Medicare Protection Act
[includes amendments up to B.C. Reg. 222/2002]
Contents
Part 1 — Definitions
1 In this regulation:
"commission" in Parts 4, 5 and 6 includes a special committee exercising the powers, duties or functions of the commission specified by the Lieutenant Governor in Council under section 5 (1) of the Medicare Protection Act;
"definition" means the definition of "resident" in section 1 of the Medicare Protection Act.
Part 2 — Beneficiaries
2 The following persons are deemed to be residents for the purposes of the definition:
(a) a person admitted to Canada as a student who,
(i) at the time of admission possesses a valid student authorization issued under the Immigration Act (Canada) for 6 or more months,
(ii) continues to retain such valid authorization, and
(iii) meets the criteria under paragraphs (b) and (c) of the definition;
(b) a person admitted to Canada to work who,
(i) at the time of admission possesses a valid employment authorization issued under the Immigration Act (Canada) for 6 or more months,
(ii) continues to retain such valid authorization, and
(iii) meets the criteria under paragraphs (b) and (c) of the definition;
(c) a diplomat accredited to represent another country in Canada who meets the criterion under paragraph (c) of the definition;
(i) is a spouse or child of a resident if the person has applied for permanent resident status and as long as the application remains active, and
(ii) meets the criteria under paragraphs (b) and (c) of the definition;
(e) a person who is a spouse or child of a resident if the person meets the criteria under paragraphs (b) and (c) of the definition and
(i) the resident has filed with Citizenship and Immigration Canada an undertaking to assist the person and paid the fee required by Citizenship and Immigration Canada, and
(ii) the application of the person for permanent resident status remains active;
(f) a child adopted, or being adopted, by a resident if the child meets the criteria under paragraphs (b) and (c) of the definition;
(g) a person who has applied for permanent resident status and as a result has been issued a permit by the federal minister responsible for immigration if
(i) issuance of the permit has been recommended by the committee established by the minister responsible for the Medicare Protection Act to review the admissibility of persons on medical grounds, and
(ii) the person meets the criteria under paragraphs (b) and (c) of the definition;
(h) a person who moves to British Columbia and meets the criteria under paragraphs (a) and (b) of the definition, but not that under paragraph (c) of the definition because the person arrived in British Columbia after June 30 in the calendar year;
(i) a person who moves to British Columbia and would be deemed to be a resident under paragraphs (a) to (g) of this section except that the criterion under paragraph (c) of the definition is not met because the person arrived in British Columbia after June 30 in the calendar year;
(j) a spouse or child of a person deemed to be a resident under paragraph (a), (b), (c) or (g) of this section if the spouse or child meets the criteria
(i) under paragraphs (b) and (c) of the definition, or
(ii) under paragraph (b) of the definition but not that under paragraph (c) of the definition because the spouse or child arrived in British Columbia after June 30 in the calendar year.
3 (1) Subject to subsections (2) and (3), a person who is absent from British Columbia to attend a university, college or other educational institution is deemed to be a resident for the purposes of the definition if
(a) the university, college or other educational institution is recognized by the commission,
(b) the person is in attendance at that educational institution on a basis recognized by the commission as full time, and
(c) at the time of leaving, the person meets the criteria under
(i) paragraphs (a) to (c) of the definition, or
(ii) paragraphs (a) and (b) of the definition and was physically present in Canada for 6 of the 12 months immediately preceding departure.
(2) If the university, college or other educational institution in subsection (1) is outside Canada, the following restrictions apply:
(a) approval by the commission for status as a resident during the absence from Canada must be obtained prior to the person leaving British Columbia;
(b) the period for which approval by the commission is given may not exceed a total of 60 months.
(3) Subsection (1) ceases to apply to a person attending a university, college or other educational institution outside Canada within one month of the earlier of
(a) the last day of the month in which the person ceased to be in full time attendance at such educational institution, or
(b) the last day of the 60th month following the date of departure from British Columbia.
(4) A spouse or child of a deemed resident under subsection (1) who accompanies that deemed resident is also deemed to be a resident for the purposes of the definition if, at the time of leaving British Columbia, the spouse or child meets the criteria under subsection (1) (c) or section 2 (d) to (g).
