Bill 8, Commitment to the Future of Medicare Act, 2004

Smitherman, Hon. George Minister of Health and Long-Term Care

Versions

Bill 8 2004

An Act to establish the
Ontario Health Quality Council,
to enact new legislation concerning
health service accessibility and repeal
the Health Care Accessibility Act,
to provide for accountability in the
health service sector, and to amend
the Health Insurance Act

CONTENTS


Preamble
PART I ONTARIO HEALTH QUALITY COUNCIL
1. 2. 3. 4. 5. 6. 7.	Interpretation Council No personal liability Functions of Council Reports Regulations Public consultation before making regulations
PART II HEALTH SERVICES ACCESSIBILITY
8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.	Definitions General Manager Persons not to charge more than OHIP Transitional Agreement for determining amount Unauthorized payment Entitlement to review Personal information Disclosure of information to the General Manager Preferences Block fees Offence Regulations
PART III ACCOUNTABILITY
21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.	Definitions Governing principle Accountability agreements Notice of non-compliance - health resource provider Compliance directives - health resource provider Recognition of accomplishment Order - health resource provider Notice in exceptional circumstance Where change in employment Where change in funding, agreement, etc. Information Non-liability Offence Regulations Public consultation before making regulations
PART IV AMENDMENTS TO HEALTH INSURANCE ACT
36. - 43.		Health Insurance Act amended
PART V REPEAL, COMMENCEMENT, SHORT TITLE
44. 45. 46.	Repeal Commencement Short title
______________

Preamble

The people of Ontario and their Government:

Recognize that Medicare - our system of publicly funded health services - reflects fundamental Canadian values and that its preservation is essential for the health of Ontarians now and in the future;

Confirm their enduring commitment to the principles of public administration, comprehensiveness, universality, portability and accessibility as provided in the Canada Health Act;

Continue to support the prohibition of two-tier medicine, extra billing and user fees in accordance with the Canada Health Act;

Believe in a consumer-centred health system that ensures access is based on assessed need, not on an individual's ability to pay;

Recognize that pharmacare for catastrophic drug costs is important to the future of the health system;

Recognize that access to community based health care, including primary health care, home care based on assessed need and community mental health care are cornerstones of an effective health care system;

Believe in public accountability to demonstrate that the health system is governed and managed in a way that reflects the public interest and that promotes efficient delivery of high quality health services to all Ontarians;

Recognize that the promotion of health, and the prevention of and treatment of disease includes mental and physical illness;

Recognize the importance of an Ontario Health Quality Council that would report to the people of Ontario on the performance of their health system to support continuous quality improvement;

Affirm that a strong health system depends on collaboration between the community, individuals, health service providers and governments, and a common vision of shared responsibility;

Therefore, Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:

PART I
ONTARIO HEALTH QUALITY COUNCIL

Interpretation

1. In this Part,

"Council" means the Ontario Health Quality Council established under section 2; ("Conseil")

"health system organization" means,

(a) any corporation, agency or entity that represents the interests of persons who are part of the health sector and whose main purpose is advocacy for the interest of those persons,

(b) the College of a health profession or group of health professions as defined under the Regulated Health Professions Act, 1991, or

"information" includes reports and data; ("renseignements")

"Minister" means the Minister of Health and Long-Term Care. ("ministre")

Council

2. (1) The Lieutenant Governor in Council shall by regulation establish a Council, under the name Ontario Health Quality Council in English, and Conseil ontarien de la qualité des services de santé in French.

Members

(2) The Council shall have no fewer than nine and not more than 12 members who shall be appointed by the Lieutenant Governor in Council.

Factors in appointment

(3) In appointing the members of the Council, regard shall be had to the desirability of appointing,

(a) experts in the health system in the areas of patient and consumer issues and health service provision;

(b) experts in the areas of governance, accountability and public finance;

Additional factor

(4) In addition to the considerations in subsection (3), in appointing the members of the Council, regard shall be had to representing the diversity of the population of Ontario and expertise with particular groups.

Ministry representative

(5) At least one member of the Council shall be an employee of the Ministry of Health and Long-Term Care, but that member shall not vote in the deliberations of the Council.

National Council representative

(6) Where there is in existence a similar council for Canada and the provinces and territories of Canada, at least one of the members of the Council shall be a person who is from Ontario and sits on the similar council.

Persons who may not be members

(7) A person who is a member of the board or the chief executive officer or an officer of a health system organization may not be a member of the Council.

No personal liability

3. No action or other proceeding for damages may be instituted against any member of the Council or any one acting on behalf of the Council for any act done in the execution or intended execution of the person's duty or for any alleged neglect or default in the execution in good faith of the person's duty.

Functions of Council

4. The functions of the Council are,

(a) to monitor and report to the people of Ontario on,

(i) access to publicly funded health services,

(ii) health human resources in publicly funded health services,

(iii) consumer and population health status, and

(iv) health system outcomes; and

(b) to support continuous quality improvement.

Reports

5. (1) The Council shall deliver to the Minister,

(a) a yearly report on the state of the health system in Ontario; and

(b) any other reports required by the Minister.

Tabling

(2) The Minister shall table the yearly report under this section in the Legislative Assembly within 30 days of receiving it from the Council, but is not required to table the Council's annual business plan.

Purpose of reporting

(3) The purpose of a report under this section is to,

(a) encourage and promote an integrated, consumer-centred health system;

(b) make the Ontario health system more transparent and accountable;

(d) help Ontarians to better understand their health system.

Recommendations

(4) In a report under this section the Council may make recommendations to the Minister but only in regard to future areas of reporting.

Annual plan

(5) At the time it makes its yearly report, the Council shall also submit to the Minister for his or her review and approval a business plan for the Council's next year's operation.

Regulations

6. (1) The Lieutenant Governor in Council may make regulations,

(a) governing the Council's constitution, management, structure and legal status;

(b) respecting specific powers and duties of the Council and its members;

(d) respecting any compensation of members;

(e) providing for a chair and vice-chair of the Council;

(f) regarding the nature and scope of the yearly report required by section 5;

(g) regarding the frequency, nature and scope of reporting in addition to the yearly report required by section 5;

(h) governing the transfer of information from persons provided for in the regulations of information, including personal information, that is relevant to carrying out the functions of the Council;

(i) governing the confidentiality and security of information including personal information, the collection, use and disclosure of such information, the retention and disposal of such information, and access to and correction of such information, including restrictions on any of these things, for the purposes of the carrying out of the functions of the Council;

(j) respecting staff for the Council, including the status of Council staff, and their compensation;

(k) respecting funding for the Council;

(l) respecting audits of the statements and records of the Council;

(m) providing whether or not the Business Corporations Act, the Corporations Information Act or the Corporations Act or any provisions of those Acts apply to the Council;

(n) governing the procedures and administration of the Council;

(o) generally to facilitate the carrying out of the functions of the Council;

(p) respecting any other matter that the Lieutenant Governor in Council considers necessary or desirable for carrying out the purposes and provisions of this Part.

Same

(2) A regulation under this Part may be general or specific in its application, may create different categories or classes, and may make different provisions for different categories, classes or circumstances.

Public consultation before making regulations

7. (1) Subject to subsection (7), the Lieutenant Governor in Council shall not make any regulation under section 6 unless,

(a) the Minister has published a notice of the proposed regulation in The Ontario Gazette and given notice of the proposed regulation by all other means that the Minister considers appropriate for the purpose of providing notice to the persons who may be affected by the proposed regulation;

(b) the notice complies with the requirements of this section;

(d) the Minister has considered whatever comments and submissions that members of the public have made on the proposed regulation, or an accurate synopsis of such comments; and

(e) the Minister has reported to the Lieutenant Governor in Council on what, if any, changes to the proposed regulation the Minister considers appropriate.

Contents of notice

(2) The notice mentioned in clause (1) (a) shall contain,

(a) a description of the proposed regulation and the text of it;

(b) a statement of the time period during which a person may submit written comments on the proposed regulation to the Minister and the manner in which and the address to which the comments must be submitted;

(c) a description of any other methods by which a person may comment on the proposed regulation and the manner in which and the time period during which they may do so;

(d) a statement of where and when members of the public may review written information about the proposed regulation;

(e) any prescribed information; and

(f) any other information that the Minister considers appropriate.

Time period for comments

(3) The time period mentioned in clauses (2) (b) and (c) shall be at least 60 days after the Minister gives the notice mentioned in clause (1) (a) unless the Minister shortens the time period in accordance with subsection (4).

