Vol. 137, No. 24 — November 19, 2003

Registration
SOR/2003-362 6 November, 2003

DEPARTMENT OF VETERANS AFFAIRS ACT

Regulations Amending the Veterans Health Care Regulations

P.C. 2003-1797 6 November, 2003

Her Excellency the Governor General in Council, on the recommendation of the Minister of Veterans Affairs and the Treasury Board, pursuant to section 5 (see footnote a)  of the Department of Veterans Affairs Act (see footnote b) , hereby makes the annexed Regulations Amending the Veterans Health Care Regulations.

REGULATIONS AMENDING THE VETERANS HEALTH CARE REGULATIONS

AMENDMENTS

1. (1) The definition "special duty area pensioner" in section 2 of the Veterans Health Care Regulations (see footnote 1)  is repealed.

(2) The definitions "income-qualified veteran" and "veteran pensioner" in section 2 of the Regulations are replaced by the following:

"income-qualified veteran" means a veteran referred to in any of paragraphs (a) to (g) of the definition "veteran" who is in receipt of an allowance under the War Veterans Allowance Act or in respect of whom a determination has been made that the veteran would be eligible for such an allowance if the veteran or their spouse or common-law partner were not in receipt of, or eligible to receive, payments under the Old Age Security Act or similar legislation of another country; (ancien combattant au revenu admissible)

"veteran pensioner" means a veteran referred to in any of paragraphs (a) to (g) of the definition "veteran" who is entitled to a pension for a war-related pensioned condition; (ancien combattant pensionné)

(3) The definition "client" in section 2 of the Regulations is amended by striking out the word "or" at the end of paragraph (f) and by adding the following after paragraph (g):

(h) a prisoner of war entitled to basic compensation under subsection 71.2(1) of the Pension Act, or

(i) a veteran described in paragraph (h) of the definition "veteran"; (client)

(4) Paragraph (c) of the definition "military service pensioner" in section 2 of the Regulations is replaced by the following:

(c) special duty service, as defined in subsection 3(1) of the Pension Act; (pensionné du service militaire)

(5) The portion of paragraph (a) of the definition "overseas service veteran" in section 2 of the Regulations before subparagraph (i) is replaced by the following:

(a) in respect of Parts I and III, a veteran referred to in any of paragraphs (a) to (g) of the definition "veteran" who, before April 1, 1946, served during World War I or World War II,

(6) The portion of paragraph (b) of the definition "overseas service veteran" in section 2 of the Regulations before subparagraph (i) is replaced by the following:

(b) in respect of Part II, a veteran referred to in any of paragraphs (a) to (g) of the definition "veteran" who served during World War I or World War II as defined in subsection 37(10) of that Act

(7) The definition "veteran" in section 2 of the Regulations is amended by adding the following after paragraph (b):

(b.1) a person who was on active service during the Korean War as a member of the special force, as defined in subsection 3(1) of the Pension Act,

(8) The definition "veteran" in section 2 of the Regulations is amended by striking out the word "or" at the end of paragraph (f), by adding the word "or" at the end of paragraph (g) and by adding the following after paragraph (g):

(h) a former member of His Majesty's forces, or of any of the forces, other than resistance groups, of any of His Majesty's allies or powers associated with His Majesty in World War I or World War II, who

• (i) served during either of those wars during the period set out in paragraph 37(10)(b) or (c), as the case may be, of the War Veterans Allowance Act,
  (ii) has resided in Canada for a total period of at least 10 years,
  (iii) does not meet the Canadian domicile requirements of subsection 37(4) of that Act, and
  (iv) served in a theatre of actual war as defined in subsection 37(8) of that Act, receives a pension for an injury or disease incurred or aggravated during service in any such force during either of those wars or accepted a commuted pension; (ancien combattant)

(9) Paragraph (c) of the definition "war-related pensioned condition" in section 2 of the Regulations is replaced by the following:

(c) special duty service, as defined in subsection 3(1) of the Pension Act;

(10) Section 2 of the Regulations is amended by adding the following in alphabetical order:

"special duty service pensioner" means a person who is entitled to a pension under the Pension Act for a disability attributable to or incurred during special duty service, as defined in subsection 3(1) of that Act; (pensionné du service spécial)

2. (1) Section 3 of the Regulations is amended by adding the following after subsection (2.1):

(2.11) Veteran pensioners and civilian pensioners, who are entitled to a pension at a rate set out in any of classes 6 to 11 of Schedule I to the Pension Act, are eligible to receive treatment benefits in Canada for any health condition, to the extent that the treatment benefits are not available to them as members or former members of the Canadian Forces or as insured services under a provincial health care system.

(2) Subsection 3(5) of the Regulations is replaced by the following:

(5) Civilian pensioners, prisoners of war entitled to basic compensation under subsection 71.2(1) of the Pension Act and Canada service veterans are also eligible to receive treatment benefits in Canada, to the extent that the treatment benefits are not available to them as insured services under a provincial health care system, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e).