4 (1) A person who is absent from British Columbia for vacation or work for more than 6 months is deemed to be a resident for the purposes of the definition for up to the initial 12 consecutive months of absence if the person
(a) obtains prior approval from the commission for status as a resident during the absence,
(b) does not establish residency outside British Columbia,
(c) has not been granted approval under this subsection during the preceding 60 months, and
(d) at the time of leaving, meets the criteria under
(i) paragraphs (a) to (c) of the definition, or
(ii) paragraphs (a) and (b) of the definition and was physically present in Canada for 6 of the 12 months immediately preceding departure.
(2) A spouse or child of a deemed resident under subsection (1) who accompanies that deemed resident is also deemed to be a resident for the purposes of the definition if, at the time of leaving British Columbia, the spouse or child meets the criteria under section 2 (d) to (g).
(3) A person who is engaged in an occupation that requires the person to travel from location to location outside British Columbia for more than 6 months in a calendar year is deemed to be a resident for the purposes of the definition if the person
(a) obtains approval from the commission for status as a resident for the period specified by the commission prior to leaving British Columbia,
(b) does not establish residency outside British Columbia,
(c) continues to have British Columbia as his or her primary base for occupational purposes,
(d) meets the criteria under paragraphs (a) and (b) of the definition, and
(e) is physically present in British Columbia at least once a month or on a sufficient number of occasions to satisfy the commission that the person continues to reside in British Columbia.
(4) A person who is not physically present in British Columbia for 6 or more months in a calendar year, but is physically present in Canada for 6 or more months in a calendar year, is deemed to be a resident for the purposes of the definition if the person
(a) obtains prior approval from the commission for status as a resident for the period specified by the commission,
(b) does not establish residency outside British Columbia,
(c) at the time of leaving British Columbia, meets the criteria under paragraphs (a) to (c) of the definition, and
(d) is physically present in British Columbia on a sufficient number of occasions to satisfy the commission that the person continues to reside in British Columbia.
(5) A person who is a deemed resident under section 2 (d) to (g) at the time of leaving British Columbia continues to be deemed to be a resident for the purposes of the definition if the person is the spouse or child of a deemed resident under subsection (4) and accompanies that deemed resident.
5 (1) For a resident who is temporarily absent from British Columbia or a person who is deemed to be a resident under section 3 or 4, the commission may approve continued status as a resident for one further period if
(a) there are extenuating health circumstances which preclude return to British Columbia at that time, and
(b) the commission is satisfied that the person would have returned to British Columbia were it not for the extenuating circumstances.
(2) The further period referred to in subsection (1) must not exceed
(a) 6 months, if the resident is absent from Canada, and
(b) 12 months, if the resident is in Canada.
6 (1) Subject to subsection (2), if the commission determines that a person has permanently departed from British Columbia, that person continues to be a beneficiary until midnight on the last day of the month in which that person departed from British Columbia.
(2) If a person has permanently departed from British Columbia but continues to live in Canada, that person remains a beneficiary of British Columbia until the expiration of both
(a) a further 2 months ending at midnight of the last day of the second month following the period referred to in subsection (1), and
(b) a reasonable period of necessary travelling time.
7 The prescribed period for the purposes of section 7.1 of the Medicare Protection Act is 12 months.
Part 3 — Premiums
8 (1) For the purposes of section 8 of the Medicare Protection Act, the monthly premium rates for beneficiaries are
(a) $54 a month for a single beneficiary,
(b) $96 a month for a beneficiary and spouse or a beneficiary and one child, and
(c) $108 a month for a beneficiary, spouse and one or more children or a beneficiary and 2 or more children.
(2) The applicable premium must be paid on or before the last day of the month preceding the period for which the beneficiary is enrolled under section 7 of the Medicare Protection Act.
[am. B.C. Reg. 79/2002, s. 1.]
9 The prescribed rate for the purposes of section 8.1 of the Medicare Protection Act is the rate established from time to time under section 4 (2) of B.C. Reg. 214/83, the Interest on Overdue Accounts Receivable Regulation.
10 (1) No premiums are payable by a resident
(a) who is a recipient of income assistance under the BC Benefits (Income Assistance) Act, a youth allowance under the BC Benefits (Youth Works) Act or a disability allowance under the Disability Benefits Program Act or was such a recipient within the past 6 months,
(b) who is an inmate in a British Columbia correctional centre, as defined under the Correction Act,
(c) who is in a facility which is designated by the commission, or
(d) who is enrolled by an agency which is designated by the commission.
(2) No premiums are payable by a resident admitted to Canada as a convention refugee and holding permanent resident status as defined in the Immigration Act (Canada) until the resident
(a) is employed in Canada, or
(b) has resided in Canada for 12 months
whichever is sooner.