Shorter time period for comments

(4) The Minister may shorten the time period if, in the Minister's opinion,

(a) the urgency of the situation requires it;

(b) the proposed regulation clarifies the intent or operation of this Part or the regulations; or

Discretion to make regulations

(5) Upon receiving the Minister's report mentioned in clause (1) (e), the Lieutenant Governor in Council, without further notice under subsection (1), may make the proposed regulation with any changes that the Lieutenant Governor in Council considers appropriate, whether or not those changes are mentioned in the Minister's report.

No public consultation

(6) The Minister may decide that subsections (1) to (5) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 6 if, in the Minister's opinion,

(a) the urgency of the situation requires it;

(b) the proposed regulation clarifies the intent or operation of this Act or the regulations; or

Same

(7) If the Minister decides that subsections (1) to (5) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 6,

(a) those subsections do not apply to the power of the Lieutenant Governor in Council to make the regulation; and

(b) the Minister shall give notice of the decision to the public as soon as is reasonably possible after making the decision.

Contents of notice

(8) The notice mentioned in clause (7) (b) shall include a statement of the Minister's reasons for making the decision and all other information that the Minister considers appropriate.

Publication of notice

(9) The Minister shall publish the notice mentioned in clause (7) (b) in The Ontario Gazette and give the notice by all other means that the Minister considers appropriate.

Temporary regulation

(10) If the Minister decides that subsections (1) to (5) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 6 because the Minister is of the opinion that the urgency of the situation requires it, the regulation shall,

(a) be identified as a temporary regulation in the text of the regulation; and

(b) unless it is revoked before its expiry, expire at a time specified in the regulation, which shall not be after the second anniversary of the day on which the regulation comes into force.

No review

(11) Subject to subsection (12), a court shall not review any action, decision, failure to take action or failure to make a decision by the Lieutenant Governor in Council or the Minister under this section.

Exception

(12) Any person resident in Ontario may make an application for judicial review under the Judicial Review Procedure Act on the ground that the Minister has not taken a step required by this section.

Time for application

(13) No person shall make an application under subsection (12) with respect to a regulation later than 21 days after the day on which,

(a) the Minister publishes a notice with respect to the regulation under clause (1) (a) or subsection (9), where applicable; or

(b) the regulation is filed, if it is a regulation described in subsection (10).

PART II
HEALTH SERVICES ACCESSIBILITY

Definitions

8. In this Part,

"Board" means the Health Services Appeal and Review Board under the Ministry of Health Appeal and Review Boards Act, 1998; ("Commission")

"designated practitioner" means a practitioner that is designated by the regulations as being a practitioner who may not charge an amount for the provision of insured services rendered to an insured person other than the amount payable by the Plan; ("praticien désigné")

"General Manager" means the General Manager of the Plan appointed under the Health Insurance Act; ("directeur général")

"insured person" means a person who is entitled to insured services under the Health Insurance Act and the regulations made under it; ("assuré")

"insured service" means a service that is an insured service under the Health Insurance Act and the regulations made under it; ("service assuré")

"non-designated practitioner" means a practitioner who is not a designated practitioner; ("praticien non désigné")

"personal information" means any information about an identifiable individual; ("renseignements personnels")

"physician" means a legally qualified medical practitioner who is lawfully entitled to practise medicine in Ontario; ("médecin")

"Plan" means the Ontario Health Insurance Plan; ("Régime")

"practitioner" means a practitioner or a health facility within the meaning of the Health Insurance Act that is prescribed as a practitioner for the purposes of this Part; ("praticien")

"prescribed" means prescribed by the regulations made under this Part; ("prescrit")

"unauthorized payment" means any payment accepted contrary to section 10. ("paiement non autorisé")

General Manager

9. Subject to this Part and the regulations, the General Manager shall carry out any functions and duties that the General Manager considers necessary for purposes related to the administration of this Part.

Persons not to charge more than OHIP

10. (1) A physician or designated practitioner shall not charge more or accept payment or other benefit for more than the amount payable under the Plan for rendering an insured service to an insured person.

Exception

(2) Subsection (1) does not apply to,

(a) a charge made to or a payment or benefit accepted from a public hospital for an insured service rendered to an insured person in that public hospital;

(b) a charge made to or a payment accepted from a prescribed facility for an insured service rendered to an insured person in that facility; or

(c) any other charge, payment, benefit or service that is prescribed, subject to any prescribed conditions or limitations.

Physicians and designated practitioners

(3) A physician or designated practitioner shall not accept payment or benefit for an insured service rendered to an insured person except,

(a) from the Plan, including a payment made in accordance with an agreement made under subsection 2 (2) of the Health Insurance Act;

(b) from a public hospital or prescribed facility for services rendered in that public hospital or facility; or

Non-designated practitioners

(4) A non-designated practitioner shall not accept payment except from the Plan for that part of his or her account for any insured service rendered to an insured person that is payable by the Plan.

Restriction on who may accept payment

(5) No person or entity may charge or accept payment or other benefit for an insured service rendered to an insured person,

(a) except as permitted under this section; or

(b) unless permitted to do so by the regulations in the prescribed circumstances and on the prescribed conditions.

Not a payment or other benefit

(6) For the purposes of subsection (5), "payment or other benefit" does not include a salary or an amount payable under a contract of employment or a contract of services to an employee of or a person who contracts with a physician, practitioner, public hospital or prescribed facility.

Transitional

11. (1) This section applies to physicians and designated practitioners who, on or before May 13, 2004, have rendered insured services to insured persons and who had never notified the General Manager of their intention to submit accounts for the performance of insured services rendered to insured persons directly to the Plan in accordance with subsection 15 (1) or 16 (1) of the Health Insurance Act, or had notified the General Manager under subsection 15 (4) or 16 (4) of the Health Insurance Act that they intended to cease submitting their accounts directly to the Plan.

Notification

(2) If a physician or designated practitioner mentioned in subsection (1) notifies the General Manager by registered mail, within 90 days of the coming into force of this section, that he or she intends not to submit his or her accounts directly to the Plan, the provisions of subsection (7) apply to him or her.

Transitional time

(3) Subsection 10 (3) does not apply to a physician or designated practitioner mentioned in subsection (1) who does not give notice under subsection (2) until the first day of the third month following the expiration of the 90-day period under subsection (2).

Subsequent election

(4) A physician or designated practitioner who has notified the General Manager under subsection (2) may subsequently notify the General Manager by registered mail that he or she intends to submit his or her accounts directly to the Plan for the performance of insured services rendered to insured persons and in such a case, subsection 10 (3) shall apply and the physician or designated practitioner may not subsequently choose to cease submitting his or her accounts directly to the Plan.

When decision takes effect

(5) A decision to submit accounts directly to the Plan under subsection (4) takes effect as of the first day of the third month following the month in which the General Manager received the notification.

Deemed election

(6) Unless the General Manager is satisfied that the account was submitted in error, if a physician or designated practitioner who has notified the General Manager under subsection (2) subsequently submits an account directly to the Plan for the performance of insured services rendered to an insured person, he or she shall be deemed to have notified the General Manager under subsection (4) that he or she intends to submit his or her accounts directly to the Plan, except in respect of any prescribed accounts or classes of accounts, and subject to any prescribed circumstances or conditions.

Where notification given

(7) The following apply to a physician or designated practitioner who has notified the General Manager under subsection (2), except in respect of any prescribed accounts or classes of accounts, and subject to any prescribed circumstances or conditions:

1. Subsection 10 (3) does not apply to the physician or designated practitioner and, despite subsection 10 (5), he or she may accept payment for the rendering of insured services to insured persons from a source not mentioned in clause 10 (3) (a), (b) or (c), if he or she complies with all other relevant provisions of this Part.

2. Subject to subsection 10 (2), the physician or designated practitioner shall not accept payment for rendering an insured service to an insured person until after he or she receives notice that the patient has been reimbursed by the Plan unless the insured person consents to make the payment on an earlier date.

3. All other applicable provisions of this Part apply to the physician or designated practitioner.

Agreement for determining amount

12. (1) The Minister of Health and Long-Term Care may enter into agreements with the associations mentioned in subsection (2), as representatives of physicians, dentists and optometrists, to provide for methods of negotiating and determining the amounts payable under the Plan in respect of the rendering of insured services to insured persons.

