Short Title

1 These Regulations may be cited as the Veterans Health Care Regulations.

Interpretation

2 In these Regulations,

adult residential care

adult residential care means a service provided in a health care facility to meet a type I health need; (soins institutionnels pour adultes)

Canada service veteran

Canada service veteran means a veteran who

• (a) served

  • (i) on full-time active service, other than service in a theatre of actual war as that expression is defined in subsection 37(8) of the War Veterans Allowance Act, as a member of the naval, army or air forces of Canada or of similar forces raised in Newfoundland, for a minimum of 365 days during any of the following periods, namely,

    • (A) the period beginning on August 4, 1914 and ending on August 31, 1921, and

    • (B) the period beginning on September 1, 1939 and ending on August 15, 1945, or

  • (ii) as a Canadian merchant mariner of World War I or World War II, as described in section 21.1 of the Pension Act, other than as a merchant navy veteran of World War I or World War II within the meaning of subsection 37(7.3) of the War Veterans Allowance Act, for a minimum of 365 days during any of the following periods, namely,

    • (A) the period beginning on August 4, 1914 and ending on August 31, 1921, and

    • (B) the period beginning on September 1, 1939 and ending on August 15, 1945,

• (b) is 65 years of age or more, and

• (c) would qualify as a recipient under the War Veterans Allowance Act but for the fact

  • (i) that the veteran does not meet the requirements of subsection 37(3) or (5) of that Act, or

  • (ii) that

    • (A) the veteran or the veteran’s spouse or common-law partner is in receipt of payments made under the Old Age Security Act or under similar legislation of another country, and

    • (B) the veteran does not meet the requirements of subsection 37(3) or (5) of the War Veterans Allowance Act; (ancien combattant ayant servi au Canada)

chronic care

chronic care means a service provided in a health care facility to meet a type III health need; (soins prolongés)

civilian

civilian has the same meaning as in subsection 56(1) of the Civilian War-related Benefits Act; (civil)

civilian pensioner

civilian pensioner means a person who is entitled to a pension under

• (a) Parts I to III or VI to X of the Civilian War-related Benefits Act, or

• (b) the Civilian Government Employees (War) Compensation Order; (pensionné civil)

client

client means a

• (a) veteran pensioner, income-qualified veteran, overseas service veteran, dual service veteran or a veteran to whom paragraphs (a) and (b) of the definition Canada service veteran apply,

• (b) civilian pensioner, income-qualified civilian or civilian,

• (c) Newfoundland Special Award pensioner,

• (d) military service pensioner,

• (e) Red Cross pensioner,

• (f) flying accident pensioner,

• (g) special duty service pensioner,

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

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

• (j) a member or former member who is entitled to a disabilty award; or

• (k) a member or former member who has received a detention benefit under Part 3 of the Canadian Forces Members and Veterans Re-establishment and Compensation Act; (client)

common-law partner

common-law partner, in relation to an individual, means a person who is cohabiting with the individual at the relevant time in a conjugal relationship, having so cohabited for a period of at least one year. For greater certainty,

• (a) in the case of an individual’s death, the relevant time means the time of that death, and

• (b) common-law partners cease to be common-law partners when they cease to cohabit except if it is by reason only of the placement of one of the partners in a health care facility; (conjoint de fait)

community facility

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, but does not include a departmental facility; (établissement communautaire)

contract bed

contract bed means a bed that is set aside in a community facility pursuant to a contractual arrangement entered into by the Minister for the adult residential care, intermediate care or chronic care of certain veterans; (lit réservé)

departmental facility

departmental facility means the Hôpital Sainte-Anne-de-Bellevue; (établissement du ministère)

dual service veteran

dual service veteran means a veteran as described in subsection 37(5) or (6) of the War Veterans Allowance Act; (ancien combattant à service double)

entitled to a disability award

entitled to a disability award in relation to a member or former member, means a member or former member who

• (a) has received a disability award under subsection 45(1) or 47(1) of the Canadian Forces Members and Veterans Re-establishment and Compensation Act;

• (b) is waiting for the Minister to determine that their disability has stabilized pursuant to section 53 of that Act; or

• (c) but for subsection 54(1) of that Act, would have received a disability award under susbsection 45(1) or 47(1) of that Act. (droit à une indemnité d’invalidité)

entitled to a disability award in respect of special duty service

entitled to a disability award in respect of special duty service in relation to a member or former member, means that the injury or disease, or aggravation thereof, for which the member or former member is entitled to a disability award, was attributable to or was incurred during special duty service as that term is defined in susbsection 2(1) of the Canadian Forces Members and Veterans Re-establishment and Compensation Act. (droit à une indemnité d’invalidité en raison du service spécial)

entitled to a pension

entitled to a pension means, in respect of a person, that the person receives a pension, has received a final payment of a pension or has been declared eligible for a pension; (droit à une pension)

flying accident pensioner

flying accident pensioner means a person entitled to a pension that is compensation under the Flying Accidents Compensation Regulations for an injury sustained by the person; (pensionné à la suite d’un accident d’aviation)

full-time active service

full-time active service means that part of active service that does not include

• (a) periods of absence without leave or leave of absence without pay,

• (b) periods in respect of which pay is forfeited, or

• (c) time served in prison or other detention; (service actif à temps plein)

health

health means a state of physical, mental and social well-being; (santé)

health professional

health professional means a physician, dentist, nurse or other health care practitioner approved by the Minister; (professionnel de la santé)

income-qualified civilian

income-qualified civilian means a civilian who is in receipt of an allowance under subsection 57(1) of the Civilian War-related Benefits Act or in respect of whom a determination has been made that the civilian would be eligible for such an allowance if the civilian 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; (civil au revenu admissible)

income-qualified overseas service civilian

income-qualified overseas service civilian means an overseas service civilian who is an income-qualified civilian; (civil au revenu admissible ayant servi outre-mer)

income-qualified veteran

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)

intermediate care

intermediate care means a service provided in a health care facility to meet a type II health need; (soins intermédiaires)

merchant navy veteran

merchant navy veteran[Repealed, SOR/2001-157, s. 1]

military service pensioner

military service pensioner means a person who is entitled to a pension under the Pension Act for a disability related to military service that was not

• (a) active service in World War I or World War II,

• (b) service in a theatre of operations, as that expression is defined in section 2 of the Veterans Benefit Act, or

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

Newfoundland Special Award pensioner

Newfoundland Special Award pensioner means a person who was not entitled to a pension in accordance with the terms of the union of Canada and Newfoundland but was recognized by the Canadian government as entitled to the continuation of an award paid before that union in respect of a disability incurred during service in World War I or World War II; (pensionné titulaire d’une attribution spéciale (Terre-Neuve))

overseas service civilian

overseas service civilian means a civilian described in paragraph (e), (f), (g), (h) or (i) of the definition civilian in subsection 56(1) of the Civilian War-related Benefits Act; (civil ayant servi outre-mer)

overseas service veteran

overseas service veteran means

• (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,

  • (i) in a theatre of actual war, as that expression is defined in subsection 37(8) of the War Veterans Allowance Act, or

  • (ii) as a merchant navy veteran of World War I or World War II within the meaning of subsection 37(7.3) of that Act,

• (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

  • (i) in a theatre of actual war, as that expression is defined in subsection 37(8) of that Act, or

  • (ii) as a merchant navy veteran of World War I or World War II within the meaning of subsection 37(7.3) of that Act, and

• (c) a veteran who

  • (i) was on service in a theatre of operations, as that expression is defined in section 2 of the Veterans Benefit Act, as a member of the Canadian Forces, including the special force, or

  • (ii) served as a Canadian merchant navy veteran of the Korean War, within the meaning of subsection 37(7.4) of the War Veterans Allowance Act; (ancien combattant ayant servi outre-mer)

pension

pension means

• (a) a pension that is awarded under the Pension Act, other than a pension that is awarded under subsection 22(2) of that Act,

• (b) a pension that is awarded under any of Parts I to III or VI to X of the Civilian War-related Benefits Act,

• (c) a pension to which a Red Cross pensioner is entitled,

• (d) compensation that is payable under the Flying Accidents Compensation Regulations, or

• (e) a pension that is awarded under the Civilian Government Employees (War) Compensation Order,

but, for greater certainty, does not include a compassionate award under section 34 of the Veterans Review and Appeal Board Act; (pension)

pensioned condition

pensioned condition means a disability in respect of which a person is entitled to a pension; (état indemnisé)

