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C.C.S.M. c. H35
The Health Services Insurance Act
| Table of Contents | Regulations |
HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Manitoba, enacts as follows:
Manitoba Health Services Insurance Plan
1(1) The plan to be administered under this Act for insurance in respect of the costs of hospital services, medical services and other health services may be referred to, or shortly described, in Acts of the Legislature or regulations made thereunder, and otherwise as: "Manitoba Health Services Insurance Plan".
Continuation of previous plans
1(2) The Manitoba Health Services Insurance Plan shall be, for all purposes, deemed to be a continuation of Manitoba Health Services Insurance Plan in effect immediately prior to the coming into force of this Act.
2(1) In this Act
"authorized charges" means the charges, determined in accordance with the regulations, that may be made directly to persons for hospital services, medical services, personal care and other health services under the plan but not including charges made by way of a premium or other amount not directly related to a specific service; (« frais admissibles »)
"benefits" means the benefits that are designated in the regulations as benefits to which an insured person is entitled under this Act; (« prestations »)
"board" means the Manitoba Health Appeal Board established under section 9; (« Conseil »)
"child" means a son or daughter, step-son or step-daughter, of any age and also includes the child of a child; (« enfant »)
"dependant" where used to refer to a dependant of a person, means, subject to subsections (3) and (5), a resident who is that person's spouse and, if that person has no spouse, a resident who is that person's dependent parent and includes any child of that person who is a resident and is dependent upon him for support and who is
(a) under the age of 18 years, or
(b) 18 years of age or older and mentally or physically incapacitated, or
(c) between 18 and 20 years of age, and is attending a university, secondary school or other educational institution, or is training at a school of nursing,
and also includes a resident who is the spouse or child of any such child to whom clause (a), (b) or (c) applies if the spouse or child of the child is dependent for support upon that person; (« personne à charge »)
"employee" means a resident who, for an employer, regularly performs services under a contract of hiring and service or apprenticeship, whether written or oral, express or implied, but does not include an independent contractor or a married person who is otherwise an insured person as the dependant of another insured person; (« employé »)
"employer" means, subject to subsection (4), a person having in his service under a contract of hiring and service or apprenticeship, written or oral, express or implied, three or more employees, and includes Her Majesty in right of the province and also includes municipal corporations and boards and commissions having the management and conduct of any work or service owned by, or operated for, a municipal corporation or by or for the government; (« employeur »)
"fund" means Manitoba Health Services Insurance Fund; (« Fonds »)
"health region" means a health region established or continued under The Regional Health Authorities Act; (« région sanitaire »)
"hospital", except in sections 57 to 60, means
(a) a hospital in Manitoba that is designated as a hospital by regulation under subsection 113(1), and
(b) a hospital or facility outside Manitoba that
(i) is approved by the minister for the purpose of this Act, and
(ii) is licensed or approved as a hospital by the governmental licensing authority in the jurisdiction in which the hospital is located; (« hôpital »)
"hospital services" means the services which an insured person is entitled to receive in hospitals without payment as described in section 46 and which are not excluded under section 47; (« services hospitaliers »)
"in-patient" means a person admitted to, and assigned to a bed in a hospital on the order of a medical practitioner or, subject to the conditions prescribed in the regulations, on the order of a licensed dentist; (« malade hospitalisé »)
"in-patient services" means such services supplied to an in-patient as are specified in the regulations; (« services en hôpital »)
"insured person" means a resident who is entitled to receive benefits under this Act and the regulations; (« assuré »)
"medical practitioner" means a person lawfully entitled to practice medicine in the place where he renders medical services; (« médecin »)
"medical review committee" means the medical review committee established under an agreement made under section 76; (« comité de révision médicale »)
"medical services" means all services rendered by a medical practitioner that are medically required but does not include those services excepted by the regulations; (« soins médicaux »)
"minister" means the member of the Executive Council charged by the Lieutenant Governor in Council with the administration of this Act; (« ministre »)
"other health services" means health services to which this Act applies by reason of an order made under section 71; (« autres soins de santé »)
"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 »)
"out-patient services" means such services supplied to an out-patient as are specified in the regulations; (« soins en consultation externe »)
"participating hospital province" means a province or territory of Canada that is party to an agreement with the Government of Canada under the Federal Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act (Canada) or the Canada Health Act and that has established a hospital insurance plan pursuant to the law of that province or territory; (« province participant au régime d'assurance-hospitalisation »)
"participating medical province" means a province or territory of Canada in which there is in operation a medical care insurance plan in respect of which a contribution is payable by Canada pursuant to the Federal-Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act (Canada); (« province participant au régime d'assurance-maladie »)
"personal care" means care in the nature of
(a) basic nursing care under the supervision of a registered nurse, or
(b) personal assistance in the activities of daily living, or
(c) supervision of activities of daily living,
together with goods and services that are specified in the regulations as goods and services that are provided as part of personal care; (« soins personnels »)
"personal care home" means a personal care home designated in the regulations; (« foyer de soins personnels »)
"plan" means Manitoba Health Services Insurance Plan; (« régime »)
"recipient of public assistance" means a person who is of a class or kind designated or described in the regulations as being recipients of public assistance; (« bénéficiaire de l'aide sociale »)
"regional health authority" means a regional health authority established or continued under The Regional Health Authorities Act; (« office régional de la santé »)
"resident" means a person who is legally entitled to be in Canada, makes his or her home in Manitoba, and is physically present in Manitoba for at least six months in a calendar year, and includes any other person classified as a resident in the regulations, but does not include
(a) a person who holds a temporary resident permit under the Immigration and Refugee Protection Act (Canada), unless the minister determines otherwise, or
(b) a visitor, transient or tourist; (« résident »)
"surgical facility" means a facility that provides surgical services outside of a hospital; (« établissement chirurgical »)
"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 »)
2(2) Repealed, S.M. 2004, c. 42, s. 32.
2(3) Where an insured person maintains, in his household, a person who, if he were a child of that insured person would be, under the definition "dependant" in subsection (1), his dependant, if the insured person satisfies the minister as to those facts and files with the minister a written request that the person so maintained be deemed to be his dependant, that person shall be deemed to be his dependant for the purposes of this Act until that insured person withdraws or revokes the request in writing or until the person so maintained ceases to be a person who, if a child of that insured person, would be his dependant.
2(4) For the purposes of determining whether a person is an employer as defined in subsection (1),
(a) another person who would be that person's employee, as defined in subsection (1) shall be deemed to be that person's employee, notwithstanding that the other person is a married person to whom reference is made in the definition of employee, and
(b) a person, other than a corporation, who has employees in his or her service shall be included among them in computing the number of employees the person employs.
Determination of attendance at educational institution
2(5) If doubt arises in any case as to whether a person is attending a university, secondary school, or other educational institution, or is training at a school of nursing, within the meaning of the definition "dependant" in subsection (1), the matter shall be decided by the minister and his decision thereon is final and conclusive.
S.M. 1990-91, c. 12, s. 10; S.M. 1991-92, c. 8, s. 2; S.M. 1992, c. 35, s. 2 and 3; S.M. 1996, c. 43, s. 2; S.M. 1996, c. 53, s. 82; S.M. 1996, c. 58, s. 454; S.M. 1998, c. 53, s. 2; S.M. 2001, c. 21, s. 2; S.M. 2004, c. 42, s. 32; S.M. 2005, c. 42, s. 20.
Minister responsible for administration of plan
3(1) The minister is responsible for the administration and operation of the plan.
