Source: https://www.leg.bc.ca/content/legacy/Web/35th1st/1st_read/gov71-1.htm
Timestamp: 2018-01-17 15:11:30
Document Index: 712848108

Matched Legal Cases: ['art 1', 'art 2', 'art 3', 'art 4', 'art 5', 'art 6', 'art 7', 'art 3', 'art 1', 'art 6', 'art 5']

BILL 71 -- 1992: MEDICAL AND HEALTH CARE SERVICES ACT
BILL 71 -- 1992
Part 1 -- Medical Services Commission
Repeal and replacement of section 2
Part 2 -- Beneficiaries
Eligibility and enrollment of beneficiaries
Payments for benefits and cancellation or extension of enrollment
Part 3 -- Practitioners
Enrollment of practitioners
Notice when rendering services
No direct or extra billing
Part 4 -- Payments
Part 5 -- Diagnostic Facilities
Part 6 -- Audit and Inspection
Audit and inspection -- practitioners and employers
Audit and inspection -- diagnostic facilities
Appeals -- beneficiaries
"appropriate disciplinary body" means the person or body having the power to suspend or cancel the right to practise as a practitioner under
(a) the Chiropractors Act, for a chiropractor,
(b) the Dentists Act, for a dentist,
(c) the Medical Practitioners Act, for a medical practitioner,
(d) the Naturopaths Act, for a naturopathic physician,
(e) the Optometrists Act, for an optometrist,
(f) the Physiotherapists Act, for a massage practitioner or physiotherapist,
(g) the Podiatrists Act, for a podiatrist, or
(h) the governing Act, bylaws or rules, for a member of a health care profession or occupation prescribed for the purposes of paragraph (h) of the definition of "health care practitioner";
"appropriation" means an appropriation as defined in the Financial Administration Act;
"approved diagnostic facility" means a diagnostic facility approved under section 28;
"beneficiary" means a resident who is enrolled in accordance with section 6, and includes that resident's spouse or child who is a resident and has been enrolled under section 6;
"benefits" means medically required services
(a) rendered by a medical practitioner who is enrolled under section 12, unless the services are determined under section 4 by the commission not to be benefits,
(b) prescribed as benefits under section 45 and rendered by a health care practitioner who is enrolled under section 12, or
(c) performed in accordance with protocols agreed to by the commission, or on order of the referring practitioner, who is a member of a prescribed category of practitioner, in an approved diagnostic facility by, or under the supervision of, a medical practitioner who has been enrolled under section 12, unless the services are determined under section 4 by the commission not to be benefits;
"board" means the Medical and Health Care Services Appeal Board established under section 35;
"chair", other than in Part 7 or with reference to a subcommittee, means the individual who is appointed under section 2 to chair the commission;
(ii) is older than 18 and younger than 25 years and is in full time attendance at a post secondary institution that is approved by the commission,
"commission" means the Medical Services Commission continued under section 2 and includes a subcommittee acting under an assignment made under section 3;
"diagnostic facility" means a facility, place or office principally equipped for
(a) prescribed diagnostic services, studies or procedures, or
(b) the taking or collecting of specimens for purposes of diagnosis, treatment or prevention of illness, injury or disease
and includes any branches of a diagnostic facility;
"enroll" means,
(a) in respect of a beneficiary, enrollment under section 6, and
(b) in respect of a practitioner, enrollment under section 12;
(a) a chiropractor under the Chiropractors Act,
(b) a dentist under the Dentists Act,
(c) a massage practitioner under Part 3 of the Physiotherapists Act,
(d) a naturopathic physician under the Naturopaths Act,
(e) an optometrist under the Optometrists Act,
(f) a physiotherapist under Part 1 or 2 of the Physiotherapists Act,
(g) a podiatrist under the Podiatrists Act, or
(h) a member of a health care profession or occupation that may be prescribed;
"payment schedule" means a payment schedule established under section 21;
"plan" means the Medical Services Plan continued under section 2;
who is enrolled under section 12;
"premium" means an amount prescribed under section 7;
"rendered by" means performed personally by or, if performance under supervision is authorized by the commission in the circumstances, under the personal supervision of the person to whom reference is being made;
(c) is physically present in British Columbia at least 6 months in a calendar year,
"spouse" with respect to another person means a resident who is married to or is living in a marriage like relationship with the other person and, for the purposes of this definition, the marriage or marriage like relationship may be between persons of the same gender;
"subcommittee" means a subcommittee established under section 3.
