Care provided by nurse practitioners will be covered in 2026

(Toronto) Provincial and territorial health insurance plans will cover primary care provided by nurse practitioners, pharmacists and midwives starting next year, federal Health Minister Mark Holland announced Friday.

Holland said regulated health professionals who are not doctors will be able to bill the government for medically necessary services that would otherwise be provided by a doctor.

These changes are part of a new interpretation of the Canada Health Act that will come into force on 1^is April 2026, the minister said, emphasizing that this measure is necessary because some patients pay out of pocket for medically necessary care, including in certain private nurse practitioner clinics.

Holland said billing patients for these services is not consistent with universal health care and that nurse practitioners should instead be able to bill the health system the same way doctors do.

The minister issued the directive in an “interpretation letter” – reviewing which providers fall under Canada’s health insurance system – sent to health ministers on Thursday, but made public Friday morning.

In an interview Thursday evening, Mr. Holland said he was “deeply concerned” about patients having to pay for public health services.

“This is certainly not in the spirit of the Canada Health Act, and this letter of interpretation puts an end to that,” he argued.

The new policy also “empowers” ​​non-physician health professionals to provide the full range of care for which they are qualified, Holland said.

Nurse practitioners, in particular, can help alleviate pressure on primary care doctors and the health care system as a whole, he said.

“The scopes of practice of many regulated health professionals (e.g., nurse practitioners, pharmacists, midwives) have been expanded to better utilize the full extent of their skills, knowledge and abilities to increase the “access to necessary care,” Mr. Holland wrote in the letter addressed to his provincial and territorial counterparts.

The changes will be implemented in provinces and territories through federal health transfer payments, which could be deducted if patients have to pay for medically necessary care, he said.

Claire Dion Fletcher, vice-president of the Canadian Association of Midwives, said after years of advocacy with health ministers, “core” midwifery services – from prenatal to six weeks after birth – are already funded by all provinces and territories.

But including midwives in the updated billing rules means they might be able to provide other services for which they are qualified, but “which are not necessarily covered by our current compensation model,” she said in an interview.

These services include screening for sexually transmitted diseases, provision of contraception, abortion care and vaccinations.

Joelle Walker, vice-president of public and professional affairs for the Canadian Pharmacists Association, said pharmacists already provide varying levels of primary care – including diagnosing illnesses and prescribing medications – depending on the province or province. territory.

She hopes the new policy will increase the services pharmacists can bill to provincial health insurance plans.

Mr. Holland said the long delay in allowing non-doctors to bill the government for care is necessary for provinces and territories to adjust their health insurance plans.

An expected measure

Holland’s directive comes almost two years after his predecessor, Jean-Yves Duclos, expressed concern in a letter to health ministers about patients paying out of pocket for medically necessary treatments.

In this letter dated March 9, 2023, Mr. Duclos committed to publishing a revised interpretation of the Canada Health Act to prevent this from happening.

Last September, the organization Canadian Physicians for Public Health wrote to the Prime Minister’s Office to ask when this “long-awaited” interpretation would be released.

The president of the group, D^re Melanie Bechard, said she would help “ensure that all Canadians continue to have access to medically necessary care based on their needs, not their ability or willingness to pay.”

“The shift toward episodic care provided virtually by physicians and longitudinal care provided by nurse practitioners (and other types of providers) was not anticipated in 1984 when the Canada Health Act was passed,” said writes M^me Bechard.

“Clarifying that medically necessary virtual care or nurse practitioner care must be publicly funded would be consistent with the spirit and intent of the Canada Health Act. »

Holland said the delay was due to ongoing consultation with provincial and territorial governments over the past two years to reach agreement on the new policy.

Mr. Duclos also identified virtual care and telemedicine as areas where some patients may be paying out of pocket inappropriately.

Holland said billing for virtual care is not addressed in his current directive, but remains a concern he is discussing with his provincial counterparts.

“If you enter a medical office that is a physical medical office or if you enter a virtual medical office, both of those things should be covered by the Canada Health Act,” he argued.

“These two things should ensure that a patient is not paying for their health care services.” »

With information from Allison Jones

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