Nursing Home Care Benefits Regulations (C.R.C., c. 334)

Short Title

1 These Regulations may be cited as the Nursing Home Care Benefits Regulations.

Interpretation

2 In these Regulations,

assistance agreement

assistance agreement means an agreement made under Part I of the Canada Assistance Plan; (accord d’assistance)

base year

base year means,

• (a) in relation to any province other than the Province of Alberta, the 12-month period immediately preceding the day on which the province has introduced a universal nursing home care benefit program, and

• (b) in relation to the Province of Alberta, April 1, 1973 to March 31, 1974; (année de base)

base year payment

base year payment means,

• (a) in relation to any province other than the Province of Alberta, the total amount determined by the Minister to have been payable by Canada to the province under an assistance agreement in respect of the cost in the base year to the province and to municipalities in the province of assistance provided to or on behalf of those persons who were residents of nursing homes that were listed, or were accepted for listing, as homes for special care in a schedule to that agreement, to the extent that such cost would have been assumed under a universal nursing home care benefit program had that program been in effect, and

• (b) in relation to the Province of Alberta, the total amount, determined in accordance with an agreement made under section 3, that would have been payable by Canada to the Province under an assistance agreement in respect of the cost to the Province and to municipalities in the Province of assistance that, if the Province had not introduced a universal nursing home care benefit program, would have been provided to those persons who were residents of nursing homes or parts thereof that during the base year were included in that program; (versement de l’année de base)

care

care includes such nursing, personal or supervisory care as is normally provided by or under the supervision of skilled nursing personnel; (soins)

contribution

contribution means a contribution payable by Canada under an agreement made under section 3; (contribution)

contribution commencement day

contribution commencement day means,

• (a) in relation to a province that on January 1, 1974 had in operation a universal nursing home care benefit program, January 1, 1974, and

• (b) in relation to any other province, the later of the day on which the province has introduced a universal nursing home care benefit program and a day that is six months prior to the day on which the province notifies the Minister in writing of its intention to enter into an agreement under section 3; (date du début de la contribution)

estimate

estimate, in relation to population, means an estimate certified by the Chief Statistician of Canada; (estimation)

initial period

initial period means the part of a year commencing on the contribution commencement day; (période initiale)

Minister

Minister means the Minister of National Health and Welfare; (ministre)

nursing home

nursing home means a residential institution the primary purpose of which is to provide care to persons who reside therein, but does not include a child care institution; (maison de repos)

provincial law

provincial law means the Acts of the legislature of a province, and any regulations made thereunder, that provide for benefits under a universal nursing home care benefit program under conditions that are consistent with these Regulations; (législation provinciale)

resident

resident means a person who resides in a nursing home for the purpose of receiving care therein, but does not include any person who is in the care or custody or under the control or supervision of a child welfare authority as defined in the Canada Assistance Plan, or who could, by reason of age, be taken into the care or custody or brought under the control or supervision of such an authority; (résident)

universal nursing home care benefit program

universal nursing home care benefit program means a program described in section 3; (programme universel de prestations pour soins dans les maisons de repos)

weighted average

weighted average means the weighted average that is determined by the province in accordance with an agreement under section 3 and that is approved by the Minister; (moyenne pondérée)

year

year means a 12-month period ending on March 31st. (année)

Agreement Authorized

• 3 (1) Where an assistance agreement is in force, the Minister may enter into an agreement with the province to provide for the payment by Canada to the province of a contribution, calculated in accordance with these Regulations, in respect of the cost to the province and to municipalities in the province of benefits paid under a universal nursing home care benefit program of the province.

• (2) A universal nursing home care benefit program means a program, established pursuant to provincial law, that

  • (a) provides for, and is administered and operated so as to provide for, the payment by the province of benefits in respect of the cost of care provided in nursing homes in the province that are included in the program; and

  • (b) is administered and operated on the basis that the benefits referred to in paragraph (a) are available on uniform terms and conditions

    • (i) to every resident of a nursing home or part thereof that is included in the program,

    • (ii) to every such resident who is receiving a level of care specified by the province for the purposes of the program, or

    • (iii) to every such resident who is within an age group specified by the province for the purposes of the program,

    without the requirement of a test of the financial circumstances of any person to determine whether or not that person is entitled to receive such benefits.