2 (1) The Medical Services Commission is continued consisting of the person or persons who may be appointed by the Lieutenant Governor in Council and reports to the minister.
(2) The Medical Services Plan established under the former Act is continued and the function of the commission is to facilitate, in the manner provided for in this Act, reasonable access, throughout British Columbia, to quality medical care, health care and diagnostic facility services for residents of British Columbia under the Medical Services Plan.
(3) If one person is appointed to the commission, that person is the chair.
(4) If more than one person is appointed to the commission, the Lieutenant Governor in Council must designate one of those persons as chair.
(5) Members of the commission or a subcommittee who are not public servants are entitled to receive reimbursement for expenses, remuneration and benefits fixed by the Lieutenant Governor in Council.
(6) If the commission is not meeting, the chair may exercise a power, duty and function that the commission may exercise unless the commission has directed that the chair is not to exercise the power, duty or function.
(7) The commission may sue or be sued in its own name or in the name of the Crown in right of the Province in any civil action respecting the commission or a subcommittee, but any proceeding by or against the commission is binding on the Crown in right of the Province, and the Crown Proceeding Act applies accordingly.
2.1 Section 2 is repealed and the following substituted:
2 (1) The Medical Services Commission is continued consisting of 9 members appointed by the Lieutenant Governor in Council as follows:
(c) 3 members appointed to represent the government
and the commission reports to the minister.
(3) The Lieutenant Governor in Council must designate a member of the commission appointed under subsection (1) (c) as its chair and may designate another member of the commission as its deputy chair.
(4) The chair must call a meeting of the commission at least once in any 3 month period and, by giving written notice to the chair, 3 or more members of the commission can require the chair to call a meeting.
(5) If the commission is not meeting, the chair may exercise a power, duty and function that the commission may exercise unless the commission has directed that the chair is not to exercise the power, duty or function.
(6) The commission may sue or be sued in its own name or in the name of the Crown in right of the Province in any civil action respecting the commission or a subcommittee, but any proceeding by or against the commission is binding on the Crown in right of the Province, and the Crown Proceeding Act applies accordingly.
(7) Members of the commission or a subcommittee who are not public servants are entitled to receive reimbursement for expenses, remuneration and benefits fixed by the Lieutenant Governor in Council.
(8) The Lieutenant Governor in Council may appoint a public administrator to discharge the powers, duties and functions of the commission under this Act if the Lieutenant Governor in Council considers this necessary in the public interest and, on the appointment of a public administrator, the members of the commission cease to hold office unless otherwise ordered by the Lieutenant Governor in Council.
3 (1) The Lieutenant Governor in Council may, after consultation with the appropriate licensing body, establish one or more subcommittees of the commission composed of such members of the commission and other people as the Lieutenant Governor in Council specifies to exercise
(a) the powers, duties and functions of the commission under sections 10, 14, 28 and 32, or
(b) other powers, duties or functions of the commission under this Act that are specified by the Lieutenant Governor in Council respecting health care practitioners on the terms and conditions the Lieutenant Governor in Council specifies.
(2) A power, duty or function given under subsection (1) to a subcommittee may continue to be exercised by the commission unless the Lieutenant Governor in Council directs that the commission not exercise the power, duty or function.
(3) A power, duty or function given under subsection (1) to one subcommittee may also be given under subsection (1) to another subcommittee.
(4) The Lieutenant Governor in Council must designate the chair of each subcommittee and may designate a deputy chair of each subcommittee.
