M.S.I. Regulations
made under Section 17 of the
Health Services and Insurance Act
R.S.N.S. 1989, c. 197
O.I.C. 69-276 (effective March 28, 1969), N.S. Reg. 41/1969
amended to N.S. Reg. 102/2024 (effective June 1, 2024)
Effective August 1, 2024, these regulations are amended by N.S. Reg. 125/2024.
1 In these regulations
(a) “Act” means the Health Services and Insurance Act;
(b) “dentist” means a person lawfully entitled to practice dentistry in the place in
which such practice is carried on by him;
(c) “general practitioner” means a physician who engages in the general practice
of medicine or a physician who is not a specialist within the meaning of
clause (f);
(d) “hospital” means a building or place that is established and operated for the
lodging and treatment of persons afflicted with or suffering from sickness,
disease or injury; and includes a mental hospital, a tuberculosis hospital and a
maternity hospital;
(e) “insured services” means all services rendered by physicians which are
medically required or which are deemed by the Commission to be medically
required but does not include
(i) services that a person is eligible for or entitled to under the Workers’
Compensation Act, the Health Services and Insurance Act or any Act
of the Parliament of Canada; or under any statute or law of any
jurisdiction either within or without Canada,
(ii) mileage, travelling or detention time, except in circumstances specified
by the Commission,
(iii) telephone advice or prescriptions unless approved by the Commission,
(iv) examinations required for the purpose of obtaining employment or
insurance and similar examinations at the request of a third party,
(v) group immunizations or inoculations unless approved by the
Commission,
(vi) preparation of records, reports, certificates or communications,
(vii) testimony in a court,
(viii) laboratory or diagnostic radiological services rendered in Nova Scotia,
(ix) services in connection with an electrocardiogram, electromyogram or
electroencephalogram, unless the physician is a specialist in the
appropriate specialty;
(ea) “optometrist” means a person lawfully entitled to practice optometry in the
place in which such practice is carried on by him;
(f) “specialist” means a physician who is recognized as a specialist by the
appropriate licensing body of the jurisdiction in which he practices.
2 (1) Subject to the Health Services and Insurance Act and these regulations
(a) a resident is insured for the payment of the cost of insured services
commencing on the first day of the third month immediately following the
month in which he becomes a resident of Nova Scotia;
(b) a new Canadian is insured for the payment of the cost of insured services that
are medically required by him, commencing on the day he becomes a resident
of Nova Scotia.
(2) In clause (b) of subsection (1) “new Canadian” means a resident who moves to
Nova Scotia from a place outside Canada and is legally entitled to remain in
Canada.
3 (1) Where a person desires to complain about any act, omission, or other matter
relating to the administration of the plan he shall, in the first instance, appeal in
writing to the President of the Corporation.
(2) Where the Corporation does not settle the complaint to the satisfaction of the
complainant, he may appeal in writing to the Chairman of the Commission.
(3) If, in the opinion of the Commission, a person's services are or were not medically
required, the person shall not be insured for the payment of the cost of the services.
(4) When, in the opinion of the Commission, a doubt exists concerning the medical
necessity for the services in any case, the Commission may appoint and empower a
medical review board to report on the case.
4 A resident of Nova Scotia who moves from Nova Scotia to acquire residence in another
part of Canada, herein called the “new province”, shall be deemed to continue to be a
resident of Nova Scotia during normal travelling time and any waiting period, not
exceeding three months, which may be necessary in order to qualify for benefits under the
medical care insurance legislation of the new province if the new province is a
participating province, as defined in subsection (i) of Section 2 of the Medical Care Act
(Canada) or shall be deemed to continue to be a resident of Nova Scotia for a period of
three months from the date of his departure from Nova Scotia if the new province is not a
participating province.
5 Where during the course of a single illness a person receives medical services with
respect to that illness from more than one physician he shall not, except for the services of
the first attending physician, be entitled to receive those services as insured services
unless
(a) he was referred by one physician to another; or
(b) the first attending physician was not available to render the subsequent
service; or
(c) the Commission approves of the receipt of the services.
6 Where a claim in respect of insured services is not received by the Corporation within a
period of six months from the date when the service was rendered, it shall not be payable
under the plan unless the Commission is of the opinion that the delay was justified in the
circumstances.
7 Where an insured service is rendered by a specialist to a resident who was not referred to
the specialist by another physician, the amount payable for the service shall be equal to
the amount that would have been paid, had the service been rendered by a general
practitioner.
8 Where a physician
(a) serves in a hospital for purposes of receiving clinical training and receives a
salary from the hospital; and
(b) renders an insured service in the hospital,
he shall not be entitled to remuneration for the service from the recipient or under the
plan.
9 A claim in respect of insured services shall not be payable under the plan unless it
contains the following information and is made on a form prescribed by the Commission
for that purpose:
(a) the patient's name in full and address, the year of his birth, his sex and plan
registration number;
(b) the diagnosis or chief complaint;
(c) where the service is provided in Nova Scotia, the fee code number and
amount corresponding to the procedure or treatment performed;
(d) where the service is provided outside Nova Scotia, a description of the service
or treatment performed;
(e) the date of each service; and for hospital visits, the name of the hospital;
(f) amounts, if any, charged pursuant to Section 21 of the Act [S.N.S. 1973, c. 8],
and the written consent to the charge by the patient or some other person
acting on his behalf;
(g) additional remarks if the nature of the service was unusual;
(h) the name and signature or approved facsimile of the person providing the
service and the identification number issued to him by the Corporation;
(i) the name of the referring physician or referred physician as the case may be;
(j) the names of other physicians attending the patient and their relationship to
the services rendered;
(k) whether the services were performed due to an automobile accident or other
third party liability; and
(l) such other information as the Commission may require.
10 [repealed]
11 (1) For the purposes of the plan, an optometrist shall be deemed to be a physician when
he performs a vision analysis which shall include the determination of the refractive
status of the eye, the presence of any observed abnormality in the visual system and
all necessary tests and prescriptions connected with such determinations.
12 For the purposes of the plan, the following prosthetic services shall be insured services
subject to such conditions as the Commission may from time to time prescribe with the
approval of the Minister of Health:
(a) assistance in the acquisition, replacement and repair of arm and leg
prostheses;
(b) [repealed]
(c) intro-oral or extra-oral prostheses including ears for persons who have
undergone maxillofacial surgery; and
(d) mastectomy prostheses.
The following regulations are not
yet in force and are not included in the current consolidation: