the time frames and making sure that we have a flexible and

transparent process for which we can make sure it works effectively.

Government does recognize the importance of keeping our legislation up to date.

These amendments were identified during ongoing monitoring of legislation to

ensure that it continues to meet its original intent and continues to serve the

needs of the people of the province. These amendments will support a more fair

process for those wishing to dispute audit findings. It needs to work both ways,

Mr. Speaker. The current timelines are rather strict and frankly quite

aggressive in some cases, when you think about some of the situations.

In some

cases, what's going to be asked of us to consider is actually freezing the

process until, for example, there are appointments made and so on. You don't

want extraneous decisions or extraneous steps interfering with your ability to

actually work your way through the process, either on the audit side or on the

appeal side. I think it's really important for everybody listening out there in

the public that these amendments will not negatively affect the practice of the

physicians or dentists and they certainly will not affect services for those

patients.

I am

looking forward to the minister's comments and I just want to again reflect on

the comment made by the Member for Mount Pearl - Southlands because we also

discussed at some length about the issue of how far back do you go when you're

conducting an audit and you discover a problem. We also heard the same reference

to the two years, but we prodded that a little bit and got into it. I'll look

for clarification from the minister, but certainly if there are serious matters,

that doesn't mean that one puts the blinders on and stops at that point. That

one will certainly go back in time.

It's

interesting that while there's cost to doing these audits, there are also

tremendous savings. If you look at the staff complement there – now eight,

moving to 11; there are a couple of empty positions. Fine, we will get those

filled, but there are savings for government, not just in what you recover from

inappropriate billings, but also through that learned process and that feedback

back and forth. Future billings would now be done in such a way that you have an

accrued saving as you're going forward.

So hats

off to Mr. Power and his team for the work they do, because I see it as very

important. With so much of our provincial budget dedicated to providing good

health care services to the people of this province, it's important to know that

there is a process in place to ensure it's being done effectively.

I thank

you very much, Mr. Speaker, and I look forward to Committee and the minister's

chance to address some of these comments.

Thank

you.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Leader of the

Third Party.

MS. COFFIN:

Thank you, Mr. Speaker.

I'm

going to try and draw from much of what I've heard, but the unbridled enthusiasm

for this bill seems to have generated a lot of discussion on the benches and

it's making it hard to hear a lot of things, so I hope that I will be able to

address that.

Certainly, this bill seems to be addressing some of the key things that are

themes for our House, including accountability of the public purse, equity and

transparency.

I'm not

going into the minute details of this bill. Certainly, I feel that the minister

has done a fine job of presenting a lot of the amendments and the rationale for

those amendments. I do have a couple of questions and concerns that I'd like to

(inaudible) out and perhaps the minister can address those as he concludes or

when we go into Committee.

One of

the key things that I note was – I looked up the members on the current board

and I did note that the current board members remain members until they are

replaced or reappointed. We have members who have been sitting there since 2015.

So I'd like to see, certainly, a rejuvenation of that board.

One of

the other recommendations we'd like to see is those review board members to be

put in on a staggered basis so we have some continuity of experience but also

some opportunity for new individuals to take

part in that and add another

dimension to the board. So I think that could be a very beneficial piece.

I'm also

pleased to see that there seems to be individuals who are non-practicing medical

professionals, or who are not medical professionals that are going to be

included on the board, because I think different perspectives will offer

different viewpoints and a different analysis and a broader range of

deliberation. So I look forward to seeing how that board manifests.

The

alternative dispute resolution mechanism, that is lovely to see. Certainly,

we've heard quite loud from other members of unionized labour that alternative

dispute mechanisms can be a reasonable way of making our way through situations

that have reached an impasse. So as we go forward, I'd like to see similar

mechanisms being considered when we look at things like the

Labour Relations Act and amendments to

that.

addition to that, I have some concerns. We're talking about changing billing;

we're looking at a number of things like that. I have a fairly significant

caution that we need to be very careful about opening the door to further

privatization of our health care system. That is a concern for us, and it ought

to be a concern for anyone who receives medical treatment in our province. We

want to be very acutely aware of any further privatization of our health care

system.

Another

key thing that I'd like to see as we reflect on billing, it would be really

beneficial for everyone and a cost-savings measure if we look at billing that

reflects improvements to technology that decrease time to complete procedures.

Certainly, we've seen advancements in medical technology that made procedures

that were complicated, time-consuming and risky have been improved so that they

are very short procedures that have much less risk and offer much quicker

recovery times. So that reduces the drain on our health care system and the

burden on our health care system. I'd like to see billing be modified to reflect

the use of advanced technologies that decrease times for procedures.

Kudos to

the Member for Mount Pearl - Southlands, which was also echoed by the Member for

Lake Melville. We need to look at incorporating nurse practitioners. We also

need to be acutely aware of women's health issues. Certainly, we've talked about

that at length. It's one thing that we, as New Democrats, recognize as hugely

important. Not only do we need nurse practitioners, but let's look at birthing

doulas and midwifery, in addition to pharmacists.

