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The Health Services Insurance Amendment Act

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If you need an official copy, contact Statutory Publications.

S.M. 1998, c. 53

THE HEALTH SERVICES INSURANCE AMENDMENT ACT


 

(Assented to June 29, 1998)

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 "board" in subsection 2(1) is amended by striking out "Manitoba Health Board" and substituting "Manitoba Health Appeal Board".

2(2)      The definition "out-patient" in subsection 2(1) is amended by repealing the part preceding clause (a) and substituting the following:

"out-patient" means a patient who is not an in-patient and who is received by a hospital or a surgical facility for necessary diagnostic or treatment services but who is not assigned to a bed other than an emergency bed or a holding bed for temporary purposes, and includes

2(3)      The definition "participating medical province" in subsection 2(1) is amended by striking out "Medical Care Act" and substituting "Federal-Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act".

2(4) The definition "resident" in subsection 2(1) is amended by repealing clause (b) and substituting the following:

(b) does not include

(i) a person who holds a minister's permit under the Immigration Act (Canada), unless the minister determines otherwise, or

(ii) a visitor, transient or tourist;

2(5)      Subsection 2(1) is amended by adding the following definition in alphabetical order:

"surgical facility" means a facility that provides surgical out-patient services outside of a hospital; (« établissement chirurgical »)

3(1)      Subsection 9(1) is amended by striking out "Manitoba Health Board" where it occurs in the section heading and the subsection and substituting "Manitoba Health Appeal Board".

3(2)      Subsection 9(4) is amended by striking out "from the fund".

4         Clause 10(1)(d) is repealed and the following is substituted:

(d) who has been refused a licence to operate a personal care home under section 118.2 or whose licence to operate a personal care home has been suspended, cancelled or not renewed under that section; or

5         The following is added after section 33:

Benefits to persons insured in other provinces

33.1      A person who is not an insured person and who provides evidence to a regional health authority, medical practitioner, hospital or surgical facility that he or she is registered or enrolled in another jurisdiction under an Act, plan or scheme in respect of which Manitoba has made an agreement under section 68 relating to the provision of hospital services or medical services is, subject to the agreement, entitled to receive benefits under this Act as though the person were an insured person.

6         Subsection 46(1) is amended

(a) in the part preceding clause (a), by adding ", surgical facility" after "hospital"; and

(b) in clause (a), by adding "and out-patient services in a surgical facility" at the end.

7(1)      Subsection 48(1) is repealed and the following is substituted:

Right to payment for hospital and out-patient services

48(1)     Subject to this Act and the regulations, an insured person is entitled to have the minister pay

(a) to the regional health authority responsible for any hospital services that the person has received, amounts due for those hospital services; and

(b) to the operator of a surgical facility, amounts due for any out-patient services the person has received in the facility.

7(2)      The following is added after subsection 48(2):

No charge for out-patient services in a surgical facility

48(3)     No person shall make any charge to an insured person for or in relation to providing out-patient services to the person in a surgical facility.

8         Section 64 is amended

(a) in the section heading, by adding ", surgical facilities" after "hospitals"; and

(b) in the section, by striking out "and" at the end of clause (a) , by adding "and" at the end of clause (b) and by adding the following after clause (b):

(c) by a surgical facility, shall be made to the operator of the facility in accordance with any agreement between the minister and the operator of the facility.

9         Section 66 is amended

(a) in clause (a), by adding "or for or in relation to out-patient services provided in a surgical facility," after "hospital services";

(b) in clause (b), by adding "or for or in relation to out-patient services provided in a surgical facility" after "hospital services"; and

(c) in the part after clause (d), by striking out "$500." and substituting "$5,000."

10        Subsection 95(2) is amended by striking out "$1,000." and substituting "$5,000."

11        Subsection 113(1) is amended

(a) in clause (h), by adding ", except to the extent provided for in clause 116(g)" at the end;

(b) in clause (t.2), by adding ", including the form in which such information must be filed" at the end;

(c) by adding the following after clause (t.2):

(t.2.1) governing the fees that may be charged to medical practitioners and other health practitioners for processing claims for payment, and governing the manner of recovering such fees including authorizing the minister to withhold payment of claims to practitioners if the fees are not paid;

(d) by repealing clauses (y) and (bb);

(e) by adding the following after clause (dd):

(ee) defining any word or expression used in this Act but not defined in this Act.