3(2) The minister has the power
(a) to provide insurance for residents of the province in respect of the costs of hospital services, medical services and other health services, and personal care;
(b) to plan, organize and develop throughout the province a balanced and integrated system of hospitals, personal care homes and related health facilities and services commensurate with the needs of the residents of the province;
(c) to ensure that adequate standards are maintained in hospitals, personal care homes and related health facilities, including standards respecting supervision, licensing, equipment and inspection, or to make such arrangements as the minister considers necessary to ensure that adequate standards are maintained;
(d) to provide a consulting service, exclusive of individual patient care, to hospitals and personal care homes in the province or to make such arrangements as the minister considers necessary to ensure that such a consulting service is provided;
(e) to require that the records of hospitals, personal care homes and related health facilities are audited annually and that the returns in respect of hospitals which are required by the Government of Canada are submitted; and
(f) in cases where residents do not have available medical services and other health services, to take such measures as are necessary to plan, organize and develop medical services and other health services commensurate with the needs of the residents.
3(3) The minister may enter into contracts and agreements with any person or group of persons that the minister considers necessary for the purposes of this Act.
3(4) The minister may make grants to any person or group of persons for the purposes of this Act on such terms and conditions as the minister considers advisable.
3(5) The minister may, in writing, delegate to any person any power, authority, duty or function conferred or imposed upon the minister under this Act or the regulations.
4 The minister shall ensure that full and accurate records of the proceedings, transactions and finances of the plan are prepared and maintained.
5(1) The minister shall ensure that an annual budget for the plan is prepared before the beginning of each fiscal year.
5(2) The fiscal year of the plan commences on April 1 of each year and ends on March 31 of the following year.
6(1) The minister shall, annually within four months after the end of the fiscal year of the plan, cause to be prepared audited financial statements of the plan showing separately the expenditures for hospital services, medical services and other health services.
6(2) The minister shall cause to be prepared an annual report which shall include the financial statements referred to in subsection (1), and the minister shall table a copy of the annual report before the Legislative Assembly within 15 days of receiving it if the Legislative Assembly is then in session, or if it is not then in session, within 15 days of the beginning of the next session.
S.M. 1991-92, c. 8, s. 3; S.M. 1992, c. 35, s. 4; S.M. 2004, c. 42, s. 32.
7 The Auditor General, or another auditor designated by the Auditor General, shall at least once annually examine and audit the accounts of the plan, prepare a report with respect to that audit and provide a copy of the report to the minister.
S.M. 1992, c. 35, s. 4; S.M. 2001, c. 39, s. 31.
8 The Insurance Act does not apply to the plan or to insurance in respect of hospital services, medical services or other health services or personal care provided under this Act.
Manitoba Health Appeal Board established
9(1) The Manitoba Health Appeal Board is established consisting of not less than five members appointed by the Lieutenant Governor in Council.
9(2) A member shall be appointed to hold office for the term specified in the order by which he or she is appointed, and shall continue to hold office until the member is reappointed, a successor is appointed or the appointment is revoked.
Chairperson and vice-chairperson
9(3) The Lieutenant Governor in Council shall designate one of the members to be chairperson of the board and another to be vice-chairperson.
9(4) The members of the board shall be paid remuneration and receive reasonable expenses at rates determined by the Lieutenant Governor in Council.
9(5) The board shall
(a) hear and determine appeals made under section 10;
(b) perform any other duties assigned by this or any other Act of the Legislature or any regulation; and
(c) perform any other duties assigned by the minister.
9(6) Except where provided otherwise in this or any other Act of the Legislature or any regulation respecting the board, any three members of the board constitute a quorum and are sufficient for the performance of all functions and duties of the board.
9(7) The board may sit in panels of at least three members.
9(8) A reference to the board in this or any other Act of the Legislature or any regulation respecting the board includes any panel of the board.
9(9) A decision or action of the majority of the members of a panel or of the majority of the members of the board constituting a quorum is a decision or action of the board.
9(10) The board may establish its own rules of practice and procedure, including rules respecting meetings and hearings, not inconsistent with this or any other Act of the Legislature or any regulation respecting the board.
9(11) The minister may provide such clerical and administrative support to the board as the minister may consider necessary to enable it to carry out its duties and functions.
9(12) Repealed, S.M. 1995, c. 26, s. 2.
S.M. 1992, c. 35, s. 4; S.M. 1995, c. 26, s. 2; S.M. 1998, c. 53, s. 3.
10(1) An appeal may be made to the board by a person
(a) who has been refused registration as an insured person under this Act or the regulations;
(b) who has been denied entitlement to a benefit under this Act or the regulations;
(c) who has been refused an approval to operate a laboratory or a specimen collection centre, on whose approval conditions have been imposed, or whose approval has been revoked under subsection 127(1);
(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
(e) prescribed by the regulations as being entitled to appeal to the board.
10(2) An appeal under this Act or the regulations shall be commenced by a notice of appeal, setting out the grounds for appeal, which must be mailed or delivered to the board not more than 30 days after the date on which the appellant receives notice of the decision that is appealed, or within such further time as the board permits.
Notice to person who made decision
10(3) The board shall promptly provide a copy of the notice of appeal to the person who made the decision that is appealed.
10(4) An appeal under this section shall be conducted on an informal basis, and the board is not bound by the rules of law respecting evidence applicable to judicial proceedings.
10(5) On considering an appeal under this Act or the regulations, the board may
(a) confirm, set aside or vary the decision in accordance with the provisions of this Act and the regulations; or
(b) refer the matter back to the person authorized to make the decision for further consideration in accordance with the board's instructions.
10(6) The board may appoint a panel of not less than three of its members for the purpose of considering an appeal under this section, and a decision of a majority of the panel is the decision of the board.
Continuation after loss of panel member
10(7) If, after a panel has commenced considering an appeal under this section, a member of the panel dies, resigns, or otherwise becomes incapable of acting, the remaining members of the panel may complete the appeal and render a decision and the decision is valid as though the remaining members constituted a full panel.
S.M. 1992, c. 35, s. 4; S.M. 1998, c. 53, s. 4.
11 and 12 Repealed.
12.1 Repealed.
S.M. 1991-92, c. 8, s. 4; S.M. 1992, c. 35, s. 4.
13 to 16 Repealed.
17 Repealed.
S.M. 1991-92, c. 8, s. 5; S.M. 1992, c. 35, s. 4.
18 Repealed.
18.1 Repealed.
S.M. 1991-92, c. 8, s. 6; S.M. 1992, c. 35, s. 4.
19 to 26 Repealed.
Disposal of moneys received from Canada
27 Despite The Financial Administration Act, moneys contributed by the Government of Canada for the purposes of this Act shall be deposited by the Minister of Finance in the Consolidated Fund; and, on the written requisition of the minister the Minister of Finance may pay over to the fund out of the moneys so contributed, credited, and remaining on deposit in the Consolidated Fund, such amount as may be stated in the requisition.
S.M. 1992, c. 35, s. 5; S.M. 1996, c. 59, s. 95.
28 The Manitoba Health Services Insurance Fund is continued.
S.M. 1990-91, c. 12, s. 10; S.M. 1992, c. 35, s. 6.
29 Despite The Financial Administration Act, the following shall be placed to the credit of the fund when received for the purposes of this Act:
(a) the amount of all premiums, fees, or other charges made, levied, or collected in respect of benefits to be paid out of the fund;
(b) all sums contributed thereto by the Government of Manitoba from the Consolidated Fund;
(c) all sums paid over by the Minister of Finance to the minister, on the minister's requisition, out of moneys contributed for the purposes of this Act by the Government of Canada;
(d) the amount of interest received upon moneys from time to time at the credit of the fund; and
(e) all other amounts received by the minister under this Act.