4 (1) The commission may
(a) administer this Act on a non-profit basis,
(b) receive premiums that are payable by beneficiaries,
(c) determine the services rendered by an enrolled medical practitioner, or performed in an approved diagnostic facility, that are not benefits under this Act,
(d) determine the manner by which claims for payment of benefits rendered in or outside British Columbia to beneficiaries are made,
(e) determine the information required to be provided by beneficiaries and practitioners for the purpose of assessing or reassessing claims for payment of benefits rendered to beneficiaries,
(f) investigate and determine whether a person is a resident and, for this purpose, require the person to provide the commission with evidence, satisfactory to the commission, that residency has been established,
(g) determine whether a person is a spouse or a child,
(h) determine whether a person is a medical practitioner or a health care practitioner,
(i) determine for the purposes of this Act whether a person meets the requirements established in the regulations for premium assistance,
(j) determine whether a service is a benefit or whether any matter is related to the rendering of a benefit,
(k) determine before or after a service is rendered outside British Columbia whether the service would be a benefit if it were rendered in British Columbia,
(l) determine whether a diagnostic facility, or a benefit performed in an approved diagnostic facility, meets the requirements of the regulations,
(m) monitor and assess the effectiveness and efficiency of benefits,
(n) enter, with the prior approval of the Lieutenant Governor in Council, into agreements on behalf of the government with Canada, a province, another jurisdiction outside Canada or a person in or outside British Columbia for the purposes of this Act,
(o) establish advisory committees, including pattern of practice committees, to advise and assist the commission in exercising its powers, functions and duties under this Act, and may remunerate members of a committee at a rate fixed by the commission and pay reasonable and necessary travelling and living expenses incurred by members of a committee in the performance of their duties,
(p) authorize surveys and research programs to obtain information for purposes related to the provision of benefits,
(q) enter into arrangements and make payment for the costs of rendering benefits that will be provided on a fee for service or other basis,
(r) provide to a person or body prescribed by the Lieutenant Governor in Council, for the purpose of an audit or investigation of a practitioner's pattern of practice or billing, information concerning claims submitted by that practitioner to the commission,
(s) establish guidelines setting the number of practitioners that a beneficiary may consult respecting the same medical condition within the period specified in the guidelines, or
(t) exercise other powers or functions that are authorized by the regulations or the minister.
(2) The commission must not act under subsection (1) in a manner that does not satisfy the criteria described in section 7 of the Canada Health Act (Canada).
(3) The commission has, for the purposes of conducting hearings under this Act, the powers, privileges and protections of a commissioner under sections 12, 15 and 16 of the Inquiry Act.
(5) The commission must prepare and file with the minister as soon as practicable each year a report for the fiscal year ending March 31 in that year respecting the work of the commission and its subcommittees, and the minister must lay the report before the Legislative Assembly as soon as is practicable.
5 The commission may delegate any of the commission's or chair's powers or duties other than the commission's power under section 10 (2), 14 (2), 19 to 21, 28 (4) or 32 (1) to a person named by the commission.
6 (1) A resident who wishes to be enrolled as a beneficiary on his or her own behalf, or on behalf of his or her spouse or children, must apply to the commission in the manner required by the commission.
(3) The commission may, at the time of enrollment under subsection
(2), or at any other time, enroll as a beneficiary a spouse or a child of a beneficiary after the commission determines that the spouse or child is a resident.
(4) An enrollment under subsection (2) or (3) may be made effective on a date preceding the date of application for enrollment.
(5) A beneficiary enrolled under subsection (2) or (3) must pay to the commission the applicable premiums.
(6) Every person who was an insured person under the former Act immediately before this Act came into force is a beneficiary under this Act until he or she ceases to be a beneficiary in accordance with this Act or the regulations.
(7) The commission may cancel the enrollment of a beneficiary if the commission considers that the beneficiary no longer is a resident.
(8) If a person paid premiums for a period after which cancellation of that person's enrollment as a beneficiary took effect, the commission must, if practicable, refund the amount of those premiums to the person who paid them.
7 (1) The Lieutenant Governor in Council may prescribe premium rates for beneficiaries.
(2) The rates may be different for different categories of beneficiaries, as defined in the regulations, and the regulations may provide that, in respect of a category of beneficiaries as defined in the regulations, no premiums are payable.
(3) A premium that has not been paid during any period in which a beneficiary has been enrolled may be recovered by the commission as a debt owing to the commission.
Payments for benefits and cancellation
or extension of enrollment
8 (1) A beneficiary is, subject to sections 9 (1), 10, 13 and 14, entitled to have payment made for a benefit that he or she has received, in accordance with amounts in a payment schedule, less any applicable patient visit charge.
(2) The commission may cancel the enrollment of a beneficiary who has failed to pay premiums
(a) within the time required by the commission, or
(b) within any extension of time that may be given by the commission.
(3) An extension under subsection (2) (b) may be given after the time under subsection (2) (a) has expired.
(4) A beneficiary whose enrollment is cancelled under subsection (2) may, with the consent of the commission, be reinstated on payment of the arrears owing at the time of the reinstatement.
(5) A beneficiary who is reinstated is entitled to have payment made for benefits that he or she has received during the period that the beneficiary's enrollment was cancelled.
9 (1) If a beneficiary receives benefits from a practitioner who has
(a) made an election under section 13 (1), or
(b) been the subject of an order made under section 14 (2) (b),
or if a beneficiary is enrolled or reinstated retroactively after receipt of benefits, the beneficiary may submit the claim form, completed as required by section 13 (9) (b), and any other prescribed or required information to the commission for payment of the amount that would otherwise be payable to the practitioner.
