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Veterans Health Care Regulations (SOR/90-594)

Regulations are current to 2021-11-17 and last amended on 2019-04-01. Previous Versions

PART IIVeterans Independence Program (continued)

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, $7,142.52 per client per year, which amount includes

      • (i) a maximum amount of $996.64 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, $830.52 per client per year;

    • (c) for transportation, $996.64 per client per year;

    • (d) for home adaptations, $4,152.63 per client per principal residence; and

    • (e) for intermediate care, $100.07 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 $2400 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  • (3) to (5) [Repealed, SOR/98-386, s. 10]

  • (6) [Repealed, SOR/2001-326, s. 6]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

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;

    • (c) overseas service veterans; and

    • (d) dual service veterans.

  • (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 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

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.

  • SOR/2012-42, s. 3
  • SOR/2012-289, s. 5(F)
  • SOR/2016-31, s. 6

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) dual service veterans;

    • (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.

  • SOR/2001-326, s. 8
  • SOR/2003-362, s. 9

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 $167.89 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]

  • SOR/98-386, s. 13
  • SOR/2001-157, s. 8

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 dual 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 dual service veterans; and

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

  • SOR/92-406, s. 8
  • SOR/2001-157, s. 9
  • SOR/2001-326, s. 9
  • SOR/2003-362, s. 10
  • SOR/2006-50, s. 78
  • SOR/2012-289, s. 7
  • SOR/2016-31, s. 7
  • SOR/2018-177, s. 22

 [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, a dual service veteran, 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.

  • SOR/95-440, s. 9
  • SOR/2001-326, s. 10
  • SOR/2003-362, s. 13
  • SOR/2006-50, s. 81
  • SOR/2012-289, s. 10
  • SOR/2018-177, s. 22

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.

 
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