Associations

(2) The associations representing physicians, dentists and optometrists are,

(a) the Ontario Medical Association, in respect of physicians;

(b) the Ontario Dental Association, in respect of dentists; and

Same

(3) The Lieutenant Governor in Council may make a regulation providing that the Minister may enter into an agreement under subsection (1) with a specified person or organization other than an association mentioned in subsection (2).

Definitions

(4) In this section,

"dentist" means a member of the Royal College of Dental Surgeons of Ontario; ("dentiste")

"optometrist" means a member of the College of Optometrists of Ontario. ("optométriste")

Unauthorized payment

13. (1) If the General Manager is of the initial opinion that a person has paid an unauthorized payment, the General Manager shall promptly serve on the physician, practitioner, other person or entity that is alleged to have received the unauthorized payment notice of the General Manager's intent to reimburse the person who is alleged to have made the unauthorized payment, together with a brief statement of the facts giving rise to the General Manager's initial opinion.

Providing information

(2) The physician, practitioner, other person or entity that is alleged to have received the unauthorized payment may, not later than 21 days after receiving the notice described in subsection (1), provide the General Manager in writing with any information that he, she or it believes is relevant to determining whether an unauthorized payment has been paid.

Payment by General Manager

(3) If, after reviewing any information provided in accordance with subsection (2), the General Manager is satisfied that a person has paid an unauthorized payment, the General Manager shall pay to the person the amount of the unauthorized payment.

Debt

(4) Where a person has paid an unauthorized payment and the General Manager has paid the person under subsection (3), the physician, practitioner, other person or entity to whom the unauthorized payment was made is indebted to the Plan for the amount of the unauthorized payment and the amount of the administrative charge prescribed by the regulations.

General Manager to recover money

(5) The General Manager may recover from the physician, practitioner, other person or entity a part or all of any amount he, she or it is indebted to the Plan under subsection (4) by set-off against any money payable by the Plan or under the Independent Health Facilities Act to him, her or it.

Applies despite SPPA

(6) Despite section 25 of the Statutory Powers Procedure Act, a request for a review under section 14 or any application for judicial review of a review under section 14 does not stay the General Manager from exercising any right of set-off under subsection (5).

Notice of recovery

(7) Following a payment under subsection (3), the General Manager shall promptly serve on the physician, practitioner, other person or entity notice of the amount of his, her or its indebtedness to the Plan, the account in respect of which the indebtedness arose and his, her or its right under section 14 to request a review of the issue.

Service of notice

(8) The notice under subsection (1) or (7) shall be served upon the physician, practitioner, other person or entity to whom the notice is required to be given in accordance with the regulations, and shall be deemed to have been given on a date determined in accordance with the regulations.

Entitlement to review

14. (1) A physician, practitioner, other person or entity is entitled to a review of the issue of whether he, she or it has received an unauthorized payment if within 15 days after receiving the notice under subsection 13 (7) he, she or it mails or delivers to the General Manager written notice requesting a review.

Referral for review

(2) The General Manager, upon receiving a request for a review in accordance with subsection (1), shall refer the matter to the Board's chair.

Persons to review

(3) The Board's chair may from time to time appoint a member of the Board to conduct a review under this Part.

Terms of reference

(4) A member of the Board conducting a review shall inquire into whether the physician, practitioner, other person or entity has received an unauthorized payment.

Right to representations

(5) The General Manager, the physician, practitioner, other person or entity to which notice must be given under subsection 13 (7) and the insured person have the right to make written representations to the member of the Board conducting the review.

Non-application of SPPA

(6) Despite any provision of the Statutory Powers Procedure Act, the written representations to the member of the Board are the only representations that may be made under this section.

Decision in writing

(7) The member of the Board conducting a review shall provide to the parties who made representations in accordance with subsection (5) a decision in writing as to whether, in the Board's opinion, an unauthorized payment was paid and, if so, the amount of that payment.

Filing of notice or decision

(8) Where a physician, practitioner, other person or entity has not requested a review in accordance with subsection (1) or where a member of the Board has conducted a review and determined that the physician, practitioner, other person or entity has received an unauthorized payment, the General Manager may file with the Superior Court of Justice a copy of the notice given by the General Manager to the physician, practitioner, other person or entity, or of the decision of the Board, as the case may be, and the notice or decision shall be entered in the same way as a judgment or order of the Superior Court of Justice and is enforceable as an order of that court.

General Manager to pay

(9) If the member of the Board conducting a review advises the General Manager that the General Manager recovered more from the physician, practitioner, other person or entity than the sum of the unauthorized payment, if any, and the administrative charge, the General Manager shall pay the physician, practitioner, other person or entity,

(a) if the member finds there was no unauthorized payment, the total amount recovered; or

(b) if the member finds there was an unauthorized payment, the difference between the amount recovered and the amount that should have been recovered.

Personal information

15. (1) The General Manager may directly or indirectly collect personal information, subject to such conditions as may be prescribed, for purposes related to the administration of this Part, the Health Insurance Act or the Independent Health Facilities Act.

Use of personal information

(2) The General Manager may use personal information, subject to any conditions that may be prescribed, for purposes related to the administration of this Part, the Health Insurance Act or the Independent Health Facilities Act.

Disclosure

(3) The General Manager shall disclose personal information if all prescribed conditions have been met and if the disclosure is necessary for purposes related to the administration of this Part, the Health Insurance Act, the Independent Health Facilities Act, the Regulated Health Professions Act, 1991 or a health profession Act as defined in that Act, but shall not disclose the information if, in his or her opinion, the disclosure is not necessary for those purposes.

Limitation

(4) The General Manager shall not collect, use or disclose more information than is reasonably necessary for the purposes of the collection, use or disclosure.

Obligation

(5) Before disclosing personal information obtained under this Part, the person who obtained it shall delete from it all names and identifying numbers, symbols or other particulars assigned to individuals unless,

(a) disclosure of the names or other identifying information is necessary for the purposes described in subsection (3); or

(b) disclosure of the names or other identifying information is otherwise authorized under the Freedom of Information and Protection of Privacy Act.

(6) Subsection (7) only applies if Bill 31, "An Act to enact and amend various acts with respect to the protection of health information", which received first reading on December 17, 2003, receives Royal Assent.

(7) On the later of the day this subsection comes into force and the day on which Bill 31 receives Royal Assent, clause (5) (b) is amended by adding "or the Personal Health Information Protection Act, 2004" at the end.

Disclosure of information to the General Manager

16. (1) The General Manager may require that any person or entity submit information to the General Manager for the purposes of determining whether there has been a contravention of or a failure to comply with any of the following provisions, if the General Manager is of the opinion that such a contravention or failure may have taken place:

1. Section 10, 13, 17 or 18 of this Act.

2. Section 15 or 15.1 of the Health Insurance Act.

3. Section 3 of the Independent Health Facilities Act.

Same

(2) The information mentioned in subsection (1) may be any information that the General Manager reasonably considers is necessary for the purposes mentioned in subsection (1).

Time and form

(3) Subject to the regulations, the information shall be submitted and disclosed,

(a) in the form required by the General Manager; and

(b) within 21 days of the receipt by the person or entity of the request by the General Manager.

Extension of time

(4) The General Manager may extend the period of time mentioned in clause (3) (b) for a time that the General Manager believes is reasonable in the circumstances, if the General Manager believes that the person or entity cannot submit or disclose the information within the period of time for reasons that he, she or it cannot control.

Suspension of payments

(5) The Minister or the General Manager may suspend payments under the Plan or under the Independent Health Facilities Act to a person or entity during any period when he, she or it fails to comply with subsection (1) without just cause, whether or not the person or entity is convicted of an offence.

Reporting

(6) Any person shall report to the General Manager any information relating to the administration or enforcement of this Part or the regulations, the Health Insurance Act or the Independent Health Facilities Act if the person believes it to be in the public interest to do so.

Application

(7) Subject to subsection (10), this section applies even if the information is confidential or privileged and despite any Act, regulation or other law prohibiting disclosure of the information.

Protection from liability

(8) No proceeding for reporting, providing or disclosing information under this section shall be commenced against a person unless he or she acts maliciously and the information is not true.

No retaliation

(9) No person or entity shall discipline or penalize any person for reporting, providing or disclosing information under this section unless he or she acts maliciously and the information is not true.

Exception: solicitor-client privilege

(10) Nothing in this section abrogates any privilege that may exist between a solicitor and his or her client.

Interpretation

(11) In this section,

"information" includes personal information.