30 The minister shall pay from the fund such amounts as are required to be paid for the purposes of this Act.
31(1) Subject to subsection (2), the minister shall deposit and keep deposited in a bank, trust company, credit union or other similar financial institution all amounts credited to the fund.
31(2) If at any time the balance at the credit of the fund is in excess of the amount that is required for the immediate purposes of this Act, the minister shall pay over any surplus funds to the Minister of Finance for investment for and on behalf of the fund.
Fund not part of Consolidated Fund
31(3) Notwithstanding The Financial Administration Act or any other Act but subject to subsection (2), the moneys in the fund do not form part of the Consolidated Fund; and the fund is not a division or part of the Consolidated Fund; but the moneys therein are the property of Her Majesty in right of the province.
Payments from Consolidated Fund
32(1) From and out of the Consolidated Fund with moneys authorized by an Act of the Legislature to be paid and applied for the purposes of this Act the Minister of Finance may pay to the fund such amounts as may from time to time be requisitioned by the minister.
32(2) With no authority other than this subsection, and with the approval of the Lieutenant Governor in Council, the Minister of Finance may make advances to the fund from and out of the Consolidated Fund at such time and upon such terms and conditions as the Lieutenant Governor in Council may prescribe.
33 Each resident is an insured person and entitled to benefits subject to such waiting period as may be prescribed in the regulations.
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.
34 For the purpose of achieving uniformity in the provision of benefits in the application of this Act Lieutenant Governor in Council may make regulations requiring residents or groups of residents to pay premiums in respect of insurance under this Act and may, by order, provide for the remittance of all or part of the premiums so paid to the residents by whom or on whose behalf any premiums are paid.
Amendments of agreements on removal of premium
35 Where an agreement between an employer and an employee respecting employment in Manitoba contains, whether by reason of an amendment made in accordance with this Act as it was prior to the coming into force of this section, or otherwise, a provision for the payment by the employer for or on behalf of the employee of all or a part of a premium under this Act as it was prior to the coming into force of this section, the agreement shall be conclusively deemed to be amended to provide for the payment by the employer to the employee, as additional wages, the amount which immediately prior to the coming into force of this section the employer was required to pay as all or part of a premium under this Act.
36 Where an agreement between an employer and a retired employee respecting payment of a pension, annuity or a superannuation allowance to the employee after retirement, or the provisions of a plan or scheme respecting the payment of pensions, annuities or superannuation allowances to retired employees that applies to the retired employee, contains a provision for the payment by the employer or from a fund operated for the purposes of paying the pensions, annuities or superannuation allowances, for or on behalf of the retired employee of all or a part of a premium under this Act as it was prior to the coming into force of this section, the agreement or the plan or scheme, as the case may be, shall be conclusively deemed to be amended to provide for payment by the employer or from the fund to the retired employee, as long as he remains a resident, as additional pension, annuity or superannuation allowance, the amount which immediately prior to the coming into force of this section was paid by the employer or from the fund as all or part of the premium under this Act.
37 Subject to such exceptions as may be prescribed in the regulations, each resident other than a dependant shall register himself and his dependants, if any, with the person specified, and at the time prescribed, in the regulations; and the registration shall be in such form, and the resident shall in making the registration furnish such information and particulars, as may be required by the minister.
38 Each employer shall register as an employer with the minister at the time prescribed, in the regulations, and he shall, at such times as may be prescribed by the minister, furnish such information and particulars as may be required by the minister.
39 Every person who is required under the regulations to accept registrations made under this Act shall discharge the duties imposed upon him in respect of such registration under this Act or the regulations or by the minister.
Issue of registration certificates
40 The minister, by such methods or through such agents, and at such time, and in such form, as may be approved by the minister, shall issue to each of such persons as are described in the regulations, a registration certificate.
Presentation of registration certificate
41 When he is received by or admitted to a hospital as a patient or when he consults a medical practitioner, or a person authorized by law to provide other health services, or, in the case of an emergency, as soon as is reasonably possible thereafter, every insured person shall present his registration certificate for the inspection of the admitting official of the hospital or the medical practitioner or a member of his staff or the person providing the other health services or a member of his staff; but, in the case of a dependant, the person of whom he is a dependant shall, on behalf of the dependant and at the time aforesaid, present or cause to be presented the registration certificate issued to him.
42 Every person who
(a) fails or refuses to comply with any provision of this Act or the regulations; or
(b) knowingly gives or makes to the minister or other person to whom any information is required to be given in a report or statement made under this Act or the regulations, any information, report or statement, that is wholly or partly false;
is guilty of an offence and if no other penalty is provided therefor herein is liable, on summary conviction, to a fine not exceeding $5,000., to which shall be added, in every case, as an additional fine an amount equal to any premium that is payable under the Act by the person convicted and that is due and unpaid.
S.M. 1991-92, c. 8, s. 7; S.M. 1992, c. 35, s. 13.
42.1 A prosecution for any offence under this Act or the regulations may be commenced not later than two years after the later of
(a) the day on which the offence was committed; or
(b) the day on which evidence of the offence first came to the attention of the minister.
Fraudulent production of registration certificate an offence
43 Any person who produces to an admitting official of a hospital, or to a medical practitioner or a member of his staff or to a person authorized by law to provide other health services or a member of his staff, a registration certificate,
(a) knowing that the person named therein is not, at the time of the production thereof, an insured person; or
(b) knowing that the person on behalf of whom, and to facilitate whose treatment it is produced, is not the person named therein or a dependant of that person;
is guilty of an offence and liable, on summary conviction, to a fine not exceeding $5,000.
44 The amount of any additional fine imposed under section 42 and paid to the convicting magistrate shall be remitted by him to the minister forthwith.
45 Repealed.
Insured hospital and personal care services
46(1) The services that an insured person is entitled under this Act to receive at any hospital, surgical facility or personal care home without payment except for any authorized charges that he may be liable to pay are
(a) in-patient services and out-patient services in a hospital and out-patient services in a surgical facility;
(b) such services in a hospital as may be specified in the regulations as being additional hospital services that an insured person is entitled to receive under this Act; and
(c) subject to any special waiting period in respect of personal care prescribed in the regulations, and subject to meeting the admission requirements for the personal care home personal care provided in premises designated as personal care homes for the purposes of this section.
Designation of personal care homes
46(2) The minister may by regulation designate premises situated in Manitoba as personal care homes for the purposes of this section.
S.M. 1992, c. 35, s. 11 and 15; S.M. 1998, c. 53, s. 6.
47 Where
(a) by virtue of any legislation enacted or made by Parliament or any Legislature in Canada or elsewhere, a person is receiving hospital care and treatment, the cost of providing which he is entitled to have paid from a fund established under, or otherwise pursuant to, that legislation; and
(b) under an agreement made with the Government of Canada under section 50, the Government of Canada does not contribute to the cost of that hospital care and treatment under the Federal Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act (Canada) or the Canada Health Act;
those services are not hospital services to which this Act applies.
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.
48(2) No hospital providing hospital services to an insured person and no regional health authority shall make any charge to an insured person for providing the hospital services, other than authorized charges.
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.
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.