(3) Section 3 of the Regulations is amended by adding the following after subsection (9):

(10) Clients who are in receipt of the cost to them of intermediate care or chronic care under section 21.1 are eligible to receive treatment benefits in Canada to the extent that the treatment benefits are not available to them as insured services under a provincial health care system.

3. Paragraph 6(c) of the Regulations is replaced by the following:

(c) the remuneration of an escort referred to in paragraph (b), where that escort is not the spouse or common-law partner or a dependant of the client or any other member of the client's household.

4. (1) The portion of subsection 15(1) of the Regulations before paragraph (a) is replaced by the following:

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

(2) Section 15 of the Regulations is amended by adding the following after subsection (1.1):

(1.11) Veteran pensioners and civilian pensioners, who are entitled to a pension at a rate set out in any of classes 6 to 11 of Schedule I to the Pension Act, are not required to meet the requirement set out in subparagraph (1)(b)(i).

(3) Section 15 of the Regulations is amended by adding the following after subsection (2):

(3) Subject to section 33.1, prisoners of war entitled to basic compensation under subsection 71.2(1) of the Pension Act 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 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 departmental facility or in a contract bed pursuant to 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 departmental facility or contract bed, and are not admitted because there is no vacancy in a departmental facility or 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.

5. The portion of paragraph 19(c) of the Regulations before subparagraph (i) is replaced by the following:

(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

6. Section 21 of the Regulations is amended by adding the following after subsection (3):

(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 departmental facility or 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.

7. The Regulations are amended by adding the following after section 21:

Care in a Community Facility

21.1 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.

8. Section 22 of the Regulations is amended by adding the following after subsection (1.1):

(1.11) Subject to section 33.1, veteran pensioners and civilian pensioners, who are entitled to a pension at a rate set out in any of classes 6 to 11 of Schedule I to the Pension Act, 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.

9. The portion of subsection 22.1(1) of the Regulations before paragraph (a) is replaced by the following:

22.1 (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:

10. (1) Section 24 of the Regulations is renumbered as subsection 24(1).

(2) Subsection 24(1) of the Regulations is amended by striking out the word "and" at the end of paragraph (b), by adding the word "and" at the end of paragraph (c) and by adding the following after paragraph (c):

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

(3) Section 24 of the Regulations is amended by adding the following after subsection (1):

(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;

(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.

11. Subsection 33.1(5) of the Regulations is replaced by the following:

(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.

12. Subsection 34.1(3) of the Regulations is amended by striking out the word "or" at the end of paragraph (a), by adding the word "or" at the end of paragraph (b) and by adding the following after paragraph (b):

(c) the person is awarded the pension and as a result qualifies as a veteran pensioner or civilian pensioner, entitled to a pension at a rate set out in any of classes 6 to 11 of Schedule I to the Pension Act.

13. The Regulations are amended by replacing the expression "special duty area" with the expression "special duty service" wherever it occurs in the following provisions:

(a) paragraph (g) of the definition "client" in section 2;

(b) subsection 3(2.2);

(c) paragraph 9(f);

(d) paragraph 13(4)(a);

(e) subsection 22(1);

(f) section 28;

(g) paragraph 30(b).

COMING INTO FORCE

14. These Regulations come into force on the day on which they are registered.

REGULATORY IMPACT
ANALYSIS STATEMENT

(This statement is not part of the Regulations.)

Description

The Veterans Health Care Regulations (the Regulations) govern the provision of health care benefits and services by the Government of Canada to veterans and other groups who served in close support of the armed forces. The Regulations provide that eligible persons may receive: pharmaceutical products; medical, surgical and dental treatment; home-based care under the Veterans Independence Program (VIP); and long-term institutional care.

The present amendment extends health care benefits and services, in respect of pensionable conditions, to military personnel injured during or as a result of special duty operations. This change is consequential to Bill C-31 (S.C. 2003, c. 12). Based on transitional provisions contained in Bill C-31, which came into force on June 19, 2003, health care benefits and services had, since that date, been provided to this group on an interim basis.

As well, the present amendment is aimed at addressing high-priority health needs of veterans by expanding program entitlement in specific areas, outlined below, where urgent needs were identified. The benefits and services provided will complement the services covered under provincial health insurance systems.

Firstly, program improvements are made for the benefit of war veterans who suffer from war-related disabilities assessed at greater than 47 percent, under the assessment scale of the Pension Act. At present, these disabled veterans receive limited health care benefits and services. Health care in respect of pensioned conditions is provided, based on those conditions having been identified in the decisions which awarded the disability pensions under the Pension Act. If, however, those veterans suffer from other, non pensionable conditions, as is frequently the case in old age, these may not be covered by Veterans Affairs' programs.