Preferences

17. (1) No person or entity shall,

(a) pay or confer a benefit upon any person or entity in exchange for conferring upon an insured person a preference in obtaining access to an insured service;

(b) charge or accept payment or a benefit for conferring upon an insured person a preference in obtaining access to an insured service;

Mandatory reporting

(2) A prescribed person who, in the course of his or her professional or official duties, has reason to believe that anything prohibited by subsection (1) has occurred shall promptly report the matter to the General Manager.

Subs. (2) prevails

(3) Subject to subsection (7), subsection (2) applies even if the information reported is confidential or privileged and despite any Act, regulation or other law prohibiting disclosure of the information.

Protection from liability

(4) No proceeding for making a report under subsection (2) or for providing information in connection with the report shall be commenced against a person unless he or she acts maliciously and the information on which the report is based is not true.

No retaliation

(5) No person or entity shall discipline or penalize any person for making a report under subsection (2) or for providing information in connection with the report unless the person who reported or provided the information acted maliciously and the information is not true.

Defence

(6) Where an employer or contractor is charged with contravening subsection (1) as a result of an act committed by an employee, subcontractor or person with whom the employer or contractor contracted, it is a defence to the charge that the employer or contractor took all reasonable steps in the circumstances to prevent such a contravention.

Exception: solicitor-client privilege

(7) Nothing in this section abrogates any privilege that may exist between a solicitor and his or her client.

Block fees

18. (1) If regulations have been made under this section, a person or entity may charge a block or annual fee only in accordance with those regulations.

Non-discrimination

(2) A physician, practitioner or hospital shall not refuse to render an insured service to an insured person or refuse to continue rendering insured services to an insured person for any reason relating to an insured person's choice not to pay a block or annual fee.

Regulations

(3) For the purposes of this section, the Lieutenant Governor in Council may make regulations governing block or annual fees, including the circumstances under which they may be charged and the information that must be provided to the person who is charged, but may not regulate the amount of such a fee.

Definition

(4) In this section,

"block or annual fee",

(a) means a fee charged in respect of one or more health services that are not insured services as defined in section 1 of the Health Insurance Act, or a fee for an undertaking not to charge for such a service or to be available to provide such a service or services if,

(i) the service or services are or would be rendered by a physician, practitioner or hospital, or the service or services are or would be necessary adjuncts to services rendered by a physician, practitioner or hospital, and

(ii) at the time the fee is paid it is not possible for the person paying the fee to know with certainty how many, if any, of the services covered by the block or annual fee the patient will require during the period of time covered by the block or annual fee, or

(b) has any other meaning that may be provided for in regulations made under subsection (3).

Offence

19. (1) Every one who contravenes a provision of this Part or the regulations is guilty of an offence.

Penalty, individual

(2) Subject to subsection (3), an individual who is convicted of an offence under this section is liable to a fine of not more than $10,000.

Same, s. 17 (2)

(3) An individual who is convicted of an offence under this section for contravening subsection 17 (2) is liable to a fine not exceeding $1,000.

Penalty, corporation

(4) A corporation that is convicted of an offence under this section is liable to a fine not exceeding $25,000.

Compensation or restitution

(5) The court that convicts a person of an offence under this section may, in addition to any other penalty, order that the person pay compensation or make restitution to any person who suffered a loss as a result of the offence.

Limitation

(6) A prosecution for an offence under this section shall not be commenced after two years after the date on which the offence was, or is alleged to have been, committed.

Regulations

20. (1) The Lieutenant Governor in Council may make regulations,

(a) prescribing practitioner and health facilities for the purposes of the definition of "practitioner" in this Part;

(b) designating practitioners as practitioners who may not charge an amount for the provision of insured services rendered to insured persons other than the amount payable by the Plan;

(d) prescribing an administrative charge for the purpose of subsection 13 (4), and for that purpose may set out a formula to determine the charge;

(e) governing service for the purposes of subsection 13 (8);

(f) prescribing conditions and purposes for the purposes of section 15;

(g) governing the information that must be provided under section 16, including its content and the form in which it must be provided;

(h) prescribing persons for the purposes of section 17;

(i) prescribing conditions and limitations for the purposes of this Part;

(j) prescribing anything that must or may be prescribed under this Part or anything that is required or permitted to be done in accordance with the regulations or as provided in the regulations.

Same

Exemptions

(3) A regulation under this Part may provide for exemption from the application of any provision of this Part.

Retroactivity

(4) A regulation under this Part is effective with respect to a period before it was filed if the regulation so provides.

Restriction

(5) A regulation made for the purposes of this Part shall not include a provision that is contrary to a provision of the Canada Health Act.

PART III
ACCOUNTABILITY

Definitions

21. In this Part,

"accountability agreement" means an agreement establishing any one or more of,

(a) performance goals and objectives respecting roles and responsibilities, service quality, accessibility of services, related health human resources, shared and collective responsibilities for health system outcomes, consumer and population health status, value for money, consistency, and other prescribed matters,

(b) a plan and a timeframe for meeting those goals and objectives,

(d) any other prescribed matter, and

(e) the standards to be used in measuring compliance with anything mentioned in clauses (a) to (d); ("entente d'imputabilité")

"chief executive officer" means any individual who holds the position of chief executive officer with a health resource provider, and any individual who, regardless of title,

(a) holds a position with a health resource provider similar to that of chief executive officer, or

(b) performs functions for a health resource provider similar to those normally performed by a chief executive officer; ("chef de la direction")

"compensation package" means the value of any compensation in any form that is provided to or on behalf of a chief executive officer in respect of his or her office with a health resource provider including,

(a) any amount that is required by section 5 of the Income Tax Act (Canada) to be included in the chief executive officer's income from his or her office with the health resource provider,

(b) any amount or benefit paid to or on behalf of another person arising directly or indirectly from the chief executive officer's position with or services provided to the health resource provider, and

"compliance directive" means a directive issued by the Minister under section 25; ("directive de conformité")

"health resource provider" means,

(a) an entity that operates,

(i) a hospital within the meaning of the Public Hospitals Act,

(ii) a private hospital within the meaning of the Private Hospitals Act,

(iii) a psychiatric facility within the meaning of the Mental Health Act, or

(iv) an institution within the meaning of the Mental Hospitals Act,

(b) an approved corporation within the meaning of the Charitable Institutions Act that operates and maintains an approved charitable home for the aged,

(c) each municipality or a board of management maintaining a home for the aged or a joint home for the aged under the Homes for the Aged and Rest Homes Act,

(d) a licensee under the Nursing Homes Act,

(e) a licensee under the Independent Health Facilities Act, or

(f) a community care access corporation within the meaning of the Community Care Access Corporations Act, 2001,

but does not include a physician or practitioner, as defined in the Health Insurance Act, or a group of physicians or practitioners, in his, her or its capacity as a physician, practitioner or group that receives any payment for the provision of an insured service to an insured person under the Health Insurance Act, or a trade union; ("fournisseur de ressources en santé")

"Minister" means the Minister of Health and Long-Term Care; ("ministre")

"performance agreement" means an agreement between a health resource provider and a chief executive officer of the health resource provider under this Part; ("convention de performance")

"personal information" means any information about an identifiable individual; ("renseignements personnels")

"prescribed" means prescribed by the regulations. ("prescrit")

Governing principle

22. (1) In administering this Part, the Minister shall be governed by the principle that accountability is fundamental to a sound health system.

Public interest

(2) The Minister and the Lieutenant Governor in Council may exercise any authority under this Part where he, she or it considers it in the public interest to do so and, in doing so, the Minister or the Lieutenant Governor in Council may consider any matter that he, she or it considers relevant in the circumstances, including any of the following:

1. Clear roles and responsibilities regarding the proper management of the health care system and any health resource provider.

2. Shared and collective responsibilities.

3. Transparency.

4. Quality improvement.

5. Fiscal responsibility.

6. Value for money.

7. Public reporting.

8. Consistency.

9. Trust.

10. Reliance on evidence.

11. A focus on outcomes and the quality of the care and treatment of individuals.

12. Timely access to care.

13. Accessibility.

14. Any other prescribed matter.

Accountability agreements

23. (1) The Minister may give notice to a health resource provider that,

(a) the Minister proposes to enter into an accountability agreement with the health resource provider; or

(b) the Minister proposes to enter into an accountability agreement with the health resource provider and one or more other health resource providers.