We know

that women use the health care system more and we want to make that more

accessible, but we also want to reduce the burden on the health care system. So

when we have health care professionals that can provide services that meet the

needs of individuals at lower cost than physicians, perhaps it would be prudent

to allocate our resources to where they will serve best. I think looking at

incorporating alternative health care professionals into this model will

certainly provide us all with a better, more affordable, more effective health

care system, and that's going to improve our health outcomes.

I do

have one other small piece that I'd like to add to this, and the minister can

probably give me a better sense of where this is most appropriate. I did notice

section 48 of the act there is a note that's saying there would be

established an average pattern of practices. Perhaps the minister can elaborate

on that and let me know if that also includes things like overprescribing of

opioids and overprescribing of antibiotics, both of which have become a

significant problem in our health care system and have generated other problems

that go beyond our health care system.

I think

that would be a very important piece to address and it's going to be a

cost-saving measure. It will result in better health care outcomes and a better,

more affordable health care system for the people of Newfoundland and Labrador.

While I

agree with the changes we see, I think that is going to give us a more

responsible, a more appropriate health care system. It will go towards equity,

transparency and accountability in the public purse. I look forward to the

discussion as we go into Committee and talking about some of these issues that I

have raised at this time.

Thank

you very much, Mr. Speaker.

MR. SPEAKER:

The hon. Member for Exploits.

MR. FORSEY:

Thank you, Mr. Speaker.

Mr.

Speaker, it was good to attend the briefing yesterday for this amendment on Bill

20. It was well done, and I thank the minister and his office for providing

that. In the briefing for the Medical Care

and Hospital Insurance Act , Mr. Speaker, the biggest things discussed there

were the timelines and having the proper people in place to make the evaluations

of the billings so that everybody concerned can make the best use of the act.

Mr.

Speaker, all people of the province deserve MCP usage, and so do the physicians

and the individuals concerned. Everybody needs the MCP and insurance acts so

that we all provide proper service. That means that this can be done to give the

people what they need and give the physicians and doctors proper funding and get

their timelines in place to get the evaluations done on the billings.

Mr.

Speaker,

section 26 really discusses the timelines. Obviously, government didn't

realize that 60 days was a tight timeline to get the billings and audits done,

so this is extended, probably, 120 days, which gives a lot more time to get the

audits done and get adequate approvals. We need to get audits done, we need to

get the approvals done so that physicians get paid, of course, and we get proper

service. Through that, the 120 days should give lots of time. It fits both the

oral surgeons and the doctors.

The

audits can be done, because in the briefing it was discussed that, in the past

two years, we've been recovering about $200,000 per year;

whereas before, it

shows, in the audits, we were doing about $700,000 per year. This needs to be

done and recovered so that we can get this money recouped and everybody is

treated fair and we can move on with the system.

Mr.

Speaker, that's basically what was there. Then in

section 27 it deals with the

board members and that is one is appointed by the minister, another appointed by

the practitioners and one appointed by both of those facilities. We need board

members there to make the proper decisions so that we can get those evaluations

done. It's great to have those people there, appointed by the practitioners and

ministers, one for the government, one for the practitioners so we can get all

sides involved, and get what is involved there, everybody understands each other

from the NLMA to the government to individuals so that everybody is on the one

page and we can make proper evaluations and get the audits done adequately and

in a timely fashion. That would cover that, Mr. Speaker.

Then in

section 28 it deals with a panel. They need the panel changed from 15 to 18

people. That also gives more discussions into what can be done, how we can

improve the system.

Mr.

Speaker, this legislation, this act, is a good one and we will support it, of

course. It gets more people involved and the more we can get involved and the

more outcomes we have from it, we can certainly proceed and make things better

in the health care system.

Again,

the Member for Mount Pearl North said the same as everybody said. They can go

back a little bit further than two years to do those audits, because if they can

recoup $700,000 in the past two years, we can probably get a little bit more

than that recouped, Mr. Speaker. It has nothing at all to do with anybody doing

anything wrong; it's just the way that things are done sometimes and audits need

to be done so that things are corrected. To see it from 60 days to 120 days,

this will be good.

To have

everybody involved and more people involved, we can improve the health care

system. It takes time to do this, so it's good to be able to speak on this bill.

We need the MCP billings, of course, and we need MCP for the people of the

province and we need the MCP insurance plans for the physicians and people

involved.

Mr.

Speaker, with that, I'll take my seat and it was good to speak on this bill.

Thank

you.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

If the minister speaks now,

he will close the debate.

The hon.

the Minister of Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Speaker.

It's

great to hear the comments from the Members opposite. I think rather than delve

into a lot of the detail – we can do that in Committee – but I think it would be

useful in a sense, really, to round out by prefacing what this bill does not do,

which would address some of the comments that were made by Members opposite.

The

rates within the MCP fee

schedule are the subject of negotiations between

government and the NLMA itself; therefore, the actual numbers there are

predetermined by a separate process and simply inserted into the new fee

schedule by mutual mechanisms that have existed for some time. To reference

specifically the new technology approach, there is actually an ability within

what's called the microallocation process between government and the NLMA to

introduce new fee codes based on new technology. That mechanism has existed for

some considerable time.

