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SNL1999 CHAPTER M-5.1

MEDICAL CARE INSURANCE ACT, 1999

Amended:

2001 c9; 2004 cC-5.1 s17; 2012 c33 s2; 2013 c16 s25

CHAPTER M-5.1

AN ACT TO REVISE THE ADMINISTRATION OF MEDICAL CARE INSURANCE

(Assented to December 14, 1999)

Analysis



Be it enacted by the Lieutenant-Governor and House of Assembly in Legislative Session convened, as follows:

Short title

        1. This Act may be cited as the Medical Care Insurance Act, 1999.

1999 cM-5.1 s1

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Definitions

        2. In this Act

             (a)  "beneficiary" means a person who is so defined under regulations made under section 21 and includes a dependant of a beneficiary;

             (b)  "dental association" means the Newfoundland Dental Association continued under theDental Act;

             (c)  "dependant" means a person who is a resident and depends upon another resident for maintenance;

             (d)  "insured services" means the services so defined under regulations made under section 20;

             (e)  "medical association" means the Newfoundland and Labrador Medical Association;

             (f)  "participating physician" means a physician who has not made an election, under subsection 7(3), to collect payments in respect of insured services rendered by him or her to residents, otherwise than from the minister;

             (g)  "physician" means a person who is lawfully entitled to practise medicine in the province and includes a person who, under the regulations, is entitled to provide insured services;

          (g.1)  "professional medical corporation" means a corporation that is permitted under Part III of the Medical Act to provide the services of a medical practitioner;

             (h)  "resident" means a person lawfully entitled to be or to remain in Canada, who makes his or her home and is ordinarily present in the province, but does not include a tourist, transient or visitor to the province; and

              (i)  "specialist" means a physician who is recognized as a specialist by the Newfoundland Medical Board or a physician practising outside the province who is recognized as a specialist by the appropriate body in the jurisdiction where the physician practises.

1999 cM-5.1 s2; 2001 c9 s12

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Confidentiality of information

        3. (1) A person employed in the administration of this Act shall preserve secrecy with respect to all matters that come to his or her knowledge in the course of that person's employment and shall not communicate the matters to another person, including a person employed by the government, except

             (a)  to a physician for a purpose relating to insured services that he or she has provided;

         (a.1)  to a professional medical corporation and its directors, officers and employees for a purpose relating to insured services that the corporation has provided;

             (b)  for the purpose of the administration of this Act;

             (c)  for purpose of consultation between the minister and the medical association or the dental association;

             (d)  to a person who is empowered by a statute which requires disclosure of information;

             (e)  at the discretion of the minister to a person engaged in health or medical research;

          (e.1)  for the purpose of releasing information, including personal  information as defined in the Access to Information and Protection of Privacy Act , to the Newfoundland and Labrador Centre for Health Information in accordance with the Centre for Health Information Act and regulations made under that Act; or

             (f)  in other circumstances that may be prescribed by the Lieutenant-Governor in Council.

             (2)  A person to whom information is provided under paragraph (1)(e) shall not publish or disclose the information where the publication or disclosure may be detrimental to the personal interest or privacy of a person.

             (3)  A person who contravenes subsection (2) is guilty of an offence and liable on summary conviction to a fine not exceeding $100 and in default of payment to a term of imprisonment not exceeding 30 days.

             (4)  The Crown is not liable for damages caused to a person as a result of the release of information under subsection (1).

             (5)  An action for defamation against the minister or an employee of the department may not be founded on the publication or disclosure of information released under subsection (1).

1999 cM-5.1 s3; 2001 c9 s13; 2004 cC-5.1 s17

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Medical plans

        4. (1) The minister shall administer a plan of medical care insurance for the residents of the province.

             (2)  Where a dental program or other services relating to the health of the public are established, the minister shall be responsible for the supervision, direction and control of those programs.

1999 cM-5.1 s4

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Duty of residents to register

        5. (1) Every resident other than a dependant shall, where required by the regulations, register himself or herself and the resident's dependants at the place, in the manner and form and at the times that may be prescribed by the regulations.

