Veterans Health Care Regulations (SOR/90-594)

Mental Health Benefits

14 The following definitions apply in sections 14.1 to 14.5.

Canadian Forces

Canadian Forces means the armed forces referred to in section 14 of the National Defence Act and includes any predecessor naval, army or air forces of Canada or Newfoundland. (Forces canadiennes)

disability benefits

disability benefits means

• (a) a pension awarded under section 21 of the Pension Act on account of a disability; or

• (b) pain and suffering compensation paid under subsection 45(1) of the Veterans Well-being Act. (prestations d’invalidité)

mental health benefits

mental health benefits means the benefits referred to in section 14.2. (avantages pour la santé mentale)

mental health client

mental health client means a person who meets the requirements of section 14.1. (client en santé mentale)

• 14.1 (1) A former member of the Canadian Forces or a reserve force member is eligible to receive mental health benefits in Canada or elsewhere in respect of any mental health condition for which they submit an application for disability benefits to the extent that those benefits are not available to them as a former member of the Canadian Forces or a reserve force member nor available as an insured service under a provincial health care system.

• (2) For the purposes of subsection (1), a mental health condition means one or more of the following psychiatric conditions:

  • (a) an anxiety disorder;

  • (b) a depressive disorder;

  • (c) a trauma- and stressor-related disorder.

14.2 Mental health benefits consist of the following:

• (a) any examination or treatment provided by a psychologist, mental health counsellor or therapist, social worker or other professional approved by the Minister; and

• (b) pharmaceuticals prescribed by a physician or other person authorized to prescribe pharmaceuticals under the laws in force in the province or the country where the pharmaceuticals are provided.

• 14.3 (1) Where mental health benefits are provided in Canada, the rate at which the mental health benefits and any related administrative costs are payable is

  • (a) where the mental health benefits are fully insured health services of the province in which they are provided, the rate established by the province for those services and costs;

  • (b) where the mental health benefits are not fully insured health services of the province in which they are provided and, in respect of that province, an association of health professionals has adopted a fee schedule for treatment benefits and costs, the rate that is approved by the Minister and that is based on that fee schedule; and

  • (c) in any other case, the rate normally paid for those mental health benefits and costs in the community in which the mental health benefits are provided.

• (2) Where mental health benefits are provided in a country other than Canada, the mental health client is eligible to receive reimbursement of the actual and reasonable expenses and any related administrative costs incurred by the mental health client, up to a maximum amount approved by the Minister.

• 14.4 (1) A mental health client becomes eligible to receive mental health benefits

  • (a) on April 1, 2022, if their application for disability benefits is received by the Minister before that date and the Minister has not yet made a decision respecting the application; or

  • (b) on the day on which the Minister receives their application for disability benefits, if their application is received on or after April 1, 2022.

• (2) Despite subsection (1), if a person who does not meet the requirements of section 14.1 submits an application for disability benefits, they become eligible to receive mental health benefits beginning on the day on which they become a mental health client.

14.5 Despite section 31, a mental health client ceases to be eligible to receive mental health benefits

• (a) if the Minister makes a favourable decision respecting their application for disability benefits, on the day on which the decision is made;

• (b) if the Minister makes an unfavourable decision respecting their application for disability benefits, two years after the applicable day determined under section 14.4 or, if the Minister makes the decision after that day, on the day on which the decision is made; and

• (c) if the Minister decides that their application for disability benefits has been withdrawn, two years after the applicable day determined under section 14.4 or, if the Minister makes the decision after that day, on the day on which the decision is made.

PART IIVeterans Independence Program

Eligibility

• 15 (1) Subject to subsections (1.1) and (1.11), veteran pensioners, civilian pensioners and special duty service pensioners are eligible to receive the veterans independence program services referred to in paragraphs 19(a), (b) and (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, if

  • (a) they are resident in Canada; and

  • (b) an assessment indicates that

    • (i) their war-related pensioned condition impairs their ability to remain self-sufficient at their principal residence without those services, and

    • (ii) the provision of those services would assist them to remain self-sufficient at their principal residence or the provision of that care is necessary for health reasons.

• (1.1) Seriously disabled veteran pensioners and seriously disabled civilian pensioners are not required to meet the requirement set out in subparagraph (1)(b)(i).

• (1.11) Veteran pensioners and civilian pensioners, whose extent of disability, in respect of 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% are not required to meet the requirement set out in subparagraph (1)(b)(i).

• (1.2) Military service pensioners and former members or reserve force members who are entitled to a disability award or entitled to pain and suffering compensation are eligible to receive the veterans independence program services referred to in paragraphs 19(a), (b) and (d) or, if 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 a member or former member of the Canadian Forces nor available as an insured service under a provincial health care system, if

  • (a) they are resident in Canada; and

  • (b) an assessment indicates that

    • (i) their pensioned condition or the disability for which they are entitled to a disability award or entitled to pain and suffering compensation, as the case may be, impairs their ability to remain self-sufficient at their principal residence without those services, and

    • (ii) the provision of those services would assist them to remain self-sufficient at their principal residence or the provision of that care is necessary for health reasons.

