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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 IIILong Term Care (continued)

Priority of Admission

  •  (1) Priority of admission to a contract bed shall be based on health need and, if the health needs of any clients are similar, admission shall be given to the clients in accordance with the following order of priority:

    • (a) first, to veteran pensioners who need care for a war-related pensioned condition;

    • (b) second, to veteran pensioners who are seriously disabled and to income-qualified veterans;

    • (c) third, to overseas service veterans; and

    • (d) fourth, to veterans described in paragraph (h) of the definition “veteran” in section 2.

  • (2) Priority of receipt of benefits or care under section 21.1, 22 or 22.1 in respect of the same community facility shall be based on health need and, where the health needs of any clients are similar, priority shall be given in the following order:

    • (a) first, to veteran pensioners, civilian pensioners, special duty service pensioners and military service pensioners who need care for a pensioned condition and former members and reserve force members who need care for a condition in respect of which they are entitled to a disability award or entitled to pain and suffering compensation;

    • (b) second, to veteran pensioners who are seriously disabled, to civilian pensioners who are seriously disabled, to veteran pensioners, to income-qualified veterans, to income-qualified civilians and to Canada service veterans;

    • (c) third, to overseas service veterans; and

    • (d) fourth, to veterans described in paragraph (h) of the definition “veteran” in section 2.

 [Repealed, SOR/2016-31, s. 8]

 [Repealed, SOR/2016-31, s. 8]

PART IVGeneral

Premiums and Fees

 Income-qualified veterans, income-qualified civilians, Canada service veterans and former members or reserve force members to whom a Canadian Forces income support benefit is payable under Part 2 of the Veterans Well-being Act are eligible to receive the cost of the premium or fee that is required to be paid in relation to

  • (a) the insured health services of the province in which they are resident; or

  • (b) municipal or provincial benefits, services or care similar to the benefits, services or care described in these Regulations.

  • SOR/2001-157, s. 10
  • SOR/2006-50, s. 79
  • SOR/2012-289, s. 8
  • SOR/2017-161, s. 10

Miscellaneous Costs of Transportation

 A veteran pensioner, a civilian pensioner, a special duty service pensioner and a former member or reserve force member who has a disability for which they are entitled to a disability award or pain and suffering compensation in respect of special duty service is eligible to receive, in accordance with section 7, the costs of transportation in Canada of an escort if

  • (a) the escort accompanies the pensioner or member on an annual vacation or on other travel approved by the Minister;

  • (b) the means of transportation is other than by automobile; and

  • (c) their pensioned condition or disability, as the case may be, is total blindness or one that otherwise requires an escort when travelling.

  • SOR/95-440, s. 8
  • SOR/2001-157, s. 11
  • SOR/2003-362, s. 13
  • SOR/2006-50, s. 80
  • SOR/2012-289, s. 9
  • SOR/2018-177, s. 23

 A client is eligible to receive in accordance with section 7, but subject to paragraph 34(2)(c), the costs of transportation in Canada incurred by them when they are transferred for medical reasons from one health care facility to another if they are eligible to receive care in a contract bed or are eligible to receive any part of the cost of intermediate care under Part II or chronic care under Part III.

  • SOR/93-309, s. 4
  • SOR/95-440, s. 9
  • SOR/98-386, s. 14(F)
  • SOR/2016-31, s. 9

 When the following clients are critically ill and the client’s attending physician is of the opinion that a visit by their spouse or common-law partner, another family member or another person designated by the client would be beneficial to the health of the client, the spouse or common-law partner, other family member or other person is eligible to receive, in accordance with section 7, the costs of transportation in Canada incurred to visit the client:

  • (a) a client who is in receipt of intermediate care or chronic care under Part II or III; and

  • (b) if in receipt of acute care in a hospital, a veteran pensioner, a civilian pensioner, a Newfoundland Special Award pensioner, a Red Cross pensioner, a flying accident pensioner, an income-qualified veteran, an income-qualified civilian, a Canada service veteran, a special duty service pensioner, a military service pensioner and a former member or reserve force member who is entitled to a disability award or entitled to pain and suffering compensation.

Continuation of Benefits, Services and Care

 Where a client who is in receipt of any benefit, service or care under these Regulations ceases to be eligible for it, the benefit, service or care shall be continued for a reasonable period in order to allow the client to make alternate arrangements.