12        Section 116 is amended

(a) by renumbering it as subsection 116(1);

(b) by repealing clause (g) and substituting the following:

(g) designating the benefits to which an insured person is entitled under this Act in relation to services rendered by medical practitioners, and respecting the manner of, and other details relating to, payments of those benefits to or on behalf of insured persons;

(h) for the purpose of clause (g), requiring as a condition of entitlement to receive benefits that services be provided

(i) in a specified hospital or facility or any class of hospitals or facilities,

(ii) by a specified class of medical practitioners, or

(iii) under any other circumstances or subject to any other conditions or limitations that the regulations may specify.

(c) by adding the following as subsection 116(2):

Retroactive regulation

116(2)    A regulation under clause (1)(g) may be made effective retroactively to a date fixed in the regulation.

13        Section 118, as enacted by R.S.M. 1987, c. H35, is repealed and the following is substituted:

Personal care home licence

118(1)    No person shall establish or operate a personal care home except under the authority of a personal care home licence issued under this Act.

Application for licence

118(2)    A person may apply for a personal care home licence by filing an application with the minister in accordance with, and including the information and the fee required by, the regulations.

Regional health authority approval

118(3)    An application may be made under subsection (2) only if the operation of the personal care home has been approved under subsection 28(1) of The Regional Health Authorities Act.

Transitional

118(4)    Subsection (3) does not apply if the application is made for a personal care home that is licensed under The Public Health Act on the day this section comes into force.

Issuing a licence

118.1(1)  The minister may issue a personal care home licence to operate a personal care home if he or she is satisfied that

(a) the applicant and the personal care home meet the requirements of this Act and the regulations; and

(b) the personal care home would, if licensed, be operated and maintained in compliance with this Act and the regulations.

Terms and conditions

118.1(2)  The minister may issue a personal care home licence subject to any terms and conditions that the minister considers appropriate.

Term of licence

118.1(3)  A personal care home licence is valid for the term provided for in the regulations.

Licence not transferable

118.1(4)  A personal care home licence is not transferable.

Refusal to issue a licence

118.2(1)  If the minister refuses to issue a personal care home licence, the minister shall notify the applicant of the refusal and the reasons for it in writing and shall inform the applicant of the right to appeal the minister's decision to the board.

Suspension or cancellation of licence

118.2(2)  The minister may suspend or cancel or refuse to renew a personal care home licence if the minister is of the opinion that

(a) the operator of the personal care home has failed to comply with this Act or the regulations or the terms and conditions of the personal care home licence;

(b) the continued operation of the personal care home by the operator would be hazardous to the health, safety or well-being of residents;

(c) the operator of the personal care home has failed to meet its financial obligations or show financial responsibility for the personal care home; or

(d) it is otherwise in the public interest to do so.

Notice

118.2(3)  If the minister suspends, cancels or refuses to renew a personal care home licence, the minister shall notify the operator of the decision and the reasons for it in writing and shall inform the operator of the right to appeal the decision to the board.

Interim licence

118.2(4)  If the minister suspends, cancels or refuses to renew a personal care home licence and the operator of the personal care home appeals the minister's decision, the minister may, if satisfied that continued operation of the personal care home would not be hazardous to the health, safety or well-being of residents, issue an interim licence for the personal care home for a term that expires on the earlier of

(a) the day the board finally disposes of the appeal; or

(b) six months after the day the earlier licence expired or was suspended or cancelled.

Appeal

118.3     An operator of a personal care home who receives a notice under subsection 118.2(1) or (3) may appeal the decision of the minister to the board by filing a notice of appeal with the board within 30 days of receiving the notice.

Inspectors

118.4(1)  The minister may appoint one or more persons as inspectors for the purpose of sections 118 to 118.5.

