OntarioDid Not Pass43rd Parliament, 1st Session

Bill 203 explained in plain English

Keeping Primary Care Fair Act (Restricting Private Payments for Nurse Practitioner Services), 2024

Health & Health Care Justice & the Law

Ontario legislature bill summary, status, timeline, sponsor, votes, and official sources.

How This Type of Bill Becomes Law Official source

At a glance

Jurisdiction

Ontario Legislature

Legislature / Parliament

Legislative Assembly of Ontario

Session

43rd Parliament, 1st Session

Bill number

Bill 203

Full title

Keeping Primary Care Fair Act (Restricting Private Payments for Nurse Practitioner Services), 2024

Current status

Did Not Pass

Latest event

Lost on division

Last updated

Oct 28, 2024

Sponsor

Adil Shamji

Official Legislative Assembly of Ontario snapshot for 43rd Parliament, 1st Session. Representative vote breakdowns appear when the Assembly publishes an Ayes and Nays page for the bill.

Chamber

Legislative Assembly of Ontario

Current Stage

Lost on division

Latest Activity

Oct 28, 2024

Sponsor

Adil Shamji

Plain-language explanation

In plain English (our explanation)

Our plain-language take, written for civic education.

Source: By PoliticalData.ca

AI-assisted, reviewed before publishing

Short Version

Bill 203 prohibits nurse practitioners in publicly-funded primary care settings from accepting private payments for insured services, increases penalties for violations, and creates a process for patient reimbursements.

What It Means

Ontario Bill 203 amends the Commitment to the Future of Medicare Act, 2004 to restrict nurse practitioners from accepting private payments for certain services. The bill defines "nurse practitioner" as a registered nurse with an extended certificate under the Nursing Act, 1991. It prohibits nurse practitioners from accepting payments or benefits (except from specified public sources or as permitted by regulations) when providing services in publicly-funded nurse practitioner-led clinics, Family Health Teams, or Community Health Centres—services that would normally be covered as insured services. The bill doubles several financial penalties for contraventions: from $10,000 to $20,000 for one violation type, from $1,000 to $2,000 for another, and from $25,000 to $50,000 for a third. It adds a new regulation-making power to govern patient reimbursements for payments or benefits made within six months after Royal Assent. The Act comes into force six months after Royal Assent.

What This Bill Does

Defines 'nurse practitioner' as a registered nurse holding an extended certificate of registration under the Nursing Act, 1991
Prohibits nurse practitioners from accepting payments or benefits when providing services to an insured person in publicly-funded nurse practitioner-led clinics, Family Health Teams, or Community Health Centres—unless the payment is from a publicly-funded provider, made under a Health Insurance Act arrangement, from a public hospital or prescribed facility, or permitted by regulations
Doubles the financial penalty under subsection 19(2) from $10,000 to $20,000
Doubles the financial penalty under subsection 19(3) from $1,000 to $2,000
Doubles the financial penalty under subsection 19(4) from $25,000 to $50,000
Adds a regulation-making power to provide for and govern reimbursements to patients for payments or benefits made for specified services within six months after Royal Assent
Sets the commencement date at six months after Royal Assent

Who Is Affected

Nurse practitioners (registered nurses with extended certificates of registration under the Nursing Act, 1991) working in publicly-funded nurse practitioner-led clinics, Family Health Teams, or Community Health Centres
Insured persons receiving services from nurse practitioners in these settings
Publicly-funded primary health care providers
Public hospitals and prescribed facilities
Patients who made private payments for nurse practitioner services within six months after Royal Assent and may be eligible for reimbursement under future regulations

Rights, Duties, Or Obligations

Nurse practitioners must not accept payments or benefits for insured services provided in publicly-funded nurse practitioner-led clinics, Family Health Teams, or Community Health Centres, except from publicly-funded providers, under Health Insurance Act arrangements, from public hospitals or prescribed facilities, or as permitted by regulations
Nurse practitioners may continue to accept payments from specified public sources without restriction
The government may make regulations to permit nurse practitioners to accept payments in prescribed circumstances and on prescribed conditions
Patients may be eligible for reimbursement of payments or benefits made within six months after Royal Assent, subject to any limitations or conditions in future regulations

Important Dates

The Act comes into force six months after the day it receives Royal Assent
Patients are eligible for reimbursement of payments or benefits made within six months after Royal Assent, subject to future regulations

Financial Or Tax Impacts

Increased financial penalties for contraventions: $10,000 to $20,000, $1,000 to $2,000, and $25,000 to $50,000
Potential financial impacts on nurse practitioners if they have been accepting private payments that will now be prohibited
Potential financial impacts on patients through reimbursement programs to be established by future regulations

Enforcement Or Penalties

Contravention of subsection 19(2) now carries a maximum penalty of $20,000 (increased from $10,000)
Contravention of subsection 19(3) now carries a maximum penalty of $2,000 (increased from $1,000)
Contravention of subsection 19(4) now carries a maximum penalty of $50,000 (increased from $25,000)
The bill text does not specify the exact nature of the violations that trigger each penalty level; these are defined in the existing Act