With this amendment, pensioners whose disabilities are assessed at greater than 47 percent will no longer be required to justify their health care needs by attributing those needs to a specific war-service injury. As a result, health care programs will address their needs in a more comprehensive manner for the entire range of needs and conditions they may experience.

Second, the present amendments provide for eligibility to the VIP services at their residence to war veterans who served overseas. These services are to be provided as an alternative to long-term care in an institution, when a veteran who would normally require intermediate care or chronic care cannot be admitted to a veterans' priority access facility due to these facilities being fully occupied in the veteran's community or region. A pilot project, initiated in July 1999, concluded that supporting the care of these aging veterans in their own homes resulted in both increased quality of life, and significant cost savings. VIP services are to be provided based on an assessment indicating that they are required to assist the veteran to remain self-sufficient at his or her home.

Third, the amendment extends long-term care (and associated health care benefits such as pharmaceutical products, dental services, vision care, etc.) to veterans of allied forces who have resided for a minimum of ten years in Canada after the end of World War I or II. Prior to 1995, when their eligibility ended in accordance with legislative measures further to a review of government programs, these veterans qualified for Veterans Affairs' health care programs. The Government now aims to re-establish the long-term care component, for those allied veterans who will be admitted in long-term care facilities subsequent to the approval of the present amendment.

Eligibility to receive care in reserved veterans' facilities (and associated health care benefits) are also extended to these allied veterans, in cases where their health needs increase to the point of requiring specialized care which cannot be adequately provided in other community facilities.

Fourth, the amendment extends the VIP to those former prisoners of war who require home-based care as a result of a total disability. Based on need, treatment benefits (such as pharmaceutical products, dental services, vision care, etc.) will be provided in conjunction with the home-based care.

Finally, other minor technical amendments are also being made.

Alternatives

The present amendment implements material improvements to veterans' programs. As veterans' health care programs are governed under a regulatory framework, an amendment to the Veterans Health Care Regulations is required for the implementation of changes to these programs.

Benefits and Costs

This initiative continues Veterans Affairs' tradition of evolving to meet changing needs. It demonstrates that the Government is committed to meeting the current and future needs of veterans, and is an opportunity to further repay a debt of gratitude to these special Canadians.

Likewise, these benefits will help allied veterans in meeting their greatest identified need; namely, access to long-term care. As such, this decision reaffirms Canada's gratitude for the role these allied veterans played in ensuring victory in the Second World War, coupled with the strong contribution they made to Canadian society in the post-war period.

The present amendment extends to individual veterans direct benefits having a total value of $59.2 millions for the initial five years, to address in an effective way some of their most significant unmet needs. The new benefits, addressing areas of higher needs, will be funded from within existing appropriations, by re-allocating funds from the Attendance Allowance program, an area of lower needs.

Consultation

The present amendment responds to a pressing need of the veteran population and is among the highest priorities of the principal veterans' organizations. This change was developed through on-going consultations with, and with the support of, the Royal Canadian Legion, the National Council of Veteran Associations in Canada, the Army, Navy and Air Force Veterans in Canada, and other organizations.

This change was also announced in the House of Commons on May 12, 2003 by the Minister of Veterans Affairs. The present amendment was also pre-published in the Canada Gazette, Part I, on August 16, 2003, providing a formal period during which interested persons could make representations. A few supportive comments were received from stakeholders (i.e., veterans and associations representing veterans), mainly seeking clarification of the policy proposal or expressing interest in applying for the new services and benefits being extended. There were no changes to the amendment as a result of pre-publication.

Compliance and Enforcement

Compliance and monitoring procedures are in place and will continue to apply to the provision of the health care benefits and referred to in this amendment. Veterans Affairs has administrative procedures in place to determine eligibility. Individual client needs are identified by a multi-disciplinary team using a client-centered service approach, and it is then determined if unmet needs can be met using departmental programs, health insurance systems, community resources, or a combination thereof. In the case of the VIP, periodic assessments are conducted to determine whether the provision of the services is required for the client to continue to live at their residence or whether the provision of care is necessary for health reasons.

The incremental cost of the changes stipulated in this amendment will be tracked and monitored.

Contact

Alex Robert
Chief
Legislation (Regulations)
Policy Coordination and Ottawa Headquarters
Veterans Affairs Canada
161 Grafton Street
Charlottetown, Prince Edward Island
C1A 8M9
Telephone: (902) 566-8189
FAX: (902) 566-8826

Footnote a 

S.C. 2001, c. 4, s. 126

Footnote b 

S.C. 2000, c. 34, par. 95(a)

Footnote 1 

SOR/90-594

NOTICE:
The format of the electronic version of this issue of the Canada Gazette was modified in order to be compatible with extensible hypertext markup language (XHTML 1.0 Strict).