  •  (1) Despite any other provision of these Regulations, an income-qualified veteran, income-qualified civilian or Canada service veteran who is in receipt of any benefit, service, care, premium or fee under paragraphs 3(3)(a) or (c) or 3(4)(c), subsection 15(2), section 17 or 17.1, subsection 21(1) or 22(2) or section 27 is eligible to receive that benefit, service, care, premium or fee for life, regardless of any change in the income of the veteran or civilian or their spouse or common-law partner, in the veteran’s or civilian’s income factor or in the class of recipient to which the veteran or civilian belongs, provided that the veteran or civilian continues to meet the requirements set out in the provision under which that benefit, service, care, premium or fee is received.

  • (2) Subject to subsection (3) but despite any other provision of these Regulations, a veteran or a civilian not referred to in subsection (1) who, at the time this section comes into force, is in receipt of any benefit, service, care, premium or fee referred to in that subsection is eligible to continue to receive that benefit, service, care, premium or fee for life, regardless of any change in the income of the veteran or civilian or their spouse or common-law partner, in the veteran’s or civilian’s income factor or in the class of recipient to which the veteran or civilian belongs, provided that the veteran or civilian otherwise continues to meet the requirements set out in the provision under which that benefit, service, care, premium or fee is received.

  • (3) Subsection (2) does not apply if the veteran or civilian

    • (a) is in receipt of the benefit, service, care, premium or fee solely in respect of a pensioned condition;

    • (b) is in receipt of the benefit, service, care, premium or fee solely as a result of being eligible to receive, in respect of a pensioned condition, another benefit, service, care, premium or fee under these Regulations;

    • (c) is in receipt of the benefit, service, care, premium or fee as a result of a determination of insufficient income in accordance with paragraph 18(2)(c) or subsection 22.1(2); or

    • (d) is in receipt of adult residential care, intermediate care or chronic care in a contract bed under paragraph 21(1)(a) or (c).

  • (4) A veteran or civilian who, under subsection (1) or (2), receives any benefit, service, care, premium or fee set out in a provision referred to in subsection (1) is deemed, for the purposes of any other provision in these Regulations, to receive it under the provision referred to in subsection (1).

  • (5) For the purposes of subsections (1) and (2), “income factor” and “class of recipient”, in relation to a veteran or civilian, means the income factor and class of recipient set out in the schedule to the War Veterans Allowance Act that are applicable to that person, or that would be applicable to that person if the person were a recipient under that Act.

Determination of When Income Insufficient

  •  (1) For the purposes of paragraph 18(2)(c) and subsection 22.1(2), a client’s income is considered to be insufficient in respect of the period of 12 months commencing on October 1 of any year or in respect of any lesser period within those 12 months if

    • (a) the amount by which

      • (i) the client’s monthly income, computed in accordance with subsection 33.1(5), for the month of July preceding those 12 months

      exceeds

      • (ii) the monthly cost of the services or care provided, or to be provided, under section 18 or 22.1,

      is less than

    • (b) the income factor applicable to the client under subsection (2) or (3) in respect of that month.

  • (2) Subject to subsection (3), the income factor applicable to a client for the purpose of paragraph (1)(b) is the income factor set out in column II of the schedule to the War Veterans Allowance Act that applies to the client for the month of July referred to in subparagraph (1)(a)(i), or that would apply if the client were a recipient under that Act during that month.

  • (3) Where subsection 4(6), (6.1) or (8) of the War Veterans Allowance Act applies to a client, the income factor applicable to the client for the purpose of paragraph (1)(b) is the sum of the income factors set out in column II of the schedule to that Act that apply to the client and to the client’s spouse or common-law partner, for the month of July referred to in subparagraph (1)(a)(i), or that would apply if the client and the client’s spouse or common-law partner were recipients under that Act during that month.

  • SOR/2001-326, s. 11

Referrals

  •  (1) Subject to subsection (2), where a person who is a member of the Canadian Forces is discharged and is hospitalized for a disability at the time of the discharge, the person is eligible to receive treatment benefits and supplementary benefits for the lesser of one year immediately following the discharge and a period that is equal to the person’s service in the Forces, if the Minister of National Defence requests that the benefits be extended to the person and agrees to reimburse the cost of the benefits to the Department of Veterans Affairs.