             (2)  A resident who fails to comply with subsection (1) or who wilfully withholds information necessary for the purpose of registration or who wilfully gives false information to the person registering him or her is guilty of an offence and liable on summary conviction to a fine not exceeding $100 and, in default of payment, to imprisonment for a term not exceeding 6 months, or to both a fine and imprisonment.

1999 cM-5.1 s5

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Actions barred

        6. An action shall not lie against a physician or a professional medical corporation providing insured services in respect of information provided to the minister with respect to an insured service provided to a beneficiary.

1999 cM-5.1 s6; 2001 c9 s14

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Physicians to submit accounts

        7. (1) Where a participating physician renders an insured service to a beneficiary, the physician shall submit his or her account for the service to the minister, together with the information that is required to substantiate the claim upon the forms that are prescribed by the minister for that purpose.

             (2)  The physician shall supply further patient information where the minister requires it to clarify or substantiate the physician's claim.

             (3)  A physician may, in writing, notify the minister of his or her election to collect payments in respect of insured services rendered by the physician to residents otherwise than from the minister.

             (4)  Where a physician makes an election under subsection (3) within one month from the date on which he or she first becomes entitled to practise medicine in the province, the election shall have effect on and from the date when the physician becomes entitled to practise medicine in the province.

             (5)  An election under subsection (3) shall have effect on and from the first day of the first month beginning after the expiration of 60 days after the date on which the minister receives the notice of election.

             (6)  A physician who has made an election under subsection (3) may revoke the election by written notice to the minister.

             (7)  A revocation of election under subsection (6) shall have effect on and from the first day of the first month beginning after the expiration of 60 days after the date on which the minister receives the notice of revocation.

1999 cM-5.1 s7

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Payment to physicians

        8. (1) Where a participating physician provides insured services to beneficiaries, he or she shall accept payment from the minister in respect of the insured services so provided, and the physician shall accept the payment as payment in full for those services.

             (2)  The minister may make regulations for the purpose of this subsection authorizing a participating physician providing services to beneficiaries to make the charges against beneficiaries receiving insured services that are specified in the regulations.

             (3)  Where a participating physician who is a specialist provides insured services to a beneficiary who has not been referred to the specialist by

             (a)  a physician; or

             (b)  by a person authorized by the minister to refer a beneficiary to a specialist,

the participating physician may make charges against that beneficiary in excess of the amount paid or payable to him or her by the minister to the extent of charges authorized by regulations made by the minister for the purpose of this subsection provided he or she so informs the beneficiary before providing the insured services.

1999 cM-5.1 s8

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Professional medical corporation

      8.1 (1) Notwithstanding a provision of this Act or the regulations, a professional medical corporation may submit accounts and be paid by the minister in respect of insured services rendered by a participating physician through the professional medical corporation to a beneficiary.

             (2)  A professional medical corporation submitting accounts shall comply with sections 7 and 8 of this Act as if it were a participating physician.

             (3)  Where a professional medical corporation submits an account for insured services, every participating physician whose services are included in that account is considered to have certified that the information provided about his or her services is accurate and true.

2001 c9 s15

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Rights

        9. Nothing in this Act or in the regulations shall

             (a)  interfere with or restrict the right of a beneficiary to select the physician, or other person providing services, from whom he or she will receive insured services;

             (b)  interfere with or restrict the right of a physician, or other person providing services, to accept or refuse to accept a patient who is a beneficiary; or

             (c)  interfere with or restrict the right of a physician, or other person providing services, to make charges for insured services provided to a patient who is not a beneficiary.

1999 cM-5.1 s9

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Payment for services

      10. (1) The minister shall, under this Act and the regulations, make payment for the providing of insured services to beneficiaries.

             (2)  Where a participating physician as an individual or through a professional medical corporation  provides insured services to a beneficiary, the minister shall make payment to the physician or professional medical corporation for the services, but where a participating physician performs professional services for a public authority or body that has received the prior approval of the minister, in addition to the provision of insured services to beneficiaries, the minister may, upon being satisfied that the participating physician is receiving remuneration for the provision by him or her of those professional services, enter into an arrangement with the public authority or body providing for the payment to it for the insured services so provided to beneficiaries, and the minister shall make the payment in accordance with the arrangements made.

