Vol. 150, No. 5 — March 9, 2016
SOR/2016-31 February 26, 2016
DEPARTMENT OF VETERANS AFFAIRS ACT
Regulations Amending the Veterans Health Care Regulations
P.C. 2016-97 February 26, 2016
His Excellency the Governor General in Council, on the recommendation of the Minister of Veterans Affairs, pursuant to section 5 (see footnote a) of the Department of Veterans Affairs Act (see footnote b), makes the annexed Regulations Amending the Veterans Health Care Regulations.
Regulations Amending the Veterans Health Care Regulations
1 (1) The definition departmental facility in section 2 of the Veterans Health Care Regulations (see footnote 1) is repealed.
(2) The definition community facility in section 2 of the Regulations is replaced by the following:
community facility means a health care facility in Canada that is approved by the Minister and provides accommodation and meals and adult residential care, intermediate care or chronic care; (établissement communautaire)
2 Paragraph 3(5)(c) of the Regulations is replaced by the following:
- (c) a client who is in receipt of adult residential care, intermediate care or chronic care in a contract bed;
3 The portion of subsection 15(4) of the Regulations before paragraph (b) is replaced by the following:
(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;
4 The heading before section 21 of the Regulations is replaced by the following:
Care in a Contract Bed
5 (1) The portion of subsection 21(1) of the Regulations before paragraph (a) is replaced by the following:
21 (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:
(2) Subsections 21(2) to (4) of the Regulations are replaced by the following:
(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.
6 Section 21.2 of the Regulations is replaced by the following:
21.2 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.
7 The portion of subsection 24(1) of the Regulations before paragraph (a) is replaced by the following:
24 (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:
8 The heading before section 25 and sections 25 and 26 of the Regulations are repealed.
9 Section 29 of the Regulations is replaced by the following:
29 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.
10 Paragraph 31.1(3)(d) of the Regulations is replaced by the following:
- (d) is in receipt of adult residential care, intermediate care or chronic care in a contract bed under paragraph 21(1)(a), (c) or (d).
11 (1) Paragraph 33.1(1)(a) of the Regulations is repealed.
(2) Paragraphs 33.1(7) (a) and (b) of the Regulations are replaced by the following:
- (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.
12 The Regulations are amended by adding the following after section 37:
38 (1) A client referred to in section 21, as it read immediately before the coming into force of this subsection, who was in receipt of adult residential care, intermediate care or chronic care in a departmental facility for any period of time that is within 30 days before the day on which the deed of transfer respecting the Hôpital Sainte-Anne-de-Bellevue is signed is not required to pay the cost of the accommodation and meals referred to in section 33.1, as it read immediately before the coming into force of this subsection, in that departmental facility for that period of time.
(2) For the purposes of subsection (1), “departmental facility” means the Hôpital Sainte-Anne-de-Bellevue.
Coming Into Force
13 (1) These Regulations come into force on the day on which the deed of transfer respecting the Hôpital Sainte-Anne-de-Bellevue is signed by the Government of Canada and the Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal.
(2) The Minister of Veterans Affairs is to publish a notice of the date referred to in subsection (1) in the Canada Gazette.
REGULATORY IMPACT ANALYSIS STATEMENT
(This statement is not part of the Regulations.)
Following the First World War, Veterans Affairs Canada (VAC) built departmental hospitals to provide care to injured military personnel returning from the War. By the 1950s and 1960s, VAC operated 18 hospitals across Canada. At the same time, the Government of Canada introduced universal hospital insurance and the provinces assumed additional responsibility for the delivery of health care. Thus, the need for VAC departmental facilities began to diminish.
In 1963, the Royal Commission on Government Organization chaired by J. Grant Glassco (the Glassco Commission) was convened to look at the organization of the federal government and recommended that all VAC departmental hospitals be transferred to the provinces. By 1995, all hospitals had been transferred, with the exception of the Hôpital Sainte-Anne-de-Bellevue (the Hospital) which, given its age, required extensive renovations in order to comply with provincial standards for long-term care facilities. The Hospital is the only remaining VAC departmental hospital.
In 2009, once the renovations were completed, VAC began discussions with the Government of Quebec for the eventual transfer of the Hospital. An agreement in principle for the transfer was signed in April 2012. These discussions resulted in a transfer agreement between the Government of Canada, the Government of Quebec and the provincial institution that will own and operate the Hospital under Quebec’s health care system, the Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Ouest-de-l’île-de-Montréal (the Institution). The transfer agreement provides for continued quality long-term care for veterans at the Hospital post-transfer. For the transfer to proceed smoothly, modifications to the Veterans Health Care Regulations (the Regulations) must be completed prior to the transfer date.
In the Regulations, the definition of a departmental facility means the “Hôpital Sainte-Anne-de-Bellevue.” With the transfer of the Hospital to the Institution, references in the Regulations to “departmental facility,” and the definition itself, are no longer needed. If the definition were to remain, it could cause confusion regarding VAC’s authority and obligation to pay for care of eligible veterans in the Hospital following the transfer.