Red Cross pensioner

Red Cross pensioner means a Red Cross worker who is entitled to a pension pursuant to the Memorandum of Agreement between Her Majesty The Queen and The Canadian Red Cross Society made on October 17, 1952; (pensionné de la Croix-Rouge)

seriously disabled

seriously disabled, in relation to a client, means that the client’s extent of disability, in respect of the aggregate of all of the client’s disability assessments under the Pension Act and the Canadian Forces Members and Veterans Re-establishment and Compensation Act, is equal to or greater than 78%; (déficience grave)

special duty area pensioner

special duty area pensioner[Repealed, SOR/2003-362, s. 1]

special duty service pensioner

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)

spouse

spouse, in relation to an individual, means a person who is legally married to the individual and who

• (a) resides with the individual or in a health care facility, or

• (b) maintains or is being maintained by the individual; (époux)

supplementary benefits

supplementary benefits means the benefits referred to in section 6; (avantages supplémentaires)

treatment benefits

treatment benefits means the benefits referred to in section 4; (avantages médicaux)

type I health need

type I health need means the need of a person for personal care and supervision on a continuing basis, where the person is ambulant or independently mobile but has decreased physical or mental faculties; (besoins de santé de type I)

type II health need

type II health need means the need of a person for personal care on a continuing basis under the supervision of a health professional, where the person has a functional disability, has reached the apparent limit of recovery and has little need for diagnostic or therapeutic services; (besoins de santé de type II)

type III health need

type III health need means the need of a person for personal care and for diagnostic, nursing and therapeutic services provided by a health professional on a continuing basis, where the person is chronically ill or has a functional disability and the acute phase of the illness or disability has ended, whether or not the status of the illness or disability is unstable; (besoins de santé de type III)

veteran

veteran means

• (a) a person who was on active service during World War I or World War II as a member of the naval, army or air forces of Canada or of similar forces raised in Newfoundland,

• (b) a person who was on service in a theatre of operations, as that expression is defined in section 2 of the Veterans Benefit Act, as a member of the Canadian Forces, including the special force,

• (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,

• (c) a special operator who is deemed to be a veteran pursuant to section 3 of the Special Operators War Service Benefits Act,

• (d) a supervisor who is deemed to be a veteran pursuant to section 3 of the Supervisors War Service Benefits Act,

• (e) an allied veteran within the meaning of subsection 37(4) of the War Veterans Allowance Act,

• (e.1) a person referred to in paragraph 64(1)(a) or (b), 65(1)(a) or (b) or 66(1)(a) or (b) of the Pension Act,

• (f) a Canadian merchant mariner of World War I, World War II or the Korean War, as described in section 21.1 of the Pension Act,

• (g) a person who is an allied veteran within the meaning of paragraph 37(4)(b) of the War Veterans Allowance Act, as that paragraph read immediately before February 27, 1995

  • (i) in respect of whom a determination has been made, on or at any time before that day, that the person is or has been an income-qualified veteran, or

  • (ii) who, on or at any time before that day, has submitted a request that has at any time been approved for

    • (A) adult residential care pursuant to section 17.1,

    • (B) veterans independence program services pursuant to section 18,

    • (C) adult residential care, intermediate care or chronic care pursuant to paragraph 21(1)(c) or subsection 21(2), or

    • (D) the cost of chronic care in a community facility pursuant to paragraph 22(4)(b), or

• (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)

veterans independence program services

veterans independence program services means the services referred to in section 19; (services du programme pour l’autonomie des anciens combattants)

veteran pensioner

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)

war-related pensioned condition

war-related pensioned condition means a pensioned condition that is related to

• (a) active service in the military during World War I or World War II,

• (b) service in a theatre of operations as that expression is defined in section 2 of the Veterans Benefit Act,

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

• (d) service as a Canadian merchant mariner of World War I, World War II or the Korean War, as described in section 21.1 of the Pension Act, or

• (e) a war injury or a war flight injury, as those expressions are defined in section 2 of the Civilian Government Employees (War) Compensation Order; (état indemnisé lié à la guerre)

World War I

World War I means World War I as defined in subsection 3(1) of the Pension Act; (Première Guerre mondiale)

World War II

World War II means World War II as defined in subsection 3(1) of the Pension Act. (Seconde Guerre mondiale)

PART IHealth Care Benefits

Treatment Benefits

• 3 (1) The following clients are eligible to receive treatment benefits in Canada or elsewhere in respect of a pensioned condition:

  • (a) veteran pensioners;

  • (b) civilian pensioners;

  • (c) [Repealed, SOR/2001-326, s. 2]

  • (d) Red Cross pensioners; and

  • (e) flying accident pensioners.