Discussion

(2) After the notice under subsection (1) is given, the Minister and the health resource provider shall negotiate the terms of an accountability agreement and enter into an accountability agreement within the applicable number of days provided for in subsection (3).

Applicable number of days

(3) The applicable number of days is,

(a) 90 days where the Minister gives notice to the health resource provider under subsection (1),

(i) for the first time, or

(ii) for the second time, where the first accountability agreement was for a term of one year or less; and

(b) 60 days in all other cases.

Information

(4) The Minister and the health resource provider shall disclose to each other any information, other than personal information, that they consider necessary for the purposes of negotiating an accountability agreement, but this subsection does not,

(a) authorize or require the Minister to disclose information that is not required to be disclosed to a requester under the Freedom of Information and Protection of Privacy Act;

(b) authorize or require a health resource provider to disclose information that is not required to be disclosed to a requester under the Municipal Freedom of Information and Protection of Privacy Act, if that Act applies to a health resource provider;

(d) require the disclosure of any information that the Minister or health resource provider is entitled not to disclose by virtue of any other law.

Direction

(5) If the health resource provider and the Minister do not enter into an accountability agreement within the applicable number of days after the Minister gave notice under subsection (1), the Minister may direct the health resource provider to enter into an accountability agreement with the Minister and with any other health resource provider on such terms as the Minister may determine, and the health resource provider shall enter into and shall comply with the accountability agreement.

Performance agreement

(6) An accountability agreement may provide that a health resource provider will enter into a performance agreement with its chief executive officer to support the achievement by the health resource provider of the terms of the accountability agreement.

Same

(7) If an accountability agreement requires that a health resource provider enter into a performance agreement, the health resource provider and its chief executive officer shall enter into a performance agreement within such period of time stipulated in the accountability agreement, and the terms of the performance agreement shall be consistent with the accountability agreement.

Exception - chief executive officer

(8) Despite subsection (7), a chief executive officer shall not be required to enter into a performance agreement except with respect to that part of the individual's appointment, employment or contract that relates to his or her function or position as a chief executive officer for the health resource provider.

Duty of health resource provider

(9) A health resource provider has a duty to take all reasonable care to ensure that its chief executive officer complies with any performance agreement and his or her duties under this Part, including taking such measures as may be necessary from time to time to enforce the health resource provider's rights under the performance agreement.

Notice of non-compliance - health resource provider

24. (1) The Minister may give notice in writing to a health resource provider where the Minister believes that any of the following circumstances have occurred:

1. A health resource provider has not entered into an accountability agreement as directed by the Minister under subsection 23 (5).

2. A health resource provider has not entered into a performance agreement with its chief executive officer as required under subsection 23 (7).

3. A chief executive officer has not entered into a performance agreement with a health resource provider as required under subsection 23 (7).

4. The terms of a performance agreement that a health resource provider and its chief executive officer have entered into or intend to enter into are not consistent with the terms of an accountability agreement as required under subsection 23 (7).

5. A health resource provider has not complied with a term of an accountability agreement.

6. A health resource provider has not complied with its duty under subsection 23 (9).

7. A health resource provider has not complied with a term of a performance agreement.

8. A chief executive officer has not complied with a term of a performance agreement, an order issued under subsection 28 (5) or any provision of this Part that a chief executive officer is required to comply with.

9. A health resource provider has not complied with a compliance directive, an order issued under section 26, or an order issued under subsection 27 (1).

10. A health resource provider has not complied with any provision of this Part.

Contents of notice

(2) A notice under subsection (1) shall briefly describe,

(a) the circumstance that has led the Minister to give the notice; and

(b) any directions that the Minister proposes to make to the health resource provider in a compliance directive or an order under subsection 27 (1).

Restriction

(3) The Minister shall not give a notice under subsection (1) that proposes to make directions in an order under subsection 27 (1) unless,

(a) a compliance directive has been issued in respect of the circumstance or a related circumstance that is referred to in the notice; or

(b) the circumstance referred to in the notice relates to non-compliance with,

(i) a compliance directive,

(ii) an order made under subsection 27 (1), or

(iii) an order made under subsection 28 (5).

Process of dispute resolution

(4) After receiving a notice under subsection (1), where a health resource provider disputes any matter set out in the notice,

(a) the Minister and the health resource provider shall discuss the circumstances that resulted in the notice or any directions that are proposed in the notice;

(b) the Minister shall provide to the health resource provider any information that the Minister believes,

(i) is appropriate for the Minister to disclose to the health resource provider, and

(ii) is necessary to an understanding of the circumstances referred to in the notice or the directions that are proposed in the notice; and

Consideration

(5) The Minister shall consider any representations made under subsection (4) before making a decision to issue a compliance directive or an order under subsection 27 (1).

Exception

(6) Subsections (1) to (5) do not apply to the issuance of an order under subsection 27 (1) if the Minister believes that,

(a) a circumstance described in subsection (1) exists which urgently requires that an order under subsection 27 (1) be issued to a health resource provider and the circumstance is,

(i) exceptional and unlikely to occur in the future, or

(ii) causing or likely to cause harm to any person or property;

(b) it is reasonable not to follow the procedures set out in subsections (1) to (5); and

(c) it is necessary to issue an order under subsection 27 (1) to a health resource provider to remedy the circumstance or alleviate the effects of the circumstance.

Compliance directives - health resource provider

25. (1) If any circumstance referred to in a notice under subsection 24 (1) continues for more than 30 days after the notice was given by the Minister, the Minister may issue a compliance directive to the health resource provider.

Compliance

(2) The health resource provider shall comply with a compliance directive.

Directions

(3) A compliance directive may require the health resource provider to comply with any directions set out in the compliance directive relating to the following:

1. Requiring the health resource provider to enter into an accountability agreement with the Minister on the terms set out in the compliance directive.

2. Requiring the health resource provider to enter into a performance agreement.

3. Requiring the health resource provider to comply with a provision of this Part, a term of an accountability agreement, or a term of a performance agreement.

4. Requiring the health resource provider to meet with the Minister or any person designated by the Minister, at a time and place set out in the compliance directive, for the purposes of discussing any non-compliance identified by the Minister.

5. Requiring the health resource provider to carry out or cause to be carried out an audit, as directed by the Minister.

6. Requiring the health resource provider to study and to report to the Minister on any matter as directed by the Minister.

7. Requiring the health resource provider to provide any information identified in the compliance directive to the Minister or to otherwise assist the Minister or any person authorized by the Minister to conduct an audit or carry out a study or report in respect of the operations of the health resource provider.

8. Requiring the health resource provider to develop or implement an education or remedial learning plan for the health resource provider, or to follow an educational or remedial learning plan.

9. Requiring the development of a budget for the review and approval of the Minister as set out in the compliance directive.

10. Requiring compliance with a budget as set out in the compliance directive.

11. Requiring the posting and distribution of any matter as required by subsection 31 (2).

12. Taking any action or refraining from taking any action that is specified in the compliance directive to correct the circumstance of non-compliance described in the notice under subsection 24 (1), to prevent its reoccurrence, or to remedy any effects of the circumstance of non-compliance.

Times

(4) In any compliance directive, the Minister may specify the time or times when or the period or periods of time within which the health resource provider must comply with the directive.

Directions not in notice

(5) Despite subsection 24 (2), a compliance directive may set out a direction that the Minister did not propose in the notice under subsection 24 (1).

Varying

(6) The Minister may vary a compliance directive after it is issued if the change relates to a circumstance referred to in the notice under subsection 24 (1).

Recognition of accomplishment

26. If a health resource provider meets or exceeds all or part of the terms of an accountability agreement, the Minister may, in his or her discretion, make an order directing that the accomplishment be recognized in any prescribed manner.

Order - health resource provider

27. (1) If the circumstance referred to in a notice under subsection 24 (1) continues for more than 30 days after the notice was given by the Minister and the Minister proposed in the notice to issue an order under this section, or if no notice was given by virtue of subsection 24 (6), the Minister may issue an order to the health resource provider.

Compliance

(2) The health resource provider shall comply with an order issued under subsection (1).

Matters in order

(3) An order issued under subsection (1) may require the health resource provider to comply with any directions set out in the order relating to any or all of the following:

1. Requiring a health resource provider to comply with any part of a compliance directive that has been issued to the health resource provider.

2. Requiring a health resource provider to comply with any direction that may be made in a compliance directive.

3. Holding back, reducing or discontinuing any payment payable to or on behalf of a health resource provider by the Crown in any manner and for any period of time as provided in the order and despite any provision in a contract to the contrary.