  • (2) Where benefits are extended in accordance with subsection (1), the costs of travel shall include travel from the hospital to the person’s selected place of residence if the costs of travel were payable by the Minister of National Defence at the time of the discharge.

Costs recoverable from Third Parties

 The portion of the cost of any benefit, service or care mentioned herein that is recoverable from a third party is not payable under these Regulations.

Accommodation and Meals

  •  (1) A client, except a client referred to in subsection (2), is required to pay for the cost of accommodation and meals, up to a maximum monthly amount determined under this section, while the client is in receipt of adult residential care, intermediate care or chronic care in

    • (a) [Repealed, SOR/2016-31, s. 11]

    • (b) a contract bed; or

    • (c) a community facility in which the cost of care is payable, in whole or in part, under these Regulations.

  • (2) The following clients are not required to pay for the cost of accommodation and meals while in receipt of adult residential care, intermediate care or chronic care:

    • (a) clients who are in receipt of the care for a pensioned condition;

    • (b) veteran pensioners who are seriously disabled and civilian pensioners who are seriously disabled; and

    • (c) a former member or reserve force member who is in receipt of the care for the disability for which they are entitled to a disability award or entitled to pain and suffering compensation.

  • (3) The maximum amount under subsection (1) for a month is the lesser of the following amounts:

    • (a) the maximum monthly accommodation and meal charge for that month, as calculated under subsection (4); and

    • (b) the amount, if any, remaining to the client after deducting from the client’s monthly income, as calculated under subsection (5), the client’s personal and family exemption amount, as calculated under subsection (6).

  • (4) The maximum monthly accommodation and meal charge for any of the 12 months after September 30 of a year is the lesser of the following amounts:

    • (a) the lowest monthly user charge for accommodation and meals permitted by a province, under section 19 of the Canada Health Act, on July 1 of the same year; or

    • (b) the maximum monthly accommodation and meal charge that applied immediately prior to October 1 of the same year, multiplied by the ratio that

      • (i) the income factor specified in paragraph 2(a) of the schedule to the War Veterans Allowance Act that is effective on July 1 of the same year

      bears to

      • (ii) the same income factor that was effective on July 1 of the preceding year.

  • (5) The client’s income for a month is the total of all amounts that are subtracted from the income factor in computing the client’s allowance payable for that month under subsection 4(3), (6), (6.1) or (8), as the case may be, of the War Veterans Allowance Act, or that would be so subtracted if the client were a recipient under that Act.

  • (6) The client’s personal and family exemption amount for any of the 12 months following September 30 of a year is the sum of the following amounts:

    • (a) the amount for personal comforts, which is equal to the amount for personal comforts that applies on September 30 of the same year, multiplied by the ratio referred to in paragraph (4)(b);

    • (b) where the client has a spouse or common-law partner, an amount equal to the income factor set out in paragraph 2(a) of the schedule to the War Veterans Allowance Act that is effective on July 1 of the same year;

    • (c) where the client has a spouse or common-law partner and one or more dependent children within the meaning of the War Veterans Allowance Act, an amount for each such child equal to the income factor set out in item 4 of the schedule to that Act that is effective on July 1 of the same year; and

    • (d) where the client does not have a spouse or common-law partner but has one or more dependent children within the meaning of the War Veterans Allowance Act,

      • (i) an amount equal to the income factor set out in paragraph 3(a) of the schedule to that Act that is effective on July 1 of the same year, and

      • (ii) for each such child in addition to one, an amount equal to the income factor set out in item 4 of the schedule to that Act that is effective on July 1 of the same year.

  • (7) The cost of accommodation and meals shall be paid by a client referred to in subsection (1) as follows:

    • (a) the client pays the cost directly to the community facility; or

    • (b) the cost is recovered by the Minister if the cost has been paid to the community facility by the Minister, in accordance with an arrangement with that facility.

  • (8) For the period beginning on October 1, 2021 and ending on September 30, 2022,

    • (a) the maximum monthly accommodation and meal charge is $1,091.43 per month; and

    • (b) the amount for personal comforts is $263.62 per month.

 

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