Issue Statement

Current policies and regulations within Primary and Preventative Health Services in Alberta restrict billing and referral privileges primarily to physicians and other regulated health professionals. This limits access to timely, preventative, and rehabilitative care for injured workers and those needing referral services, especially in rural and underserved areas.

Background

Primary and Preventative Care in Alberta was created to ensure all Albertans have access to timely, appropriate, and person-centered primary health care. The system aims to strengthen the foundation of health care by focusing on prevention, early intervention, and continuity of care, with a goal to improve health equity, especially for rural, remote, and Indigenous communities.

The MAPS 2-Year Implementation Plan and Health Care Refocusing Framework identify the need to expand interdisciplinary teams to include allied health professionals. Despite this, many allied health professionals face barriers in obtaining a practitioner ID (Prac ID) and billing for services such as WCB.

Allied health professionals in Alberta continue to face significant restrictions regarding their ability to bill for services and to issue referrals under the current Alberta Health Care Insurance Plan (AHCIP). Unlike some comparable colleagues (physicians, nurse practitioners), RNs and other Allied Health Professionals, cannot bill directly for referrals or insured services, and their referrals are often not recognized for the purposes of patient reimbursement or access to specialist care. This creates unnecessary complexity, limits patients’ access to timely care, and devalues the role of allied health professionals, despite their qualifications and expertise. This situation results in increased administrative burden, fragmented care, and missed opportunities for cost-effective, preventative health interventions.

AHCIP and related provincial policies govern which professionals may submit claims and issue referrals for insured services. In Alberta, most allied health professionals cannot submit billing claims for insured primary care services or have their referrals recognized financially, except under limited arrangements and only if they maintain a registered practitioner identification number (PRAC ID). RNs, and other allied health professionals, are restricted from direct billing for referrals or consultations. Regulations only recognize referrals from certain prescribers (e.g., physicians, nurse practitioners, dentists).

Federal legislation under the Canada Health Act guides provincial health funding and restricts user charges and extra billing for insured services but leaves scope for provinces to decide which professionals can bill and refer. Recent federal policy shifts have started to allow nurse practitioners, pharmacists, and midwives to bill for primary care medically necessary services as of April 2026; however, this does not yet apply to RNs or all allied health providers across provinces.

Other provinces, such as British Columbia, Saskatchewan and Ontario, permit a wider range of billing and referral privileges for group-based services and interdisciplinary care, recognizing the importance of collaborative models. Internationally, countries like the UK and Australia have broader nurse-led billing and referral programs, enhancing care access and system efficiency.

Impact

This regulatory barrier affects allied health professionals in Alberta, including registered nurses, physiotherapists, occupational therapists, registered hearing practitioners, pedorthists, dietitians, and counsellors; who contribute integral health services. This devalues allied health expertise, limits their professional autonomy, and impacts multidisciplinary team-based care models, leading to inequality within the health professions and underutilization of highly qualified workers.

Affected industry groups include:

• Independent nurse-run clinics
• Allied health practices in primary, community, and workplace settings
• Employers seeking timely, direct access to holistic health interventions
• Patients who experience access barriers and care delays due to referral/billing limitations

Patients, especially seniors, low-income individuals, and rural residents, face redundant appointments and long waits for referrals and insurance approvals. These delays can worsen symptoms and lead to progressive conditions that could have been addressed earlier.

Clinics and small businesses lose time coordinating extra signatures and performing uncompensated diagnostic testing. Family physicians, ENT specialists and other specialists face administrative burdens for non-clinical referrals. Public payers and insurers incur unnecessary costs for gatekeeping visits, and unequal treatment persists within health services.

Compelling data illustrates that unlocking allied health billing and referral privileges enhances access, reduces wait times, improves health system ROI, and better utilizes Alberta’s health workforce. These changes will benefit patients by lowering barriers to care, improve retention and satisfaction of allied professionals, and align with federal health reforms and interprovincial best practices.

Recommendations

To resolve these inequities, the following actions are recommended:

1. Amend Alberta policy and regulations to recognize referrals made by registered nurses and other allied health professionals for insured services under AHCIP, enabling direct billing and Prac IDs for allied health professionals, RNs, nurse-led referrals and consultative care.

2. Amend legislative and regulatory requirement to align with evolving federal Canada Health Act interpretation and best practices seen in other provinces.

3. Implement standardized billing codes for registered nurses and allied health professionals, mirroring policies that exist for nurse practitioners and other non-physician providers, thereby allowing billing for direct patient care and referrals through public and private insurers.

4. Expand interdisciplinary billing models in alignment with models of care in British Columbia, Ontario and Saskatchewan, facilitating collaborative care teams and improving patient access without redundant physician gatekeeping.

5. Ensure equity in compensation and referral rights for all regulated health professions performing functions recognized within their scope of practice.

6. Fund community care pilots for non-invasive procedures, such as ear-care services in Registered Hearing Practitioner clinics, with direct referral authority.

7. Engage stakeholders, including regulatory bodies, unions, and advocacy groups to ensure equitable and evidence-based policy development.

8. Collect outcome data on cost savings, reduced wait times, and improved access to care.

Date Drafted: October 27, 2025

Date Approved: November 19, 2025