  • (f) [Repealed, SOR/2001-326, s. 2]

• (2) Newfoundland Special Award pensioners are eligible to receive treatment benefits in Canada or elsewhere in respect of the disability for which they receive the award.

• (2.1) Clients referred to in subsections (1) and (2) who are seriously disabled 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.

• (2.11) A veteran pensioner or a civilian pensioner is eligible to receive treatment benefits in Canada for any health condition, to the extent that the treatment benefits are neither available to them as members or former members of the Canadian Forces nor available as insured services under a provincial health care system, if the extent of their disability in respect of the aggregate of all of their disability assessments under the Pension Act and the Canadian Forces Members and Veterans Re-establishment and Compensation Act, is equal to or greater than 48%.

• (2.2) Special duty service pensioners are eligible to receive treatment benefits

  • (a) in Canada or elsewhere in respect of a pensioned condition to the extent that the treatment benefits are not available to them as members or former members of the Canadian Forces; and

  • (b) in Canada 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, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e).

• (2.21) A member or former member who is entitled to a disability award in respect of special duty service is eligible to receive treatment benefits

  • (a) in Canada or elsewhere in respect of a disability for which they are entitled to a disability award, to the extent that the treatment benefits are not available to them as a member or former member of the Canadian Forces; and

  • (b) in Canada, in respect of any health condition, to the extent that the treatment benefits are neither available to them as a member or former member of the Canadian Forces nor available as an insured service 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).

• (2.3) Military service pensioners who are no longer members of the Canadian Forces, or who are members of the Canadian Forces as members of the reserve force, are eligible to receive treatment benefits in Canada or elsewhere in respect of a pensioned condition to the extent that the treatment benefits are not available to them as members or former members of the Canadian Forces.

• (2.4) A member or former member who is no longer a member of the Canadian Forces, or who is a member of the Canadian Forces as a member of the reserve force, is eligible to receive treatment benefits, in Canada or elsewhere, in respect of the injury or disease for which they are entitled to a disability award, to the extent that the treatment benefits are not available to them as a member or former member of the Canadian Forces.

• (3) Where a client is hospitalized and the client asserts that hospitalization is required in respect of the client’s pensioned condition, treatment benefits in respect of that hospitalization, in Canada or elsewhere, are deemed to be required in respect of the pensioned condition, for the period during which there is uncertainty as to whether the primary condition in respect of which the treatment benefits are required is the client’s pensioned condition.

• (4) Income-qualified veterans and income-qualified civilians 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.

• (5) Civilian pensioners, prisoners of war who are entitled to basic compensation under subsection 71.2(1) of the Pension Act, Canada service veterans and a member or veteran who has received a detention benefit under Part 3 of the Canadian Forces Members and Veterans Re-establishment and Compensation Act 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).

• (6) Veteran pensioners, overseas service veterans, dual service veterans and overseas service civilians 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, if they are eligible to receive any of the veterans independence program services referred to in paragraphs 19(a), (b) and (e) or are in receipt of any of those services under section 18.

• (7) Clients who are in receipt of adult residential care, intermediate care or chronic care in a departmental facility or contract bed 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.

• (8) Canada service veterans who are in receipt of chronic care in a community facility under subsection 22(2) 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.

• (9) Clients who are in receipt of chronic care in a community facility under section 22.1 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.

• (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.

4 Treatment benefits consist of the following:

• (a) any medical, surgical or dental examination or treatment provided by a health professional;

• (b) the provision of any surgical or prosthetic device or any aid approved by the Minister, the maintenance of the device or aid and any home adaptation that is necessary to accommodate or facilitate its use;

• (c) preventive health care approved by the Minister; and

• (d) pharmaceuticals prescribed by a physician, dentist or other person authorized to prescribe pharmaceuticals under the laws in force in the province or the country where the pharmaceuticals are provided.

