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Veterans Health Care Regulations (SOR/90-594)

Regulations are current to 2024-05-28 and last amended on 2022-04-01. Previous Versions

PART IIVeterans Independence Program (continued)

Continuation of Services (continued)

  •  (1) A client described in section 15, 17 or 18 who, on June 30, 1993, is in receipt of adult residential care in a community facility other than in a contract bed, may continue to receive that care for as long as

    • (a) the provision of those services is uninterrupted; and

    • (b) the client meets the requirements set out in that section.

  • (2) A client described in section 15, 17 or 18 whose request for the care referred to in subsection (1) is approved on or after June 30, 1993, may receive that care if the request is submitted before that day.

  • (3) Clients referred to in subsections (1) and (2) are subject to the provisions of sections 29 and 33.1.

  • SOR/93-309, s. 1
  • SOR/98-386, s. 8

Exceptional Health Needs

  •  (1) Subject to subsections (2) and (3) and sections 20 and 33.1, the following clients are eligible to receive the veterans independence program services referred to in paragraphs 19(a) to (d) or, where it is not reasonably practicable for those services to be provided at their principal residence, the care referred to in paragraph 19(e), to the extent that those services or that care is not available to them as an insured service under a provincial health care system:

    • (a) veteran pensioners;

    • (b) overseas service veterans;

    • (c) [Repealed, SOR/2022-69, s. 7]

    • (d) overseas service civilians; and

    • (e) veterans to whom paragraphs (a) and (b) of the definition “Canada service veteran” in section 2 apply.

  • (2) Payments shall be made in respect of services or care provided under subsection (1) to or in respect of a client referred to in that subsection for any period of 12 months commencing on October 1 of any year, or for any lesser period within those 12 months, if

    • (a) the client is resident in Canada;

    • (b) the client has exceptional health care needs that require services or care referred to in paragraphs 19(a) to (e);

    • (c) a determination in respect of that period has been made under section 31.2 that the client’s income is insufficient to enable the client to pay for those services or that care; and

    • (d) an assessment indicates that the provision of those services would assist the client to remain self-sufficient at the client’s principal residence or the provision of that care is necessary for health reasons.

  • (3) The following amounts are not payable under this section:

    • (a) the amount by which the client’s monthly income as computed under section 31.2 exceeds the income factor applicable to the client under that section; and

    • (b) that part of the amount payable for intermediate care under these Regulations, calculated monthly, that is equal to the maximum monthly amount that the client is required to pay for the cost of accommodation and meals, as determined under section 33.1.

  • SOR/92-406, s. 5
  • SOR/94-791, s. 1
  • SOR/98-386, s. 9
  • SOR/2001-326, s. 5
  • SOR/2022-69, s. 7

Services

 The veterans independence program consists of the following services:

  • (a) home care that is provided to or on behalf of a client at the client’s principal residence, namely,

    • (i) health and support services by a health professional, such as nursing care, therapy and personal care,

    • (ii) personal care services by a person other than a health professional,

    • (iii) housekeeping services, namely, those tasks or domestic chores to assist with daily living, which services normally include only routine housekeeping unless the health and safety of the client is at risk,

    • (iv) access to nutrition services, and

    • (v) maintenance of the grounds necessary to permit independent living at the principal residence, such as the mowing of lawns and the removal of ice, snow and leaves from the walkways, driveways and eavestroughs, providing:

      • (A) the maintenance is the responsibility of the client and would normally be performed by the client were the client’s ability to do so not impaired as a result of the health condition the assessment of which indicated the client’s eligibility for the service, and

      • (B) there are no relatives of the client living at the residence who are capable of performing such maintenance;

  • (b) ambulatory health care, namely, health services such as health assessments, diagnostic services and social and recreational services that are provided by a health professional, and transportation between the client’s residence and the health centre or other similar facility where the health services are provided;

  • (c) transportation to foster independence and to enable a client to participate in social activities, if an assessment referred to in paragraph 15(2)(b), subparagraph 17(c)(ii) or paragraph 18(2)(d) indicates that

    • (i) the client requires home care or ambulatory health care, and

    • (ii) social isolation is harmful to the client’s health;

  • (d) home adaptations to a client’s principal residence to enable the client to carry out the activities of daily living; and

  • (e) intermediate care in a community facility, other than in a contract bed.

