Summary#

Bill 203, Keeping Primary Care Fair Act (Restricting Private Payments for Nurse Practitioner Services), 2024, would amend Ontario’s Commitment to the Future of Medicare Act, 2004. Its stated aim is to restrict nurse practitioners from accepting private payments or benefits for certain services provided to insured people.

• The restriction would apply to services that would normally be insured if delivered in a publicly funded nurse practitioner-led clinic, or by a nurse practitioner in a Family Health Team or Community Health Centre.
• A nurse practitioner could accept payment or a benefit for those services only through one of four routes: from a publicly funded primary care provider; under an arrangement made under the Health Insurance Act; from a public hospital or prescribed facility for services provided there; or where regulations allow it, under prescribed conditions.
• The bill would increase three penalty amounts in the existing Act: $10,000 to $20,000, $1,000 to $2,000, and $25,000 to $50,000. The supplied text does not explain which contraventions each amount applies to.
• It would let regulations provide for and govern patient reimbursements for these payments or benefits for services provided during the six months after Royal Assent. Reimbursement would depend on what the regulations provide.
• If enacted, the bill would come into force six months after Royal Assent.

What it means for you#

• Nurse practitioners: You would be barred from accepting payment or a benefit for the specified services to an insured person, except through one of the four routes listed above.
• Patients: The bill would not itself guarantee reimbursement for payments already made. Regulations may set up reimbursements for qualifying payments or benefits made during the six months after Royal Assent, and may set limits or conditions.
• Publicly funded primary care providers, Family Health Teams, Community Health Centres, hospitals and prescribed facilities: The bill does not require them to offer new services or create a process for patients to use them.
• People who use nurse practitioner services: The restriction is not written as a ban on all private nurse practitioner services. It covers the specified services provided to insured people.

Money#

No publicly available information on the bill’s implementation costs.

• The bill increases three penalty amounts, but the supplied text does not show when each applies or how often penalties might be imposed.
• It permits regulations to provide for patient reimbursements, but does not itself set a reimbursement amount or require that reimbursements be paid.
• The bill does not state a budget for staffing, enforcement or reimbursement.

What is unclear#

• The parent Act was not supplied, so the current law and the meaning of the three penalty provisions cannot be verified against it.
• The bill does not define “benefit” or “publicly-funded provider” in the supplied text. Whether the parent Act defines these terms is unclear.
• The regulations could set the circumstances and conditions for an exception and for reimbursements, but their details are not in the bill.
• The bill does not set out how suspected contraventions would be handled, or any review or appeal process.
• The supplied material does not state the bill’s current status.

Case for#

• The bill appears intended to prevent private payments for certain services that would normally be insured when delivered in specified publicly funded primary care settings.
• Applying a restriction to those services could help keep payment arrangements consistent across the named settings, while preserving the listed public and regulated exceptions.
• A possible argument for allowing reimbursement regulations is that they could address payments made during the six-month period before the bill takes effect.

Case against#

• The restriction depends partly on exceptions to be set by regulation. The bill does not say what those exceptions or conditions will be.
• The bill does not require another provider to offer a service when a nurse practitioner cannot accept private payment for it.
• The bill raises penalty amounts, but the supplied text does not explain which conduct attracts each amount or how penalties would be applied.
• Reimbursement is not automatic under the bill; whether patients receive money back would depend on regulations.