• 5 (1) Where treatment benefits are provided in Canada, the rate at which the treatment benefits and any administrative costs related thereto are payable is

  • (a) where the treatment benefits are fully insured health services of the province in which they are provided, the rate established by the province for those services and costs;

  • (b) where the treatment benefits are not fully insured health services of the province in which they are provided and, in respect of that province, an association of health professionals has adopted a fee schedule for treatment benefits and costs, the rate that is approved by the Minister and that is based on that fee schedule; and

  • (c) in any other case, the rate normally paid for those treatment benefits and costs in the community in which the treatment benefits are provided.

• (2) Where treatment benefits are provided in a country other than Canada, the rate at which the treatment benefits and any administrative costs related thereto are payable is

  • (a) the rate established for former members of the armed forces of that country for those treatment benefits and costs; or

  • (b) where no rate referred to in paragraph (a) is established, the lesser of the rate that would be payable to the client under subsection (1) if the client were resident in Ottawa, Ontario and the actual rate paid by the client for the treatment benefits and costs.

Supplementary Benefits

6 A client who receives treatment benefits referred to in paragraph 4(a) or (b) is eligible to receive supplementary benefits as follows:

• (a) the costs of travel incurred by the client who travels to receive those treatment benefits;

• (b) where the client’s health needs are such that the client needs to be accompanied by an escort on travel referred to in paragraph (a), the costs of travel incurred by that escort; and

• (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.

• (d) [Repealed, SOR/95-440, s. 2]

• 7 (1) Subject to subsections (2), (2.1), (2.2) and (3), the costs of travel referred to in paragraphs 6(a) and (b) are payable in respect of a client who receives treatment benefits in Canada in respect of

  • (a) transportation by the most convenient and economical means of transportation appropriate to the condition of the client

    • (i) where the client is resident in Canada, between the client’s residence and the appropriate treatment centre nearest to that residence, and

    • (ii) where the client is resident in a country other than Canada, between the client’s point of entry into Canada and the appropriate treatment centre nearest to that point;

  • (b) transportation between the treatment centre and the accommodations referred to in paragraph (d);

  • (c) meals; and

  • (d) standard commercial sleeping accommodations that are conveniently located in respect of the treatment centre, or private accommodations.

• (2) Where the means of transportation referred to in subparagraph (1)(a)(i) or (ii) is a taxi, $5.00 shall, subject to subsection 34(2), be deducted from the costs of travel for each trip.

• (2.1) Where the means of transportation referred to in subparagraph (1)(a)(i) or (ii) is a private automobile other than a taxi, whether belonging to the client or otherwise, the costs of travel

  • (a) are payable at the rate applicable to employees of the public service of Canada who have requested to use their own cars, plus two cents per kilometre; and

  • (b) include the cost of parking while the client is at the treatment centre.

• (2.2) The costs of travel referred to in subsections (1), (2) and (2.1) are payable

  • (a) at the same rates, less any minimum rates that may apply, as those established for employees of the public service of Canada in chapters 1-1 and 1-3 of the Personnel Management Component of the Treasury Board Manual, as amended from time to time; and

  • (b) subject to the requirement to provide receipts, as specified in the Treasury Board Manual.

• (3) The costs of travel referred to in paragraphs 6(a) and (b) are payable, in respect of a client who receives treatment benefits in a country other than Canada and who is a resident of that country or who is in that country for a purpose other than seeking treatment, at the same rate and subject to the same conditions as the rate and conditions that are established for former members of the armed forces of that country for similar costs of travel or, where no such rate is established, at the rate that would be payable under subsection (1) if the client were resident in Canada.

• 8 (1) The remuneration referred to in paragraph 6(c) is payable

  • (a) where the treatment benefits are provided in Canada, at a daily rate computed by dividing by 30 the sum of the basic pension and the additional pension for a spouse or common-law partner that are payable for a class 1 pension under Schedule I to the Pension Act, as adjusted in accordance with Part V of that Act; and

  • (b) where the treatment benefits are provided in a country other than Canada, at the same rate and subject to the same conditions as the rate and conditions that are established for former members of the armed forces of that country for such escorts or, where no such rate is established, at the rate referred to in paragraph (a).