             (3)  Where an insured service is provided in the province to a beneficiary by other than a participating physician as an individual or through a professional medical corporation, the minister shall make payment to the beneficiary in respect of that insured service.

             (4)  Where an insured service is provided in the province to a person who is an insured resident of another jurisdiction in Canada by other than a participating physician as an individual or through a professional medical corporation, the responsibility for payment will not rest with the medical care plan of this province.

             (5)  The right of the beneficiary to receive payment from the minister in respect of insured services provided in the province by other than a participating physician, as an individual or through a professional medical corporation, is a contractual right and the beneficiary is entitled to receive payment from the minister in respect of those services in an amount equal to the amount payable, for similar services, to a participating physician by the minister under the regulations.

1999 cM-5.1 s10; 2001 c9 s16

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Right not to be assigned or attached

      11. The right of a beneficiary to receive payment from the minister in respect of insured services provided in the province to a beneficiary shall not be assigned, and a sum owing in respect of the right shall not be charged or attached, and a transaction purporting to assign the right or to charge or attach the sum is void.

1999 cM-5.1 s11

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Non-application of Act

      12. (1) Where a physician providing insured services is not a participating physician, and the physician provides an insured service to a beneficiary, the physician is not subject to this Act or the regulations relating to the provision of insured services to beneficiaries or the payment to be made for the services except that he or she shall

             (a)  before providing the insured service, if he or she wishes to reserve the right to charge the beneficiary for the service an amount in excess of that payable by the minister under this Act, inform the beneficiary that he or she is not a participating physician and that the physician may so charge the beneficiary; and

             (b)  provide the beneficiary to whom the physician has provided the insured service with the information required by the minister to enable payment to be made under this Act to the beneficiary in respect of the insured service.

             (2)  Where a physician who is not a participating physician provides insured services through a professional medical corporation, the professional medical corporation is not, in relation to those services, subject to this Act or the regulations relating to the provision of insured services to beneficiaries or the payment to be made for the services and the professional medical corporation and the physician providing the insured services shall comply with subsection (1).

1999 cM-5.1 s12; 2001 c9 s17

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Non-liability of minister

      13. (1) An action shall not lie against the minister with respect to an act or omission, relating to the providing of insured services under this Act, of a physician, professional medical corporation or other person providing those services or of a person in the employ or acting on behalf of a physician, professional medical corporation or other person.

             (2)  An action shall not lie against a member of a medical or other committee serving the minister in a consultative or advisory capacity in respect of anything done or omitted to be done in good faith in the performance of the duties of the member.

1999 cM-5.1 s13; 2001 c9 s18

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Penalties for false statements

      14. (1) A physician providing insured services, to a beneficiary, who wilfully makes a false statement in a report, form or return required to enable a payment to be made under this Act or the regulations is guilty of an offence and liable on summary conviction to a fine of not less than $100 nor more than $500.

             (2)  A person, other than a physician providing insured services to a beneficiary, who wilfully makes a false statement in a report, form or return prescribed by or required for the purpose of this Act or the regulations is guilty of an offence and liable on summary conviction to a fine of not less than $100 nor more than $500.

             (3)  A professional medical corporation that makes a false statement in a report, form or return required to enable a payment to be made under this Act or the regulations is guilty of an offence and liable on summary conviction to a fine of not less than $2,000 and not more than $10,000.

             (4)  The liability of a physician under subsection (1) is not affected because the physician provides services through a professional medical corporation.

1999 cM-5.1 s14; 2001 c9 s19

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Notification of default

      15. (1) Where, after an inquiry, the minister finds or has reasonable cause to believe that

             (a)  a participating physician or professional medical corporation has been convicted of an offence under this Act;

             (b)  a participating physician or professional medical corporation has submitted false statements in a report, form or return required to enable a payment to be made under this Act;

             (c)  the pattern of practice of a participating physician of a certain class or specialty or of a professional medical corporation in the whole or an area of the province deviates significantly from the average pattern of practice of physicians of a similar class or specialty or of a professional medical corporation in the whole or an area of the province as defined in the regulations made under section 21; or

             (d)  a claim for payment is made by a participating physician or professional medical corporation for services which are not insured services,

the minister shall notify the physician or professional medical corporation of his or her finding or belief in writing by registered mail and shall state the reasons for that finding or belief in the notification.