• (2) Subject to section 33.1, income-qualified veterans who are 65 years of age or more, income-qualified overseas service civilians who are 65 years of age or more and Canada service veterans 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, if

  • (a) they are resident in Canada; and

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

• (3) Subject to section 33.1, prisoners of war who are entitled to basic compensation under subsection 71.2(1) of the Pension Act and former members and reserve force members who have received a detention benefit under Part 3 of the Veterans Well-being Act are eligible to receive the veterans independence program services referred to in paragraphs 19(a), (b) and (d) or, if 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 as an insured service under a provincial health care system, if

  • (a) they are totally disabled, whether by reason of military service or not;

  • (b) they are resident in Canada; and

  • (c) an assessment indicates that the provision of those services would assist them to remain in their principal residence or that the provision of that care is necessary for health reasons.

• (4) Subject to section 33.1, overseas service veterans eligible for intermediate care or chronic care in a contract bed under subsection 21(1) are also eligible to receive the veterans independence program services referred to in paragraphs 19(a), (b) and (d), to the extent that those services are not available to them as an insured service under a provincial health care system, if

  • (a) 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;

  • (b) they are resident in Canada; and

  • (c) an assessment indicates that the provision of those services would assist them to remain self-sufficient at their principal residence.

Continuation of Services

• 16 (1) Subject to subsection (2), the primary caregiver of a client is entitled to any of the services referred to in subparagraphs 19(a)(iii) and (v) that the client was receiving under the Department of Veterans Affairs Act at the time the client died or began residing in a health care facility if

  • (a) the primary caregiver is assessed within one year after the earlier of client's death and the client's admission into the health care facility, or presents evidence relating to their health condition during that period on the basis of which an assessment can be made;

  • (b) the assessment and all subsequent assessments indicate that the provision of the services is necessary for health reasons and to assist the primary caregiver to remain self-sufficient at their principal residence; and

  • (c) the primary caregiver is resident in Canada.

• (1.1) Despite subsection (1), the primary caregiver of a client who died or began residing in a health care facility during the period beginning on October 14, 2008 and ending on December 31, 2009 is entitled to the services in accordance with subsection (1) that the client would have been entitled to receive if paragraph (d) of the definition overseas service veteran and paragraph (e) of the definition veteran in section 2 had come into force on October 14, 2008 provided that

  • (a) the client 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;

  • (b) the client is not an allied veteran described in paragraph (g) of the definition veteran in section 2; and

  • (c) the primary caregiver applies to the Minister for the services no later than December 31, 2010.

• (2) The primary caregiver is entitled to the services to the extent that they are not available to the primary caregiver as an insured service under a provincial health care system or a private insurance policy.

• (3) In this section, primary caregiver, in relation to a client, means the adult person who, immediately before the client died or was admitted into a health care facility,

  • (a) was primarily responsible, without remuneration, for ensuring that care was provided to the client; and

  • (b) for a continuous period of at least one year, resided in the principal residence of the client and maintained the client or was maintained by the client.

• 16.1 (1) The survivor of a person — who was an income-qualified civilian, an income-qualified veteran, a veteran pensioner or a civilian pensioner and who, at the time of their death, was not in receipt of the services referred to in subparagraphs 19(a)(iii) and (v) — is eligible to receive those services if

  • (a) an assessment and all subsequent assessments indicate that the provision of the services is necessary for reasons related to the health of the survivor and to assist the survivor to remain self-sufficient at their principal residence;

  • (b) the survivor is in receipt of the guaranteed income supplement under the Old Age Security Act or an amount is deductible in respect of the survivor under section 118.3 of the Income Tax Act in computing an individual’s tax payable under Part I of that Act;

  • (c) the services are not available as an insured service under a provincial health care system or a private insurance policy;

  • (d) the survivor is not eligible to receive any services under section 16; and

  • (e) the survivor is resident in Canada.

• (2) In this section, survivor means, in relation to the person, the adult individual who, immediately before the person died or, if the person died in a health care facility, immediately before the person was admitted into the health care facility,

  • (a) was primarily responsible, without remuneration, for ensuring that care was provided to the person; and

  • (b) for a continuous period of at least one year, resided in the principal residence of the person and maintained the person or was maintained by the person.

17 Subject to section 33.1, income-qualified veterans who are under 65 years of age 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, if

• (a) they are resident in Canada;

• (b) as of August 31, 1990, they were the subject of an assessment based on current data that indicated that

  • (i) the provision of those services would assist them to remain self-sufficient at their principal residence, or

  • (ii) the provision of that care was appropriate in the circumstances; and

• (c) they continue after August 31, 1990, without interruption

  • (i) to qualify as income-qualified veterans, and

  • (ii) to be the subject of an assessment that indicates that the provision of those services would assist them to remain self-sufficient at their principal residence or that the provision of that care is appropriate in the circumstances.