Letter to Manitoba Health Re: Public Consultation on Regulations under The Regulated Health Professions Act (RHPA)

Date de parution : 04/08/2013
Personne(s)-ressource(s) : Stephen Frank

April 8, 2013

Manitoba Health - Legislative Unit
300 Carlton Street
Winnipeg, MB, R3B 3M9

Re: Public Consultation on Regulations under The Regulated Health Professions Act (RHPA)

On behalf of the Canadian life and health insurance industry, I am pleased to participate in the consultation process regarding regulations for the Regulated Health Professions Act. The CLHIA is a strong supporter of regulation of health professionals as a means to help protect private plan members and the public generally.

Who we are - The CLHIA is a voluntary trade association with member companies that account for 99 per cent of Canada's life and health insurance business. In Manitoba, at the end of 2011, the life and health insurance industry provided about 820,000 residents with supplementary health benefit coverage. During 2011, the industry reimbursed roughly $66 million for paramedical and other healthcare goods and services.

Overall, I would like to commend the government of Manitoba for establishing robust umbrella health professions legislation that contains a strong public participation component. More specifically, the life and health insurance industry offers the following specific comments on both the RHPA General Regulation, as well as the practice of Audiology and Speech-Language Pathology Regulation.

Specific Comments- RHPA General Regulation

It appears that the General Regulation provides exceptions to the restricted acts for certain professions, even though it is our understanding that this would generally be accomplished by individual regulations under the RHPA. For example, psychologists are already regulated in

Manitoba under The Psychologists Registration Act. We would like to gain an understanding on why it is necessary to have specific exceptions for psychologists under the General Regulation rather than under their own Regulation.

Further, certain acts performed by members of the Manitoba Association of Medical Radiation Technologists are also excepted from the list of reserved acts. We assume the exceptions under the General Regulation have been included because medical radiation technologists are not currently regulated in Manitoba. As an alternative, we would suggest that Manitoba consider implementing a Regulation under the RHPA to address radiation technologists. We would note that this would be more consistent with other provinces (i.e. Alberta, New Brunswick, Nova Scotia, Ontario, Quebec and Saskatchewan) which regulate medical radiation technologists.

In Section 9(2), the regulation appears to allow non-certified or other types of health professionals to do certain acts that were formally restricted to another profession. We would recommend that the province ensure that the scope of acts that a non-certified health professional can perform remain restricted to avoid the potential for harm to members of the public.

Use of the Terms "Registered" and "Licensed"

The consultation indicates that several organizations will be permitted to use the terms "registered" and "licensed" in their titles. While we appreciate the rationale for this, we are concerned that this may create confusion if some providers use those words in their title while others do not. In particular, we note that only one massage therapy association is listed (i.e., the Massage Therapy Association of Manitoba Inc.). However, this is not the only massage therapy association in Manitoba that has members providing services where the fees associated with those services may be covered by insurers. We recommend that prior to implementing this exception the government identify all associations with members in Manitoba and only allow members of those associations who meet certain criteria to use these terms "registered" or "licensed". It will also be important for our members to understand what the education and training requirements will be for those unregulated providers that are permitted to use the terms "registered" or "licensed" in their title so that our members can determine eligibility under their benefit plans. In addition, we will need to understand how the list of providers that can use the term "registered" or "licensed" in their titles will be developed, validated, and maintained and when the list will be available, and how our member companies will be able to access it. We would be pleased to work with you on this.

With respect to massage therapists specifically, massage therapy benefits are often included as part of an employee's overall benefits plan. In the absence of regulation, each insurer independently determines the requirements that a massage therapist must meet in order for their services to be eligible for coverage under the insurer's benefit plans. Quite often, insurers will look to the requirements of provinces that have regulated massage therapists to determine reasonable requirements for coverage. For example, many of our members require massage
therapists to have a minimum of 2200 hours of education and training for their services to be eligible for coverage; this is consistent with the requirements that have been adopted by those provinces that regulate massage therapy. While this provides a short-term solution, it is not our preferred model for the future. This approach presents a cost to the industry as each company is independently conducting this assessment. Generally, the absence of regulation also does not provide overall protection to the public as there remains a confusing number of different standards and educational requirements for massage therapists in the marketplace. Regulation of massage therapists would assist in resolving these issues. In general, where members of certain associations are not regulated but will be permitted to use the terms "registered" or "licensed" as part of their title, we encourage Manitoba to ensure that those providers have a minimum of 2200 hours of education and training.

Practice of Audiology and Speech-Language Pathology Regulation

In general, we support the regulation of audiologists and speech-language pathologists under the RHPA. We would however, recommend that Manitoba take this opportunity to implement some of the best practices being implemented in other provinces. Specifically, Ontario is adding quality assurance programming requirements to its health professions legislation (e.g., the recently passed Quality Assurance Program Regulation under the Audiology and Speech­ Language Pathology Act, 1991 (Ontario), and the recently amended Dietetics Act, 1991 (Ontario). Generally, these quality assurance programs are designed to:

    • promote continuing competence and continuing quality improvements among members,
    • address changes in practice environments,
    • incorporate standards of practice, advance in technology, changes made to entry to practice competencies and other relevant issues, and
    • provide for peer and practice assessments.
One of the key objectives of the RHPA is to strengthen accountability between the regulatory bodies and the government, and improve public protection. Implementing quality assurance programming requirements in each of the Regulations that apply to relevant health professions under the RHPA will help to meet these objectives.

Additional Comments

In addition to our comments above, we share the following additional suggestions for your consideration:
    • One of the considerations when a profession becomes regulated is grandfathering criteria for those currently practising within the province. The challenge our industry frequently encounters is that the criteria will vary from one profession to another. We recommend that Manitoba consider the development of standard criteria that would be consistently applied across any profession as it becomes regulated.
    • One of the RHPA objectives is to offer more effective protection for the public. In that regard, we recommend that the government consider adding a requirement in each of the Regulations that apply to relevant health professions under the RHPA that they be required to report to law enforcement any situations where fraud by one of their members is suspected or has occurred.
Thank you for allowing us to comment. We would be pleased to discuss this with your officials at their convenience or provide any other information. In this regard, please feel to contact Karen Voin, Director Health and Dental at (416)-359-2020.


(Original signed by)

Stephen Frank
Vice President
Policy Development and Health