S.M. 1992, c. 35, s. 11; S.M. 1996, c. 53, s. 82; S.M. 1997, c. 41, s. 20; S.M. 1998, c. 53, s. 7; S.M. 2001, c. 21, s. 3.
Terms of provision of hospital services
49 Hospitals shall provide hospital services to insured persons as prescribed herein and in the regulations, under uniform terms and conditions.
50(1) With the approval of the Lieutenant Governor in Council, the Government of Manitoba, represented by the minister, may enter into agreements with the Government of Canada under the Federal Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act (Canada) or the Canada Health Act to provide for contributions under those Acts by the Government of Canada towards the cost of providing hospital services to insured persons.
Payment by minister of cost of hospital services to insured persons
50(2) Subject to subsection (3) and in accordance with sections 60 and 64 and the regulations, the minister shall pay from the fund to the hospitals in Manitoba that are not owned or operated by the Government of Canada the amounts due to those hospitals in respect of the cost of providing the hospital services received therein by insured persons.
Payments to regional health authority
50(2.1) Notwithstanding subsection 59(2) and subject to subsection 50(3.1) and section 64,
(a) where a hospital providing hospital services to an insured person is in a health region and the operator of the hospital is a regional health authority for the health region, the minister shall pay from the fund any amounts due under subsection (2) to the regional health authority; and
(b) where a hospital providing hospital services to an insured person is in a health region and a regional health authority is not the operator of the hospital, the minister shall pay from the fund any amounts due under subsection (2) to the regional health authority which has the responsibility to provide the hospital services in the health region, for payment to the hospital in accordance with any agreement reached between the regional health authority and the operator of the hospital under section 64.
50(3) Where a hospital fails to keep the books or records, or make the returns required under this Act or the regulations, the minister may withhold payments due to it until the hospital complies with this Act and the regulations.
Withholding of payments where hospital is in a health region
50(3.1) Notwithstanding subsection 50(3), where a hospital in a health region fails to keep the books or records or make the returns required under this Act or the regulations, the minister may,
(a) where the operator of the hospital is a regional health authority for the health region, withhold the payments due to the regional health authority until the regional health authority complies with this Act and the regulations; and
(b) where the operator of the hospital is not a regional health authority, withhold the payments due to the regional health authority for the health region, which has the responsibility to provide the hospital services, for payment to the hospital, and the regional health authority is not required to make payments to the hospital under clause 50(2.1)(b), until the hospital complies with this Act and the regulations.
S.M. 1988-89, c. 11, s. 11; S.M. 1990-91, c. 12, s. 10; S.M. 1991-92, c. 8, s. 9; S.M. 1992, c. 35, s. 11; S.M. 1996, c. 53, s. 82; S.M. 1997, c. 41, s. 20.
51(1) Payments made under subsection 50(2) shall be accepted by the hospital as, and shall be conclusively deemed to be, payment in full for the hospital services provided to the insured persons for whom they are made, except for authorized charges.
Effect of making payments to regional health authority
51(2) Payments made under subsection 50(2.1) shall be accepted by the hospital and the regional health authority, as, and shall be conclusively deemed to be, payment in full for the hospital services provided to the insured person for whom the payments are made, except for authorized charges.
Payments to Canadian Government Hospitals
52 The minister shall, in accordance with an agreement made under subsection 50(1), pay from the fund to hospitals owned or operated by the Government of Canada the amounts due to the hospitals in respect of the cost of providing the hospital services received in those hospitals by insured persons.
Payments in respect of hospitalization outside the province
53(1) Subject to subsection (2) the minister shall
(a) pay from the fund to hospitals in any participating hospital province such amounts as are prescribed in the regulations and specified in an agreement made with that province in respect of the cost of providing services equivalent to hospital services received in those hospitals by insured persons; and
(b) reimburse any insured person who, because of accident or illness, requires admission to a hospital that is outside the province but not in a participating hospital province, for hospital charges thereby incurred by him in such amounts as may be provided for in the regulations.
Alternative payments for outside hospitalization
53(2) In lieu of making payment as provided in subsection (1), the minister may
(a) pay an amount the payment of which is authorized under clause (1)(a), directly to the insured person in respect of whom or whose dependants the services were provided, if he has himself paid the cost of those services to the hospital by which they were provided; and
(b) pay an amount the payment of which is authorized under clause (1)(b), directly to the hospital to which the insured person is liable for the cost of services provided by it, if the insured person has not paid the charge for those services.
Hospitalization in mental hospitals outside province
54(1) Notwithstanding clause 47(b), and as provided in section 53, the minister may pay from the fund to hospitals or insured persons amounts due in respect of the cost of providing hospital services under the terms and conditions and in such amounts as may be provided under the regulations.
54(2) In this section
"hospital" includes a hospital as defined in this Act, and also includes a hospital or institution for the mentally ill or disabled that is outside the province and that is approved by the minister; (« hôpital »)
"hospital services" includes hospital services as defined in this Act, and also includes services which an insured person is entitled to receive in a hospital as defined in this subsection and for which payment is provided in subsection (1). (« soins hospitaliers »)
S.M. 1992, c. 35, s. 11 and 16; S.M. 1993, c. 29, s. 184.
55 In making payments to a hospital which is not in a health region the minister may deduct therefrom amounts in reduction of any overpayments previously made to that hospital until the total of the amounts so deducted is equal to the amount of the overpayment.
S.M. 1992, c. 35, s. 11; S.M. 1996, c. 53, s. 82.
56 The minister shall designate a budget officer or officers for the purposes of this Act.
S.M. 1991-92, c. 8, s. 10; S.M. 1992, c. 35, s. 17.
57(1) In this section and in sections 58 to 60, "hospital" means
(a) a hospital in Manitoba that is designated as a hospital by regulation under subsection 113(1) and that is not in a health region; and
(b) an institution or organization that is not a hospital but that provides facilities or services in Manitoba for, or ancillary to, the treatment or diagnosis of disease, illness or injury and that is designated in the regulations as an institution or organization to which this section applies.
Duties of budget officer re hospital budgets
57(1.1) Subject to the direction of the minister, a budget officer shall
(a) examine the budget of each hospital;
(b) subject to subsection (2), approve and recommend to the minister a budget for each hospital showing separately
(i) the budget for the provision of hospital services, and
(ii) the budget for such services and costs as are not included in an agreement but are designated in the regulations; and
(c) on the basis of that budget recommend to the minister the rates of payment that should be made in respect of each hospital and that should be approved by the minister, showing separately
(i) the rates for hospital services, and
(ii) the rates for such hospital services and costs as are not included in an agreement but are designated in the regulations.
57(2) On examining the budget of a hospital and recommending rates in respect of the hospital as provided in subsection (1.1), the budget officer shall notify the hospital of the budget and rates to be recommended, and the hospital may, within 30 days of such notification, request that the budget officer change the budget and rates to be recommended.
57(3) If the hospital does not request changes, or if changes are requested and a decision is made respecting them, the budget officer shall provide a recommendation to the minister as to a budget and rates for the hospital and shall notify the hospital to that effect.
57(4) A hospital that is dissatisfied with the recommended budget or rates may, within 30 days after receiving notice under subsection (3), request that the minister refer the matter to the board.
57(5) If a hospital requests a referral under subsection (4), the minister shall refer the matter to the board and the board shall hear the matter and make a recommendation to the minister, but the minister is not bound by the board's recommendation.
S.M. 1991-92, c. 8, s. 11, 12 and 13; S.M. 1992, c. 35, s. 18 and 19; S.M. 1993, c. 30, s. 2; S.M. 1996, c. 53, s. 82.