It's

always a bit of a challenge and one of the procedures that has never really

worked with – because I suspect the mechanism postdates the change – for

example, is cataract surgery. The original fee for cataract surgery was set at a

time when it was a general anesthetic. It was an hour and 20 minutes to do. Now

it's local anesthetic and 15 minutes in an accomplished surgeon's hands will

give you excellent results. There is a mechanism; some things have fallen

because of timing.

These

audits are around financial audits. Audits around the quality of care and the

outcomes, referenced by the Leader of the Third Party, are really important, but

patents of practice like that come through other mechanisms. They will come

through the Prescription Monitoring Program, for example. They come through

regional health authority; PGME, post-graduate medical education programs around

utilization of labs and that kind of thing. Our main thrust there has been to

support Quality of Care NL and Choosing Wisely NL as provider-led mechanisms who

would engage in that education piece.

As far

as the financial audit of physicians is concerned, I think it would be useful to

point out that what you're seeing here and what we're referencing is actually

the end of a road. Every practising fee-for-service physician, by and large,

every two to three billing cycles will receive a request on a fairly routine

basis for a verification of service. What that will be, it will be a code

picked, usually a common code or a code of interest to the department at the

time, and that's done through the audit division out in Grand Falls-Windsor.

Simply then, as referenced by my colleague from Lake Melville, the practitioner

has to find – in the case of a specialist – the referral letter asking for the

service to be provided and a documentation of what was provided.

So there

are criteria laid out, and interestingly enough laid out in the

preamble to the

fee schedule. They're not included by reference at the moment because they're in

the

preamble, not in the actual money piece, that actually determine whether or

not that service meets the criteria. Do you do a full history and physical? Do

you have a discussion with the patient? Were the therapeutic options discussed

and a diagnosis arrived at? That kind of thing has to be demonstrated.

If you

supply that information, it's fine. Your fee gets remunerated. If you don't or

you ignore it, they ask you for three more of the same code. If you ignore that

or don't satisfy that, they ask you for five more or seven. If you don't, you

are audited on that fee code for two years.

The

reason for that is that's done on a cycle that is shorter than two years. That

has been the practice. Whilst the rules, the regulations allow you to go back

five years, in practical terms that is not the case. We can talk about flagged

audits and people whose practice is more than two standard deviations from the

group of rural family doctors or urban surgeons, for example, or it consists of

a significant financial payout. Those are flags and they will trigger audits of

a more localized nature.

Finally,

to reference what this isn't about in terms of midwives, I hear the Member for –

sorry, the Leader of the Third Party. I always forget your district. I do

apologize. We are very keen on utilizing these extended roles. They are not paid

through MCP because MCP is set up under the

Canada Health Act which stipulates physicians and hospital-based

services. That's why it's in that box. That's historical.

Midwives, for example, are currently compensated through the regional health

authorities. We have them in Gander. That will roll out and evolve over time.

The

discussion about how to compensate nurse practitioners who choose to work

outside regional health authorities is actually a subject of integration. We

don't want to recreate the siloed, fee-for-service family doctor, for example,

and replace that with a siloed, fee-for-service nurse practitioner. The

integration piece is the key.

We've

had discussions with the Registered Nurses' Union and, unfortunately, owing to

some weather events, our discussions with the Nurse Practitioner Association

have had to be rescheduled. That's a topic for us at the moment.

So,

again, alternate route, bearing in mind the comments the Members opposite have

made, but the focus is on integration and a collaborative team-based approach.

With that, Mr. Speaker, I will take my seat and strongly urge the House to vote

in favour of second reading.

Thank

you very much.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

Is the House ready for the

question?

The

motion is that Bill 20 be now read a second time.

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against, 'nay.'

Carried.

CLERK:

A bill,

An Act To Amend The

Medical Care And Hospital Insurance Act. (Bill 20)

MR. SPEAKER:

The bill has now been read a

second time.

When

shall the bill be referred to a Committee of the Whole?

MS. COADY:

Now, Mr. Speaker.

MR. SPEAKER:

Now.

motion, a bill, “An Act To Amend The Medical Care And Hospital Insurance Act,”

read a second time, ordered referred to a Committee of the Whole House

presently, by leave. (Bill 20)

MR. SPEAKER:

The hon. Government House

Leader.

MS. COADY:

Thank you, Mr. Speaker.

I move,

seconded by the Minister of Health and Community Services, that the House

resolve itself into a Committee of the Whole to consider Bill 20.

MR. SPEAKER:

It is moved and seconded that

I do now leave the Chair for the House to resolve itself into Committee of the

Whole to consider the said bill.

Is it

the pleasure of the House to adopt this motion?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against, 'nay.'

Carried.

motion, that the House resolve itself into a Committee of the Whole, the Speaker

left the Chair.

Committee of the

Whole

CHAIR (Bennett):

Order, please!

We are

now considering Bill 20,

An Act To Amend The Medical Care And Hospital Insurance

Act.