4. Requiring a health resource provider to enforce any provision of a performance agreement with a chief executive officer.

5. Varying any term of an agreement, as set out in the order, between the Crown and the health resource provider.

Times for compliance

(4) In an order under this section, the Minister may specify the time or times when or the period or periods of time within which the health resource provider must comply with the order.

Direction not in notice

(5) An order under this section may set out a direction that the Minister did not propose in the notice under subsection 24 (1).

Varying

(6) The Minister may vary an order after it is issued if the changes relate to a circumstance which caused the order to be issued under subsection (1).

Orders without notice

(7) If, by virtue of subsection 24 (6), the Minister did not give notice under subsection 24 (1) before issuing an order under this section, the Minister shall, as soon as reasonably possible after issuing the order, provide the health resource provider with,

(a) reasons for the issuance of the order;

(b) the matters that the Minister took into account in making his or her decision to issue an order; and

(c) the matters that caused the Minister to form his or her belief under subsection 24 (6) and to not follow the procedures set out in subsections 24 (1) to (5).

No delegation

(8) Despite subsection 3 (3) of the Ministry of Health and Long-Term Care Act, the Minister shall not delegate the power to issue an order under subsection (1).

Notice in exceptional circumstance

28. (1) The Minister may give notice in writing to a chief executive officer and a health resource provider where,

(a) the Minister has issued a compliance directive or an order under subsection 27 (1) to a health resource provider in respect of non-compliance by the health resource provider under the accountability agreement or any provision of this Part or by its chief executive officer under a performance agreement or any provision of this Part which the chief executive officer is required to comply with;

(b) the Minister believes that the health resource provider has not complied with an accountability agreement or any provision of this Part or the chief executive officer has not complied with a performance agreement or has not complied with a provision under this Part which the chief executive officer is required to comply with, despite a compliance directive or an order under subsection 27 (1); and

(c) the Minister believes that, even though attempts have been made to require the health resource provider or chief executive officer to comply, an exceptional circumstance may exist which may require that an order be issued under subsection (5) to the chief executive officer and the health resource provider.

Contents of notice

(2) A notice under subsection (1) shall briefly describe,

(a) the reasons for the notice; and

(b) any directions that the Minister proposes to recommend be made in an order under subsection (5).

Dispute resolution process

(3) After receiving a notice under subsection (1), where a chief executive officer or a health resource provider disputes any matter set out in the notice,

(a) the Minister and the health resource provider and the chief executive officer shall discuss the circumstances that resulted in the notice or any directions that are proposed in the notice;

(b) the Minister shall provide to the chief executive officer and the health resource provider any information that the Minister believes is necessary to an understanding of the reasons for the notice or the directions that are recommended in the notice; and

(c) the chief executive officer or the health resource provider may make representations to the Minister about the matters set out in the notice.

Consideration

(4) The Minister shall consider any representations made under subsection (3) before making a recommendation to issue an order under subsection (5).

Order in exceptional circumstances

(5) The Lieutenant Governor in Council may make an order to the chief executive officer and the health resource provider, where,

(a) the Lieutenant Governor in Council believes that an exceptional circumstance exists which makes it necessary to issue an order;

(b) a period of 30 days has passed since the Minister gave notice under subsection (1) and the circumstance of non-compliance that caused the notice under subsection (1) to be issued has not been remedied to the satisfaction of the Minister;

(d) the Minister has notified the chief executive officer and the health resource provider that he or she has made the recommendation to the Lieutenant Governor in Council and the reasons for the recommendation.

Directions

(6) An order issued under subsection (5) may require the chief executive officer and health resource provider to comply with any directions set out in the order relating to any or all of the following:

1. Holding back, reducing or varying the compensation package provided to or on behalf of a chief executive officer in any manner and for any period of time as provided for in the order and despite any provision in a contract to the contrary.

2. Requiring a chief executive officer to pay any amount of his or her compensation package to the Crown or any person.

Compliance

(7) A chief executive officer and a health service provider shall comply with the directions set out in the order.

Times

(8) In an order under subsection (5), the Lieutenant Governor in Council may specify the time or times when or the period or periods of time within which the chief executive officer and health service provider must comply with the order.

Direction not in notice

(9) An order under subsection (5) may set out a direction that the Minister did not propose in the notice under subsection (1).

Varying

(10) The Lieutenant Governor in Council may vary an order after it is issued if the change relates to a circumstance which caused the order to be issued under subsection (5).

Maximum limit

(11) An order issued under subsection (5) shall not require the payment by the chief executive officer of more than, or shall not hold back, reduce or vary the compensation package by more than, 10 per cent of the compensation package in respect of the calendar year during which the non-compliance occurred which caused the notice under subsection (1) to be given.

Prohibition

(12) Where an order is issued under subsection (5) that holds back, reduces or varies the compensation package of a chief executive officer or requires the chief executive officer to make a payment,

(a) no person shall provide any payment, compensation or benefit to the health resource provider or the chief executive officer or to any other person on behalf of the health resource provider or the chief executive officer to compensate for or reduce or alleviate the effects of the order on the chief executive officer, despite any provision at law or in a contract to the contrary; and

(b) the health resource provider or the chief executive officer shall not accept or permit any other person to accept on its or his or her behalf any compensation, payment or benefit to compensate for or to reduce or alleviate the effects of the order on the chief executive officer, despite any provision at law or in a contract to the contrary.

Civil enforcement

(13) An order under subsection (5) that requires a chief executive officer to pay an amount may be filed by the Minister with a local registrar of the Superior Court of Justice and enforced by the Minister as if it were an order of that court.

Same

(14) Section 129 of the Courts of Justice Act applies in respect of an order filed with the Superior Court of Justice, and the date of filing shall be deemed to be the date of the order.

Where change in employment

29. (1) Where, as the result of entering into a performance agreement under subsection 23 (7) or the making of an order made under subsection 27 (1) or 28 (5), there is a material change in a chief executive officer's terms of employment with a health resource provider, including a holdback, reduction or variation of the compensation package or a payment by the chief executive officer,

(a) the change shall be deemed to have been mutually agreed upon by the chief executive officer and the health resource provider;

(b) no proceeding shall be brought by or on behalf of the chief executive officer for any payment, compensation, benefits or damages from the health resource provider, the Minister or any other person, despite any provision to the contrary at law or in his or her contract of employment; and

(c) the chief executive officer shall not receive any payment, compensation, benefits or damages from the health resource provider, the Minister or any other person, despite any provision to the contrary at law or in his or her contract of employment.

Services

(2) Subsection (1) applies with necessary modification to a contract or agreement for services between a health resource provider and a chief executive officer.

Where change in funding, agreement, etc.

30. Where, as the result of an order made under subsection 27 (1), any funding or payment by the Crown to a health resource provider is withheld, reduced or discontinued, or any term of a contract or agreement between the Crown and a health resource provider is varied, the reduction, variance or discontinuance,

(a) shall be deemed to have been mutually agreed upon by the parties; and

(b) does not entitle the health resource provider to payment or compensation, despite any provision to the contrary at law or in the contract or agreement.

Information

31. (1) For the purposes of carrying out the provisions of this Part, the Minister may require any health resource provider or chief executive officer to provide the Minister with a performance agreement or any information that the Minister considers necessary other than personal health information, in such form and at such times as the Minister may require, and the health resource provider or chief executive officer shall comply with the Minister's requirement.

Posting and distribution

(2) A health resource provider shall post in a conspicuous place or distribute all or part of any accountability agreement, notice under subsection 24 (1), compliance directive, order issued under section 27 (1), notice under subsection 28 (1) or order issued under subsection 28 (5) when required to do so by the Minister, even if this results in the disclosure of personal information.

Public disclosure

(3) The Minister shall disclose to the public all or part of any accountability agreement, notice under subsection 24 (1), representations under subsection 24 (5), compliance directive, order issued under subsection 27 (1), notice under subsection 28 (1), representations under subsection 28 (3), order issued under subsection 28 (5) or any enforcement action taken by the Minister even if personal information is contained in what is disclosed, if the Minister is of the opinion that disclosure would promote accountability.

Offence

(4) Every person who fails to provide a performance agreement or information as provided in subsection (1) or refuses to post or distribute as required by subsection (2) is guilty of an offence and on conviction is liable to a fine of not more than $10,000.