58 On the expiration of the time for a hospital to request a referral to the board under subsection 57(4) or, if a referral has been made, on a recommendation being made by the board under subsection 57(5), the minister shall approve a budget for the hospital and establish a rate of payment in respect of that hospital.
59 Repealed.
Retention of moneys by minister in reduction of overpayments
60(1) Where, at any time during the course of a year, it appears to the minister from an examination of the accounts of a hospital that the sum of the amounts paid by the minister to the hospital during the year up to that time, together with the sum of the amounts to be paid to the hospital on an estimated basis in respect of the remainder of that year, will exceed the amount to be determined under subsection (2) in respect of the hospital for that year, the minister may retain such portion as the minister deems advisable of the amounts to be paid as aforesaid in respect of the remainder of that year, pending final determination under subsection (2), of the amount which the hospital is entitled to be paid in respect of that year.
Annual adjustment of payments to hospitals
60(2) Notwithstanding the rates established as hereinbefore provided, the total amount that a hospital, other than a hospital owned or operated by the Government of Canada, is entitled to receive in respect of
(a) hospital services; and
(b) other services to which reference is made in sub-clause 57(1.1)(c)(ii);
that have been received in the hospital by insured persons during any year, and in respect of the costs to which reference is made in sub-clause 57(1.1)(c)(ii) incurred in that year, shall be determined by the minister at the end of that year in the manner provided in the regulations.
60(3) In settling the amount to be paid to a hospital in respect of any year
(a) if the total of the sums paid to the hospital by the minister during that year is less than the amount determined under subsection (2), the minister shall pay to the hospital an amount equal to that deficiency; and
(b) if the total of the sums paid to the hospital by the minister during that year exceeds an amount equal to the amount determined under subsection (2) plus an amount determined by the minister but not exceeding 2% of the approved operating costs of the hospital, the minister shall, for that year, recover from the institution an amount equal to that excess;
but, if it is not practicable to deduct the amount recoverable under clause (b) from the amount the hospital is otherwise entitled to receive in respect of that year, it may be deducted in the manner provided in the regulations.
S.M. 1991-92, c. 8, s. 14; S.M. 1992, c. 35, s. 11 and 21.
Application of budget review to personal care homes
61 Sections 55, 57, 58 and 60 apply, with such modifications as the circumstances require, to a personal care home that is owned and operated by a municipality or by a non-profit corporation or organization and that is not in a health region.
S.M. 1992, c. 35, s. 22; S.M. 1996, c. 53, s. 82.
62 Every hospital, other than a hospital owned and operated by the Government of Canada, shall install and maintain an accounting system in such form and manner as the minister may require, and shall maintain records in accordance with the regulations.
63(1) The minister may, in writing, appoint inspectors for the purpose of this section.
63(2) An inspector exercising a power under this section must produce a certificate of appointment when requested to do so.
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.
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.
S.M. 1992, c. 35, s. 24; S.M. 2001, c. 21, s. 4.
Rates of payments to hospitals and personal care homes
64(1) Payments for services provided to insured persons
(a) by a hospital or personal care home in a health region, shall be made to the hospital or personal care home in accordance with any agreement between the regional health authority for the health region which has the responsibility to provide the hospital services or personal care services, as the case may be, and the operator of the hospital or personal care home; and
(b) by a hospital or personal care home which is not in a health region and to which subsection 57(1.1) does not apply shall be at the rates set by the minister;
(c) repealed, S.M. 2001, c. 21, s. 5.
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.
S.M. 1991-92, c. 8, s. 15; S.M. 1992, c. 35, s. 25; S.M. 1996, c. 53, s. 82; S.M. 1997, c. 41, s. 20; S.M. 1998, c. 53, s. 8; S.M. 2001, c. 21, s. 5.
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.
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.
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.
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.
Agreement with outside hospitals
65 The minister may enter into an agreement with the operator of an institution situated outside Manitoba and that provides facilities for care and treatment of disease or injury respecting the payment for hospital services provided to insured persons in the institution.
Unauthorized charging an offence
66 Any person who
(a) knowingly makes a charge, or renders an account, or causes an account to be rendered, to an insured person for hospital services or for or in relation to out-patient services provided in a surgical facility, other than for authorized charges; or
(b) knowingly collects any sum of money or other thing of value from an insured person for hospital services or for or in relation to out-patient services provided in a surgical facility, other than in respect of authorized charges; or
(b.1) knowingly contravenes subsection 48(4);
(c) knowingly makes a charge, or renders an account, or causes an account to be rendered to an insured person for personal care provided in a personal care home other than for authorized charges; or
(d) knowingly collects any sum of money or other thing of value from an insured person for personal care provided in a personal care home other than in respect of authorized charges;
is guilty of an offence and liable, on summary conviction, to a fine not exceeding $30,000.
S.M. 1998, c. 53, s. 9; S.M. 2001, c. 21, s. 7.
67 Repealed.
Agreements with participating hospital and medical provinces
68(1) The minister may, with the approval of the Lieutenant Governor in Council, enter into an agreement with the Crown in right of a participating hospital province or participating medical province, or with an authority duly constituted in the participating hospital province or participating medical province to administer matters relating to hospital or medical services insurance, respecting the provision of hospital or medical services
(a) to residents of Manitoba who are in the participating hospital province or participating medical province; and
(b) to residents of the participating hospital province or participating medical province who are in Manitoba;
including in each case, if so provided in the agreement, services equivalent to hospital or medical services.
68(2) Notwithstanding any other provision of this Act, where an agreement is made under subsection (1), the persons to whom it relates are entitled to receive hospital or medical services or reimbursement for the cost thereof as provided in the agreement.
R.S.M. 1987 Supp., c. 31, s. 10; S.M. 1992, c. 35, s. 11.
Agreements to act as trustee for hospitals
69 The minister may enter into an agreement with any hospital which is not in a health region
(a) by which the hospital assigns to the minister out of funds payable by the minister to the hospital in each year, an amount that is equal to the total of principal and interest payable by the hospital in that year on securities issued by it, or for sinking funds created in respect thereof; and
(b) in which the minister undertakes to hold the moneys so assigned in trust, and to pay, or arrange for the payment, from those moneys of the principal and interest on the securities as it becomes payable, or the sinking funds created in respect thereof.
S.M. 1992, c. 35, s. 27; S.M. 1996, c. 53, s. 82.
Restrictions respecting sale of facilities
70(1) Where the government or a regional health authority has provided funds under this Act respecting the construction, expansion, conversion or relocation of, or major renovations to, a hospital, personal care home or facility, no person may sell, lease or otherwise dispose of the hospital, personal care home or other health facility, or real property associated with the hospital, personal care home or other health facility, without the approval of
(a) the minister; or
(b) where the hospital, personal care home or other health facility is in a health region, the regional health authority for that health region which has the responsibility to provide the hospital services, personal care services or other health services that were last provided by the hospital, personal care home or other health facility.
Regional health authority requires approval of minister
70(2) A regional health authority shall not provide an approval under clause (1)(b) without the prior approval of the minister.
Approvals may be subject to conditions
70(3) An approval given by the minister or a regional health authority under this section may be subject to terms and conditions.
S.M. 1992, c. 35, s. 28; S.M. 1996, c. 53, s. 82; S.M. 1997, c. 41, s. 20.