11 (1) For this section, "eligible person" means a beneficiary who satisfies the commission that he or she
(a) has, for the 12 consecutive months immediately prior to the date from which premium assistance is given, made his or her home in Canada and been a citizen of Canada or lawfully admitted to Canada for permanent residence,
(b) is not a child of a beneficiary,
(c) is not exempt from liability to pay income tax by reason of any other Act, and
(d) is not a person
(i) for whom medical, surgical or obstetrical care or diagnostic services are provided under an agreement or arrangement that the care or services are paid for by the government of British Columbia other than under the Hospital Insurance Act, or
(ii) for whose health and welfare care the government of Canada is responsible.
(2) In this section, "adjusted net income" means the net income of an eligible person in the immediately preceding taxation year as shown on his or her income tax return or notice of assessment and, if an eligible person has a spouse resident in British Columbia or elsewhere, means the combined net income of the eligible person and his or her spouse in the immediately preceding taxation year, adjusted by the following deductions:
(a) $3 000 for a dependent spouse;
(b) $3 000 for each of the eligible person and his or her spouse who has attained the age of 65 years on or before December 31 of the current taxation year;
(c) $3 000 for each dependent child minus one-half of the child care expense deduction the eligible person is entitled to claim under the Income Tax Act of Canada;
(d) $3 000 for each family member who had a disability within the meaning of the Income Tax Act of Canada during the immediately preceding taxation year.
(3) For the purposes of subsection (2), the net income of an eligible person who is a minor and supported by parents who are not beneficiaries is the sum of the net incomes of the eligible person and the parents of the eligible person.
(4) In this section, "family member" means the eligible person, or the eligible person's spouse or child, who has been enrolled under section 7 of the Medicare Protection Act.
(5) Subject to section 9, the percentage of premium payable by an eligible person is
(a) nil if the adjusted net income does not exceed $16 000,
(b) 20% if the adjusted net income exceeds $16 000 but does not exceed $18 000,
(c) 40% if the adjusted net income exceeds $18 000 but does not exceed $20 000,
(d) 60% if the adjusted net income exceeds $20 000 but does not exceed $22 000,
(e) 80% if the adjusted net income exceeds $22 000 but does not exceed $24 000, or
(f) 100% if the adjusted net income exceeds $24 000.
[am. B.C. Regs. 218/98; 79/2002, s. 2.]
12 Premium assistance for a beneficiary who is separated, divorced, widowed or has been otherwise abandoned by his or her spouse is determined, so long as that condition endures, on the basis of that beneficiary's adjusted net income, excluding the income of his or her spouse, despite the fact that, during the previous taxation year, that beneficiary's spouse was in receipt of an income.
13 (1) The commission may provide premium assistance to an eligible person, for a period approved by the commission, if the eligible person satisfies the commission that he or she is not able to pay the premium because of financial hardship and could not reasonably have budgeted for the premium.
(2) The commission may waive payment of the applicable premium for the approved period if undue hardship would otherwise result to the eligible person.
14 On application, the commission may retroactively extend premium assistance to an eligible person for the calendar year immediately preceding the year in which the application is made if eligibility for the calendar year is established.
[am. B.C. Reg. 312/98.]
15 (1) In this section, “CareCard” means the identity card that
(a) is issued by the commission to a person on enrollment with the plan, and
(b) contains the person’s personal health number,
and includes a Gold CareCard.
(2) A person must pay an application fee of $20 for a new CareCard if the card
(a) replaces a lost or stolen card,
(b) replaces a damaged card that was issued less than 5 years before the date of application,
(c) is a duplicate card, or
(d) makes a change to the personal data on the card which the person has requested but which is not necessary to properly identify the person.
(3) Subsection (2) (a), (b) and (c) does not apply to a person making a first application for a new CareCard if the person is receiving
(a) financial assistance under the BC Benefits (Income Assistance) Act, a youth allowance under the BC Benefits (Youth Works) Act or a disability allowance under the Disability Benefits Programs Act, or
(b) premium assistance under the Medicare Protection Act.
(4) Despite subsection (2), if an application is made for new CareCards for
(a) 2 persons in the same family at the same time, the fee is $34, and
(b) 3 or more persons in the same family at the same time, the fee is $50.
[am. B.C. Reg. 222/2002.]