Definition of "personal health information"

(5) In subsection (1),

"personal health information" means information, other than information referred to in subsection (6), that is in oral or recorded form, if the information,

(a) is information that identifies an individual or for which it is reasonably foreseeable in the circumstances that it could be utilized, either alone or with other information, to identify an individual, and

(b) is information that,

(i) relates to the physical or mental health of the individual, including information that consists of the medical history of the individual's family,

(ii) relates to the providing of health care to the individual, including the identification of a person as a provider of health care to the individual,

(iii) is a plan of service within the meaning of the Long-Term Care Act, 1994 for the individual,

(iv) relates to payments or eligibility for health care in respect of the individual,

(v) relates to the donation by the individual of any body part or bodily substance of the individual or is derived from the testing or examination of any such body part or bodily substance,

(vi) is the individual's health number, or

(vii) identifies an individual's substitute decision-maker.

Exception

(6) "Personal health information" does not include identifying information contained in a record that is in the custody or under the control of a person if,

(a) the identifying information contained in the record relates primarily to one or more employees or other agents of the person; and

(b) the record is maintained primarily for a purpose other than the provision of health care or assistance in providing health care to the employees or other agents.

Non-liability

32. (1) No compensation or damages shall be payable by the Crown, the Minister or an employee or agent of the Crown or Minister for any act done in good faith in the execution or intended execution of a duty or authority under this Part or the regulations, or for any alleged neglect or default in the execution in good faith of any such duty or authority.

Same

(2) No action or proceeding for damages or otherwise, other than an application for judicial review, shall be instituted against the Crown, the Minister or an employee or agent of the Crown or Minister for any act done in good faith in the execution or intended execution of a duty or authority under this Part or the regulations or for any alleged neglect or default in the execution in good faith of any such duty or authority.

Offence

33. (1) Subject to subsection (2), every health resource provider that fails to comply with an order under subsection 27 (1), every health resource provider or chief executive officer who fails to comply with an order made under subsection 28 (5), every person who fails to comply with subsection 28 (12) and every person who wilfully attempts to circumvent or obstruct compliance with an order under subsection 27 (1) or 28 (5) is guilty of an offence.

Exception

(2) Despite subsection (1), where a health resource provider consists of a board of trustees of a non-profit oriented entity, an individual member of the board of trustees is not liable to a conviction for failing to comply with an order under subsection 27 (1), if that individual receives no compensation of any kind for being a member of the board of trustees.

Penalty - individual

(3) An individual who is convicted of an offence under this section is liable to a fine of not more than $10,000.

Penalty - corporation

(4) A corporation that is convicted of an offence under this section is liable to a fine of not more than $25,000.

Regulations

34. (1) The Lieutenant Governor in Council may make regulations,

(a) prescribing anything that may be prescribed for the purposes of this Part;

(b) respecting the content or terms and conditions of any accountability agreement;

Same

Exemptions

(3) A regulation under this Part may provide for exemption from the application of any provision of this Part.

Public consultation before making regulations

35. (1) Subject to subsection (7), the Lieutenant Governor in Council shall not make any regulation under section 34 unless,

(b) the notice complies with the requirements of this section;

(d) the Minister has considered whatever comments and submissions that members of the public have made on the proposed regulation, or an accurate synopsis of such comments; and

(e) the Minister has reported to the Lieutenant Governor in Council on what, if any, changes to the proposed regulation the Minister considers appropriate.

Contents of notice

(2) The notice mentioned in clause (1) (a) shall contain,

(a) a description of the proposed regulation and the text of it;

(c) a description of any other methods by which a person may comment on the proposed regulation and the manner in which and the time period during which they may do so;

(d) a statement of where and when members of the public may review written information about the proposed regulation;

(e) any prescribed information; and

(f) any other information that the Minister considers appropriate.

Time period for comments

Shorter time period for comments

(4) The Minister may shorten the time period if, in the Minister's opinion,

(a) the urgency of the situation requires it;

(b) the proposed regulation clarifies the intent or operation of this Part or the regulations; or

Discretion to make regulations

No public consultation

(6) The Minister may decide that subsections (1) to (5) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 34 if, in the Minister's opinion,

(a) the urgency of the situation requires it;

(b) the proposed regulation clarifies the intent or operation of this Act or the regulations; or

Same

(7) If the Minister decides that subsections (1) to (5) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 34,

(a) those subsections do not apply to the power of the Lieutenant Governor in Council to make the regulation; and

(b) the Minister shall give notice of the decision to the public as soon as is reasonably possible after making the decision.

Contents of notice

(8) The notice mentioned in clause (7) (b) shall include a statement of the Minister's reasons for making the decision and all other information that the Minister considers appropriate.

Publication of notice

(9) The Minister shall publish the notice mentioned in clause (7) (b) in The Ontario Gazette and give the notice by all other means that the Minister considers appropriate.

Temporary regulation

(10) If the Minister decides that subsections (1) to (5) should not apply to the power of the Lieutenant Governor in Council to make a regulation under section 34 because the Minister is of the opinion that the urgency of the situation requires it, the regulation shall,

(a) be identified as a temporary regulation in the text of the regulation; and

(b) unless it is revoked before its expiry, expire at a time specified in the regulation, which shall not be after the second anniversary of the day on which the regulation comes into force.

No review

Exception

Time for application

(13) No person shall make an application under subsection (12) with respect to a regulation later than 21 days after the day on which,

(a) the Minister publishes a notice with respect to the regulation under clause (1) (a) or subsection (9), where applicable; or

(b) the regulation is filed, if it is a regulation described in subsection (10).

PART IV
AMENDMENTS TO HEALTH INSURANCE ACT

Health Insurance Act amended

36. Section 15 of the Health Insurance Act, as amended by the Statutes of Ontario, 2000, chapter 42, Schedule, section 17 and 2001, chapter 8, section 32, and section 16 of the Act, as amended by the Statutes of Ontario, 2000, chapter 42, Schedule, section 18 and 2001, chapter 8, section 33, are repealed and the following substituted:

Billing - physicians

15. (1) A physician shall submit all of his or her accounts for the performance of insured services rendered to an insured person directly to the Plan in accordance with and subject to the requirements of this Act and the regulations, unless an agreement under subsection 2 (2) provides otherwise.

Requirements where Plan billed

(2) Where a physician submits his or her accounts directly to the Plan under this section,

(a) payment shall be made,

(i) directly to the physician, or

(ii) as the physician directs in accordance with section 16.1; and

(b) the payment by the Plan for the insured services rendered to an insured person constitutes payment in full of the account.

Where s. 2 (2) applies

(3) Where an account is submitted to the Plan in accordance with subsection 2 (2) with respect to insured services rendered to an insured person, the payment by the Plan constitutes payment in full of the account.

Billing - practitioners

15.1 (1) A designated practitioner shall submit all of his or her accounts for the performance of insured services directly to the Plan in accordance with and subject to the requirements of this Act and the regulations, unless an agreement under subsection 2 (2) provides otherwise.

Same - non-designated

(2) A non-designated practitioner shall submit directly to the Plan that part of his or her account for insured services rendered to an insured person that is payable by the Plan, unless an agreement under subsection 2 (2) provides otherwise.

Requirements where Plan billed

(3) Where a practitioner submits his or her accounts directly to the Plan under this section,

(a) payment shall be made,

(i) directly to the practitioner, or

(ii) as the practitioner directs in accordance with section 16.1;

(b) in the case of a designated practitioner, the payment by the Plan for the insured services performed constitutes payment in full of the account; and

(c) in the case of a non-designated practitioner, the payment by the Plan for that part of his or her account for an insured service rendered to an insured person that is payable by the Plan constitutes payment in full of that part of the account.

Where s. 2 (2) applies

(4) Where an account is submitted to the Plan in accordance with subsection 2 (2) with respect to insured services rendered to an insured person, the payment by the Plan constitutes payment in full of the account.

Interpretation

(5) In this section,

"designated practitioner", "non-designated practitioner" and "practitioner" have the same meanings as in Part II of the Commitment to the Future of Medicare Act, 2004.

Transitional

15.2 (1) The following rules apply with respect to a physician or designated practitioner to whom subsection 11 (7) of the Commitment to the Future of Medicare Act, 2004 applies:

1. Sections 15 and 15.1 do not apply to him or her.

2. Subsections 15 (5), 16 (5), 16.1 (2), 17 (2), 25 (2) to (9), and 27.2 (3) and (4), as applicable, as they existed immediately before their repeal by the Commitment to the Future of Medicare Act, 2004 continue to apply to the physician or designated practitioner, as the case may be, as if they had not been repealed, except in respect of any prescribed accounts or classes of accounts, and subject to any prescribed circumstances or conditions.

