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Second Session, Thirty-Seventh Legislature

This version is based on the printed bill that was distributed in the Legislature after First Reading.
It is not the official version.   If accuracy is critical, you can obtain a copy of the printed bill from Statutory Publications.

Bill 25

THE HEALTH SERVICES INSURANCE AMENDMENT AND CONSEQUENTIAL AMENDMENTS ACT


Explanatory Note

(Assented to                                         )

HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Manitoba, enacts as follows:

C.C.S.M. c. H35 amended

1           The Health Services Insurance Act is amended by this Act.

2(1)        The definition "out-patient" in subsection 2(1) is replaced with the following:

"out-patient" means a patient of a hospital or surgical facility who receives necessary diagnostic or treatment services, and, in the case of a hospital, excludes

(a) an in-patient, and

(b) any other person assigned to a bed other than an emergency or temporary holding bed; (« malade en consultation externe »)

2(2)        The definition "surgical facility" in subsection 2(1) is amended by striking out "surgical out-patient services" and substituting "surgical services".

2(3)        Subsection 2(1) is amended by adding the following definition in alphabetical order:

"surgical service" means the alteration of the human body manually or through the use of an instrument or the introduction of an instrument into the human body, when the procedure is carried out with the concurrent use of

(a) a drug to induce sedation, or

(b) local, regional or general anaesthesia,

to a degree that requires the monitoring of vital signs, but does not include a surgical procedure that is exempted in the regulations. (« soins chirurgicaux »)

3(1)        Subsection 48(1) is replaced with the following:

Right to payment for hospital and out-patient services

48(1)       Subject to this Act and the regulations,

(a) an insured person who has received hospital services is entitled to have the minister pay the amounts due for those services to the regional health authority responsible for the services;

(b) an insured person who has received out-patient services in a surgical facility operated by a regional health authority is entitled to have the minister pay the amounts due for those services to the authority;

(c) an insured person who has received out-patient services in a surgical facility not operated by a regional health authority is entitled to have the minister pay the amounts due for those services to the operator of the facility, but only if the operator has an agreement with the minister under section 64.1.

3(2)        The following is added after subsection 48(3):

No collection from others for out-patient services in a surgical facility

48(4)       Except pursuant to an agreement under section 64.1, no person shall accept a fee or other payment made on behalf of an insured person for or in relation to providing out-patient services to the insured person in a surgical facility.

4           Section 63 is replaced with the following:

Inspectors

63(1)       The minister may, in writing, appoint inspectors for the purpose of this section.

Certificate to be produced

63(2)       An inspector exercising a power under this section must produce a certificate of appointment when requested to do so.

Entry and inspection

63(3)       An inspector may, at any reasonable time when required to determine compliance with this Act or the regulations or an agreement referred to in section 64.1,

(a) enter a hospital, surgical facility or other health care facility; and

(b) require the hospital, surgical facility or other health care facility to produce for examination, audit or copying, any books, records or things relating to its activities which are in its possession or under its control.

Assistance to inspector

63(4)       Any person who operates or is in charge of a hospital, surgical facility or other health care facility or who has custody or control of any books, records or things referred to in subsection (3) shall give an inspector all reasonable assistance to enable the inspector to carry out his or her duties, and shall provide the inspector with any information the inspector may reasonably require.

5(1)         Section 64 is amended

(a) by renumbering it as subsection 64(1);

(b) in the section heading, by striking out ", surgical facilities";

(c) by adding "and" at the end of clause (a) and by striking out "and" at the end of clause (b); and

(d) by repealing clause (c).

5(2)        The following is added as subsection 64(2):

Rates of payments to surgical facilities

64(2)       Payments for out-patient services that a surgical facility has provided to insured persons shall be made to the operator of the facility and, where the operator is not a regional health authority, shall be made

(a) only if the operator has an agreement with the minister under section 64.1; and

(b) only in accordance with the terms of that agreement.

6           The following is added after section 64:

Agreement with surgical facility

64.1(1)     The minister may enter into an agreement with the operator of a surgical facility respecting payment to the operator for or in relation to providing out-patient services to insured persons in the facility.

Requirements for agreement

64.1(2)     The minister shall not enter into an agreement under subsection (1) unless the minister is satisfied that

(a) the surgical facility is accredited by the College of Physicians and Surgeons;

(b) the provision of insured services as contemplated under the proposed agreement will be consistent with the principles of the Canada Health Act; and

(c) the agreement will serve the public interest.

No overnight stay in surgical facility

64.2(1)     No operator of a surgical facility, and no medical practitioner, shall provide a surgical service in a surgical facility if the person receiving the service would normally require post-operative care in the facility after 11:00 p.m. on the day the service is provided.

Restraining order

64.2(2)      The minister may, by notice of application, apply to a judge of the Court of Queen's Bench for an order restraining any person from contravening subsection (1).  On an application, the judge may make any order the judge considers appropriate.

Offence

64.2(3)     Any person who contravenes subsection (1) is guilty of an offence and is liable on summary conviction to a fine not exceeding $30,000.

7           Section 66 is amended

(a) by adding the following after clause (b):

(b.1) knowingly contravenes subsection 48(4);

(b) in the part after clause (d), by striking out "$5,000." and substituting "$30,000.".

8           Section 94 is replaced with the following:

Statement by opted out doctor

94          When a medical practitioner who has made an election under subsection 91(1) renders a medical service to an insured person, he or she shall

(a) send to the minister, on behalf of the insured person, a claim for the services in the form the minister requires; and

(b) send to the insured person a statement of the fees and charges for the services.