Insurance for other health services
71 The Lieutenant Governor in Council may order that this Act applies to chiropractic, optometric, or midwifery services, or to services provided in hospitals by certified oral and maxillofacial surgeons, or to services provided in hospitals by licensed dentists, or to the provision of prosthetic or orthotic devices, or to any or all of those services, or to any class of those services, and to insurance in respect of the cost of those services or that class of those services, and that the minister shall provide insurance in respect of the cost of those services or that class of those services in the same manner as the minister provides insurance in respect of the cost of medical services; and upon an order being made under this section in respect of any of those services or class thereof, this Act applies mutatis mutandis to and in respect of
(a) those services or that class of those services;
(b) insurance in respect of the cost of those services or that class of those services; and
(c) persons lawfully entitled to render those services or that class of those services within Manitoba or in the place where they are rendered.
S.M. 1990-91, c. 12, s. 10; S.M. 1992, c. 35, s. 29; S.M. 1997, c. 9, s. 63.
72 The minister may communicate
(a) information pertaining to the utilization of chiropractic services to The Manitoba Chiropractors Association;
(b) information pertaining to the utilization of optometric services to the Manitoba Association of Optometrists;
(c) information pertaining to the utilization of dental services to The Manitoba Dental Association; and
(d) information respecting the utilization of medical services, hospital services, dental services and other health services by a worker or workers, as defined in The Workers Compensation Act, to The Workers Compensation Board.
S.M. 1991-92, c. 36, s. 64; S.M. 1992, c. 35, s. 11; S.M. 1995, c. 26, s. 4.
73 Repealed.
Agreements re medical fees and payments
74 The minister, with the approval of the Lieutenant Governor in Council, and notwithstanding that it is not an incorporated association, the Manitoba Medical Association, through its officers, may enter into an agreement respecting all matters relevant to
(a) a schedule of fees to be paid by the minister to medical practitioners in respect of medical services rendered to insured persons;
(b) terms and conditions relating to the application of the schedule of fees in respect of medical services rendered to insured persons; and
(c) methods of payment to medical practitioners of benefits payable in respect of medical services rendered to insured persons.
75(1) In this section and in sections 75.1.1 to 75.2, "practitioner" means a medical practitioner and any other health practitioner who provides services for which payment is made under this Act.
Special arrangements for remuneration
75(2) The minister may pay remuneration, either directly or through another person, to practitioners who provide services to residents on a basis other than a fee for services rendered.
75(3) Payments under subsection (2) shall be made at a rate prescribed in the regulations.
S.M. 1991-92, c. 8, s. 16; S.M. 1992, c. 35, s. 11 and 31; S.M. 2005, c. 38, art. 2.
Agreements with Workers Compensation Board
75.1(1) The minister may enter into agreements with The Workers Compensation Board respecting methods of payment by the minister or The Workers Compensation Board of the costs of medical aid provided under The Workers Compensation Act.
75.1(2) The minister may enter into agreements with The Manitoba Public Insurance Corporation respecting methods of payment by the minister or The Manitoba Public Insurance Corporation of the costs of medical aid provided under The Manitoba Public Insurance Corporation Act.
S.M. 1991-92, c. 36, s. 64; S.M. 1992, c. 35, s. 11; S.M. 1993, c. 36, s. 6.
75.1.1 Every practitioner shall, for the purpose of assessment, payment and audit of claims, provide the minister with the particulars of the services and claims that are required by this Act and the regulations.
S.M. 1991-92, c. 8, s. 17; S.M. 1992, c. 35, s. 32.
Information to be given to patient utilization review committee
75.1.2(1) Without limiting section 75.1.1, a practitioner must, upon the committee's request, provide information about the practitioner's care of a patient to a committee established by the minister to monitor patient utilization of health services.
75.1.2(2) A committee referred to in subsection (1) must limit its request for information about the care of a patient to the minimum amount necessary to properly carry out its duties.
75.2(1) The minister may, in writing, appoint inspectors who may, at any reasonable time and upon presentation of identification,
(a) enter the office of a practitioner or group of practitioners, or a hospital, personal care home, surgical facility or other health care facility in which a practitioner's books, accounts or records referred to in clause (b) are kept; and
(b) require the production of, examine, audit and make copies of any books, accounts and records, including medical or clinical records, kept there that relate to claims for benefits for insured services.
Use of data processing system and copying equipment
75.2(2) In carrying out an inspection or examination under this section, an inspector may
(a) use a data processing system at the place where the books, accounts or records 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 place; and
(c) use any copying equipment at the place to make copies of any record or document.
75.2(3) A practitioner and any other person who has custody or control of a book, account or record must give an inspector all reasonable assistance to enable the inspector to carry out his or her duties and must furnish to the inspector any information the inspector may reasonably require.
75.2(4) 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 issue a warrant authorizing the inspector and any other person named in the warrant to exercise those powers.
S.M. 1991-92, c. 8, s. 17; S.M. 1992, c. 35, s. 11; S.M. 1995, c. 26, s. 5; S.M. 2005, c. 38, s. 4.
Agreement re medical review committee
76(1) With the approval of the Lieutenant Governor in Council, the minister may enter into an agreement with the Manitoba Medical Association or the College of Physicians and Surgeons of Manitoba, or both, respecting
(a) the establishment of a medical review committee;
(b) the number of members that constitute the committee and their terms of office;
(c) the remuneration and expenses to be paid to the members;
(d) the conduct of the affairs of the committee;
(e) the administrative support to be provided to the committee by the minister; and
(f) the duties of the committee in addition to those described in section 76.1.
76(2) Notwithstanding that it is not an incorporated association, the Manitoba Medical Association may, through its officers, enter into an agreement under subsection (1).
76(3) If no agreement is concluded under subsection (1), the minister, with the approval of the Lieutenant Governor in Council, may appoint a medical review committee of not less than 3 members, and may pay such remuneration to the members as the Lieutenant Governor in Council determines.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
Duties of medical review committee
76.1(1) The medical review committee shall review the past and present patterns of medical practice of medical practitioners.
Application to former practitioners
76.1(2) If a medical practitioner's right to practice medicine is suspended, cancelled or not renewed, whether before or after this subsection comes into force, this section and sections 77 to 85.1 apply as if his or her right to practice were still in effect.
S.M. 1991-92, c. 8, s. 18; S.M. 1995, c. 26, s. 6.
77(1) When it appears to the medical review committee that the past or present pattern of practice of a medical practitioner departs from the average pattern of practice of medical practitioners who, in the opinion of the committee, practice in comparable circumstances, the committee may conduct an investigation of the pattern of practice of that medical practitioner.
77(2) In the conduct of an investigation, the medical review committee may require the investigated medical practitioner
(a) to produce to the committee any records in his or her possession or under his or her control;
(b) to produce in a form acceptable to the committee information that the committee requests in respect of the care of patients by the medical practitioner; and
(c) to attend at the investigation.
77(3) The medical review committee may summarily apply ex parte to the Court of Queen's Bench for an order
(a) directing the investigated medical practitioner to produce to the medical review committee any records in his or her possession or under his or her control, if it is shown that the medical practitioner failed to produce them when required to do so by the committee; or
(b) directing any person to produce to the medical review committee any records that are or may be relevant to the matter being investigated.
77.1 Every insured person is deemed to have authorized a medical practitioner who rendered services to which the insured person is entitled as a benefit under this Act to provide any of the following committees with such information as it requires:
(a) the medical review committee;
(b) the formal inquiry committee established by subsection 79(1);
(c) a committee established by the minister to monitor patient utilization of health services.
No action lies against a medical practitioner for providing such information.