(2) After assessing the claim under section 22 (2), the commission may make payment to the beneficiary.
10 (1) In this section "cause", in respect of a beneficiary, includes, but is not limited to,
(a) knowingly requesting services that are not medically required from a practitioner to be claimed as a benefit,
(b) submitting a claim under section 9 (1) to the commission for payment knowing that
(c) contravening section 11, and
(3) Notwithstanding subsection (4), if the commission has reason to believe that the beneficiary is not a resident, it may make an order described in subsection (2) for a period not exceeding 30 days without hearing the beneficiary and without cause being proven.
11 A person must not knowingly, in order to obtain benefits,
(b) use the identity number issued to that person where
(i) the commission has cancelled his or her enrollment, or
(ii) he or she contravenes a restriction imposed under section 10 (2).
12 (1) A medical practitioner or health care practitioner who wishes to be enrolled as a practitioner must apply to the commission in the manner required by the commission.
(2) On receiving an application under subsection (1), the commission must enroll the applicant if the commission is satisfied that the applicant is in good standing with the appropriate licensing body and is not a person in respect of whom enrollment has been cancelled under section 14 (2).
(3) A practitioner who renders benefits to a beneficiary is, if this Act and the regulations made under it are complied with, eligible to be paid for his or her services in accordance with the appropriate payment schedule, less any applicable patient visit charge or reduction made under section 19 (2).
(4) Payments for benefits performed in an approved diagnostic facility must be paid to the enrolled medical practitioner who was responsible for rendering the benefit.
(6) A practitioner is not entitled to be paid if that practitioner provides a service contrary to any directions or prohibitions that have been imposed on that practitioner by the appropriate disciplinary body, or by this Act, the regulations made under it or rules that regulate services provided by the practitioner.
(8) A practitioner who is enrolled under this section may cancel this enrollment by giving 30 days' written notice of the cancellation to the commission.
13 (1) A practitioner may elect to be paid for benefits directly from a beneficiary.
(a) immediately on enrollment if the practitioner is not enrolled under section 12 on that date, or
(b) on a date specified by the commission between 30 and 45 days after notice of the election is received by the commission, if the practitioner is enrolled under section 12 on that date.
(a) prior to the date the election under subsection (1) takes effect, if the commission and the practitioner agree to this, or
(b) if the election under subsection (1) has taken effect, by the giving of notice of revocation in the same manner as the giving of notice under subsection (2).
(i) the amount that is provided in the appropriate payment schedule for the benefit, less any applicable patient visit charge, or
(8) If a practitioner makes an election under subsection (1), he or she must not submit a claim on his or her own behalf under section 22 (1) for services rendered to a beneficiary after the date the election becomes effective.
(9) If a practitioner has made an election under subsection (1), the practitioner must, unless the medical condition or incapacity of the beneficiary makes this impractical,
(a) before rendering a benefit, advise the beneficiary in a manner the beneficiary can understand
(i) that the practitioner has made the election and proposes to collect the account directly from the beneficiary, and
(ii) how much the practitioner will charge to render the benefit, including any amount that is in excess of the amount in the appropriate payment schedule, and
(b) as soon as practical after rendering the benefit, provide the beneficiary with a claim form that is completed by the practitioner in the manner required by the commission.
(10) If a practitioner fails to comply with subsection (9), a beneficiary is not liable to pay for the benefit unless the benefit was rendered in an emergency situation that made it impractical to comply with subsection (9).
(11) If a practitioner does not advise a beneficiary under subsection (9) because of the medical condition or incapacity of the beneficiary, the amount the practitioner may charge the beneficiary for rendering a benefit may not exceed the amount specified in the appropriate payment schedule for the rendering of such a benefit.
14 (1) In this section "cause", in respect of a practitioner, includes, but is not limited to,
(d) contravention of section 16,
(f) failure to comply with a written order made under section 32 (1) (e) to adopt an appropriate pattern of practice or billing, or
(a) cancel a practitioner's enrollment and order that the practitioner not apply under section 12 (1) for a period specified by the commission, or
(b) order the practitioner, for a period fixed by the commission, to make claims, including claims for services provided by a diagnostic facility, as though an election had been made under section 13, and section 13 (7) to (11) applies.
(5) If the commission has cancelled the enrollment of a practitioner under subsection (2), a beneficiary is not entitled to have payment made by the commission for any service rendered by that practitioner.