9           Subsection 95(2) is amended by striking out "$5,000." and substituting "$30,000."

10          The following is added after subsection 97(3):

Certificate

97(4)       For the purpose of an action referred to in this section, the minister may issue one or more certificates that set out

(a) the insured hospital, medical or other health services that an insured person has received for bodily injuries suffered as a result of the negligence or other wrongful act or omission of another person; and

(b) the cost of those services.

Admissibility of certificate

97(5)       A certificate under subsection (4) is admissible in evidence as proof, in the absence of evidence to the contrary, of the facts stated in the certificate without proof of the minister's appointment or signature.

11          Section 98 is replaced with the following:

Requirement to notify the minister

98          When an insured person to whom section 97 applies retains a lawyer to pursue recovery of damages for bodily injuries the insured person has suffered — or when a lawyer is retained on the insured person's behalf — the insured person shall, within 30 days after the lawyer is retained,

(a) notify the minister in writing of the claim; and

(b) provide the minister with the information prescribed in the regulations.

Information from insured person

98.1(1)     At the minister's request, every insured person to whom section 97 applies shall promptly provide the minister with information about

(a) the negligence or other wrongful act or omission that caused the person bodily injuries;

(b) the bodily injuries suffered;

(c) the insured hospital, medical or other health services received for the bodily injuries; and

(d) any other matter the minister may specify.

Information from others

98.1(2)     Any person who has information about insured hospital, medical or other health services provided to an insured person to whom section 97 applies shall, at the minister's request, promptly provide that information to the minister.  However, this requirement does not apply to information subject to solicitor-client privilege.

Duty to cooperate

98.2(1)     An insured person to whom section 97 applies shall cooperate fully with the minister and his or her officials and lawyers in establishing and proving the minister's right to recover the past cost of insured services and the future cost of insured services that have been provided to or that will be required by the insured person.

Duty applies in all cases

98.2(2)     The duty to cooperate applies whether the costs are included in a claim brought by the insured person, or are claimed in an action brought in the name of Her Majesty in right of the province.

12          Section 108 is amended by striking out "to which reference is made in section 106" and substituting "to which reference is made in section 110".

13          Subsection 110(1) is amended in the part after clause (b) by adding "written" before "notice".

14          The following is added after section 110:

Interest

110.1(1)    When a claim for amounts described in clause 97(2)(a) or (b) is settled or a judgment is obtained, the settlement or judgment must include an amount for prejudgment interest.

Calculation

110.1(2)    Prejudgment interest is to be calculated in accordance with Part XIV of The Court of Queen's Bench Act from the date the cause of action arose to the date of the settlement or judgment.

Periodic payments

110.2       If an insured person to whom section 97 applies

(a) enters into a settlement that provides for amounts described in clause 97(2)(a) or (b) to be paid wholly or partly by periodic payments; or

(b) obtains a judgment that orders amounts described in clause 97(2)(a) or (b) to be paid wholly or partly by periodic payments;

the insured person shall provide the minister with a copy of the settlement document or judgment as soon as possible after the settlement is entered into or the judgment is obtained.

15          Subsection 113(1) is amended by adding the following after clause (a):

(a.1) providing for the exemption of surgical procedures from the definition of "surgical service" in subsection 2(1);

16          Subsection 116(1) is amended by adding the following after clause (h):

(i) prescribing information required to be provided by an insured person under section 98.

Consequential amendment, C.C.S.M. c. E145

17          Section 1 of The Essential Services Act is amended

(a) by striking out "as defined in The Hospitals Act" in clause (b) of the definition "employer" ; and

(b) by adding the following definition in alphabetical order:

"hospital" means an institution or other facility for the care and treatment of persons who are ill or injured, but does not include

(a)  a psychiatric facility as defined in The Mental Health Act,

(b)  a hospital owned or operated by the Government of Canada, or

(c)  a developmental centre as defined in The Vulnerable Persons Living with a Mental Disability Act; (« hôpital »)

Consequential amendment, C.C.S.M. c. H120

18          The definition "hospital" in section 1 of The Hospitals Act is replaced with the following:

"hospital" means a hospital as defined in The Health Services Insurance Act; (« hôpital »)

Consequential amendments, C.C.S.M. c. P130

19(1)       The Private Hospitals Act is amended by this section.

19(2)       The definition "private hospital" in section 1 is replaced with the following:

"private hospital" means a house or building in which one or more patients are received and lodged for medical treatment or for care and treatment for childbirth, but does not include a hospital as defined in The Hospitals Act; (« clinique privée »)

19(3) Section 2 is amended by adding "or building" after "house".

19(4)       Clause 4(1)(b) is amended by striking out "or surgical".

19(5)       Clause 4(1)(c) is amended by striking out "and surgical".

19(6)       Subsection 4(2) is amended by adding "or building" after "house" wherever it occurs.

19(7)       Subsection 9(1) is amended by adding "or building" after "house" wherever it occurs.

19(8)       The following is added after section 9:

No surgical service

9.1         No licensee and no medical practitioner shall provide a surgical service, as that term is defined in The Health Services Insurance Act, in a private hospital.

19(9)       Subsection 11(1) is amended by adding "or building" after "house".

19(10)      Subsection 12(1) is amended by adding "or building" after "house".

19(11)      Section 14 is replaced with the following:

Penalty: section 2 or 9.1

14(1)       A person who contravenes section 2 or 9.1 is guilty of an offence and is liable on summary conviction to a fine not exceeding $30,000.

General penalty

14(2)       A person who contravenes any provision of this Act other than section 2 or 9.1 is guilty of an offence and is liable on summary conviction to a fine not exceeding $5,000.

Coming into force

20          This Act comes into force on a day fixed by proclamation.

Explanatory Note

This Bill amends The Health Services Insurance Act with respect to surgical facilities, and makes changes to the law dealing with the government's ability to recover the costs of insured services from negligent third parties.