Commitment to the Future of Medicare Act, 2004, S.O. 2004, c. 5

• Jurisdiction: Ontario

Commitment to the Future of Medicare Act, 2004

S.o. 2004, chapter 5

Consolidation Period: From September 25, 2023 to the e-Laws currency date.

Last amendment: 2023, c. 4, Sched. 2, s. 1.

CONTENTS

Preamble

The people of Ontario and their Government:

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

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

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

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

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

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

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

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

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

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

Section Amendments with date in force (d/m/y)

2019, c. 5, Sched. 3, s. 4 - 01/04/2020

Part I (ss. 1-7) Repealed: 2010, c. 14, s. 18 (1).

1 Repealed: 2010, c. 14, s. 18 (1).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2 Repealed: 2010, c. 14, s. 18 (1).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3.-7 Repealed: 2010, c. 14, s. 18 (1).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

Definitions

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 practitioner who is not a designated practitioner; (“praticien non désigné”)

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

“physician” means a legally qualified medical practitioner who is lawfully entitled to practise medicine in Ontario or another prescribed person; (“médecin”)

“Plan” means the Ontario Health Insurance Plan; (“Régime”)

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

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

“unauthorized payment” means any payment accepted contrary to section 10. (“paiement non autorisé”) 2004, c. 5, s. 8; 2009, c. 33, Sched. 18, s. 17 (2); 2023, c. 4, Sched. 2, s. 1.

Section Amendments with date in force (d/m/y)

2009, c. 26, s. 1 (1) - no effect - see Table of Public Statute Provisions Repealed Under Section 10.1 of the Legislation Act, 2006 - 31/12/2019; 2009, c. 33, Sched. 18, s. 17 (2) - 15/12/2009

2023, c. 4, Sched. 2, s. 1 - 24/07/2023

General Manager

9 Subject to this Part and the regulations, the General Manager shall carry out any functions and duties that the General Manager considers necessary for purposes related to the administration of this Part. 2004, c. 5, s. 9.

Persons not to charge more than OHIP

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

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

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

(c) if permitted to do so by the regulations in the prescribed circumstances and on the prescribed conditions. 2004, c. 5, s. 10 (3).

Non-designated practitioners

(4) A non-designated practitioner shall not accept payment except from the Plan for that part of his or her account for any insured service rendered to an insured person that is payable by the Plan. 2004, c. 5, s. 10 (4).

Restriction on who may accept payment

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

(a) except as permitted under this section; or

(b) unless permitted to do so by the regulations in the prescribed circumstances and on the prescribed conditions. 2004, c. 5, s. 10 (5).

Not a payment or other benefit

(6) For the purposes of subsection (5), “payment or other benefit” does not include a salary or an amount payable under a contract of employment or a contract of services to an employee of or a person who contracts with a physician, practitioner, public hospital or prescribed facility. 2004, c. 5, s. 10 (6).

Transitional

11 (1) This section applies to physicians and designated practitioners who, on or before May 13, 2004, have rendered insured services to insured persons and who had never notified the General Manager of their intention to submit accounts for the performance of insured services rendered to insured persons directly to the Plan in accordance with subsection 15 (1) or 16 (1) of the Health Insurance Act, or had notified the General Manager under subsection 15 (4) or 16 (4) of the Health Insurance Act that they intended to cease submitting their accounts directly to the Plan. 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 (7) apply to him or her. 2004, c. 5, s. 11 (2).

Transitional time

(3) Subsection 10 (3) does not apply to a physician or designated practitioner mentioned in subsection (1) who does not give notice under subsection (2) until the first day of the third month following the expiration of the 90-day period under subsection (2). 2004, c. 5, s. 11 (3).

Subsequent election

(4) A physician or designated practitioner who has notified the General Manager under subsection (2) may subsequently notify the General Manager by registered mail that he or she intends to submit his or her accounts directly to the Plan for the performance of insured services rendered to insured persons and in such a case, subsection 10 (3) shall apply and the physician or designated practitioner may not subsequently choose to cease submitting his or her accounts directly to the Plan. 2004, c. 5, s. 11 (4).

When decision takes effect

(5) A decision to submit accounts directly to the Plan under subsection (4) takes effect as of the first day of the third month following the month in which the General Manager received the notification. 2004, c. 5, s. 11 (5).

Deemed election

(6) Unless the General Manager is satisfied that the account was submitted in error, if a physician or designated practitioner who has notified the General Manager under subsection (2) subsequently submits an account directly to the Plan for the performance of insured services rendered to an insured person, he or she shall be deemed to have notified the General Manager under subsection (4) that he or she intends to submit his or her accounts directly to the Plan, except in respect of any prescribed accounts or classes of accounts, and subject to any prescribed circumstances or conditions. 2004, c. 5, s. 11 (6).

Where notification given

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