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Veterans Health Care Regulations (SOR/90-594)

Regulations are current to 2024-04-01 and last amended on 2022-04-01. Previous Versions

PART IVGeneral (continued)

Exceeding Rates

  •  (1) The Minister shall authorize the payment of costs at a rate that is higher than a rate set out in section 20 or 23 if

    • (a) the higher rate is necessary in order to provide an appropriate standard of service or care;

    • (b) the higher rate is, in the opinion of the Minister, necessary on humanitarian grounds;

    • (c) no bed is available for less than the higher rate in any health care facility that is within a reasonable distance of the community in which the client is normally resident;

    • (d) the client is not accepted for the care the client requires by any health care facility that is within a reasonable distance of the community in which the client is normally resident and the rate at the nearest health care facility that will accept the client is higher than the rate set out in that section for that care; or

    • (e) an agreement between the Minister and the health care facility or the province in which the health care facility is situated provides for a higher rate.

  • (2) The Minister may authorize that no deduction under subsection 7(2) be made

    • (a) if the client’s mobility or cognition is severely impaired;

    • (b) if the deduction would seriously impede the client’s ability to access treatment benefits; or

    • (c) in the case of a transfer referred to in section 29.

  • SOR/95-440, s. 10
  • SOR/98-386, s. 16

Limitation on Reimbursements and Payments

  •  (1) Where a person incurs an expenditure to meet a health need, no reimbursement or payment shall be made under these Regulations to or in respect of the person except in accordance with this section.

  • (2) Subject to subsections (4) to (6), reimbursement or payment shall be made if the person was eligible to receive benefits, services or care under these Regulations for that health need at the time that the expenditure was incurred.

  • (3) Subject to subsections (4) to (6), reimbursement or payment shall be made if the person, within 90 days after incurring the expenditure, applies for a pension and

    • (a) the person is awarded the pension for the condition in respect of which the expenditure was incurred and would have been eligible to receive benefits, services or care in respect of that condition if the person had been entitled to the pension at the time the expenditure was incurred;

    • (b) the person is awarded the pension and as a result qualifies as a seriously disabled veteran or seriously disabled civilian; or

    • (c) the person is awarded the pension and, as a result, qualifies as a veteran pensioner or civilian pensioner, if 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%.

  • (4) A claim for reimbursement or payment must be made by or on behalf of the person within 18 months of the day on which the expenditure was incurred.

  • (5) Proof of the expenditure must be provided by the person or on the person’s behalf.

  • (6) Subject to subsection 34(1), no reimbursement or payment shall exceed the maximum amount payable under these Regulations at the time the expenditure was incurred.

  • (7) This section does not apply to a claim in respect of the services referred to in subparagraph 19(a)(iii) or (v). Payment shall be made for those services only in respect of periods during which a person is eligible to receive those services.

  • SOR/2001-157, s. 13
  • SOR/2001-326, s. 13
  • SOR/2003-362, s. 12
  • SOR/2005-39, s. 2
  • SOR/2006-50, s. 83
  • SOR/2012-221, s. 1
  • SOR/2017-161, s. 10

Payment Arrangements

 Where a client is eligible under these Regulations to receive a payment in respect of a benefit, service or care provided or paid for by a third party, the payment may be made

  • (a) directly to the client;

  • (b) to the third party on behalf of the client; or

  • (c) to the client and the third party jointly.

Notice of Decisions

 The Minister shall notify a client or the client’s representative of any decision relating to the award, increase, decrease, suspension or cancellation of any benefit under these Regulations concerning or affecting the client.

  • SOR/98-386, s. 17

Review of Decisions

  •  (1) A person who is dissatisfied with any decision made under these Regulations may, within 60 days after receiving notice of the decision or, where circumstances beyond the control of the person necessitate a longer period, within that longer period, apply in writing to the Minister for a review of that decision by an official of the Department of Veterans Affairs other than the official who made the original decision.

  • (2) Where a person is dissatisfied with the results of a review referred to in subsection (1), the person may, within 60 days after receiving notice of the decision on the review unless circumstances beyond the control of the applicant necessitate a longer period, apply in writing to the Minister for a final decision to be rendered by an official of the Department of Veterans Affairs other than the official who made the original decision or who reviewed it.

  • SOR/98-386, s. 18
  • SOR/2001-157, s. 14(E)
  • SOR/2009-225, s. 17

Reciprocal and Other Arrangements

 Benefits, services or care under these Regulations may be accorded to residents of a country other than Canada in accordance with

  • (a) a reciprocal or other arrangement made by the Minister with the government of that country, with such modifications as are necessary to comply with the terms of that arrangement; or

  • (b) special arrangements under which the benefits, services or care are provided at the expense of that country, with such modifications as are necessary to comply with the terms of those arrangements.

Transition Period

 [Repealed, SOR/2022-69, s. 17]

 

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