• (3) Notwithstanding subsection (2), a universal nursing home care benefit program described in that subsection includes a program that is administered and operated under terms and conditions that require

  • (a) all persons who receive the care referred to in paragraph (2)(a) to pay the same fixed amount representing a portion of the cost of such care;

  • (b) a period of residence in the province as a condition of eligibility for the benefits referred to in paragraph (2)(a);

  • (c) the payment of a premium in respect of the program; or

  • (d) a test of the financial circumstances of any person to determine the ability of that person to pay the amount referred to in paragraph (a) or the premium referred to in paragraph (c).

Calculation of Contributions

4 The amount of the contribution payable by Canada to a province for a year is the amount obtained by multiplying the base year payment by the product of the cost increase factor and the population increase factor.

5 For the purposes of section 4,

• (a) the cost increase factor is the quotient obtained by dividing the per diem cost of care determined by the Minister for the year for which a contribution is paid by the per diem cost of care determined by the Minister for the base year; and

• (b) the population increase factor is the quotient obtained by dividing

  • (i) an estimate of the number of persons in the total population of the province who were 65 years of age or over on October 1st of the year for which a contribution is paid

  by

  • (ii) an estimate of the number of persons in the total population of the province who were 65 years of age or over on whichever of the following dates last precedes or represents the first day of the seventh month of the base year, namely, January 1st, April 1st, June 1st, July 1st or October 1st.

6 The amount of the contribution payable by Canada to a province for an initial period is

• (a) in relation to any province other than the Province of Alberta, that proportion of the amount, as determined by the Minister, obtained by multiplying the base year payment by the product of the cost increase factor and the population increase factor that the initial period is of a year; and

• (b) in relation to the Province of Alberta, one-quarter of the base year payment.

7 For the purposes of paragraph 6(a),

• (a) the cost increase factor is the quotient obtained by dividing the amount of the per diem cost of care for the period of computation comprising, at the election of the province,

  • (i) the initial period, or

  • (ii) the year during which the initial period began,

  by the per diem cost of care for the base year; and

• (b) the population increase factor is the quotient obtained by dividing

  • (i) an estimate of the number of persons in the total population of the province who were 65 years of age or over on whichever of the following dates last precedes or represents the first day of the second half of the initial period as determined by the Minister, namely, January 1st, April 1st, June 1st, July 1st or October 1st,

  by

  • (ii) an estimate of the number of persons in the total population of the province who were 65 years of age or over on whichever of the following dates last precedes or represents the first day of the seventh month of the base year, namely, January 1st, April 1st, June 1st, July 1st or October 1st.

• 8 (1) In sections 5 and 7, "per diem cost of care” means

  • (a) in respect of a year or an initial period for which a contribution is paid, the weighted average of the daily operating costs incurred for the care provided during that year or initial period in nursing homes included in a universal nursing home care benefit program of the province;

  • (b) in respect of the base year for any province other than the Province of Alberta, the weighted average of the daily operating costs incurred for the care provided during that base year in nursing homes that

    • (i) were listed, or were accepted for listing, as homes for special care in a schedule to an assistance agreement, and

    • (ii) were, upon the introduction of a universal nursing home care benefit program of the province, included in that program; and

  • (c) in respect of the base year for the Province of Alberta, the weighted average of the daily operating costs incurred for the care provided during that base year in nursing homes that, during the base year, were included in a universal nursing home care benefit program of the Province.

• (2) In subsection (1), “operating costs” means that portion of the total operating costs of a nursing home that may, in accordance with recognized and generally accepted accounting principles, be properly considered as having been incurred for the care of residents therein.

Terms of Agreement

• 9 (1) Every agreement made under section 3 (hereinafter referred to as an “agreement”)

  • (a) shall include a schedule listing the Acts and regulations, or any portion of the Acts and regulations, referred to in the definition “provincial law” in section 2;

  • (b) shall provide for the exchange between Canada and the province of statistical and other information relating to the administration and operation of these Regulations and the provincial law; and

  • (c) may contain such other terms and conditions as the Minister and the province may agree upon.

• (2) Every agreement shall provide that the province

  • (a) for a period of five years will ensure, for examination and audit by the Minister or any person designated by him, the maintenance and availability of such records and accounts respecting the provision of benefits under the universal nursing home care benefit program of the province as the agreement may require; and

  • (b) will furnish the Minister with copies of the Acts and regulations referred to in the definition “provincial law” in section 2.

• (3) Every agreement shall provide that Canada will pay to the province the contribution or advances on account thereof that Canada is authorized to pay to the province under these Regulations.

Payment of Contributions

• 10 (1) Subject to sections 13 and 14 and to the observance of the undertakings contained in an agreement, contributions or advances on account thereof may be paid, on the certificate of the Minister, out of the Consolidated Revenue Fund.

