Commitment to the Future of Medicare Act, 2004

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 ne…

1 Repealed: 2010, c. 14, s. 18 (1). Section Amendments with date in force (d/m/y) 2010, c. 14, s. 18 (1) - 08/06/2010

2 Repealed: 2010, c. 14, s. 18 (1). Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (1) - 28/03/2006 2010, c. 14, s. 18 (1) - 08/06/2010

3.-7 Repealed: 2010, c. 14, s. 18 (1). Section Amendments with date in force (d/m/y) 2010, c. 14, s. 18 (1) - 08/06/2010

PART II HEALTH SERVICES ACCESSIBILITY

8 In this Part, “Board” means the Health Services Appeal and Review Board under the Ministry of Health and Long-Term Care 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 practit…

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. 2004, c. 5, s. 9.

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. 2004, c. 5, s. 10 (1). 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. 2004, c. 5, s. 10 (2). 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…

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. 2004, c. 5, s. 11 (1). 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…

11.1 Section Amendments with date in force (d/m/y) 2009, c. 26, s. 1 (2) - no effect - see Table of Public Statute Provisions Repealed Under Section 10.1 of the Legislation Act, 2006 - 31/12/2019 2010, c. 14, s. 18 (2) - no effect - see 2009, c. 26, s. 1 (2) - 31/12/2019

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. 2004, c. 5, s. 12 (1). 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 (c) the Ontario Association of Optometrists, in respect of optometrists. 2004, c. 5, s. 12 (2). No liability (2.1) No cause of action arises and no civil proceedings may be brought or maintained against a director, officer, member, employee or agent of the Ontario Medical Association for anything done in good faith…

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. 2004, c. 5, s. 13 (1). 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. 2004, c. 5, s. 13 (2)…

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. 2004, c. 5, s. 14 (1). 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. 2004, c. 5, s. 14 (2). 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. 2004, c. 5, s. 14 (3). 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. 2004, c. 5, s. 14 (4). Right to represent…

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 Integrated Community Health Services Centres Act, 2023. 2004, c. 5, s. 15 (1); 2023, c. 4, Sched. 1, s. 68 (2). 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 Integrated Community Health Services Centres Act, 2023. 2004, c. 5, s. 15 (2); 2023, c. 4, Sched. 1, s. 68 (2). 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, t…

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 4 of the Integrated Community Health Services Centres Act, 2023. 2004, c. 5, s. 16 (1); 2023, c. 4, Sched. 1, s. 68 (3). 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). 2004, c. 5, s. 16 (2). Time and form (3) Subject to the regulations, the information shall be submitted and disclosed, (a) in the form required by the Ge…

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; (c) offer to do anything referred to in clause (a) or (b). 2004, c. 5, s. 17 (1). 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. 2004, c. 5, s. 17 (2). (3) Repealed: 2004, c. 3, Sched. A, s. 79 (4). 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 …

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. 2004, c. 5, s. 18 (1). 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. 2004, c. 5, s. 18 (2). 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. 2004, c. 5, s. 18 (3). Definition (4) In this section, “block or annual fee”, (a) means a fee charg…

19 (1) Every one who contravenes a provision of this Part or the regulations is guilty of an offence. 2004, c. 5, s. 19 (1). 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. 2004, c. 5, s. 19 (2). 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. 2004, c. 5, s. 19 (3). Penalty, corporation (4) A corporation that is convicted of an offence under this section is liable to a fine not exceeding $25,000. 2004, c. 5, s. 19 (4). 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 of…

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; (c) governing circumstances and prescribing conditions for the purposes of subsection 10 (5); (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 …

21 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (2-5) - 18/07/2007 2007, c. 8, s. 199 (1) - no effect - see 2006, c. 4, s. 44 (3) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

22 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (6, 7) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

23 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (8-13) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

24 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (13-22) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

25 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (13, 18, 23-26) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

26 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (27) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

27 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (18, 28-35) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

28 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (36-46) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

29 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (47) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

30 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (48) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

31 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (49) - 18/07/2007 2007, c. 8, s. 199 (2) - 01/07/2010 2016, c. 30, s. 33 - 8/12/2016

32 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (50) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

33 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (51, 52) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

34 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2006, c. 4, s. 44 (53, 54) - 18/07/2007 2016, c. 30, s. 33 - 8/12/2016

35 Repealed: 2016, c. 30, s. 33. Section Amendments with date in force (d/m/y) 2016, c. 30, s. 33 - 8/12/2016

36-44 Omitted (amends or repeals other Acts). 2004, c. 5, ss. 36-44.

45 Omitted (provides for coming into force of provisions of this Act). 2004, c. 5, s. 45.

46 Omitted (enacts short title of this Act). 2004, c. 5, s. 46. ______________