• (2) [Repealed, SOR/95-440, s. 4]

Treatment Allowances

9 The following clients are eligible to receive a treatment allowance in respect of a period of acute care for a pensioned condition provided in a hospital or on an out-patient basis:

• (a) veteran pensioners;

• (b) civilian pensioners;

• (c) military service pensioners;

• (d) Red Cross pensioners;

• (e) flying accident pensioners; and

• (f) special duty service pensioners.

• 10 (1) A treatment allowance is payable at a rate that is equal to the difference between the monthly pension paid to the client, including any additional pension paid for a spouse or common-law partner or dependant of the client, and the amount that the client would receive were the client in receipt of a class 1 pension under Schedule I to the Pension Act.

• (2) A treatment allowance is payable for a maximum of 60 days in any calendar year.

• (3) Notwithstanding subsection (2), the Minister may authorize the payment of a treatment allowance to a client for more than 60 days in a calendar year if a medical assessment indicates the client’s need for acute care.

11 and 12 [Repealed, SOR/95-440, s. 5]

Miscellaneous Benefits

• 13 (1) Where the Minister requests that a person undergo a medical examination in order to establish that person’s entitlement to any benefit, service or care, the person is eligible to receive

  • (a) reimbursement of the cost of the examination incurred by the person; and

  • (b) reimbursement of the costs of travel incurred by the person in respect of the examination, in accordance with section 7.

  • (c) [Repealed, SOR/95-440, s. 6]

• (2) Where the Veterans Review and Appeal Board requests that a person undergo a medical examination, the person is eligible to receive

  • (a) reimbursement of the cost of the examination incurred by the person;

  • (b) reimbursement of the costs of travel incurred by the person in respect of the examination, in accordance with section 7; and

  • (c) a treatment allowance payable in accordance with section 10 if the person is a client referred to in section 9 and is hospitalized in order to undergo the examination.

• (3) Subsections (1) and (2) do not apply in respect of a medical examination required under the Canadian Forces Members and Veterans Re-establishment and Compensation Act.

• (4) The following clients are eligible to receive treatment benefits and supplementary benefits for a period that is equal to the shorter of one year and the total period of service of the client:

  • (a) veteran pensioners, special duty service pensioners and military service pensioners, if they take a course of training under the Pensioners Training Regulations; and

  • (b) veteran pensioners whose war-related pensioned condition is blindness, if they take a course of rehabilitative training in respect of blindness.

14 [Repealed, SOR/2001-157, s. 4]

PART IIVeterans Independence Program

Eligibility

• 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

  • (a) they are resident in Canada; and

  • (b) an assessment indicates that

    • (i) their war-related pensioned condition impairs their ability to remain self-sufficient at their principal residence without those services, and

    • (ii) the provision of those services would assist them to remain self-sufficient at their principal residence or the provision of that care is necessary for health reasons.

• (1.1) Seriously disabled veteran pensioners and seriously disabled civilian pensioners are not required to meet the requirement set out in subparagraph (1)(b)(i).

• (1.11) Veteran pensioners and civilian pensioners, whose extent of disability, in respect of the aggregate of all of their disability assessments under the Pension Act and the Canadian Forces Members and Veterans Re-establishment and Compensation Act, is equal to or greater than 48% are not required to meet the requirement set out in subparagraph (1)(b)(i).

• (1.2) Military service pensioners and members or former members entitled to a disability award are eligible to receive the veterans independence program services referred to in paragraphs 19(a), (b) and (d) or, if 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 neither available to them as members or former members of the Canadian Forces nor available as an insured service under a provincial health care system, if

  • (a) they are resident in Canada; and

  • (b) an assessment indicates that

    • (i) their pensioned condition or the disability for which they are entitled to a disability award, as the case may be, impairs their ability to remain self-sufficient at their principal residence without those services, and

    • (ii) the provision of those services would assist them to remain self-sufficient at their principal residence or the provision of that care is necessary for health reasons.

• (2) Subject to section 33.1, income-qualified veterans who are 65 years of age or more, income-qualified overseas service civilians who are 65 years of age or more and Canada service veterans are eligible to receive the veterans independence program services referred to in paragraphs 19(a) to (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 resident in Canada; and

  • (b) an assessment indicates that the provision of those services would assist them to remain self-sufficient at their principal residence or the provision of that care is necessary for health reasons.