15 (1) A practitioner must, before rendering a service to a beneficiary, advise the beneficiary in a manner the beneficiary can understand, unless the medical condition or incapacity of the beneficiary makes this impractical,
(a) if the service is not a benefit, or
(b) if, in accordance with a payment schedule, the beneficiary will be required by the practitioner to pay all or any portion of the cost of a service and, if so, how much that cost will be.
(2) A beneficiary is not liable to pay a practitioner for a service unless
(a) the advice referred to in subsection (1) was given, and
(b) after that advice was given, the beneficiary agreed to pay the practitioner for the service.
(3) A medical practitioner or health care practitioner who is not enrolled must advise a beneficiary, unless the medical condition or incapacity of the beneficiary makes this impractical, in a manner the beneficiary can understand that his or her services will not be paid for by the commission and, unless that advice is given, the beneficiary is not liable to pay for the services.
16 (1) A practitioner or other person on a practitioner's behalf must not charge a beneficiary
(a) for rendering a benefit, or
(b) for any other matter that relates to the rendering of a benefit except as provided for in the regulations under this Act.
(a) to a practitioner if, at the time a service was rendered,
(i) the person receiving the service was not enrolled or reinstated as a beneficiary, or
(ii) the service was not considered by the commission to be a benefit,
(b) to a medical practitioner or health care practitioner
(i) who is not enrolled under section 12 or for whom an election under section 13 is effective, or
(ii) whose enrollment has been cancelled under section 14 (2) (a) or in respect of whom an order under section 14 (2) (b) has been made, or
(c) if a payment schedule or regulation under this Act permits a practitioner to require a beneficiary to pay all or a portion of the cost of a service and, before rendering the service and unless the medical condition or incapacity of the person receiving the service makes this impractical, the practitioner advises the person receiving the service how much the practitioner will charge for the service.
(3) If a practitioner does not advise a person as required under subsection (2) (c), the person is not liable to pay for the benefit unless the service was rendered in an emergency situation that made it impractical to comply with subsection (2) (c).
(4) If a practitioner does not advise a person under subsection
(2) (c) because of the medical condition or incapacity of the person, the amount the practitioner may charge for the service may not, if the service is a benefit, exceed the amount specified in the appropriate payment schedule for rendering such a benefit.
17 The chair must, where he or she has reasonable grounds to believe that a practitioner may be guilty of incompetence or misconduct, report the grounds on which that belief is based to the appropriate disciplinary body.
18 (1) In this Part
"available amount" means, for a category, the available amount set under section 20 (1) for that category for a fiscal year;
"category" means a category established under section 21;
19 (1) All reasonable and practical measures must be taken by the commission to ensure that the total of payments made under this Part for a fiscal year does not exceed the appropriations for the fiscal year for those payments.
(3) If the commission considers that the special circumstances of a practitioner's patients so warrant, the commission may order that a reduction calculated under subsection (2) does not apply, or applies to a limited extent, to payments to the practitioner.
20 (1) The commission may set the available amount for a category that may be paid under all payment schedules to practitioners in the category for rendering benefits under this Act in the fiscal year specified by the commission.
(2) The total amount that may be paid by the commission to all practitioners in a category for rendering benefits under this Act in a fiscal year must not exceed the available amount for the fiscal year.
21 (1) The commission must establish payment schedules that specify the amounts that may be paid to or on behalf of practitioners for rendering benefits under this Act, less applicable patient visit charges, and may establish different categories of practitioners for the purposes of those payment schedules on the basis of past service levels, of estimated future service levels from payments for rendering benefits, of pattern of practice or of type of practice or specialty.
(6) The commission may continue or establish a medical educational program, a disability insurance program or other practitioner benefit plan for practitioners and the plans may be different for different categories of practitioners.
22 (1) Every practitioner who renders a benefit to a beneficiary must, for the purpose of assessing or reassessing the claim for payment, provide particulars of services and accounts to the commission that are required by this Act and the regulations in the manner the commission specifies.
(a) a practitioner must provide the commission with any record that the commission considers relevant to substantiate a claim, including any medical record, in the care or control of the practitioner, and
(b) a practitioner must retain records, including medical records, for a period specified by the appropriate licensing body or, if the appropriate licensing body has not specified a period, for a period the commission specifies.
23 A person who is not a resident of British Columbia and who provides evidence to a practitioner that he or she is enrolled under an Act, plan or scheme in another province of Canada in respect of which British Columbia has made reciprocal agreements related to the provision of medical or health care services is, subject to the agreements, entitled to receive benefits under this Act, and this Act applies in respect of those benefits as though the person were a beneficiary under this Act.