A bill,

“An Act To Amend The Medical Care And Hospital Insurance Act.” (Bill 20)

CLERK:

Clause 1.

CHAIR:

Shall clause 1 carry?

The hon.

the Opposition House Leader.

MR. BRAZIL:

Thank you, Mr. Chair.

Just a

few questions here related to the bill itself, just for some clarification. The

bill notes that: “Sections 1 to 6 and

section 8 come into force on a day to be

proclaimed by the Lieutenant-Governor in Council.”

What

steps need to be taken before that for the process to be effective?

CHAIR:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Chair.

The

reason I would flip round and say the delay on the other sections is simply to

allow for the extra individuals to be appointed through the process we've

outlined in terms of with the NLMA, the NLDA, and to reference comments from the

other side, the public interest members are tier-two Independent Appointments

Commission appointments. We need to populate that, and that's the reason for

delaying that

section rather than bringing the other

section into force early.

We're ready to roll with that.

CHAIR:

The hon. the Opposition House

Leader.

MR. BRAZIL:

I thank the minister for that

clarification. I'm curious – and I'll ask two questions together, even though

they're not directly connected, that way when you get up, because one is a very

quick yes or no where you have a time frame.

The

legislation here talks about eight must be medical practitioners appointed from

the list submitted by the medical association, and four from the dentists

appointed from the list submitted by the dental association. Is there a process

for anybody outside of that that can be appointed?

Sorry,

while I have you, a follow-up from the one before. What's the minister's

timelines for the legislation to come into effect? Do you have any idea around

that?

CHAIR:

The Chair recognizes the

Minister of Health and Community Services.

MR. HAGGIE:

Thank you very much.

The

process for the others, there would be basically 12 in the pool of professional

designations, if you like, chosen by the appropriate bodies. The remainder would

go through the Independent Appointments Commission as tier-two appointments and

they would then be notified.

We don't

have a particular timeline with that. The IAC has increased its staffing and is

now able to empanel two appointments commissions simultaneously, but I would not

be able to give you a turnaround time for the IAC. That actually falls under

remit of somebody else, the Public Service Commission. So I would hope as

expeditiously as we can. I don't anticipate much problem with the professional

associations; although, again, one never knows. There is a lag time getting

names back.

CHAIR:

The hon. the Opposition House

Leader.

MR. BRAZIL:

Thank you, Mr. Chair, and I

thank the minister for that clarification.

We noted

yesterday in the discussion – and I realize it's a bit of a time frame for the

Independent Appointments Commission to do its job, but it was noted yesterday in

the briefing that there are a number of auditing positions that are vacant. My

suggestion and our suggestion would have been in a timely fashion now, while you

have some downtime, to expedite that as quick as possible, because having six to

eight vacant audit positions obviously is going to slow down and hinder what

we're trying to change here as legislation.

Can the

minister assure us that there's a process in play to move those as quick as

possible so they're in play as soon as the legislation is ready to go?

CHAIR:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Chair.

understanding is there are currently two positions that are vacant. Both of

those are into the HRS process and out of Health at the moment. We're out there

and if need be I will poke the Minister Responsible for HRS.

Thank

you.

CHAIR:

The hon. the Opposition House

Leader.

MR. BRAZIL:

Thank you, Mr. Chair, and I

thank the minister again.

Yesterday, our understanding was that there were a few other ones and I know

there were some in play, but that's fine. As long as they're all in play by the

time the legislation is ready to go, that will expedite everything and ensure

that the process moves the way it should.

We noted

in the discussions that a normal year would be $700,000 recovered. I think last

fiscal there was $200,000. Can the minister explain? Is that relevant because

there were less auditors or is it just that everybody are following the process?

I'm just curious to know what the variation is there of half a million dollars

in the recovery process.

CHAIR:

The Chair recognizes the

Minister of Health and Community Services.

MR. HAGGIE:

Thank you very much.

It's

difficult to be dogmatic. I do know that there has been, as was alluded to

earlier, a greater interest in pursuing dispute resolution processes rather than

coming to a settlement. I suspect, but don't have any direct evidence, that this

is actually due to factors in the physician community and their advisors. It's

certainly not anything we've had any particular control over, so the amounts may

vary from year to year.

couldn't speak to a particular year and a particular amount and I wouldn't be in

a position to contradict the Member's comments, but I think some of the driver

is external and lies within the professional bodies and their advisors. I don't

think it's actually within the department.

CHAIR:

Shall clause 1 carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, clause 1 carried.

CLERK:

Clause 2 through 9 inclusive.

CHAIR:

Shall clauses 2 through 9

inclusive carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, clauses 2 through 9 carried.

CLERK:

Be it enacted by the

Lieutenant-Governor and House of Assembly in Legislative Session convened, as

follows.

CHAIR:

Shall the enacting clause

carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, enacting clause carried.

CLERK:

An Act To Amend The Medical

Care And Hospital Insurance Act.

CHAIR:

Shall the title carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, title carried.

CHAIR:

Shall I report Bill 20

without amendment?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

Motion,

that the Committee report having passed the bill without amendment, carried.