• (2) Subject to any allowance for depreciation calculated in accordance with recognized and generally accepted accounting principles, no contribution shall be paid to a province under these Regulations in respect of any cost incurred by the province or municipalities in the province for care provided prior to the contribution commencement day.

11 No contributions shall be paid to a province under these Regulations for any cost in respect of which the payment of a grant or contribution by Canada is authorized under any Act of Parliament other than an Appropriation Act authorizing payments in relation to the operation of universal nursing home care benefit programs.

Operation of Agreement

12 Every agreement shall contain provisions to the effect that

• (a) the agreement will continue in force until March 31, 1976 so long as the provincial law remains in operation, and may, with the approval of the Governor in Council, be renewed each year for a period of one year by consent of the Minister and the province;

• (b) the agreement may, with the approval of the Governor in Council, be amended or terminated at any time by consent of the Minister and the province;

• (c) any schedule to the agreement may be amended at any time by consent of the Minister or a person designated by him and the province;

• (d) the province may at any time give to Canada notice of intention to terminate the agreement;

• (e) Canada may, at any time, give to the province notice of intention to terminate the agreement;

• (f) where notice of intention to terminate the agreement is given under the provision described in paragraph (d), the agreement shall cease to be effective for any period after the day fixed in the notice; and

• (g) where notice of intention to terminate the agreement is given under the provision described in paragraph (e), the agreement shall cease to be effective for any period after the day fixed in the notice or for any period after the expiration of three months from the day on which the notice is given, whichever is the later.

Claims for Contributions and Advances

• 13 (1) Where a contribution is payable to a province, the province shall furnish to the Minister a statement containing such information as the Minister may require for the purpose of determining the amount of that contribution.

• (2) The statement referred to in subsection (1) shall be in a form satisfactory to the Minister and shall be certified as to its correctness

  • (a) by a provincial minister or such other person, approved by the Minister, as may be designated by a provincial minister for that purpose; and

  • (b) by the provincial auditor or such other official or body as may be designated by the province, subject to such conditions as may be agreed to by the Minister.

• (3) The statement referred to in subsection (1) shall be furnished to the Minister within one year after the end of the year or initial period to which the statement relates or within such further period as the Minister may specify.

• (4) Upon the certificate of the Minister that the statement referred to in subsection (1) or such further information as the Minister may have requested for the purpose referred to in that subsection has been received and that the amount of the contribution has been determined, an amount equal to the amount of the contribution so determined, less the total of any advances pursuant to section 14 paid to the province on account of such contribution, shall be paid to the province.

• 14 (1) Where a contribution is payable to a province for a year or an initial period, an advance on account thereof may be paid to the province for any month in that year or initial period.

• (2) Where a province has requested an advance on account of a contribution, the province shall furnish to the Minister

  • (a) a statement, in a form satisfactory to the Minister and certified by a provincial minister or other person referred to in paragraph 13(2)(a), showing an estimate of the contribution payable to the province; and

  • (b) such further information as the Minister may require for the purpose of determining the amount of the advance.

• (3) Upon the certificate of the Minister that the statement referred to in paragraph (2)(a) and such further information as may be required under paragraph (2)(b) have been received, an advance in an amount determined in accordance with subsection (4) or (5), as the case may be, shall be paid to the province on or after the 20th day of the month for which the advance is made.

• (4) Where an advance is on account of a contribution payable to a province for a year, the amount of the advance shall be an amount equal to

  • (a) one-twelfth of the most recent estimate made by the Minister of the contribution payable for that year

  less

  • (b) any amount by which the aggregate of advances paid for prior months in that year exceeds the portion of that estimate that is payable to the province for those prior months.

• (5) Where an advance is on account of a contribution payable to a province for an initial period, the amount of the advance shall be an amount equal to

  • (a) that proportion of the most recent estimate made by the Minister of the contribution payable for that initial period that one month is of the total number of months in the initial period

  less

  • (b) any amount by which the aggregate of advances paid for prior months in that initial period exceeds the portion of that estimate that is payable to the province for those prior months.

15 Every agreement shall provide that

• (a) where a contribution or an advance on account thereof has been paid to a province and it is determined by the Minister that the amount paid is in excess of the amount payable under the agreement, an amount equal to the amount in excess thereof shall be paid to Canada by the province and, in the event that the amount is not so paid, it may be recovered at any time by Canada as a debt due to Canada by the province; and

• (b) in recovering any amount due as a debt under the provision described in paragraph (a), Canada may deduct, from any contribution or advance payable under the agreement or from any amount payable under an assistance agreement, an amount equal to the amount of the debt.