24 (1) In this section "medical practitioner" includes a medical practitioner or dentist who is authorized to practise medicine or dentistry in the jurisdiction where the services were rendered.
(5) If the government has made an agreement with the government of another province that provides for arrangements to pay for medically required services rendered in that other province, the agreement applies.
25 (1) If the commission has paid an amount
(a) for a service rendered to a person who is not a beneficiary,
(b) for a service that was not a benefit, or
(c) by mistake,
the person who was paid must repay the amount to the commission.
(3) An amount that must be paid to the commission under this section or section 32 (1) (d) may be recovered as a debt owing to the commission, or the commission may deduct it from other money owed by the commission to the person.
26 (1) Notwithstanding any other section of this Act or the regulations, the commission may pay a practitioner for benefits rendered to a resident for a condition that the commission considers to be immediately life threatening.
27 (1) If a person makes an agreement
(2) Subject to subsection (3), premiums collected under an agreement referred to in subsection (1) constitute a lien in favour of the commission or its assignee payable in priority over all liens, charges or mortgages of every person, whenever created or to be created, with respect to property or proceeds of property, real, personal or mixed of the person who collected the premiums.
(3) Subsection (2) applies notwithstanding any other enactment but a lien under section 52 of the Workers Compensation Act, or a lien for wages due to workers by their employer other than a lien postponed to a mortgage or debenture by section 15 (3) of the Employment Standards Act, is payable in priority over a lien constituted under subsection (2) of this section.
(5) If a person is convicted under section 40 (3), the court
(b) may assess a penalty, not to exceed 10 times the amount that was not paid or collected and remitted, and
28 (1) On application, in the manner required by the commission, the commission may, in accordance with the regulations,
(4) If, in respect of an approved diagnostic facility, there is a contravention of this Act, the regulations made under it or a condition imposed on an approval under this section, the commission may, after giving the owner of the diagnostic facility an opportunity to be heard, amend, suspend or cancel an approval granted under this section and section 25 applies to the amount, if any, that was paid by the commission for services on the basis of the approval applying.
(8) An owner of a diagnostic facility who on the date this Act comes into force has an approval under the former Act to operate the diagnostic facility also has an approval under this section to operate the diagnostic facility.
29 (1) A practitioner must not knowingly refer a beneficiary to a diagnostic facility that is not approved under this Part unless he or she first notifies the beneficiary that services performed in the diagnostic facility are not benefits in respect of which payment will be made under this Act.
(3) Subsections (1) and (2) only apply where the service to be provided to the beneficiary would be a benefit if it were rendered by an approved diagnostic facility.
30 (1) A practitioner must not refer beneficiaries to an approved diagnostic facility in which he or she has a financial or other interest, without the prior written approval of the commission.
31 (1) In this Part
"former practitioner" means an individual who was formerly enrolled under section 12 or under the former Act;
"practitioner" includes a former practitioner.
(2) The commission may appoint inspectors to audit claims for payment by practitioners and the patterns of practice or billing followed by practitioners under this Act.
(3) Medical records may only be requested or inspected under this section or section 22 (6) or 34 by an inspector who is a medical practitioner.
(4) An audit under subsection (2) may be made in respect of claims and patterns of practice or billing followed by practitioners before this Act came into force.
(a) records of a practitioner, and
(6) The power to enter a place under subsection (5) or (12) must not be used to enter a dwelling house occupied as a residence without the consent of the occupier except under the authority of a warrant under subsection (7).
(c) answer all questions of the inspector respecting the records referred to in subsection (5) or (12).
32 (1) If the commission, after giving a practitioner, an owner of a diagnostic facility or a representative of a professional corporation an opportunity to be heard, determines that, by reason of
(b) a claim for payment by a practitioner in respect of a benefit that was not rendered, or
(c) a misrepresentation about the nature or extent of benefits rendered by the practitioner,
(2) An owner of a diagnostic facility or a representative of a professional corporation has the right to appear in person or with legal counsel at a hearing under subsection (1).
(3) The commission must advise the appropriate licensing or disciplinary body that an order under subsection (1) has been made respecting the practitioner or the owner of the diagnostic facility, if the owner is a practitioner,
(4) The commission may, for the purposes of this section and for the guidance of practitioners, prepare guidelines and criteria that may be applied to the patterns of practice of practitioners.
(5) In making an order under subsection (1), the commission may consider any relevant source of information, including a source created on a statistical basis or by a comparison between benefits provided by the practitioner or diagnostic facility and corresponding benefits provided by other practitioners or diagnostic facilities but it is not necessary for the commission to consider any particular benefit that the practitioner or owner of the diagnostic facility provided.