CHAIR:

The Chair recognizes the

Government House Leader.

MS. COADY:

Thank you, Mr. Chair.

I move

that the Committee rise and report Bill 20.

CHAIR:

The motion is that the

Committee rise and report Bill 20.

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, that the Committee rise, report progress and ask leave to sit again, the

Speaker returned to the Chair.

MR. SPEAKER (Reid):

Order, please!

The hon.

the Member for Lewisporte - Twillingate.

MR. BENNETT:

Thank you, Mr. Speaker.

The

Committee of the Whole have considered the matters to them referred and have

directed me to report Bill 20 without amendment.

MR. SPEAKER:

The Chair of the Committee of

the Whole has reported that the Committee have considered the matters to them

referred and have directed him to report Bill 20 without amendment.

When

shall the report be received?

MS. COADY:

Now.

MR. SPEAKER:

Now.

When

shall the said bill be read a third time?

MS. COADY:

Tomorrow.

MR. SPEAKER:

Tomorrow.

motion, report received and adopted. Bill ordered read a third time on tomorrow.

MR. SPEAKER:

The hon. the Government House

Leader.

MS. COADY:

Thank you, Mr. Speaker.

Considering the hour of the day, I move, seconded by the Deputy Government House

Leader, that we recess until 2 p.m.

MR. SPEAKER:

Pursuant to our Standing

Orders, the House is now recessed until 2 p.m. this afternoon.

Recess

The

House resumed at 2 p.m.

MR. SPEAKER (Reid):

Order, please!

In the

Speaker's gallery today, I would like to welcome William and Anabel Fagan, who

are the subject of a Member's statement this afternoon. They are accompanied by

their mom, Peggy Fagan, and their grandmother, Nancy Hynes.

Welcome.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

Before I proceed, I want to

rule on a point of order that was raised yesterday by the Member for Lake

Melville following Question Period yesterday. The Member for Lake Melville

stated that during Question Period, the Leader of the Official Opposition used

the surname of the Minister of Natural Resources.

I remind

all Members that parliamentary convention is that Members do not refer to one

another by their names but rather by their title, position or constituency in

order to guard against the tendency to a personalization of the debate. I note

that the House has dealt with Commissioner for Legislative Standards reports

where the title of the report includes a name of Members; however, in this

particular situation no such reports exists.

I have

reviewed Hansard and found that the

Leader of the Official Opposition did refer to a Member by her surname. I ask

the hon. Member to withdraw his remarks.

MR. CROSBIE:

I stand corrected, Mr.

Speaker.

withdraw that statement or remark or use of the hon. Member's name.

MR. SPEAKER:

Thank you.

The hon.

the Minister of Education and Early Childhood Development.

MR. WARR:

Thank you, Mr. Speaker.

I stand

on a point of personal privilege this afternoon. Yesterday during Question

Period, the hon. Member for Stephenville - Port au Port raised an issue with

regard to the school systems review. At that particular time, Mr. Speaker, I had

stated that it was an annual process. I stand corrected. It is not; it is at the

discretion of the district. I wanted to clear the air on that.

Thank

you.

MR. SPEAKER:

Thank you.

Statements by

Members

MR. SPEAKER:

Today we have Members'

statements by the hon. Members for the Districts of Mount Scio, Terra Nova,

Mount Pearl North and Conception Bay South.

The hon.

the Member for Mount Scio.

MS. STOODLEY:

Mr. Speaker, I rise in this

hon. House today to recognize Enactus Memorial and their notable newest venture

HeartStarter.

Enactus

Memorial are solving a global problem. If someone is having a sudden cardiac

arrest, it's critically important that they seek medical attention as soon as

possible. Usually only one in 10 people survive cardiac arrest under these

circumstances, with CPR or defibrillation their best chance for survival. For

every one minute delay in defibrillation, survival rates decrease 7 to 10 per

cent.

partnership with local companies AS Works and Creative Maple, HeartStarter

connects the location of an automated external defibrillators, an AED, with a

first responder. If needed, a specially designed drone can transport an AED to

the individual in cardiac arrest.

The

HeartStarter project aims to save lives by significantly reducing the delay in

defibrillation, bringing an AED to an individual in cardiac arrest. We can all

help by adding the AEDs in our communities to a registry. One way of doing that

is using a phone app such as PulsePoint AED.

I ask

all Members to join me in congratulating Enactus Memorial on this innovative,

life-saving venture.

Thank

you.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for Terra

Nova.

MR. PARROTT:

Mr. Speaker, today I rise to congratulate and support a dedicated group of

volunteers from my district. Time and time again, I have had the opportunity to

witness the strength of volunteers throughout my district and the Regional

Action Committee on Housing, or REACH, is another fine example.

In 2008,

a community advisory group comprised of 15 different organizational groups

masterminded a homelessness strategy for the Bonavista and Clarenville region.

In 2010, REACH was incorporated. In 2015, there was a partnership formed with NL

Housing and the REACH House was obtained. It went on to provide a place for the

homeless and victims of violence, a safe and affordable emergency house where

clients could maintain their dignity.