Part 4 — Services of Health Care Practitioners
16 In this Part "adequate clinical record" means a record of a health care practitioner, prepared in accordance with the applicable payment schedule, that contains sufficient information to allow another practitioner of the same profession, who is unfamiliar with both the beneficiary and the attending practitioner, to determine from that record, together with the beneficiary's clinical records from previous encounters, information about the service provided to the beneficiary including:
(a) the date, time and location of the service;
(b) the identity of the beneficiary and the attending practitioner;
(c) if the service resulted from a referral, the identity of the referring practitioner and the instructions and requests of the referring practitioner;
(d) the presenting complaints, symptoms and signs, including their history;
(e) the pertinent previous history including family history;
(f) the positive and negative results of a systematic inquiry relevant to the beneficiary's problems;
(g) the identification of the extent of the physical examination and all relevant findings from that examination;
(h) the results of any investigations carried out during the encounter;
(i) the differential diagnosis, if appropriate;
(j) the provisional diagnosis;
(k) the summation of the beneficiary's problems and the plan for their management.
17 The following health care professions and occupations are prescribed for the purposes of paragraph (f) of the definition of "health care practitioner" in section 1 of the Medicare Protection Act:
(a) physical therapy;
(b) massage therapy;
(c) naturopathic medicine.
[am. B.C. Reg. 44 2/99, s. 3.]
18 Repealed. [B.C. Reg. 301/2001, s. 1.]
19 (1) Subject to section 27, a dental or orthodontic service is a benefit if the service is
(a) related to the remedying of a disorder of the oral cavity or a functional component of mastication,
(b) listed in a payment schedule for dentists and described in subsection (2),
(c) rendered by an enrolled dentist, and
(d) described in an adequate clinical record.
(2) The following apply for the purpose of subsection (1) (a) or (b)
(a) an oral surgical procedure rendered to a beneficiary who
(i) has been properly admitted to a hospital, or
(ii) is a patient under the Day Care Services Program
and for whom hospitalization is medically required for the safe and proper performance of the surgery,
(b) a medically required service rendered in association with, and followed by, an oral surgical procedure meeting the requirements of paragraph (a),
(c) a medically required service rendered by a specialist in oral medicine to a beneficiary with a severe systemic disease,
(d) orthodontic service provided by a dentist only if
(i) the beneficiary is 20 years of age or younger, and
(ii) the service arises as part of or following plastic surgical repair performed by a medical practitioner in the treatment of severe congenital facial abnormalities, or
(e) a dental technical procedure provided by a dentist if rendered in conjunction with an oral surgical procedure meeting the requirements of paragraph (a).
(3) There will not be payment for a service covered by subsection (2) (d) or (e) if performed outside British Columbia unless the service is rendered
(a) by a person authorized to practise dentistry in the place where the service is rendered,
(b) to a beneficiary who resides in British Columbia for whom the location for the service nearest the place of residence is outside British Columbia but in Canada, and
(c) following approval of payment of the service by the commission.
20 and 21 Repealed. [B.C. Reg. 301/2001, s. 1.]
22 (1) Subject to section 27, the extended role services of a registered nurse are benefits if
(a) an arrangement for the rendering and for the payment of these services is approved by the commission,
(b) a medical practitioner is not normally available at the place in British Columbia where these services are rendered, and
(c) the services are described in an adequate clinical record.
(2) A registered nurse performing the services described in subsection (1) is a health care practitioner for the purposes of paragraph (f) of the definition of "health care practitioner" in the Medicare Protection Act.
23 (1) Subject to subsection (2) and to section 27, the examination of a beneficiary's eyes is a benefit if the service is
(a) listed in a payment schedule for optometrists,
(b) rendered in British Columbia to a beneficiary,
(c) rendered by an enrolled optometrist, and
(d) described in an adequate clinical record.
(2) An examination referred to in subsection (1) is not a benefit unless the beneficiary
(a) suffers from a disease or condition, has experienced trauma or injury, or is using a medication which could reasonably be expected to cause a change in refractive status, or
(b) is under the age of 19 years or over the age of 64 years.
(3) For the purposes of this section
"examination of a beneficiary's eyes" includes
(a) the determination of the refractive status and all tests necessary for this determination,
(b) the determination of any observed abnormality in the visual system, and
(c) the provision of a written prescription if lenses are required;
"change in refractive status" means a change of not less than 0.5 dioptres to the spherical or cylinder lens, or a change in axis equal to or greater than
(a) 20 degrees for a cylinder lens of 0.50 dioptres or less,
(b) 10 degrees for a cylinder lens of more than 0.50 dioptres but not more than 1.0 dioptre, and
(c) 3 degrees for a cylinder lens of more than 1.0 dioptre.
[am. B.C. Reg. 247/2001.]
24 Repealed. [B.C. Reg. 301/2001, s. 1.]
25 (1) Subject to section 27, a surgical podiatric service is a benefit if the service is
(a) listed in a payment schedule for podiatrists,
(b) rendered in British Columbia to a beneficiary,
(c) rendered by an enrolled podiatrist, and
(d) described in an adequate clinical record.
(2) Repealed. [B.C. Reg. 301/2001, s. 2.]
[am. B.C. Reg. 301/2001, s. 2.]
25.1 (1) Subject to section 27, a chiropractic, massage, naturopathic, physical therapy or non-surgical podiatric service is a benefit if the service is
(a) listed in a payment schedule for supplemental services,
(b) rendered in British Columbia to a beneficiary who
(i) is receiving premium assistance under section 10, 11, 12 or 13, or
(ii) pays no premiums as a result of section 13,
(c) rendered by an enrolled health care practitioner, and
(d) described in an adequate clinical record.
(2) Subject to subsection (1), chiropractic, massage, naturopathic, physical therapy and non-surgical podiatric services are benefits up to a combined maximum of 10 visits during each calendar year.
[en. B.C. Reg. 301/2001, s. 3.]
26 Repealed. [B.C. Reg. 301/2001, s. 1.]
27 Benefits under the plan do not include services rendered by a health care practitioner that a person is eligible for and entitled to under
(a) the Aeronautics Act (Canada),
(b) the Civilian War Pensions and Allowances Act (Canada),
(c) the Government Employees Compensation Act (Canada),
(d) the Merchant Seaman Compensation Act (Canada),
(e) the National Defence Act (Canada),
(f) the Pension Act (Canada),
(g) the Royal Canadian Mounted Police Act (Canada),
(h) the Royal Canadian Mounted Police Pension Continuation Act (Canada),
(i) the Royal Canadian Mounted Police Superannuation Act (Canada),
(j) the Veterans Rehabilitation Act (Canada),
(k) the Penitentiary Act (Canada),
(l) the Workers Compensation Act,
(m) the Hospital Insurance Act, or
(n) the Insurance (Motor Vehicle) Act.
28 General hospital services provided by a health care practitioner under the Hospital Insurance Act or its regulations are not benefits.
29 (1) Services are not benefits if they are provided by a health care practitioner to the following members of the health care practitioner's family
(b) a son or daughter,
(c) a step-son or step-daughter,
(d) a parent or step-parent
(e) a mother-in-law or a father-in-law,
(f) a grandparent,
(h) a brother or sister, or
(i) a spouse of a person referred to in paragraph (b) to (h).
(2) Services are not benefits if they are provided by a health care practitioner to a member of the same household as the health care practitioner.
Part 5 — Direct Billing
30 For the purposes of section 18 of the Medicare Protection Act, a practitioner or other person on a practitioner's behalf may charge a beneficiary for
(a) the services of diagnostic facilities and practitioners which have not been determined under section 5 (1) (j) of the Medicare Protection Act to be benefits,
(b) the cost to a practitioner of therapeutic drugs, appliances, implants, materials or dental laboratory services if
(i) these items are related to a benefit but are not themselves benefits, and
(ii) the commission or special committee determines that the individual cost of these items is significant in comparison to the fee payable for the related benefit, and
(c) the difference between the amount that is actually paid under the appropriate payment schedule to a specialist and the amount that would have been payable under the appropriate payment schedule had the beneficiary been referred, in a case in which a specialist sees a beneficiary without a referral from a practitioner in a category approved by the commission.
Part 6 — Payment of Claims
31 A practitioner, other than a practitioner who has made an election under section 14 of the Medicare Protection Act or who is subject to an order under section 15 (2) (b) of the Medicare Protection Act, must submit a claim by an electronic data processing system, or other system, approved by the commission and
(a) is responsible for the accuracy of the information which is submitted, and
(b) must maintain and make available to the commission such sources of information as may be required by it, which must include
(i) the name and identity number of the beneficiary,
(ii) the practitioner number of the practitioner who personally rendered or was personally responsible for the benefit, and
(iii) the details of the benefit including, but not limited to an adequate clinical record, the location where the benefit was rendered, the length of time spent rendering the service and the diagnosis.
32 The commission may approve a system for submitting claims other than an electronic data processing system but only for a practitioner
(a) who bills for less than 2400 services per year, and
(b) whose gross billings total less than $72 000 per year.
33 For the purposes of section 27 (3) (a) of the Medicare Protection Act, the prescribed period is 90 days.
34 For the purposes of section 27 (3) (b) of the Medicare Protection Act, the prescribed period is 90 days.
35 A beneficiary is entitled to payment for the cost of services of a medical practitioner, as defined in section 29 of the Medicare Protection Act, which are rendered outside British Columbia if
(a) the beneficiary resides in British Columbia and the nearest convenient location for the service is outside British Columbia but within Canada, or
(b) authorization is obtained from the plan according to guidelines established by the commission.
36 (1) Payment under the plan for benefits on behalf of a beneficiary must be made directly to the practitioner who renders the benefit, except payment may be made
(a) to any person to whom a practitioner has assigned his or her right to collect his or her fees under the plan, or
(b) to a beneficiary who submits a substantiated claim as required by the commission in respect of a benefit as provided in section 10 (2) or 29 (4) of the Medicare Protection Act.
(2) An assignment made under subsection (1) (a) has no force or effect for purposes of the plan unless the commission approves of the terms and conditions of the assignment including the period of time for which the assignment is to be in effect, and a copy of the assignment is filed with the commission.
37 (1) For the purposes of sampling and confirming claims submitted for payment, the commission may request that a beneficiary or a practitioner verify the details of the benefit which is the subject of a claim.
(2) If a request for verification is made under subsection (1), a statement of a payment made under the plan for benefits will be mailed to the beneficiary who received the benefits, and the statement must show
(a) the name of the practitioner to whom the payment was made,
(b) the amount charged by the practitioner,
(c) the amount paid under the plan,
(d) the date or dates upon which the service or services were rendered, and
(e) the type or types of service rendered.
Part 7 — Diagnostic Facilities
38 (1) In paragraph (a) of the definition of "diagnostic facility" in section 1 of the Medicare Protection Act "prescribed diagnostic services, studies or procedures" means the services, studies or procedures of
(a) laboratory medicine,
(b) diagnostic radiology,
(c) diagnostic ultrasound,
(d) nuclear medicine scanning,
(e) pulmonary function,
(f) computerized axial tomography (CT, CAT),
(g) magnetic resonance imaging (MRI),
(h) positron emission tomography (PET), or
(i) electrodiagnosis, including electrocardiography, electroencephalography, and polysomnography.
"application", unless otherwise indicated, means an application for approval of
(a) a new diagnostic facility,
(b) the relocation of an existing diagnostic facility,
(c) an expansion of an existing diagnostic facility, or
(d) a transfer of a material financial interest in a diagnostic facility;
"material financial interest" means
(a) the interest of a sole proprietor,
(b) the interest of a partner, or
(c) an interest of more than 10% of the shares in the corporation;
"public diagnostic facility" means
(a) a hospital as defined in section 1 of the Hospital Act, or
(b) an establishment which has been designated a diagnostic and treatment centre under the Hospital Insurance Act
which provides diagnostic services prescribed in subsection (1);
"specimen collection station" means a facility for collection of laboratory specimens.
(3) For the purposes of this Part, a practitioner has a potential conflict of interest respecting a diagnostic facility who has a material or indirect financial interest in
(a) a diagnostic facility, existing or proposed, which is within the same catchment area and provides the same services as a public diagnostic facility at which the practitioner provides diagnostic services, or
(b) a diagnostic facility to which the practitioner could potentially refer beneficiaries for diagnostic services.
(4) For the purposes of this Part, a practitioner has an indirect financial interest in a diagnostic facility if
(a) the practitioner or the practitioner's nominee has a material financial interest in a corporation which has a material financial interest in a diagnostic facility,
(b) the practitioner is a partner of a person, is a member of a firm or is in the employment of a person or firm that has a material financial interest in a diagnostic facility, or
(c) a material financial interest in the diagnostic facility is held by the following members of the practitioner's family,
(ii) a son or daughter,
(iii) a step-son or step-daughter,
(iv) a parent or step-parent
(v) a mother-in-law or a father-in-law,
(vi) a grandparent,
(vii) a grandchild,
(viii) a brother or sister, or
(iv) a spouse of a person referred to in subparagraph (ii) to (viii),
and the practitioner is aware of the financial interest.