Powers of inspectors

118.4(2)  For the purpose of determining whether there is compliance with this Act and the regulations, an inspector may

(a) at any reasonable time, and upon presentation of identification, enter and inspect a personal care home and the operations in the personal care home;

(b) inspect any records, documents or other things relevant to the inspection;

(c) demand the production for inspection of records, documents or other things relevant to the inspection, including records, documents or other things that are not kept on the premises of the personal care home;

(d) conduct any examination or test that is reasonably necessary for the inspection; and

(e) on providing a receipt, remove a record, document, sample of a substance, or any other thing, if it is relevant to the inspection.

Unlicensed premises

118.4(3)  An inspector may enter and inspect any premises that the minister believes on reasonable grounds is operated as a personal care home in contravention of this Act.

Use of data processing system and copying equipment

118.4(4)   In carrying out an inspection or examination under this Act, an inspector may

(a) use a data processing system at the personal care home or the place where the records, documents or things are kept to examine any data contained in or available to the system;

(b) reproduce, in the form of a print-out or other intelligible output, any record from the data contained in or available to a data processing system at the personal care home or in the place; and

(c) use any copying equipment at the personal care home or place to make copies of any record or document.

Assistance to inspectors

118.4(5)  An operator of a personal care home and any other person who has custody or control of a record, document or thing referred to in subsection (2) shall give an inspector all reasonable assistance to enable the inspector to carry out his or her duties and shall furnish to the inspector any information the inspector may reasonably require.

Warrant by justice

118.4(6)  A justice, who is satisfied by information on oath that an inspector has been prevented from exercising his or her powers under this section, may at any time issue a warrant authorizing the inspector and any other person named in the warrant to exercise the powers granted.

Obstruction

118.4(7)  No person shall hinder, obstruct or interfere with an inspector conducting an inspection under this section.

Regulations

118.5(1)  For the purpose of sections 118 to 118.4, the minister may make regulations

(a) respecting the licensing of personal care homes, including the fees payable for licences;

(b) respecting the management and operation of personal care homes;

(c) respecting the construction, establishment, location, safety, equipment, maintenance and repair of personal care homes;

(d) respecting standards for personal care homes and their operation, including but not limited to standards of care, accommodation, services and programs;

(e) governing the staff requirements for personal care homes;

(f) governing the qualifications of administrators, staff and employees of personal care homes and governing their powers and duties;

(g) requiring operators of personal care homes to make by-laws that include matters specified in the regulations;

(h) respecting the admission of residents to personal care homes and their discharge from personal care homes;

(i) respecting the books, accounts and records, including health records, that are to be kept and retained by operators of personal care homes;

(j) requiring operators of personal care homes to provide such financial statements, reports and returns as the minister may require in the form and in the manner and at the time required by the minister;

(k) respecting the establishment and operation of resident councils for personal care homes;

(l) concerning the discontinuance or suspension of operation of personal care homes;

(m) establishing transitional provisions respecting personal care homes that are licensed under The Public Health Act on the day this section comes into force;

(n) respecting any matter necessary or advisable to carry out the intent and purpose of this Act effectively.

Scope of regulations

118.5(2)  A regulation under subsection (1) may be made applicable to different classes of personal care homes.

14        Section 129 is amended

(a) in the part of the section preceding clause (a), by striking out "118" and substituting "119"; and

(b) by repealing clause (a), as enacted by S.M. 1991-92, c. 8, s. 30.

15        Sections 130 and 131 are repealed and the following is substituted:

Offence and penalty

130       A person who contravenes a provision of

(a) sections 118 to 128;

(b) a condition of an approval granted under section 121; or

(c) a regulation made under section 118.5 or 129;

is guilty of an offence and is liable, on summary conviction, to a fine of not more than $5,000. for each day the contravention continues.

Coming into force

16(1)      Except as provided in subsection (2), this Act comes into force on a day fixed by proclamation.

16(2)     Subsections 2(1), (3) and (4), sections 3, 5 and 10, clauses 11(a), (b), (c) and (e)  and section 12 come into force on the day this Act receives royal assent.