Last

week, I attended an annual pancake breakfast to help raise awareness for

homelessness in the district. REACH is a not-for-profit group of volunteers, and

they rely heavily on the churches, community group and businesses for donations

of furniture, gift cards and start-up kits to help with everyday needs of their

clients. This board is complemented with two full-time housing support workers,

and I'd like to give everyone a very special thank you, and a special mention

its co-chairs, Tracy Fleming and Jodean Jefford.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for Mount

Pearl North.

MR. LESTER:

Mr. Speaker, from February 5

to 16 the annual Frosty Festival 2020 brought Mount Pearl to life with an array

of activities offered at various venues and an impressive

schedule of events

designed to entertain and warm the hearts of visitors young and old.

Many

thanks to many organizations, volunteers, entertainers and sponsors who've

helped make this event a success again this year. Your passion and enthusiasm

add sparkle and energy to our city each winter.

opening night, crowds bundled up into toques, mittens and puff-filled jackets

and enjoyed a magical, light-filled parade. I was honoured to transport Frosty

along the brilliantly lit parade route to the cauldron lighting in St. David's

Field.

Although

Mother Nature didn't full co-operate throughout the festival, it didn't cool

enthusiasm, as Mount Pearl is very fortunate to have some fantastic indoor

venues that are perfect to host festival events. Frosty brought people of all

ages, of all walks of life together to celebrate winter fellowship with one

another in our community.

I ask

all those present to join me in congratulating Chair Robert Hayes, Vice-Chair

Renee Pendergast and the entire organizing committee, the council, city staff

and, of course, over 500 volunteers who made this year's 38th Frosty Festival

the best yet.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for

Conception Bay South.

MR. PETTEN:

Thank you, Mr. Speaker.

I rise

today to acknowledge two young people from my District of Conception Bay South

who started a trend in taking it upon themselves to shovel out fire hydrants in

our community after Snowmageddon 2020.

Anabel

and William Fagan, ages 17 and 14, from Foxtrap took to the streets armed with

nothing but a shovel each to try and clear as many fire hydrants, driveways and

steps which were blocked after the 90 centimetres of snow we received as a

result of the massive snowstorm. A lot of those were seniors.

Conception Bay South has nearly 1,300 fire hydrants to clear. The duo's kind

gesture did not go unnoticed by the Town of Conception Bay South or the

residents. They're invited to make a live appearance on K-Rock's morning show as

the Rocket Bakery's Volunteers of the Week, received recognition from the Town

of CBS and their volunteer efforts were reported on Facebook, along with many

other media sites.

Mr.

Speaker, there's no truer example of helping your community in a time of need;

it actually sparked a series of acts of kindness in our town. I know for certain

their family and friends are very proud of them, as are all our residents.

I ask

all hon. Members to join me in congratulating Anabel and William Fagan for their

hard work and thank them for their efforts in making Conception Bay South a

better place.

Thank

you very much.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

Statements by Ministers.

Statements by

Ministers

MR. SPEAKER:

The hon. the Minister of

Tourism, Culture, Industry and Innovation.

MR. DAVIS:

Thank you, Mr. Speaker.

Newfoundland and Labrador is home to an inventive, productive and

competitive innovation ecosystem.

Last month, I started TechTour 2020, by visiting Genesis and Memorial's

Centre for Entrepreneurship, two of the province's well-known business

incubators. I also toured innovative start-up companies CoLab and Mysa, both of

which were fostered at the Centre for Entrepreneurship, where more than 300

students now avail of programming.

Mr. Speaker, I also visited Virtual Marine Technology and Genoa Design,

companies which have grown to become respected global leaders in their fields.

Both of these companies were nurtured at Genesis, which has clients and graduate

companies generating in excess of $200 million in revenues annually, and are all

headquartered here in Newfoundland and Labrador.

Other innovative companies I met with included Kraken Robotics, a company

developing next generation sensors and robotics to support the ocean economy;

and Score Canada, which has developed cutting-edge valve management technologies

to aid the oil and gas sector.

I also had the good fortune to visit C-Core and met with some Memorial

students who are designing Killick One, the first ever provincially built and

operated observation satellite – which is pretty cool.

Mr. Speaker, through the Business Innovation Agenda and Technology Sector

Work Plan, our government is committed to enabling entrepreneurs and helping to

create new innovative businesses and exceptional employment opportunities. I

assure you, there are many, many more good things on the horizon.

I ask all hon. Members to help me acknowledge the innovative technology

being developed in our province, and recognize the resources and capabilities we

have right here at home.

Thank

you, Mr. Speaker.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for Terra

Nova.

MR. PARROTT:

Mr. Speaker, I thank the minister for an advance copy of his statement.

Mr.

Speaker, I join with the minister in acknowledging the great advancements and

achievements of the technology and innovation sector within the province. The

work being carried out by Genesis and Memorial Centre for Entrepreneurship is

truly creating a positive change in our province. Through mentorship and

resource cultivation, they are helping to create jobs, bringing wealth into our

province and increasing our economy.