39 (1) In order to apply for approval of a diagnostic facility, a person who owns or intends to own a diagnostic facility must apply in writing to the commission at least 60 days prior to the date on which he or she requests the approval to be effective and must provide
(a) the proposed address of the diagnostic facility or, if it will be a mobile service, the specific addresses for the proposed services and the address of the base facility,
(b) a map showing the locations of the proposed diagnostic facility and all other diagnostic facilities of the same category, both public and private, located within the catchment area of the proposed facility, including specimen collection stations if applicable, and designating distances to these facilities, both in kilometres and in usual driving times,
(c) appropriate descriptions of the capabilities and capacities of the major equipment which is intended to be used in the diagnostic facility,
(d) the names of the owner and the medical director of the diagnostic facility,
(e) the names of all persons who have a material financial interest in the diagnostic facility and, if the persons are shareholders, the percentage of the shares which they own,
(f) information about any existing or potential conflict of interest,
(g) the names and qualifications of all medical, scientific, technical and supervisory staff employed by or providing occasional services at the diagnostic facility,
(h) the proposed hours of operation of the diagnostic facility, and
(i) a list and description of all quality control procedures planned for the facility, including quality control programs of a formal nature.
(2) If there is a transfer of material financial interest in a diagnostic facility, the facility must apply for, and have received a new approval prior to the material change in financial interest.
40 (1) The commission must not issue a certificate of approval for
(a) a new diagnostic facility,
(b) the relocation of an existing diagnostic facility, or
(c) the expansion of an existing diagnostic facility
unless it is satisfied that
(d) there is sufficient medical need to warrant the proposed services,
(e) the quality of diagnostic services will be maintained at a sufficiently high level,
(f) there is reasonable utilization of existing approved diagnostic facilities which render the services for which approval is sought and which are located within the catchment area under consideration, and
(g) the person applying for the certificate of approval does not have a potential conflict of interest.
(2) Subsection (1) (g) does not apply if the commission concludes that the service to be provided at the diagnostic facility for which the certificate of approval is sought can not reasonably be provided by another diagnostic facility for which a potential conflict of interest does not exist.
(3) If a transfer of a material financial interest in a diagnostic facility gives rise to a potential conflict of interest, the commission must not issue a certificate of approval for the transfer unless the services provided by the diagnostic facility for which the certificate of approval is sought could not reasonably be provided by another diagnostic facility for which a potential conflict of interest does not exist.
41 An approval, renewal of an approval or amendment of an approval
(a) must be communicated in writing to the owner of the diagnostic facility by registered mail addressed to the address of the diagnostic facility specified in the certificate of approval unless otherwise agreed to by the commission, and
(b) is effective from the date specified by the commission.
42 The commission may establish the period for which an approval or renewal of an approval applies.
43 (1) In addition to other conditions which may be specified by the commission under section 33 (1) (c) of the Medicare Protection Act, every approval granted after this Part comes into force is subject to the following conditions:
(a) the diagnostic facility must not submit a claim for any service under the payment number of a medical practitioner who has not rendered or supervised that service in accordance with paragraph (c) of the definition of "benefits" in the Medicare Protection Act;
(b) the diagnostic facility must not render benefits in respect of a beneficiary on the referral of a practitioner who, directly or indirectly, would receive financial profit or other material benefit as a result of those services being rendered by the diagnostic facility unless the certificate of approval issued to the diagnostic facility authorizes the diagnostic facility to accept referrals from that particular practitioner;
(c) the diagnostic facility must comply with diagnostic protocols and guidelines which are adopted and communicated by the commission from time to time;
(d) the diagnostic facility must not provide to its referring practitioners requisition forms which do not comply with requisition standards which are established by the commission from time to time;
(e) there must not be, without the prior approval of the commission,
(i) any change in the location of the diagnostic facility from that designated in the certificate of approval,
(ii) any significant changes in the diagnostic facility's operating hours or to its capability or capacity to perform diagnostic services, and
(iii) any transfer of material financial interest in the diagnostic facility;
(f) the standards of testing and analysis of the diagnostic facility, the number of skilled and qualified personnel employed by the diagnostic facility, the level of supervision by medical personnel, and the range and availability of services provided by the diagnostic facility must be maintained at a level the commission considers satisfactory;
(g) the commission must be notified of any changes made to the diagnostic facility's medical staff or supervisory personnel, as previously represented to the commission in an application or otherwise;
(h) the owner of the diagnostic facility must keep the books, accounts, and financial transactions of the diagnostic facility in the form and manner required by the commission;
(i) the owner of the diagnostic facility must retain all records of requisitions, referrals, internal protocols and results of diagnostic investigations in a readily retrievable manner and for the length of time specified or agreed to by the commission;
(j) a certificate of approval which is granted with respect to an application or other submission which
(i) contains information that the applicant knew or ought to have known to be false or inaccurate, or
(ii) omits information which the applicant knew or ought to have known was pertinent to the consideration of the application by the commission
is void, and all services rendered under it were not benefits.