             (2)  Within 30 days from the date of the notification referred to in subsection (1), the physician or professional medical corporation may make written representations to the minister upon matters contained in the notification, and may in the representation request a hearing by a review board established under subsection (5).

             (3)  After considering the written representations made by a physician or professional medical corporation under this section, the minister shall either

             (a)  revoke allegations made in the notification sent under subsection (1), and notify the physician or professional medical corporation accordingly; or

             (b)  consult with the medical association or the dental association by referring to it in writing the allegations raised by the minister in the notification made under subsection (1), and require the association to make those representations that it may consider appropriate in the circumstances within 14 days from the date of dispatch of the written referral.

             (4)  Where a hearing is requested under subsection (2), the minister shall, except in the case of a revocation of the allegations under paragraph (3)(a), give the physician or professional medical corporation an opportunity of appearing before and being heard by a review board established under subsection (5).

             (5)  The review board referred to in subsection (4) shall consist of  3 members, one of whom shall be appointed by the minister, one of whom shall be appointed by the physician or professional medical corporation, where the request for a hearing is made by a physician or professional medical corporation, or one of whom shall be appointed by the dentist, where the request for a hearing is made by a dentist, and one of whom shall be appointed jointly by the minister and the physician or professional medical corporation or the minister and the dentist, whichever is appropriate, drawn from the panel appointed under subsection (7) but where the minister and the physician or professional medical corporation or the minister and the dentist cannot agree the last person rejected by either of them shall be considered to be their nominee.

             (6)  A review board established under subsection (5) shall have power to direct the procedure adopted at the hearing, which procedure shall permit the minister and the physician, professional medical corporation or dentist to be represented by a solicitor or other person, to lead evidence from witnesses and to produce documents, and for the purpose of the hearing each member of the committee shall be considered to be a commissioner and shall have all the powers of a commissioner appointed under the Public Inquiries Act.

             (7)  The Lieutenant-Governor in Council shall appoint a panel of persons to act as members of a review board consisting of  up to 15  persons, 5 of whom shall be physicians and 2 of whom shall be dentists selected from lists of nominees provided by the medical association and the dental association respectively.

             (8)  The members of the panel appointed under subsection (7) shall be appointed for a term of 3 years and are eligible for reappointment.

         (8.1)  Where the term of a member of the panel expires, he or she continues to be a member until reappointed or replaced.

             (9)  The review board established under subsection (5) shall make a report to the minister containing its findings and the report shall also contain recommendations.

          (10)  Except in the case of a revocation of allegations under paragraph (3)(a), the minister may after considering

             (a)  the representation made to it by the medical association or the dental association under the consultation under paragraph (3)(b); and

             (b)  where a hearing is held by a review board established under subsection (5), the report of the review board,

make an order which may include one or more of the following:

             (c)  withholding from a physician, who is a participating physician, or professional medical corporation all or a part of the money which at the date of the order has been claimed to be due in respect of insured services under subsection 10(2), but which, following the notification and procedure set out under this section, have been found by the minister to be in respect of services to which paragraphs (1)(b), (c) and (d) apply;

             (d)  estimating and imposing on the physician or professional medical corporation a penalty of an amount not exceeding the amount of a loss sustained by the Crown because of a payment to the physician, professional medical corporation or the beneficiary for services which are, or are related to, the subject of the notification under subsection (1), together with 10% of the amount of the loss, and, for the purpose of this paragraph, the estimate shall, subject to proof to the contrary or appeal in accordance with section 17, be considered to be the actual loss sustained;

             (e)  considering the physician to be a physician who is not a participating physician for the purpose of this Act either permanently or for the period that may be stated in the order; and

             (f)  reducing the amount payable to a participating physician or professional medical corporation for insured services by the percentage and in respect of the period that may be specified in the order.

          (11)  An order made under subsection (10) is in addition to another penalty or fine that may be prescribed under this Act.