S.M. 1991-92, c. 8, s. 18; S.M. 2005, c. 38, s. 5.
Decision of medical review committee
78(1) At the conclusion of an investigation, the medical review committee shall direct that no further action be taken if
(a) in the opinion of the committee, the pattern of practice of the investigated medical practitioner does not depart unjustifiably from the average pattern of practice to which that medical practitioner's pattern has been compared; or
(b) the investigated medical practitioner has entered into an agreement with the minister to pay to the minister an amount of money that the minister considers reasonable because the pattern of practice of the investigated medical practitioner has departed unjustifiably from the average pattern of practice to which that medical practitioner's pattern has been compared.
Referral to formal inquiry committee
78(2) If it does not make a direction under subsection (1), the medical review committee shall, at the conclusion of an investigation, refer the matter under investigation to the formal inquiry committee.
Decision to be served on physician
78(3) The medical review committee shall notify the investigated medical practitioner and the minister, in writing, of any decision it makes under subsection (1) or (2), and the reasons for its decision.
Examination of documentary evidence
78(4) The investigated medical practitioner and the minister may examine any documentary evidence that the medical review committee has considered in making a decision under this section.
S.M. 1991-92, c. 8, s. 18: S.M. 1992, c. 35, s. 58.
79(1) A formal inquiry committee of 3 medical practitioners entitled to practise in Manitoba is hereby established consisting of
(a) a medical practitioner appointed by the minister;
(b) a medical practitioner appointed by the College of Physicians and Surgeons of Manitoba; and
(c) a medical practitioner appointed by the Manitoba Medical Association.
Where College or M.M.A. does not appoint
79(2) If no appointment is made to the formal inquiry committee by the College of Physicians and Surgeons of Manitoba or the Manitoba Medical Association, the minister shall appoint a member for the College or the Manitoba Medical Association, or both, as the case may be.
79(3) An appointment of a member to the formal inquiry committee shall be for a term of 3 years and may be renewed once, and where a term has expired, the member shall continue to act until a successor is appointed.
79(4) The medical practitioner appointed by the College of Physicians and Surgeons of Manitoba shall be the chairperson of the formal inquiry committee.
Appointment of alternate members
79(5) When a member is absent or unable to act for any reason, an alternate may be appointed in accordance with this section to act in that person's place for such period as the appointment may specify.
79(6) No person who is or has been a member of the medical review committee shall subsequently be appointed as a member of the formal inquiry committee.
79(7) A quorum at a hearing of the formal inquiry committee is 3.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
80(1) The minister shall pay the members of the formal inquiry committee such remuneration and expenses as the minister determines.
80(2) The formal inquiry committee shall be provided with such clerical and other administrative support, including the engaging of assistance for the committee, as the minister determines.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
80.1 The formal inquiry committee may determine its own practice and procedure.
Hearing by formal inquiry committee
81(1) On referral of a matter to the formal inquiry committee under subsection 78(2), the formal inquiry committee shall hold a hearing to determine whether the past or present pattern of practice of the investigated medical practitioner departs from the average pattern of practice of medical practitioners who, in the opinion of the committee, practice in comparable circumstances.
81(2) At least 30 days before the date of the hearing, the formal inquiry committee shall provide a notice of hearing to the minister, the medical review committee and the investigated medical practitioner, and the copy provided to the medical practitioner shall either be served personally or sent by registered mail to the last address of the medical practitioner shown in the records of the minister.
81(3) The notice of hearing under subsection (2) shall state the date, time and place at which the formal inquiry committee will hold a hearing and shall identify the specific matters in respect of which the hearing will be held.
81(4) The minister, the medical review committee and the investigated medical practitioner may appear and be represented by counsel or an agent at a hearing of the formal inquiry committee.
81(5) A hearing of the formal inquiry committee shall be held in private.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58; S.M. 1995, c. 26, s. 7.
Medical review committee to forward material
81.1 The medical review committee shall forward to the formal inquiry committee any information or material in its possession that the formal inquiry committee requests, and the formal inquiry committee shall give the minister and the investigated medical practitioner an opportunity to examine any information and material that it receives.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
82(1) A member of the formal inquiry committee has power to administer oaths and affirmations for the purpose of a hearing of the committee.
82(2) The formal inquiry committee may at a hearing
(a) examine witnesses under oath or affirmation;
(b) require the attendance of the investigated medical practitioner and any other witnesses; and
(c) require the production of any records relevant to the proceedings.
Notice to attend and produce records
82(3) The attendance of witnesses before the formal inquiry committee and the production of records may be enforced by a notice issued by the committee requiring the witness to attend and stating the date, time and place at which the witness is to attend and the records, if any, that the witness is required to produce.
82(4) A patient who is given a notice under subsection (3) is excused from testifying before the formal inquiry committee if he or she provides a certificate of a medical practitioner certifying that testifying would likely jeopardize the patient's health.
Failure to attend or give evidence
82(5) Proceedings for civil contempt of court may be brought against a witness
(a) who fails to attend before the formal inquiry committee in compliance with a notice to attend;
(b) who fails to produce any records in compliance with a notice to produce them; or
(c) who refuses to be sworn or to answer any question he or she is asked by the formal inquiry committee.
Hearing in absence of investigated medical practitioner
82.1 The formal inquiry committee, on proof of service on the investigated medical practitioner of the notice of hearing, may
(a) proceed with the hearing in the absence of the medical practitioner or his or her agent; and
(b) determine the matter being heard in the same way as if the medical practitioner were in attendance.
83 The oral evidence given at a hearing of the formal inquiry committee shall be recorded.
Finding of formal inquiry committee
83.1 The formal inquiry committee may find that the pattern of practice of an investigated medical practitioner
(a) departs unjustifiably; or
(b) does not depart unjustifiably;
from the average pattern of practice to which the medical practitioner's pattern has been compared.
Order of formal inquiry committee
84(1) Where the formal inquiry committee determines that, by reason of an unjustifiable departure by the medical practitioner from the average pattern of practice to which that medical practitioner's pattern has been compared, the minister has paid amounts to the medical practitioner or any other person, or both, the formal inquiry committee may by written order require the practitioner to pay to the minister a sum of money that the committee specifies.
84(2) An order made under subsection (1) may include a requirement to pay all or part of the costs of the investigation and of the hearing.
84(3) The formal inquiry committee shall provide a copy of an order made under subsection (1) to the minister and to the medical practitioner affected by it, and the copy provided to the medical practitioner shall either be served personally or sent by registered mail to the last address of the medical practitioner shown in the records of the minister.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
84.1(1) The formal inquiry committee shall, at the request of the minister or an investigated medical practitioner who intends to appeal the order of the committee under section 84.4, compile a record of the hearing it has held which shall include
(a) the notice of hearing;
(b) all documentary evidence;
(c) the transcript of any oral evidence given at the hearing; and
(d) the order of the committee and the reasons for the order.
84.1(2) When compiling the record under subsection (1), the formal inquiry committee shall strike out or delete information that might identify individual patients.
84.1(3) The minister and the investigated medical practitioner may examine the record described in subsection (1).
84.1(4) An investigated medical practitioner is entitled to a copy of the record referred to in subsection (1),
(a) at no cost, if the minister or the medical practitioner appeals the order of the formal inquiry committee under section 84.4; and
(b) on payment of the reasonable costs of providing the record as determined by the committee, if no appeal is taken from the order of the committee under section 84.4.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
84.2(1) The minister may withhold from money owing or money that becomes owing to a medical practitioner any amount that the medical practitioner is, by order of the formal inquiry committee made under subsection 84(1), required to pay to the minister.
