NLR 16/16 - Pharmaceutical Services Audit and Recovery Regulations under the Pharmaceutical Services Act

NEWFOUNDLAND AND LABRADOR REGULATION 16/16 Pharmaceutical Services Audit and Recovery Regulations under the Pharmaceutical Services Act (O.C. 2016-049) Amended by: 2024 cP-12.3 s84 NEWFOUNDLAND AND LABRADOR REGULATION 16/16 Pharmaceutical Services Audit and Recovery Regulations under the Pharmaceutical Services Act (O.C. 2016-049) (Filed April 19, 2016) Under the authority of section 51 of the Pharmaceutical Services Act, the Lieutenant-Governor in Council makes the following regulations. Dated at St. John’s , April 14, 2016. Julia Mullaley Clerk of the Executive Council REGULATIONS Analysis 1. Short title 2. Definitions 3. Techniques necessary to complete audits 4. Cancellation or suspension of provider numbers 5. Manner of recovering benefits 6. Debt due 7. Interest may be charged 8. Alternate dispute resolution 9. ADR agreement 10. Remuneration 11. Transitional 12. Commencement Short title 1. These regulations may be cited as the Pharmaceutical Services Audit and Recovery Regulations . 16/16 s1 Back to Top Definitions 2. In these regulations (a) "Act" means the Pharmaceutical Services Act ; (b) "board" means the audit appeal board appointed under section 42 of the Act; (c) "committee" means the Pharmaceutical Audit Review Committee appointed under section 34 of the Act; (d) "program" means the Newfoundland and Labrador Prescription Drug Program; and (e) "written notice" means the written notice referred to in section 39 of the Act. 16/16 s2 Back to Top Techniques necessary to complete audits 3. (1) Audits shall be conducted in accordance with (a) generally accepted auditing standards; and (b) standards and policies respecting auditing developed by the department. (2) Audits may include the following: (a) statistical sampling; (b) extrapolation; (c) beneficiary confirmation; (d) prescriber and third party confirmations; and (e) claims monitoring. 16/16 s3 Back to Top Cancellation or suspension of provider numbers 4. A provider number issued under subsection 16(2) of the Act may be suspended or cancelled where (a) a pharmacy or dispensing physician refuses to provide documentation and other information required under subsections 31(1)(2)(4) or (5) of the Act; (b) a pharmacy or dispensing physician refuses to allow access to a pharmacy or pharmacy related business premises as required by subsection 31(3) of the Act; (c) a pharmacy or dispensing physician refuses to provide information in the time period set by the minister; (d) a pharmacy or dispensing physician refuses to provide further information as required under section 33 of the Act; (e) the College of Pharmacy of Newfoundland and Labrador has suspended, imposed terms and conditions upon or cancelled the pharmacy's licence or where a dispensing physician's licence has been suspended, had terms and conditions imposed upon it or has been cancelled; (f) a pharmacy or dispensing physician owes money to the Crown; (g) a person is guilty of an offence under section 47 of the Act; or (h) at the discretion of the minister, where a pharmacy or dispensing physician fails to comply with the Act, regulations made under the Act, the policies of the department or any terms and conditions of participation in the program. 16/16 s4 ; 2024 cP-12.3 s84 Back to Top Manner of recovering benefits 5. Payments made to a pharmacy or dispensing physician determined to be in excess under section 38 of the Act shall be recovered in a manner acceptable in law or equity. 16/16 s5 Back to Top Debt due 6. For the purpose of recovery under Part VII of the Act, a debt shall be due from the date the minister issues a notice under section 39 of the Act. 16/16 s6 Back to Top Interest may be charged 7. (1) Where payments made to a pharmacy or dispensing physician have been determined to be in excess of the amount which was required to be paid under the program, the minister shall charge interest on the sum which has been paid in excess. (2) Interest charged under subsection (1) shall be levied upon the sum which has been paid in excess for each month or part of a month beginning 30 days after (a) the date of notification under section 39 where the amount owing is not subject to alternative dispute resolution or appeal; or (b) the final resolution of an alternative dispute resolution process or an appeal of an amount owing, whichever is later, which interest shall be levied until the amount owing is paid in full. (3) For the purpose of subsection (1), the annual rate of interest with respect to a sum due is the rate equal to the sum of (a) the prime lending rate of the bank holding the province's general revenue fund as determined and adjusted in accordance with this section; and (b) 4 percentage points. (4) Interest calculated under subsection (3) shall be compounded monthly. (5) The interest rate prescribed by this section shall be determined on June 15 and December 15 in each year and (a) the interest rate as determined on June 15 shall apply to unpaid sums that are owing after June 30; and (b) the interest rate as determined on December 15 shall apply to unpaid sums that are owing after December 31. (6) Notwithstanding subsection (1), interest shall not be levied for a month in which the sum due is less than $1000. 16/16 s7 Back to Top Alternate dispute resolution 8. (1) Where a pharmacy or dispensing physician wishes to dispute the results of an audit, the pharmacy or dispensing physician may make a request, in writing, for alternate dispute resolution, and that request shall be made within 30 days of receipt of the written notice under section 39 of the Act. (2) Alternate dispute resolution shall be completed no more than 30 days after it has been requested, or within another period that the parties may agree to in writing. (3) Where an agreement is reached by alternate dispute resolution, the pharmacy or dispensing physician waives the right to appeal to the board appointed under the Act. (4) Alternate dispute resolution under these regulations is subject to the provisions of the Financial Administration Act. 16/16 s8 Back to Top ADR agreement 9. Where an agreement has been reached under section 8, adjustments to the recovery shall be made accordingly. 16/16 s9 Back to Top Remuneration 10. The members of the board appointed under section 42 of the Act shall be remunerated in accordance with Treasury Board Guidelines. 16/16 s10 Back to Top Transitional 11. Where a notice was given under section 39 of the Act before the coming into force of these regulations, the matters referred to in that notice shall be determined as if these regulations had not come into force. 16/16 s11 Back to Top Commencement 12. These regulations come into force on September 30, 2016. 16/16 s12