          (12)  An order made under subsection (10) shall be served by the minister by registered mail upon the physician or professional medical corporation affected by it, and a copy of the order shall be sent by the minister to the medical association or the dental association.

          (13)  A physician in respect of whom an order is in force under paragraph (10)(e) shall, for the purpose of this Act, be considered to be a physician who is not a participating physician, and subsection 10(3) shall apply to all beneficiaries, in respect of whom insured services are provided by that physician.

1999 cM-5.1 s15; 2001 c9 s20; 2012 c33 s2

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Joint and individual liability

   15.1 Where an order is made under section 15 against a professional medical corporation, a physician who provided services which are, or are related to, the subject of the notification in respect of which the order was made, is jointly and individually liable with the professional medical corporation for the penalty imposed on the corporation.

2001 c9 s21

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Debt due the Crown

   15.2 A penalty imposed on a physician or professional medical corporation under section 15 or 15.1 is recoverable by action in a court as a debt due to the Crown.

2001 c9 s21

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Withholding of payments

      16. Where a notification is made by the minister under subsection 15(1), the minister may withhold from payments which would, apart from allegations to the contrary contained in the notification, be due to be paid to a participating physician or professional medical corporation under subsection 10(2) for the provision of insured services, up to the amount which, in the opinion of the minister, constitutes the value of the subject matter raised by the notification, but only until the matter has been finally determined, subject always to the right of permanent retention or withholding for the purpose of compliance with an order made under paragraphs 15(10)(c), (d) and (f).

1999 cM-5.1 s16; 2001 c9 s22

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Appeal

      17. (1) A physician or professional medical corporation aggrieved by an order of the minister under section 15 may, within 60 days from the date of the order, appeal against the order to a judge of the Trial Division by filing a notice of appeal with the court, and by serving a copy of the notice of appeal on the minister.

             (2)  Notwithstanding a rule or practice to the contrary, the notice of appeal shall

             (a)  set out in detail the allegations of the appellant and the grounds upon which the order is appealed against; and

             (b)  be signed by the appellant or his or her solicitor.

             (3)  The appellant shall within 14 days after service of the notice of appeal under this section, apply to the judge for the appointment of a day for the hearing of the appeal and shall not less than 14 days before the hearing serve upon the minister a written notice of the day appointed for the hearing.

             (4)  The minister shall produce to the judge hearing the appeal all papers and documents in his or her possession affecting the subject matter of the appeal.

             (5)  The judge shall hear the appeal and the evidence brought forward before him or her by the appellant, the Crown and the minister in a summary manner, and after considering all aspects which the judge, in his or her discretion considers appropriate to consider in the interests of justice, equity and fairness, decide the matter of the appeal by

             (a)  upholding, amending or revoking the order; or

             (b)  making another decision which he or she considers to be appropriate in the circumstances,

and with power also to make orders as to costs for or against the appellant or the Crown and to fix the amount.

             (6)  An appeal may be taken from an order or decision of the judge to the Court of Appeal upon a point of law raised on the hearing of the appeal, and the rules governing appeals to that court from an order or decision of a judge of the Trial Division apply to appeals under this subsection.

             (7)  The filing of a notice of appeal under this section or the appeal itself shall not affect the order of the minister which shall remain in force pending the outcome of the appeal.

1999 cM-5.1 s17; 2001 c9 s23; 2013 c16 s25

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Levy

      18. (1) This section applies where insured services are provided with respect to an injury or disability where the injury or disability was caused by, or contributed to by, or results from, a motor vehicle accident occurring on or after this section comes into force in which the person, whose fault, negligence or other wrongful act or omission caused, contributed to or resulted in the injury or disability, is insured, at the date of the accident, by a policy of third party liability insurance through a licensed insurer carrying on business in the province.

             (2)  In this section

             (a)  "earned vehicles" means the aggregate exposure, in car years, for automobile liability coverage derived from all statistical experience reported and accepted by the Superintendent of Insurance under all types of business other than type 3, miscellaneous and fleets on an earnings, receipts or payroll basis, for those vehicle types exhibited annually in the Actual Loss Ratio Exhibits covering the general categories of private passenger, farmers, commercial, motor cycles, snow vehicles and interurban trucks; and

             (b)  "levy year" means a calendar year in which a levy is due from insurance companies with respect to automobile insurance business transacted in the province.