  • SOR/93-309, s. 2
  • SOR/2003-362, s. 5

Costs

  •  (1) Subject to subsection (1.1) and section 34, the maximum rates at which the costs of veterans independence program services are payable are the following:

    • (a) for home care, $11,842.40 per client per year, which amount includes

      • (i) a maximum amount of $1,652.41 per year for maintenance of the grounds of the client’s principal residence, and

      • (ii) where the client is in receipt of an attendance allowance under subsection 38(1) of the Pension Act, an amount for personal care services referred to in subparagraph 19(a)(ii) that is in respect of not more than one week in any year plus 52 days in that year;

    • (b) for ambulatory health care, $1,377.02 per client per year;

    • (c) for transportation, $1,652.41 per client per year;

    • (d) for home adaptations, $6,775.43 per client per principal residence; and

    • (e) for intermediate care, $165.91 per client per day.

  • (1.1) Subject to section 34, the maximum rate at which the costs of veterans independence services referred to in section 16.1 are payable is $3,198.80 per year, which amount includes the adjusted maximum amount referred to in subparagraph 20(1)(a)(i) per year for maintenance of the grounds of the client’s principal residence.

  • (2) The rates referred to in subsections (1) and (1.1) shall be adjusted in the same manner and on the same day as pensions are adjusted under Part V of the Pension Act.

  • (3) to (5) [Repealed, SOR/98-386, s. 10]

  • (6) [Repealed, SOR/2001-326, s. 6]

  • SOR/93-309, s. 3
  • SOR/98-386, s. 10
  • SOR/2001-157, s. 5
  • SOR/2001-326, s. 6
  • SOR/2008-41, s. 2
  • SOR/2022-69, s. 8

PART IIILong Term Care

Care in a Contract Bed

[
  • SOR/2016-31, s. 4
]
  •  (1) Subject to section 33.1, the following clients are eligible to receive adult residential care, intermediate care or chronic care in a contract bed:

    • (a) veteran pensioners;

    • (b) income-qualified veterans; and

    • (c) overseas service veterans.

    • (d) [Repealed, SOR/2022-69, s. 9]

  • (2) Subject to section 33.1, a client who on August 31, 1990 was in receipt of adult residential care, intermediate care or chronic care in a departmental facility, as that term is defined in the regulations as they read on September 1, 1990, or in a contract bed is eligible to receive care in a contract bed after August 31, 1990 for as long as the client continues, without interruption, to need adult residential care, intermediate care or chronic care.

  • (3) Subsection (2) does not apply to a client who is discharged from a departmental facility, as that term is defined in the regulations as they read on September 1, 1990, pursuant to section 26, as it read immediately before the coming into force of this subsection, or whose discharge from a contract bed is recommended pursuant to that section.

  • (4) Subject to section 33.1, veterans described in paragraph (h) of the definition veteran in section 2 are eligible to receive intermediate care or chronic care in a contract bed if an assessment indicates that their health care needs have increased and that they require specialized care that cannot adequately be provided in a community facility other than in a contract bed.

  • (5) Despite subsection (1), an income-qualified veteran or an overseas service veteran, who is an allied veteran described in paragraphs 37(4)(c.1) and (d.1) or subsection 37(4.1) or (4.2) of the War Veterans Allowance Act and who is not an allied veteran described in paragraph (g) of the definition veteran in section 2, is not eligible to receive the care referred to in subsection (1).

  • SOR/92-406, s. 6
  • SOR/98-386, s. 11
  • SOR/2001-157, s. 6
  • SOR/2001-326, s. 7
  • SOR/2003-362, s. 6
  • SOR/2009-334, s. 3
  • SOR/2016-31, s. 5
  • SOR/2022-69, s. 9

Care in a Community Facility

 Subject to section 33.1, veterans described in paragraph (h) of the definition “veteran” in section 2, who are admitted for the first time for intermediate or chronic care to a community facility other than in a contract bed after this section comes into force, are eligible to receive the cost to them of that care to the extent that it is not available to them as an insured service under a provincial health care system.

