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Veterans Health Care Regulations (SOR/90-594)

Regulations are current to 2019-11-19 and last amended on 2019-04-01. Previous Versions

PART IVGeneral (continued)

Determination of When Income Insufficient

  •  (1) For the purposes of paragraph 18(2)(c) and subsection 22.1(2), a client’s income is considered to be insufficient in respect of the period of 12 months commencing on October 1 of any year or in respect of any lesser period within those 12 months if

    • (a) the amount by which

      • (i) the client’s monthly income, computed in accordance with subsection 33.1(5), for the month of July preceding those 12 months

      exceeds

      • (ii) the monthly cost of the services or care provided, or to be provided, under section 18 or 22.1,

      is less than

    • (b) the income factor applicable to the client under subsection (2) or (3) in respect of that month.

  • (2) Subject to subsection (3), the income factor applicable to a client for the purpose of paragraph (1)(b) is the income factor set out in column II of the schedule to the War Veterans Allowance Act that applies to the client for the month of July referred to in subparagraph (1)(a)(i), or that would apply if the client were a recipient under that Act during that month.

  • (3) Where subsection 4(6), (6.1) or (8) of the War Veterans Allowance Act applies to a client, the income factor applicable to the client for the purpose of paragraph (1)(b) is the sum of the income factors set out in column II of the schedule to that Act that apply to the client and to the client’s spouse or common-law partner, for the month of July referred to in subparagraph (1)(a)(i), or that would apply if the client and the client’s spouse or common-law partner were recipients under that Act during that month.

  • SOR/2001-326, s. 11

Referrals

  •  (1) Subject to subsection (2), where a person who is a member of the Canadian Forces is discharged and is hospitalized for a disability at the time of the discharge, the person is eligible to receive treatment benefits and supplementary benefits for the lesser of one year immediately following the discharge and a period that is equal to the person’s service in the Forces, if the Minister of National Defence requests that the benefits be extended to the person and agrees to reimburse the cost of the benefits to the Department of Veterans Affairs.

  • (2) Where benefits are extended in accordance with subsection (1), the costs of travel shall include travel from the hospital to the person’s selected place of residence if the costs of travel were payable by the Minister of National Defence at the time of the discharge.

Costs recoverable from Third Parties

 The portion of the cost of any benefit, service or care mentioned herein that is recoverable from a third party is not payable under these Regulations.

Accommodation and Meals

  •  (1) A client, except a client referred to in subsection (2), is required to pay for the cost of accommodation and meals, up to a maximum monthly amount determined under this section, while the client is in receipt of adult residential care, intermediate care or chronic care in

    • (a) [Repealed, SOR/2016-31, s. 11]

    • (b) a contract bed; or

    • (c) a community facility in which the cost of care is payable, in whole or in part, under these Regulations.

  • (2) The following clients are not required to pay for the cost of accommodation and meals while in receipt of adult residential care, intermediate care or chronic care:

    • (a) clients who are in receipt of the care for a pensioned condition;

    • (b) veteran pensioners who are seriously disabled and civilian pensioners who are seriously disabled; and

    • (c) a former member or reserve force member who is in receipt of the care for the disability for which they are entitled to a disability award or entitled to pain and suffering compensation.

  • (3) The maximum amount under subsection (1) for a month is the lesser of the following amounts:

    • (a) the maximum monthly accommodation and meal charge for that month, as calculated under subsection (4); and

    • (b) the amount, if any, remaining to the client after deducting from the client’s monthly income, as calculated under subsection (5), the client’s personal and family exemption amount, as calculated under subsection (6).

  • (4) Effective on October 1, 1998, the maximum monthly accommodation and meal charge for any of the 12 months after September 30 of a year is the lesser of the following amounts:

    • (a) the lowest monthly user charge for accommodation and meals permitted by a province, under section 19 of the Canada Health Act, on July 1 of the same year; or

    • (b) the maximum monthly accommodation and meal charge that applied immediately prior to October 1 of the same year, multiplied by the ratio that

      • (i) the income factor specified in paragraph 2(a) of the schedule to the War Veterans Allowance Act that is effective on July 1 of the same year

      bears to

      • (ii) the same income factor that was effective on July 1 of the preceding year.

  • (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.

  • (6) The client’s personal and family exemption amount for any of the 12 months following September 30 of a year is the sum of the following amounts:

    • (a) the amount for personal comforts, which is equal to the amount for personal comforts that applies on September 30 of the same year, multiplied by the ratio referred to in paragraph (4)(b);

    • (b) where the client has a spouse or common-law partner, an amount equal to the income factor set out in paragraph 2(a) of the schedule to the War Veterans Allowance Act that is effective on July 1 of the same year;

    • (c) where the client has a spouse or common-law partner and one or more dependent children within the meaning of the War Veterans Allowance Act, an amount for each such child equal to the income factor set out in item 4 of the schedule to that Act that is effective on July 1 of the same year; and

    • (d) where the client does not have a spouse or common-law partner but has one or more dependent children within the meaning of the War Veterans Allowance Act,

      • (i) an amount equal to the income factor set out in paragraph 3(a) of the schedule to that Act that is effective on July 1 of the same year, and

      • (ii) for each such child in addition to one, an amount equal to the income factor set out in item 4 of the schedule to that Act that is effective on July 1 of the same year.

  • (7) The cost of accommodation and meals shall be paid by a client referred to in subsection (1) as follows:

    • (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.

  • (8) For the period beginning on the day on which this subsection comes into force and ending on September 30, 2001,

    • (a) the maximum monthly accommodation and meal charge is $739.50 per month; and

    • (b) the amount for personal comforts is $161.40 per month.

  • SOR/98-386, s. 15
  • SOR/2001-157, s. 12
  • SOR/2001-326, ss. 12, 14
  • SOR/2003-362, s. 11
  • SOR/2006-50, s. 82
  • SOR/2012-289, s. 12
  • SOR/2016-31, s. 11
  • SOR/2018-177, s. 22

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
 
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