             (3)  The minister shall impose a levy to be paid by every licensed motor vehicle insurer with respect to each vehicle insured by that insurer for the purpose of recovering insured services incurred by insured persons as a result of personal injury or disability where the injury or disability was caused by, or contributed to by, or results from, motor vehicle accidents.

             (4)  Every licensed insurer who carries on the business of automobile insurance in the province shall, in respect of each levy year, pay to the minister a levy determined by multiplying the base rate per vehicle by the number of earned vehicles at the end of each levy year.

             (5)  Every licensed insurer liable to pay a levy under subsection (4) shall before the last day of March, June, September and December in each levy year pay 1/4 of the levy estimated to be payable as calculated by the minister or his or her representative by reference to the number of earned vehicles and the base rate per vehicle for the immediately preceding levy year.

             (6)  Where a licensed insurer provides the minister with satisfactory proof that the actual earned vehicle count will vary significantly from the previous year on which the estimated levy is based, the minister may adjust the estimated levy.

             (7)  The Superintendent of Insurance shall provide annually to the minister, a report detailing actual automobile experience including the number of earned vehicles and the number of claims for every licensed insurer as provided under the Insurance Companies Act .

             (8)  Based on the report in subsection (7), the minister shall issue an adjustment invoice or credit as applicable to licensed insurers in respect of the immediately preceding levy year payable or refundable within 30 days of issuance.

             (9)  Where the levy is not paid in full on the due date, the licensed insurer shall pay to the minister, interest on the unpaid portion calculated at the rate of prime plus 2% from the due date of payment.

          (10)  The insurer shall pay a levy payable under this section prior to the issuance or renewal of a licence under the Insurance Companies Act .

          (11)  An amount payable under this section and unpaid constitutes a debt due the Crown and the minister may sue for its recovery in a court in the province.

          (12)  The minister may make regulations

             (a)  establishing an initial base rate per vehicle on the coming into force of this section;

             (b)  establishing a formula for the determination of the base rate for each vehicle in subsequent years;

             (c)  defining words and phrases not defined in this section required to give effect to the section; and

             (d)  generally, to give effect to the purpose of this section.

1999 cM-5.1 s18

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Recovery of costs for services

      19. (1) This section applies where insured services are provided to an injured or disabled person, in this section referred to as the "insured person", with respect to an injury or disability where the injury or disability was caused by, or contributed to by, or results from an occurrence other than a motor vehicle accident in which the person, whose fault, negligence or other wrongful act or omission caused, contributed to or resulted in the injury or disability, in this section referred to as the "tortfeasor", is insured at the date of the accident, by a policy of insurance through a licensed insurer carrying on business in the province.

             (2)  An insured person who receives insured services in respect of an injury or disability caused or contributed to by or resulting from the fault, negligence or other wrongful act or omission of a tortfeasor has the same right to recover the cost of those insured services from the tortfeasor as he or she would have had if the person had himself or herself been required to pay for the services.

             (3)  An insured person who, under subsection (1), recovers from another person the whole or a part of the cost of insured services shall, on recovery from that other person, pay to the minister the amount recovered and the minister may, if the amount so recovered is not paid to it within a reasonable time, recover the amount from the insured person as a debt due the Crown.

             (4)  Where the cost of insured services referred to in subsection (1) is paid, or an agreement has been entered into covering payment, by the minister to a person, physician or professional medical corporation or where the services are provided by a person employed in the department, the minister is subrogated to all rights of recovery of or on behalf of the insured person against the tortfeasor and may bring an action in his or her own name or in the name of the insured person to enforce those rights against the tortfeasor in respect of the cost of the insured services.

             (5)  The rights conferred upon the minister by subsection (4) shall not be considered to restrict other rights of recovery of the insured person in respect of the injury or disability referred to in subsection (1) for loss or damage not the subject of insured services and if the insured person starts an action in respect of that loss or damage he or she shall include a claim on behalf of the minister for the cost of the insured services provided to the insured person.