CoLab and Mysa are a true reflection of the talent in our province and the

successes which can happen with determination, perseverance and positive

mentoring.

While I

congratulate those in industry, I do want to encourage this government to do

more to support all businesses in all areas and all industries within our

province. We must diversify the economy, and that includes making it easier for

all businesses to grow and thrive in our province.

Thank

you.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. Leader of the Third

Party.

MS. COFFIN:

Thank you, Mr. Speaker, and

I, too, thank the minister for an advance copy of his statement.

Good job

to the many people involved in the TechTour 2020. I admire your enthusiasm in

embracing economic diversification and pioneering technology. Let's see more

employment here in these sectors. This is a good start to diversification and I

look forward to a future where we divert oil revenues towards a greener economy.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

Further statements by

ministers?

The

Minister of Municipal Affairs and Environment.

MR. BRAGG:

Thank you, Mr. Speaker.

I rise

today to remind the public that the provincial ban on retail plastic shopping

bags is fast approaching. As of July 1, regulations under the

Environmental Protection Act will come

into force, banning the distribution of retail plastic bags in Newfoundland and

Labrador.

We are

proud that our province is the second in Canada to implement a ban on the

distribution of plastic retail bags. We have proceeded with the ban based on

significant public consultations. The ban will help us protect the environment

and improve the waste management system.

Mr.

Speaker, we are also continuing our work with the federal, provincial and

territorial governments to address the broader category of paper and packaging.

We are working on the development of the Extended Producer Responsibility

program under the national Zero Plastic Waste strategy.

We have

been encouraging people to start new habits and consider potential alternatives

to single-use plastic bags. We've already seen many residents and businesses

begin to reduce plastic waste.

Thank

you, Mr. Speaker.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. Member for Mount

Pearl North.

MR. LESTER:

I thank the hon. minister for

an advance copy of his statement.

We are

pleased to see that the ban on retail plastic bags will finally be coming into

effect in our province this coming July. I know that some businesses and

municipalities have already made the move and residents are proactively finding

alternatives and bringing reusable bags along.

I would

like to take this opportunity to encourage government to increase the public

awareness and engagement of such activities as the benefits of composting and,

of course, putting waste in its proper place. We also encourage government to

find additional ways and means to reuse collected recyclable materials in our

province.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for St.

John's Centre.

MR. J. DINN:

Thank you, Mr. Speaker.

I, too,

thank the minister for an advance copy of his statement. The banning of plastic

retail shopping bags in this province is a small but significant first step, and

one that we might not have thought possible a few years ago.

Having

an Extended Producer Responsibility program is certainly the next one, because

unnecessary plastic packaging seems to grow every year. Reducing plastics is

also about raising cautiousness about changing the mindset we've had for

generations and about being good stewards of a planet we call home.

Thank

you.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

Further statements by

ministers?

The hon.

the Minister of Fisheries and Land Resources.

MR. BYRNE:

Thank you very much, Mr.

Speaker.

I am

very pleased to provide details of a bilateral Boreal Caribou Conservation

Agreement which was recently reached between the Government of Newfoundland and

As a

result of strong work by our team of wildlife experts to highlight the plight of

Labrador's boreal caribou and the steadfast negotiating position taken by the

province, we have been able to successfully leverage $5.4 million from the

federal government devoted solely to the conservation and protection of

Labrador's boreal caribou, or the woodland non-migratory caribou – which include

the Mealy Mountains, Lac Joseph, and Red Wine herds.

This

agreement, Mr. Speaker, builds on the efforts of our government to protect and

facilitate the recovery of the species and its critical habitat, and to help

change the trajectory of caribou in Labrador from declining populations to

stable ones, and eventually to growing herds. Mr. Speaker, the agreement

recognizes the wide range of threats to Labrador caribou and outlines a

strategic approach that focuses on research, monitoring and conservation. We now

have the tools to secure enhanced guardianship and stewardship that will seek to

address the challenge of unsanctioned hunting which is inhibiting the caribou's

recovery.

Mr.

Speaker, boreal caribou of Labrador have long held intrinsic value to Indigenous

culture and traditions. I am proud today to highlight this agreement, which

formally recognizes the importance of Indigenous engagement and traditional

Indigenous knowledge in the future recovery and protection of the herds. It will

help forge a much needed broader, deeper partnership with Indigenous communities

that focuses on specific, realized threats and which is integral to the

successful recovery of boreal caribou in Labrador.

As the

implementation of this plan begins, we look forward to continuing ongoing

engagement with our Indigenous partners in Labrador and, indeed, all those with

a vested interest in the protection and recovery of Labrador's precious caribou

resource.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for

Exploits.

MR. FORSEY:

I thank the minister for an

advance copy of his statement.

Mr.

Speaker, this is positive news for the sedentary caribou herds and we certainly

hope that it will conserve and protect those herds.

Mr.

Speaker, the decline of the migratory George River caribou herd is also a great

concern, and this herd needs urgent attention as well. We encourage efforts to

support conservation and protection of the Labrador caribou which will hopefully

lead to the successful recovery of all these vital herds.