(6) The chair must give a copy of any order made under subsection (1) to the practitioner or owner of the diagnostic facility affected by it.
(7) An order under subsection (1) may include a requirement to pay the costs, or part of the costs, of the audit and hearing.
33 Subject to section 37 (4), the chair may file an order made under section 32 (1) in the Supreme Court, and on the order being filed in the court, it is enforceable in the same manner as an order of the Supreme Court.
34 (1) An inspector appointed under section 31 (2) may inspect records, equipment and premises in a diagnostic facility for the purpose of ensuring that this Act, the regulations and any conditions of approval under section 28 are being complied with.
(c) records that would aid the commission in determining whether a hearing under section 28 is warranted, which
are appropriate to the operation and functions performed by the diagnostic facility under the approval or whether there has been a significant change in the circumstances from those that applied when the diagnostic facility was approved under section 28.
(4) If records referred to in subsection (1) are not located on the premises of an approved diagnostic facility, a person who has possession of those records must, on the request of the inspector, produce and permit inspection of those records by the inspector, as the case may be.
35 (1) The Lieutenant Governor in Council must, after consultation with the appropriate licensing bodies, establish a Medical and Health Care Services Appeal Board consisting of a chair and 2 or more other members whom the Lieutenant Governor in Council may appoint.
(2) The chair must be a member in good standing of the Law Society of British Columbia.
(3) The chair and other members of the board must be appointed for a term fixed by the Lieutenant Governor in Council and may be reappointed to further terms.
(4) The chair and members of the board must be paid reasonable travelling and other out of pocket expenses necessarily incurred in the discharge of their duties, and may be paid remuneration fixed by the Lieutenant Governor in Council for their services.
(5) The chair has and may exercise the administrative jurisdiction of the board on any matter within the administrative jurisdiction of the board.
(6) The chair may appoint a panel, consisting of 3 members of the board, to hear any matter before the board, and, if a panel has been appointed,
(a) the chair, or a member of the board who is a member in good standing of the Law Society of British Columbia specified by the chair, must preside, and
(b) the panel has the jurisdiction of the board with respect to matters that come before it.
36 (1) A beneficiary in respect of whom an order is made under section 10 (2) may appeal to the board.
(2) On an appeal under subsection (1), the board may
(a) confirm, vary or rescind the order of the commission,
(b) make any order that the commission could have made under section 10 (2), or
(c) make any other order or decision that the commission could have made that the board considers fair.
(3) Unless the board otherwise orders, an appeal under this section operates to stay the decision appealed from.
37 (1) A practitioner in respect of whom an order was made under section 14 (2) or 32 (1) may appeal to the board.
(2) The owner of a diagnostic facility may appeal to the board an action taken by the commission under section 28 (2) or (4).
(3) On an appeal under subsection (1) or (2), the board may
(a) confirm, vary or rescind the order or action of the commission,
(b) make any order or take any action that the commission could have made or taken under section 14 (2), 28 (2) or (4) or 32 (1), as the case may be, or
(c) make any other order or take any other action that the board considers fair that the commission could have made.
(4) Unless the board otherwise orders, an appeal under this section operates to stay the order or action appealed from.
38 (1) The board may make rules governing practice and procedure for all appeals before the board, and the rules may be different for appeals by beneficiaries and practitioners and in respect of diagnostic facilities and a copy of these rules must be made available on request to any person who appeals.
(2) The board has the same powers, protections and privileges that a commission has under sections 12, 15 and 16 of the Inquiry Act.
(3) The board may order that costs be paid
(a) by the commission to the person who appealed, or
(b) by the person who appealed, to the commission.
(4) If costs are awarded, the costs must consist of the fees, expenses and disbursements that were reasonably necessary and proper in connection with the conduct of the appeal, subject to any limitations that the board may order.
(5) If an order for costs is made, the costs must be reviewed before the registrar of the Supreme Court, and the registrar must consider the circumstances set out in section 71.1 (2) of the Legal Profession Act.
(6) The provisions of the Rules of Court respecting the review of costs apply to a review under subsection (5) as though the order for costs were made by a court.
39 (1) A person must not provide, offer or enter into a contract of insurance with a resident for the payment, reimbursement or indemnification of all or part of the cost of services that would be benefits if performed by a practitioner.
(2) Subsection (1) does not apply to a patient visit charge under section 45 (2) (r) if the commission has given approval for the contract before or after the service was rendered.