             (6)  It is not a defence to an action brought by the minister under subsection (4) that a claim for damages has been adjudicated upon unless that claim included a claim for the sum paid for insured services, and it is not a defence to an action for damages for personal injuries brought by an insured person that an action taken by the minister under subsection (4) has been adjudicated upon.

             (7)  A release or settlement of claim which includes the cost of insured services is not effective unless the minister has consented to the release or settlement or unless the minister is satisfied with the provisions of the release or settlement.

             (8)  The costs of an action by or on behalf of an insured person in which a claim has been included on behalf of the minister under subsection (5) shall be borne by the minister in the same proportion as the claim of the minister for the cost of insured services provided bears to the total claim by or on behalf of the insured person in the action.

             (9)  If within 2 months after the last act or omission which caused the injury or disability of an insured person an action has not been started by or on behalf of that person under subsection (1) for the recovery of damages arising out of the injury or disability, the minister upon service of notice on the insured person may start an action in his or her own name or in the name of that person for the recovery of the cost of the insured services, and before trial of the action that person may join in the action another claim arising out of the same occurrence upon the conditions as to costs or otherwise that to the court may seem just and may in that case effect settlement of that claim.

          (10)  A liability insurer shall pay to the minister an amount referable to a claim for recovery of the cost of insured services that would otherwise be payable to an insured person and payment of that amount to the minister discharges the liability of the insurer to pay that amount to the insured person or to a person claiming under or on behalf of the insured person.

          (11)  For the purpose of subsection (10) a "liability insurer" means a person regularly engaged in the business of underwriting risks in respect of negligence.

          (12)  Where as a result of a claim under this section there are insufficient funds to provide complete recovery to an insured person for his or her losses or injury and to pay the cost of insured services, that person and the minister shall share to that extent in proportion to their respective losses in a recovery, but nothing in this provision prevents the minister from waiving in whole or in part its share of an amount recovered where in the opinion of the minister the circumstances so warrant.

          (13)  For the purpose of this section,

             (a)  "insured services" means insured services as defined in the regulations made under this Act;

             (b)  "participating province" means a participating province as defined by theCanada Health Act (Canada ); and

             (c)  the cost of insured services provided is,

                      (i)  in the province, or a participating province, the cost as established by the minister, and

                     (ii)  elsewhere than in the province or a participating province, the cost calculated at a rate which, in the opinion of the minister, is fair having regard of the services provided.

1999 cM-5.1 s19; 2001 c9 s24

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Regulations

      20. The Lieutenant-Governor in Council may make regulations

             (a)  defining which medical services in the province provided or authorized by a physician are insured services for the purpose of this Act;

             (b)  prescribing which services are not insured services for the purpose of this Act;

             (c)  prescribing the facilities in which insured services may be provided; and

             (d)  notwithstanding anything contained in this Act, adapting, modifying, qualifying or altering the provisions of this Act to meet the requirements of the Canada Health Act (Canada) for the purpose of rendering the medical care insurance plan of the province one in respect of which a contribution is payable by Canada under the Canada Health Act (Canada).

1999 cM-5.1 s20

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Regulations by minister

      21. (1) The minister may make regulations

             (a)  to prevent unnecessary use or abuse of insured services;

             (b)  providing for the investigation of complaints of violations of this Act or regulations made under this Act or of an order made under this Act or the regulations;

             (c)  providing for the holding of inquiries into a complaint referred to in paragraph (b) or into the operation of this Act or into a charge or complaint that a person has contravened this Act or the regulations made under this Act, or has made a false statement in a form, return, account or statement required to be completed or made under this Act, or into another matter arising in the administration of this Act, and providing that the person holding the inquiry shall have the powers that may be conferred upon a commissioner under the Public Inquiries Act, including the power to take evidence under oath or affirmation;

             (d)  prescribing the waiting period that must elapse before a resident becomes a beneficiary and the other conditions to be observed by a resident in order that he or she may qualify as a beneficiary;

             (e)  defining what residents are beneficiaries for the purpose of this Act;

             (f)  providing for the furnishing to the Minister of Health for Canada of the information and at the times that the minister may require for the purpose of the Canada Health Act (Canada );