(2) Every approval that is in force in respect of a diagnostic facility at the time this section comes into force is amended to include the conditions in subsection (1).
44 Approval of a diagnostic facility must be for a specific address or specific addresses of that diagnostic facility, and if a diagnostic facility operates from more than one address, the application for approval must include information concerning each of the addresses and their inter-relationship.
45 For the purpose of paragraph (c) of the definition of "benefits" in the Medicare Protection Act, the following categories of practitioners are permitted to request those types of diagnostic services as specified, unless precluded by protocols approved by the commission:
| (a) | medical practitioners: | all laboratory medicine, diagnostic radiology and imaging; |
| (b) | dentists: | laboratory medicine and diagnostic radiology services which are associated with the remedying of disorders of the oral cavity and functional components of mastication; |
| (c) | podiatrists: | laboratory medicine and diagnostic radiology services which are associated with the remedying of disorders of the feet; |
| (d) | midwives: | laboratory and radiology services related to the routine prenatal and post natal delivery and care of a newborn which are associated with the scope of practice of a midwife. |
Part 8 — Audit and Inspection
46 For the purposes of section 5 (1) (r) of the Medicare Protection Act, the following may be provided information concerning claims submitted by a practitioner to the commission:
(a) an appropriate disciplinary body or appropriate licensing body under the Medicare Protection Act;
(b) the Health Care Practitioners Special Committee for Audit;
(c) the Patterns of Practice Committee or the Reference Committee of the British Columbia Medical Association;
(d) the Patterns of Practice Committee of the Chiropractic Association;
(e) the Patterns of Practice Committee of the British Columbia Federation of Dental Societies;
(f) the Patterns of Practice Committee of the Massage Therapists' Association of British Columbia;
(g) the Patterns of Practice Committee of the British Columbia Naturopathic Association;
(h) the Patterns of Practice Committee of the British Columbia Association of Optometrists;
(i) the Patterns of Practice Committee of the Physical Therapists' Association of British Columbia;
(j) the Patterns of Practice Committee of the British Columbia Association of Podiatrists.
Part 9 — Prescribed Forms
47 The forms in the Schedule are prescribed for the purpose of section 8.2 of the Medicare Protection Act.
Part 10 — Orders of the Commission
48 The prescribed surcharge for the purposes of section 37 (1.1) of the Medicare Protection Act is 5% of the amount ordered under section 37 (1) (d) of that Act.
[en. B.C. Reg. 180/2002.]
IN THE SUPREME COURT OF BRITISH COLUMBIA
IN THE PROVINCIAL COURT OF BRITISH COLUMBIA
IN THE MATTER OF THE MEDICARE PROTECTION ACT
R.S.B.C. 1996, c. 286
CERTIFICATE
Pursuant to section 8.2 of the Medicare Protection Act, IT IS HEREBY CERTIFIED that
(a) . is in default of payment of premiums including any interest on premiums, payable under the Medicare Protection Act;
(b) the amount remaining unpaid as of the date of this certificate including interest
is $. ;
(c) that amount is payable by . .
CERTIFIED AND DATED at . British Columbia, this . day of . . .
.
Medical Services Commission
(By its duly Authorized Representative)
NOTICE OF FILING
TAKE NOTICE THAT a certificate under the Medicare Protection Act will be filed in the Supreme Court of British Columbia/Provincial Court of British Columbia, . Registry, in 30 days. A copy of the certificate is attached.
.
Medical Services Commission
(By its duly Authorized Representative)
Note: this regulation replaces B.C. Regs. 144/68, 281/92 and 489/94
[Provisions of the Medicare Protection Act, R.S.B.C. 1996, c. 286, relevant to the enactment of this regulation: sections 8 and 51]
Copyright (c) 2004: Queen's Printer, Victoria, British Columbia, Canada