Thank

you, Mr. Speaker.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Member for

Labrador West.

MR. BROWN:

Thank you, Mr. Speaker.

I, too,

thank the minister for an advance copy of his statement. I thank those in

government who successfully negotiated this agreement in protecting boreal

caribou.

As a

Labradorian, I understand the importance of protecting boreal caribou in our

region and also their cultural significance to our region. We must continue to

have partners engaged in protecting these important herds, including Indigenous

partners and a full contingent of wildlife enforcement officers.

Thank

you.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

Further statements by

ministers?

Oral

Questions.

Oral Questions

MR. SPEAKER:

The hon. the Leader of the

Opposition.

MR. CROSBIE:

Mr. Speaker, thank you.

In view

of the fine progress we made yesterday, my question is for the Minister of

Natural Resources.

January 2019, an order-in-council was issued removing the conflict of interest

bar which otherwise prevented the employment of the consultant, McIntosh.

Was the

order issued by the Cabinet of which the minister was a member, or was it issued

solely on the direction of the Premier?

MR. SPEAKER:

The hon. the Premier.

PREMIER BALL:

Thank you, Mr. Speaker.

First of

all, before I begin today, this is my first opportunity to express my sympathies

to the family in this sitting on the passing of your father. I think the whole

province watched that week and we were actually just – part of the memories, it

brought us back in time for the value that your dad brought to our province, and

certainly pass on my sympathies to your mom again.

Mr.

Speaker, to the question, yes, this has been –

SOME HON. MEMBERS:

Hear, hear!

PREMIER BALL:

Mr. Speaker, to the process;

as you know with Cabinet, and these OCs have been made public, there was a

request that would've come in from, I understand, then it was from Nalcor who

was actually putting this contract in place. It went to Cabinet Secretariat down

to the department that would've come up for me, in this particular case, at the

request of the department and Cabinet Secretariat, which originated within

Nalcor to waive the conflict of interest.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Leader of the

Official Opposition.

MR. CROSBIE:

I thank the Premier for his

kind remarks.

What I

take from his answer is that through the process he described the

order-in-council was initiated under his responsibility. That's what I take from

that. Is that correct?

MR. SPEAKER:

The hon. the Premier.

PREMIER BALL:

What I'm saying is the

request would have come in, would have originated, as I said publicly in the

past, when the OC was written and then the request would have come up to my

office for the order-in-council. That is what I just said, but it was not

unusual when you see conflict of interest waivers. That happens quite often from

deputy ministers, once they leave government, as they go out into the private

sector. In this case, this was a contract, as you are now aware of, but the

request would have come up through the department in to me asking for, to sign

an OC to waive the conflict of interest.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Leader of the

Official Opposition.

MR. CROSBIE:

For those of us who are not

intimately familiar with the procedure, I take it that means that the OC was

under the Premier's responsibility rather than Cabinet's. Is that correct?

MR. SPEAKER:

The hon. the Premier.

PREMIER BALL:

Mr. Speaker, I just outlined

the process here. As I said, the request would have come, I understood from

Nalcor into the Cabinet Secretariat down to the department to do the discussion

and for me then to, as representative of Cabinet here, which is not unusual for

the order-in-council, which are all made public by the way. This is all public

information on this order-in-council.

As I

said, Mr. Speaker, it's not unusual at all. There have been waivers for conflict

of interest that are signed often, and there has been many examples of when

people enter into, once they leave government to go in, and you'll see conflict

of interest.

Mr.

Speaker, these things are public knowledge. This was all part of the process

that would have been in place, giving this contract, before any employment would

have been with – with Nalcor, in this particular case. That is where this

contract was negotiated.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Leader of the

Official Opposition.

MR. CROSBIE:

Mr. Speaker, the Minister of

Natural Resources told us yesterday that she has ordered a review of all

contractors and contracts with the oil company.

How many

contracts are under review, and does it include the $350,000 consulting contract

with Gordon McIntosh?

MR. SPEAKER:

The hon. the Minister of

Natural Resources.

MS. COADY:

Thank you very much, Mr.

Speaker.

I have

asked the oil company to review their requirements for contractors throughout

this year. That would include the contract for Mr. McIntosh that the minister is

referencing. We've also asked them to look at all the contracts themselves, so

not only the requirement for having a consultant but also the contracts

themselves. We have made that request of the oil company and we expect to have

some results very soon.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

The hon. the Leader of the

Official Opposition.

MR. CROSBIE:

Mr. Speaker, the minister

yesterday described McIntosh as a world-renowned international consultant whose

job is to make sure we have supply and service development.

McIntosh is so world renowned, why is the minister reviewing his contract?

MR. SPEAKER:

The Minister of Natural

Resources.

MS. COADY:

Thank you, Mr. Speaker.

I'm a

business person, I'm a business leader and it is prudent and important that you

ensure every year that you review your contracts and your requirements for

consultants. We're coming through to a budgeting process, we're coming through

to ensuring that we're being very fiscally responsible; therefore, it is prudent

and responsible to review all requirements for con