3. Where, under subsection 27.2 (3), the physician or designated practitioner is required to temporarily submit his or her accounts directly to the Plan, the submission of the accounts is not a deemed election for the purposes of subsection 11 (6) of the Commitment to the Future of Medicare Act, 2004, but subsection 10 (3) of that Act applies to him or her during the time that he or she is temporarily required to submit accounts directly to the Plan.

4. All other applicable provisions of this Act apply to the physician or designated practitioner.

Same

(2) Where a physician or designated practitioner to whom section 11 of the Commitment to the Future of Medicare Act, 2004 applies submits his or her accounts for the rendering of insured services to insured persons directly to the Plan, subsections 25 (2) to (9) of this Act, as they existed before their repeal, apply to him or her with respect to accounts submitted before he or she commenced submitting his or her accounts directly to the Plan.

Interpretation

(3) In this section,

"physician" and "designated practitioner" mean a physician or designated practitioner within the meaning of Part II of the Commitment to the Future of Medicare Act, 2004.

Billing numbers

16. (1) An account or claim submitted in the name of a physician or practitioner in conjunction with the billing number issued to the physician or practitioner, and any payment made pursuant to the account or claim is deemed to have been,

(a) submitted personally by the physician or practitioner;

(b) paid to the physician or practitioner personally;

(d) made by and submitted with the consent and knowledge of the physician or practitioner.

Health facilities

(2) Subsection (1) applies with necessary modifications to health facilities.

Applies despite direction

(3) This section applies despite a direction given pursuant to section 16.1.

Exception

(4) This section does not apply to an account, claim or payment in the circumstances and on the conditions prescribed in the regulations.

Definition

(5) In this section,

"billing number" means the unique identifying number issued by the General Manager to a physician, practitioner or health facility for the purpose of identifying the accounts or claims for insured services rendered by that physician, practitioner or health facility.

Same

37. Subsection 16.1 (2) of the Act, as enacted by the Statutes of Ontario, 2000, chapter 42, Schedule, section 19, is repealed.

Same

38. Subsection 17 (2) of the Act, as re-enacted by the Statutes of Ontario, 1996, chapter 1, Schedule H, section 11, is repealed.

Same

39. Section 19.1 of the Act, as enacted by the Statutes of Ontario, 1993, chapter 32, section 2 and amended by 1996, chapter 1, Schedule H, section 14, is repealed.

Same

40. (1) Subsection 25 (2) of the Act, as amended by the Statutes of Ontario, 2002, chapter 18, Schedule I, section 8, is repealed.

(2) Subsection 25 (3) of the Act, as re-enacted by the Statutes of Ontario, 2002, chapter 18, Schedule I, section 8, is repealed.

(3) Subsections 25 (4), (5), (6) and (7) of the Act are repealed.

(4) Subsections 25 (8) and (9) of the Act, as amended by the Statutes of Ontario, 2002, chapter 18, Schedule I, section 8, are repealed.

Same

41. Subsections 27.2 (3) and (4) of the Act, as enacted by the Statutes of Ontario, 1996, chapter 1, Schedule H, section 21, are repealed.

Same

42. The Act is amended by adding the following section:

Filing with court

38.1 A copy of any of the following may be filed with the Superior Court of Justice after the time in which an appeal may be made has passed, and once filed shall be entered in the same way as a judgment or order of the Superior Court of Justice and is enforceable as an order of that court:

1. A decision of the General Manager made under this Act.

2. A decision of the Appeal Board made under this Act.

Same

43. (1) Clause 45 (1) (m) of the Act is amended by striking out "may" and substituting "shall".

(2) Clause 45 (1) (n) of the Act is amended by striking out "may" and substituting "shall".

(3) Section 45 of the Act, as amended by the Statutes of Ontario, 1993, chapter 32, section 2, 1994, chapter 17, section 72, 1996, chapter 1, Schedule H, section 35 and 1999, chapter 10, section 2, is amended by adding the following subsections:

Ministerial order

(2.1) Upon the advice of the General Manager, and where the Minister considers it to be in the public interest to do so, the Minister may make an order amending a schedule of fees or benefits that has been adopted in a regulation in any manner the Minister considers appropriate for the purposes of the regulation.

Duration

(2.2) An order made under subsection (2.1) remains in force until the earliest of the following events occurs:

1. The order is cancelled by an order made under subsection (2.3).

2. A regulation is made adopting a schedule of fees or benefits or an amendment to the schedule of fees or benefits in which essentially the same subject-matter is addressed.

3. Twelve months have elapsed from the making of the order.

Cancellation

(2.3) Upon the advice of the General Manager, and where the Minister considers it to be in the public interest to do so, the Minister may make an order cancelling an order under subsection (2.1).

Not a regulation

(2.4) An order made under subsection (2.1) or (2.3) is not a regulation for the purposes of the Regulations Act, but has the same effect as if the schedule of fees or benefits as amended by the order had been adopted by regulation.

Publication

(2.5) The Minister shall publish an order made under subsection (2.1) or (2.3) in The Ontario Gazette, and in any other manner the Minister considers appropriate, and the order is effective from the publication date of the issue of the Gazette in which publication is made, unless paragraph 2 or 3 of subsection (2.2) applies first.

Variation

(2.6) An amendment made by an order under subsection (2.1) may be varied at any time by regulation.

Restriction

(2.7) An order under subsection (2.1) may not be made more than once with respect to essentially the same subject-matter.

PART V
REPEAL, COMMENCEMENT, SHORT TITLE

Repeal

44. The Health Care Accessibility Act, as amended, is repealed.

Commencement

45. (1) Subject to subsections (2) and (3), this Act comes into force on the day it receives Royal Assent.

Same

(2) Sections 1 to 6, 8 to 20 and 36 to 44 come into force on a day to be named by proclamation of the Lieutenant Governor.

Same

(3) Section 28 comes into force two years after this Act receives Royal Assent.

Short title

46. The short title of this Act is the Commitment to the Future of Medicare Act, 2004.

EXPLANATORY NOTE

This Explanatory Note was written as a reader's aid to Bill 8 and does not form part of the law. Bill 8 has been enacted as Chapter 5 of the Statutes of Ontario, 2004.

Part I of the Bill provides for the establishment of the Ontario Health Quality Council, provides for its functions and reporting, and gives a framework to make regulations concerning the organization and work of that Council.

Part II replaces the Health Care Accessibility Act. Among the provisions of this Part, restrictions are placed on the receiving of payments by physicians and certain health service practitioners from sources other than the Plan under the Health Insurance Act, and remedies are provided for dealing with overpayments.

Part III establishes a framework dealing with the entering into of accountability agreements and the issuance of compliance directives. Rewards for compliance and remedies for non-compliance are provided for.

Part IV makes assorted amendments to the Health Insurance Act, most of them complementary to Part II.

Part V repeals the Health Care Accessibility Act, and provides for the commencement and short title of the Bill.

[38] Bill 8 As Amended by Standing Committee (PDF)

Bill 8 2004

CONTENTS


Preamble
PART I ONTARIO HEALTH QUALITY COUNCIL
1. 2. 3. 4. 5. 6. 6.1	Interpretation Council No personal liability Functions of Council Reports Regulations Public consultation before making regulations
PART II HEALTH SERVICES ACCESSIBILITY
7. 8. 9. 9.1 10. 11. 12. 13. 14. 15. 16. 17. 18.	Definitions General Manager Persons not to charge more than OHIP Transitional Agreement for determining amount Unauthorized payment Entitlement to review Personal information Disclosure of information to the General Manager Preferences Block fees Offence Regulations
PART III ACCOUNTABILITY
19. 20. 21. 21.1 22. 25. 26. 26.1 27. 28. 29. 30. 31. 32. 32.1	Definitions Governing principle Accountability agreements Notice of non-compliance - health resource provider Compliance directives - health resource provider Recognition of accomplishment Order - health resource provider Notice in exceptional circumstance Where change in employment Where change in funding, agreement, etc. Information Non-liability Offence Regulations Public consultation before making regulations
PART IV AMENDMENTS TO HEALTH INSURANCE ACT
33. - 40.		Health Insurance Act amended
PART V REPEAL, COMMENCEMENT, SHORT TITLE
41. 42. 43.	Repeal Commencement Short title
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