  • SOR/2003-362, s. 7

 Subject to section 33.1, an overseas service veteran is eligible to receive the cost to them of intermediate care or chronic care in a community facility to the extent that it is not available to them as an insured service under a provincial health care system if they have applied to the Minister for admission to a contract bed and are not admitted because there is no vacancy in a contract bed within a reasonable distance of the community in which they normally reside.

Chronic Care in a Community Facility

  •  (1) Veteran pensioners, civilian pensioners and special duty service pensioners are eligible to receive, in respect of a war-related pensioned condition, the cost to them of chronic care

    • (a) received in Canada in a community facility, other than in a contract bed; and

    • (b) received in a health care facility outside Canada that is of a standard equivalent to the care that would have been provided under paragraph (a), provided that the cost of such care does not exceed the usual cost of chronic care in the jurisdiction in which the care is received.

  • (1.1) Seriously disabled veteran pensioners and seriously disabled civilian pensioners are eligible to receive the cost to them of chronic care received in Canada in a community facility, other than in a contract bed, to the extent that the chronic care is not available to them as an insured service under a provincial health care system.

  • (1.11) Subject to section 33.1, a veteran pensioner or a civilian pensioner, in respect of whom the aggregate of all of their disability assessments under the Pension Act and the Veterans Well-being Act is equal to or greater than 48%, is eligible to receive the cost to them of chronic care received in Canada in a community facility, other than in a contract bed, to the extent that the chronic care is not available as an insured service under a provincial health care system.

  • (1.2) Military service pensioners, former members and reserve force members are eligible to receive, in respect of a pensioned condition or a disability for which they are entitled to a disability award or entitled to pain and suffering compensation, the cost to them of chronic care

    • (a) received in Canada in a community facility, other than in a contract bed; and

    • (b) received in a health care facility outside Canada that is of a standard equivalent to the care that would have been provided under paragraph (a), provided that the cost of such care does not exceed the usual cost of chronic care in the jurisdiction in which the care is received.

  • (2) Subject to section 33.1, income-qualified veterans, Canada service veterans and income-qualified civilians are eligible to receive the cost to them of chronic care received in Canada in a community facility, other than in a contract bed, to the extent that the chronic care is not available to them as an insured service under a provincial health care system.

  • SOR/92-406, s. 7
  • SOR/98-386, s. 12
  • SOR/2001-157, s. 7
  • SOR/2001-326, s. 8
  • SOR/2003-362, ss. 8, 13
  • SOR/2006-50, s. 77
  • SOR/2012-289, s. 6
  • SOR/2017-161, s. 10
  • SOR/2018-177, s. 22

When Income Insufficient for Chronic Care To Be Affordable

  •  (1) Subject to subsections (2) and (3) and sections 23 and 33.1, the following clients are eligible to receive chronic care in a community facility, other than in a contract bed, to the extent that the chronic care is not available to them as an insured service under a provincial health care system:

    • (a) veteran pensioners;

    • (b) overseas service veterans;

    • (c) [Repealed, SOR/2022-69, s. 11]

    • (d) civilians; and

    • (e) veterans to whom paragraphs (a) and (b) of the definition “Canada service veteran” in section 2 apply.

  • (2) Payments shall be made in respect of the care provided under subsection (1) to or in respect of a client referred to in that subsection for the period of 12 months commencing on October 1 of any year, or for any lesser period within those 12 months, if a determination in respect of that period has been made under section 31.2 that the client’s income is insufficient to enable the client to pay for that care.

  • (3) The following amounts are not payable under this section:

    • (a) the amount by which the client’s monthly income as computed under section 31.2 exceeds the income factor applicable to the client under that section; and

    • (b) that part of the amount payable for chronic care under these Regulations, calculated monthly, that is equal to the maximum monthly amount that the client is required to pay for the cost of accommodation and meals, as determined under section 33.1.

Costs

  •  (1) Subject to section 34, the maximum rate at which the cost of chronic care in a community facility other than in a contract bed is payable is $278.39 per client per day, as adjusted in accordance with subsection (2).

  • (2) The rate referred to in subsection (1) shall be adjusted in the same manner and on the same day as pensions are adjusted under Part V of the Pension Act.

  • (3) to (6) [Repealed, SOR/98-386, s. 13]

 

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