In addition, the Regulations require veterans in receipt of financial support from VAC for long-term care, including veterans at the Hospital, to contribute to the cost of their care through a monthly accommodations and meals (A&M) payment. The A&M amount is dependent on the individual’s financial circumstances and the reason for receiving long-term care (depending on an income test, some veterans do not have to pay, some pay the full amount and others pay an amount from $0 to the full amount). As of October 1, 2015, veterans pay an A&M amount up to the current maximum of $950 per month. VAC invoices veteran residents at the Hospital at the beginning of each month for the previous month’s A&M (i.e. in arrears). On transfer of the Hospital to the Institution, veteran residents will be invoiced at the beginning of each month for the current month’s A&M (i.e. in advance).
Given the difference in billing practices between VAC and the Government of Quebec, veterans will be responsible to pay their contribution to A&M costs for both the previous month and the current month at the same time, in the first month following the transfer of the Hospital. In what should be a seamless transition of ownership of the Hospital, receiving two invoices for payment due at the same time could create undue emotional and financial hardship for veteran residents, most of whom are elderly and frail.
The first objective of the regulatory amendments is to provide clarity to stakeholders and ensure continued authority to pay for care of eligible veterans in the Hospital. These technical amendments will remove all references to “departmental facility” as no such facility will exist once the Hospital is transferred.
The second objective is to alleviate any undue emotional and financial hardship for veterans as a result of the differences in A&M billing practices by eliminating the need for these veterans to pay two months’ worth of A&M at the same time.
The regulatory amendments, which are mainly housekeeping in nature, will remove any reference to the Hospital or “departmental facility” and will waive the obligation of veteran residents at the Hospital to pay to VAC A&M costs for the 30 days prior to transfer.
More specifically, the amendments to the Regulations will
- Amend the definition of “community facility”, which currently means “a health care facility in Canada that is approved by the Minister and provides accommodation and meals and adult residential care, intermediate care or chronic care, but does not include a departmental facility.” Since there will no longer be a departmental facility, this definition will be amended to remove such reference.
- Repeal the definition of “departmental facility,” which is defined as Hôpital Sainte-Anne-de-Bellevue. Post-transfer, there will no longer be a departmental facility; therefore, the definition will be repealed.
- Remove all provisions which refer specifically to a departmental facility, since there will no longer be any such facility.
- Repeal the section regarding performing light duties in a departmental facility on the advice of a physician as part of a therapeutic program. This rarely used provision will be deleted since the Hospital will no longer be under the jurisdiction of the Government of Canada and the provision of care at the Hospital post-transfer will be the responsibility of a provincial governing body.
- Add a clause to exempt veterans residing at the Hospital from having to pay to VAC the amount of A&M owed in the 30 days prior to the transfer of the Hospital.
The “One-for-One” Rule does not apply, as there is no change in administrative costs to business as a result of this regulatory amendment.
Small business lens
The small business lens does not apply, as there are no costs to small business as a result of this regulatory amendment.
VAC has been transferring hospitals to the provinces since the 1960s. The Hospital’s transfer has, therefore, long been anticipated by stakeholders (particularly veterans, their families, employees and management). In general terms, stakeholders have been engaged from the beginning and have been kept informed of the pertinent details of the transfer throughout the process.
No consultations have been held specifically on the regulatory amendments. However, the regulatory amendment which exempts residents from having to pay the amount of A&M owed in the 30 days prior to the transfer was crafted specifically to remove any possible financial burden associated with the transition and is expected to be received favourably by Hospital residents and their families. The rest of the regulatory amendments are housekeeping in nature and are expected to have little or no impact on Canadians.
The regulatory amendments are to support the transfer of the Hospital to the Institution. They ensure clarity and enhance accuracy in the application and interpretation of the Regulations by veterans and their families, stakeholder groups, VAC personnel, and Canadians in general. Veterans residing at the Hospital prior to the transfer will not be burdened with the requirement to pay two A&M invoices at the same time.
The transfer will result in VAC no longer owning or operating a departmental hospital. Under the Regulations, the Hospital will be a community facility. VAC has the authority to pay for the care of eligible veterans in a community facility and will continue to pay for eligible veterans receiving care at the Hospital.
The regulatory amendments will create no cost or administrative burden for veterans or businesses and has no impact on public policy. There will be no new additional cost to Government associated with these regulatory changes. Veterans residing at the Hospital will not be required to pay the A&M amount owed in the 30 days prior to the transfer of the Hospital. The amount of revenue foregone by VAC is estimated at $238,800 in 2015–2016 based on the forecasted number of veterans residing at the Hospital in the month prior to transfer (304) multiplied by the average A&M payment at the Hospital ($785.40).
Implementation, enforcement and service standards
The regulatory amendments will come into force on the day the deed of transfer for the Hospital is signed (anticipated to take place on April 1, 2016). VAC will also publish a notice of this date in the Canada Gazette.
The amendments are mainly housekeeping or transitional in nature and do not impose new restrictions or regulatory burdens on individuals or industry and are expected to have little impact on Canadians. There is no change expected to how the Regulations are implemented or enforced.
Cabinet Business Unit
Policy and Research Division
Veterans Affairs Canada
161 Grafton Street, Room 436
Daniel J. MacDonald Building
Charlottetown, Prince Edward Island