Uncertainties Or Limits

The bill text does not specify which penalties (subsection 19(2), (3), or (4)) apply to which specific violations; this depends on the existing Commitment to the Future of Medicare Act
The bill does not define 'prescribed circumstances,' 'prescribed conditions,' or 'prescribed facility'—these will be determined by future regulations
The bill does not specify how patient reimbursements will be calculated or distributed; this will be determined by future regulations
The bill does not explain the scope of 'arrangements made under subsection 2(2) of the Health Insurance Act' that would permit nurse practitioners to accept payments
It is unclear whether the six-month commencement period allows time for regulations to be drafted and implemented before the Act takes effect

Laws Or Regulations Affected

Commitment to the Future of Medicare Act, 2004

amended

Bill 203 adds a definition of 'nurse practitioner' to section 8, adds new subsections 10(4.1) and 10(4.2) that restrict nurse practitioner private payments for insured services in specific settings, increases penalties in subsection 19(2), (3), and (4), and adds a new regulation-making power in subsection 20(1) regarding patient reimbursements

Source: Sections 1, 2, 3, and 4 of Bill 203

Nursing Act, 1991

referenced

The bill uses the Nursing Act's definition of extended certificate of registration to define who qualifies as a nurse practitioner for purposes of this legislation

Source: Section 1 of Bill 203

Health Insurance Act

referenced

Arrangements made under subsection 2(2) of the Health Insurance Act are specified as an exception allowing nurse practitioners to accept payments

Source: Section 2 of Bill 203

Generated using AI from official bill text. Not legal advice. It is written by PoliticalData.ca for civic education, automatically checked and spot-reviewed before publishing.

Official text

Process Snapshot

Step 1

First reading

May 29, 2024

Step 2

Second reading

Oct 28, 2024

Step 3

Committee review

Not reached yet

Step 4

Third reading

Not reached yet

Step 5

Royal assent

Not reached yet

Vote Summary

Yes

Abstain

Absent / Other

Final recorded vote

Oct 28, 2024

99 representative positions are recorded in this official snapshot for this vote.

Sponsor

Adil Shamji

Ontario Liberal Party | Don Valley East

Jurisdiction

Ontario Legislature

Representative Voting Breakdown

Vote badges include text labels so the table stays readable for everyone, even without color cues alone.