             (g)  respecting the registration of residents for the purpose of this Act;

             (h)  defining

                      (i)  the terms and conditions relating to the provision of dental and other health related services, and

                     (ii)  to what extent and under what circumstances dental and other health related services shall be paid for by the minister;

              (i)  prescribing, by reference to professional or other scales of fees, the rates of payments to be made under this Act in respect of insured services provided to beneficiaries by physicians, with power to prescribe

                      (i)  varying rates for different classes of physicians or for the same class of physicians in different circumstances or locations, and

                     (ii)  payments by scale or reference to scale either on a fixed level or on a diminishing or increasing basis throughout or at a point on the scale;

              (j)  governing the method of assessing accounts submitted by physicians, professional medical corporations and other persons;

             (k)  following consultation with the medical association and the dental association, prescribing a formula for the determination of the average pattern of practice for the whole or an area of the province and defining the words "pattern of practice" for the purpose of paragraph 15 (1)(c);

              (l)  respecting the manner and form in which accounts shall be rendered and in which other information required in connection with the accounts shall be submitted;

           (m)  respecting the manner and form in which payments to physicians, professional medical corporations and other persons shall be made under this Act;

        (m.1)  respecting the application of this Act to a professional medical corporation;

             (n)  prescribing for the purpose of paragraph 2 (g) which persons are entitled to provide insured services;

             (o)  respecting the manner in which persons may be identified as beneficiaries; and

             (p)  generally, to give effect to the purpose of this Act.

             (2)  Regulations made under paragraph (1)(i) do not constitute subordinate legislation for the purpose of the Statutes and Subordinate Legislation Act .

1999 cM-5.1 s21; 2001 c9 s25

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Offence and penalty

      22. The Lieutenant-Governor in Council may, in regulations made under section 20 , and the minister may, in regulations made under section 21 , provide that a person who contravenes a specified provision of the regulations is guilty of an offence and may prescribe penalties to which the person is liable, on summary conviction, for failing to comply with or otherwise contravening the provisions of the regulations.

1999 cM-5.1 s22

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Date of effect of regulations

      23. Regulations made under section 20 or 21 may be made with retroactive effect.

1999 cM-5.1 s23

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Consultation with medical association

      24. The medical association and the dental association shall be consulted by the minister with reference to the rates of payments to be made under this Act in respect of insured services provided to beneficiaries by physicians, the manner and form in which the payments to physicians shall be made and changes in connection with payments and, where the minister considers it necessary, with reference to general questions of principle concerning the practise of medicine.

1999 cM-5.1 s24

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Plan to be non-profit

      25. The plan of medical care insurance under this Act shall be administered and operated on a non-profit basis.

1999 cM-5.1 s25

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Offence

      26. (1) A person who contravenes this Act, or the regulations that are required to be published in the Gazette , is guilty of an offence and where no penalty is specifically provided in this Act or the regulations, liable on summary conviction in the case of a first conviction to a fine not exceeding $100 and in the case of a second or subsequent conviction for a similar offence to a fine not exceeding $200 and, in either case, in default of payment to imprisonment for a term not exceeding 3 months.

             (2)  For the purpose of subsection (1) a conviction is not considered to be a second or subsequent conviction unless it is in respect of an offence committed within 12 months after a prior offence.

1999 cM-5.1 s26

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Physician liability

   26.1 It is not a defence to a prosecution of a physician for an offence under section 26 that insured services were provided through a professional medical corporation or that a claim for payment in respect of service provided by that physician were submitted by a professional medical corporation.

2001 c9 s26

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Successor to commission

      27. (1) The Crown is the successor in law to the Newfoundland Medical Care Commission established under the Medical Care Insurance Act .

             (2)  The assets and liabilities of the commission are the assets and liabilities of the Crown.

1999 cM-5.1 s27

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Repeal

      28. The Medical Care Insurance Act is repealed.

1999 cM-5.1 s28

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Commencement

      29. This Act comes into force on a day to be proclaimed by the Lieutenant-Governor in Council.  (In force - Apr. 1/00)

1999 cM-5.1 s29