40 (1) A beneficiary or practitioner who misrepresents the nature or extent of the benefit in a claim for payment commits an offence.
(3) A person who fails to pay or to collect and remit premiums in accordance with an agreement referred to in section 27 (1) commits an offence.
(5) A person who contravenes section 11 or 43 commits an offence.
42 (1) No action for damages because of anything done or omitted to be done in good faith under this Act or the regulations,
may be brought against a member of the commission, a member of a subcommittee, a member of the board, an inspector appointed under Part 6, a member of an advisory committee or any employee or other person who is subject to the commission's direction or to whom a power has been delegated under this Act.
(2) Subsection (1) does not absolve the Crown from vicarious liability for an act or omission of an inspector or an employee referred to in subsection (1) for which act or omission the Crown would be vicariously liable if this section were not in force.
43 Each member or former member of the commission or the board, each employee or former employee of the ministry employed in the administration of this Act, each inspector or former inspector appointed under this Act, every member or former member of an advisory committee and any other person engaged or previously engaged in the administration of this Act must keep confidential matters that identify an individual beneficiary or practitioner that come to his or her knowledge in the course of their employment or duties, and must not communicate any of those matters except
(a) in the course of the administration of this Act or another Act or program administered by the minister,
(b) in court proceedings, or
(c) in a regulatory body that has authorized a practitioner or diagnostic facility to render services in British Columbia.
44 (1) Unless otherwise provided by this Act or the regulations, a document or notice required to be given to a person under this Act or under the regulations must be given by delivering it to that person or to the last known address of that person.
(2) If a document is deposited at the office of the commission or the board during normal business hours, the document shall be deemed to have been personally delivered to the commission or the board.
45 (1) The Lieutenant Governor in Council may make regulations.
(f) prescribing the conditions for payment for benefits or any class of benefits, including
(i) requiring that the services be provided in a specified hospital, health facility or diagnostic facility or any category of hospital, health facility or diagnostic facility, and
(ii) permitting different conditions for payment for different categories of practitioners;
(g) respecting the approval of diagnostic facilities under Part 5, including the establishment of criteria and conditions for approval of diagnostic facilities and including, but not limited to, the establishment of different criteria and conditions
(h) establishing terms and conditions relating to the functions and operations of specific approved diagnostic facilities and categories of approved diagnostic facilities and authorizing the commission to establish those terms and conditions;
(i) respecting applications for approval of diagnostic facilities and the information required to be disclosed;
(j) prescribing the form and content of records, other than medical records, required under this Act or the regulations;
(k) respecting the provision of dental care services and benefits to beneficiaries or any designated categories of beneficiaries, including specifying those provisions of this Act and the regulations respecting the plan which apply or do not apply to the provision of dental care services and benefits;
(l) respecting rights of subrogation in favour of the commission;
(m) providing for transition arising from repeal of the former Act and the Medical Service Plan Act, 1981;
(n) providing for sampling and confirmation of claims submitted for payment under this Act;
(o) setting standards and conditions for the purposes of services provided outside British Columbia;
(p) establishing fees for applications or renewals under the Act and different fees may be established for different applications or for applications by practitioners in different categories;
(q) respecting any other matter for which regulations are required under this Act;
(r) permitting a health care practitioner to request that a beneficiary pay a patient visit charge to cover all or part of the cost of a visit.
46 The Medical Service Act, R.S.B.C. 1979, c. 255, and the Medical Service Plan Act, 1981, S.B.C. 1981, c. 18, are repealed.
47 Sections 11 (1) (a) and 12 (2) (a) of the Guaranteed Available Income for Need Act, R.S.B.C. 1979, c. 158, are amended by striking out "Medical Service Act;" and substituting "Medical and Health Care Services Act;".
48 The definition of "resident" in section 1 of the Hospital Insurance Act, R.S.B.C. 1979, c. 180, is repealed and the following substituted:
(a) is a citizen of Canada or lawfully admitted to Canada for permanent residence,
49 Section 15 (5) of the Pension (College) Act, R.S.B.C. 1979, c. 316, is amended by striking out "established under the Medical Service Act," and substituting "continued under the Medical and Health Care Services Act,".
50 Section 13 (6) of the Pension (Municipal) Act, R.S.B.C. 1979, c. 317, is amended by striking out "established under the Medical Service Act" and substituting "continued under the Medical and Health Care Services Act".
51 Section 14 (4) of the Pension (Teachers) Act, R.S.B.C. 1979, c. 320, is amended by striking out "established under the Medical Service Act" and substituting "continued under the Medical and Health Care Services Act".