Representative	Role	Riding	Party	Vote	Notes
Adil ShamjiSponsor MPP	MPP	Don Valley East	Ontario Liberal Party	Yes	Recorded without an additional note.
Aislinn Clancy MPP	MPP	Kitchener Centre	Green Party of Ontario	Yes	Recorded without an additional note.
Bhutila Karpoche MPP	MPP	Parkdale—High Park	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Catherine Fife MPP	MPP	Waterloo	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Chandra Pasma MPP	MPP	Ottawa West—Nepean	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Chris Glover MPP	MPP	Spadina—Fort York	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Guy Bourgouin MPP	MPP	Mushkegowuk—James Bay	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Jamie West MPP	MPP	Sudbury	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Jennifer (Jennie) Stevens MPP	MPP	St. Catharines	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Jennifer K. French MPP	MPP	Oshawa	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Jessica Bell MPP	MPP	University—Rosedale	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Jill Andrew MPP	MPP	Toronto—St. Paul's	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Joel Harden MPP	MPP	Ottawa Centre	New Democratic Party of Ontario	Yes	Recorded without an additional note.
John Fraser MPP	MPP	Ottawa South	Ontario Liberal Party	Yes	Recorded without an additional note.
Karen McCrimmon MPP	MPP	Kanata—Carleton	Ontario Liberal Party	Yes	Recorded without an additional note.
Kristyn Wong-Tam MPP	MPP	Toronto Centre	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Lisa Gretzky MPP	MPP	Windsor West	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Lise Vaugeois MPP	MPP	Thunder Bay—Superior North	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Lucille Collard MPP	MPP	Ottawa—Vanier	Ontario Liberal Party	Yes	Recorded without an additional note.
Marit Stiles MPP	MPP	Davenport	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Mary-Margaret McMahon MPP	MPP	Beaches—East York	Ontario Liberal Party	Yes	Recorded without an additional note.
Mike Schreiner MPP	MPP	Guelph	Green Party of Ontario	Yes	Recorded without an additional note.
Monique Taylor MPP	MPP	Hamilton Mountain	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Peggy Sattler MPP	MPP	London West	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Peter Tabuns MPP	MPP	Toronto—Danforth	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Sandy Shaw MPP	MPP	Hamilton West—Ancaster—Dundas	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Sarah Jama MPP	MPP	Hamilton Centre	Independent	Yes	Recorded without an additional note.
Stephanie Bowman MPP	MPP	Don Valley West	Ontario Liberal Party	Yes	Recorded without an additional note.
Ted Hsu MPP	MPP	Kingston and the Islands	Ontario Liberal Party	Yes	Recorded without an additional note.
Terence Kernaghan MPP	MPP	London North Centre	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Teresa J. Armstrong MPP	MPP	London—Fanshawe	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Tom Rakocevic MPP	MPP	Humber River—Black Creek	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Wayne Gates MPP	MPP	Niagara Falls	New Democratic Party of Ontario	Yes	Recorded without an additional note.
Amarjot Sandhu MPP	MPP	Brampton West	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Andrew Dowie MPP	MPP	Windsor—Tecumseh	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Anthony Leardi MPP	MPP	Essex	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Aris Babikian MPP	MPP	Scarborough—Agincourt	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Billy Pang MPP	MPP	Markham—Unionville	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Bobbi Ann Brady MPP	MPP	Haldimand—Norfolk	Independent	No	Recorded without an additional note.
Brian Riddell MPP	MPP	Cambridge	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Brian Saunderson MPP	MPP	Simcoe—Grey	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Christine Hogarth MPP	MPP	Etobicoke—Lakeshore	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Daisy Wai MPP	MPP	Richmond Hill	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
David Smith MPP	MPP	Scarborough Centre	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Dawn Gallagher Murphy MPP	MPP	Newmarket—Aurora	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Deepak Anand MPP	MPP	Mississauga—Malton	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Effie J. Triantafilopoulos MPP	MPP	Oakville North—Burlington	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hardeep Singh Grewal MPP	MPP	Brampton East	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Caroline Mulroney MPP	MPP	York—Simcoe	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Charmaine A. Williams MPP	MPP	Brampton Centre	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. David Piccini MPP	MPP	Northumberland—Peterborough South	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Donna Skelly MPP	MPP	Flamborough—Glanbrook	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Doug Downey MPP	MPP	Barrie—Springwater—Oro-Medonte	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Ernie Hardeman MPP	MPP	Oxford	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Graham McGregor MPP	MPP	Brampton North	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Graydon Smith MPP	MPP	Parry Sound—Muskoka	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Kinga Surma MPP	MPP	Etobicoke Centre	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Laurie Scott MPP	MPP	Haliburton—Kawartha Lakes—Brock	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Lisa M. Thompson MPP	MPP	Huron—Bruce	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Michael Parsa MPP	MPP	Aurora—Oak Ridges—Richmond Hill	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Michael S. Kerzner MPP	MPP	York Centre	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Mike Harris MPP	MPP	Kitchener—Conestoga	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Natalia Kusendova-Bashta MPP	MPP	Mississauga Centre	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Nina Tangri MPP	MPP	Mississauga—Streetsville	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Nolan Quinn MPP	MPP	Stormont—Dundas—South Glengarry	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Paul Calandra MPP	MPP	Markham—Stouffville	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Peter Bethlenfalvy MPP	MPP	Pickering—Uxbridge	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Prabmeet Singh Sarkaria MPP	MPP	Brampton South	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Raymond Sung Joon Cho MPP	MPP	Scarborough North	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Rob Flack MPP	MPP	Elgin—Middlesex—London	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Sam Oosterhoff MPP	MPP	Niagara West	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Stan Cho MPP	MPP	Willowdale	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Stephen Crawford MPP	MPP	Oakville	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Stephen Lecce MPP	MPP	King—Vaughan	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Steve Clark MPP	MPP	Leeds—Grenville—Thousand Islands and Rideau Lakes	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Todd J. McCarthy MPP	MPP	Durham	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Trevor Jones MPP	MPP	Chatham-Kent—Leamington	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Vijay Thanigasalam MPP	MPP	Scarborough—Rouge Park	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Hon. Zee Hamid MPP	MPP	Milton	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Jess Dixon MPP	MPP	Kitchener South—Hespeler	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
John Jordan MPP	MPP	Lanark—Frontenac—Kingston	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
John Yakabuski MPP	MPP	Renfrew—Nipissing—Pembroke	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Logan Kanapathi MPP	MPP	Markham—Thornhill	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Lorne Coe MPP	MPP	Whitby	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Matthew Rae MPP	MPP	Perth—Wellington	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Natalie Pierre MPP	MPP	Burlington	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Patrice Barnes MPP	MPP	Ajax	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Ric Bresee MPP	MPP	Hastings—Lennox and Addington	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Rick Byers MPP	MPP	Bruce—Grey—Owen Sound	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Robert Bailey MPP	MPP	Sarnia—Lambton	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Robin Martin MPP	MPP	Eglinton—Lawrence	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Ross Romano MPP	MPP	Sault Ste. Marie	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Rudy Cuzzetto MPP	MPP	Mississauga—Lakeshore	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Sheref Sabawy MPP	MPP	Mississauga—Erin Mills	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Stéphane Sarrazin MPP	MPP	Glengarry—Prescott—Russell	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Steve Pinsonneault MPP	MPP	Lambton—Kent—Middlesex	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Tyler Allsopp MPP	MPP	Bay of Quinte	Progressive Conservative Party of Ontario	No	Recorded without an additional note.
Vincent Ke MPP	MPP	Don Valley North	Independent	No	Recorded without an additional note.
Will Bouma MPP	MPP	Brantford—Brant	Progressive Conservative Party of Ontario	No	Recorded without an additional note.

Official sources

Status, sponsor, votes, and timeline on this page are drawn from these official legislative sources and public records. Each summary above is attributed to its own source.

How this data is sourced