84.2(2) The minister may cause to be filed a copy of an order made under subsection 84(1) in the Court of Queen's Bench, and on the order being filed it may be enforced in the same manner as a judgment of the court.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
84.3(1) If a medical practitioner is served with an order under subsection 84(3) and does not pay the amount specified in the order within 30 days of receiving a demand for payment from the minister, the minister is entitled to be paid interest on the amount not paid, and the rate of interest per annum shall
(a) for the period January 1 to June 30 in each year, be the prime lending rate of the fund's principal banker as that rate stood on January 1 of that year, plus 1%; and
(b) for the period July 1 to December 31 in each year, be the prime lending rate of the fund's principal banker as that rate stood on July 1 of that year, plus 1%;
compounded annually.
84.3(2) Interest payable under subsection (1) is a debt owing to the minister and the minister may recover the amount of the interest by action or by withholding it from money owing or against money that becomes owing by the minister to the medical practitioner.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
84.4(1) An investigated medical practitioner or the minister may appeal to the Court of Appeal a finding or an order, or both, made by the formal inquiry committee.
84.4(2) An appeal under this section shall be commenced by filing a notice of appeal with the Registrar of the Court of Appeal within 30 days from the date on which the order of the formal inquiry committee is served under subsection 84(3).
84.4(3) An appeal to the Court of Appeal shall be founded on the record of the hearing before the formal inquiry committee.
84.4(4) The Court of Appeal on hearing an appeal may
(a) make any decision or order that in its opinion should have been made;
(b) quash, vary or confirm the order of the formal inquiry committee or any part of it; or
(c) refer the matter back to the formal inquiry committee for further consideration in accordance with any direction of the Court.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58.
Appeal does not operate as stay
85 An appeal taken under section 84.4 does not operate as a stay of an order appealed against.
85.1(1) Except for the purpose of enforcement of this Act or the regulations, information obtained by or provided to the minister or a person engaged in the administration of this Act or the regulations, the board, the medical review committee, the formal inquiry committee or a committee established by the minister to monitor patient utilization of health services, and relating to
(a) the relationship of a medical practitioner to a patient; or
(b) the medical services rendered by a medical practitioner to a patient, including information contained in a medical or clinical record;
is confidential and shall not be communicated to any person not entitled by law to that information.
Right of M.M.A. and College of Physicians and Surgeons to information
85.1(2) Despite subsection (1), the minister or a person engaged in the administration of this Act or the regulations, the board, the medical review committee and the formal inquiry committee may communicate any information referred to in subsection (1) to the Manitoba Medical Association and the College of Physicians and Surgeons of Manitoba.
Exception re order of formal inquiry committee
85.1(3) Notwithstanding subsection (1), the minister or the formal inquiry committee may disclose information respecting an order made by the formal inquiry committee under section 84, including
(a) the name of the medical practitioner affected by the order;
(b) the amount the medical practitioner has been required to pay by the order; and
(c) the reasons for the order;
provided that no information which could reasonably be expected to identify a patient who has received medical services from the medical practitioner shall be disclosed.
S.M. 1991-92, c. 8, s. 18; S.M. 1992, c. 35, s. 58; S.M. 1996, c. 43, s. 3; S.M. 2005, c. 38, s. 6.
Payment of benefits direct to insured persons
86(1) If an insured person
(a) receives medical services in Manitoba from a medical practitioner who has elected under section 91 to collect his fees otherwise than from the minister in accordance with this Act and the regulations; or
(b) receives elsewhere than in Manitoba medical services designated or described in the regulations as medical services in respect of which benefits are payable when they are rendered to an insured person elsewhere than in Manitoba;
the minister, upon receipt of a proven claim, and subject to sections 87 and 88, shall pay to the insured person, or in accordance with an agreement made under section 89, the amount that would have been paid a medical practitioner who collects fees for medical services rendered to insured persons from the minister in accordance with this Act and the regulations.
Larger payment for services received outside province
86(2) Notwithstanding subsection (1), if an insured person receives elsewhere than in Manitoba medical services designated or described in the regulations as medical services in respect of which benefits are payable when they are rendered to an insured person elsewhere than in Manitoba, the minister, upon receipt of a proven claim, and subject to sections 87 and 88, may pay to the insured person a greater amount, as provided in the regulations, than would have been paid a medical practitioner who collects fees from the minister in accordance with this Act and the regulations for medical services rendered to insured persons in Manitoba.
Direct payments to out of province practitioners
86(3) In lieu of making payments as provided in subsection (1) or (2), if the insured person has not paid the fees for services rendered to him elsewhere than in Manitoba, the minister may pay an amount, the payment of which is authorized under subsection (1) or (2), directly to the medical practitioner who rendered those services to the insured person.
Payment not to exceed benefits
87 The minister is not liable to pay fees for any medical service rendered to an insured person in excess of the benefits payable under this Act and the regulations in respect of the medical service.
Payment not to exceed fees charged
88 Where the amount of any fee charged by a medical practitioner is less than the amount of benefit payable under this Act and the regulations for the medical services that were rendered, the minister shall pay only the amount charged by or paid to the medical practitioner in respect of those medical services.
Payment of benefits to government
89(1) The minister may pay from the fund to the Minister of Finance amounts in respect of the cost of medical services or other health services rendered to insured persons by medical practitioners, or persons authorized by law to provide those health services, who are employed by the government.
Agreements with doctors outside Manitoba
89(2) The minister may enter into an agreement with a medical practitioner practising medicine outside Manitoba who frequently renders medical services to insured persons providing for the payment of benefits in respect of those medical services directly to the medical practitioner.
S.M. 1992, c. 35, s. 11 and 35.
Right to select medical practitioner
90(1) Subject to subsection (2), nothing in this Act or in the regulations interferes with the right of an insured person to select the medical practitioner from whom he wishes to receive medical services.
Right of medical practitioner to refuse service
90(2) Nothing in this Act or the regulations imposes any obligations upon any medical practitioner to render medical services to any insured person.
Medical practitioner may opt out
91(1) A medical practitioner, by giving to the minister at any time notice in writing, may elect to collect his fees for medical services rendered to insured persons otherwise than from the minister in accordance with this Act and the regulations.
Date of effect of notice by new doctor
91(2) Where a medical practitioner gives notice under subsection (1) within one month after the date on which he first becomes entitled to practise medicine in Manitoba, the election takes effect on the date on which he becomes entitled to practise medicine in Manitoba.
Date of effect of notice by other doctors
91(3) Where a notice under subsection (1) is given otherwise than as mentioned in subsection (2) the election takes effect on the first day of the first month beginning after the expiration of 90 days after the date on which the notice is given.
92 A medical practitioner who has made an election under subsection 91(1) may, by giving to the minister at any time notice in writing, revoke the election; and from and after the first day of the first month beginning after the date on which the notice of revocation is given to the minister the election ceases to have effect.
Collection of medical fees direct from patient
93 Unless
(a) he has made an election under subsection 91(1) which is in effect; and
(b) prior to rendering a medical service to an insured person he has given to the insured person reasonable notice that he proposes to collect the amount of his fees for the medical services from the insured person and not from the minister;
a medical practitioner shall not collect from the insured person or any other person except the minister that part of any fee for the medical service rendered to the insured person that is paid as a benefit in respect of the medical service.
94 When a medical practitioner who has made an election under subsection 91(1) renders a medical service