• (3) Subject to section 33.1, prisoners of war entitled to basic compensation under subsection 71.2(1) of the Pension Act and members or former members who have received a detention benefit under Part 3 of the Canadian Forces Members and Veterans Re-establishment and Compensation Act are eligible to receive the veterans independence program services referred to in paragraphs 19(a), (b) and (d) or, if 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 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.

Continuation of Services

• 16 (1) Subject to subsection (2), the primary caregiver of a client is entitled to any of the services referred to in subparagraphs 19(a)(iii) and (v) that the client was receiving under the Department of Veterans Affairs Act at the time the client died or began residing in a health care facility if

  • (a) the primary caregiver is assessed within one year after the earlier of client's death and the client's admission into the health care facility, or presents evidence relating to their health condition during that period on the basis of which an assessment can be made;

  • (b) the assessment and all subsequent assessments indicate that the provision of the services is necessary for health reasons and to assist the primary caregiver to remain self-sufficient at their principal residence; and

  • (c) the primary caregiver is resident in Canada.

• (2) The primary caregiver is entitled to the services to the extent that they are not available to the primary caregiver as an insured service under a provincial health care system or a private insurance policy.

• (3) In this section, primary caregiver, in relation to a client, means the adult person who, immediately before the client died or was admitted into a health care facility,

  • (a) was primarily responsible, without remuneration, for ensuring that care was provided to the client; and

  • (b) for a continuous period of at least one year, resided in the principal residence of the client and maintained the client or was maintained by the client.

• 16.1 (1) The survivor of a person — who was an income-qualified civilian, an income-qualified veteran, a veteran pensioner or a civilian pensioner and who, at the time of their death, was not in receipt of the services referred to in subparagraphs 19(a)(iii) and (v) — is eligible to receive those services if

  • (a) an assessment and all subsequent assessments indicate that the provision of the services is necessary for reasons related to the health of the survivor and to assist the survivor to remain self-sufficient at their principal residence;

  • (b) the survivor is in receipt of the guaranteed income supplement under the Old Age Security Act or an amount is deductible in respect of the survivor under section 118.3 of the Income Tax Act in computing an individual’s tax payable under Part I of that Act;

  • (c) the services are not available as an insured service under a provincial health care system or a private insurance policy;

  • (d) the survivor is not eligible to receive any services under section 16; and

  • (e) the survivor is resident in Canada.

• (2) In this section, survivor means, in relation to the person, the adult individual who, immediately before the person died or, if the person died in a health care facility, immediately before the person was admitted into the health care facility,

  • (a) was primarily responsible, without remuneration, for ensuring that care was provided to the person; and

  • (b) for a continuous period of at least one year, resided in the principal residence of the person and maintained the person or was maintained by the person.

17 Subject to section 33.1, income-qualified veterans who are under 65 years of age are eligible to receive the veterans independence program services referred to in paragraphs 19(a) to (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 resident in Canada;

• (b) as of August 31, 1990, they were the subject of an assessment based on current data that indicated that

  • (i) the provision of those services would assist them to remain self-sufficient at their principal residence, or

  • (ii) the provision of that care was appropriate in the circumstances; and

• (c) they continue after August 31, 1990, without interruption

  • (i) to qualify as income-qualified veterans, and

  • (ii) to be the subject of an assessment that indicates that the provision of those services would assist them to remain self-sufficient at their principal residence or that the provision of that care is appropriate in the circumstances.

• 17.1 (1) A client described in section 15, 17 or 18 who, on June 30, 1993, is in receipt of adult residential care in a community facility other than in a contract bed, may continue to receive that care for as long as

  • (a) the provision of those services is uninterrupted; and

  • (b) the client meets the requirements set out in that section.

• (2) A client described in section 15, 17 or 18 whose request for the care referred to in subsection (1) is approved on or after June 30, 1993, may receive that care if the request is submitted before that day.

• (3) Clients referred to in subsections (1) and (2) are subject to the provisions of sections 29 and 33.1.

Exceptional Health Needs

• 18 (1) Subject to subsections (2) and (3) and sections 20 and 33.1, the following clients are eligible to receive the veterans independence program services referred to in paragraphs 19(a) to (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:

  • (a) veteran pensioners;

  • (b) overseas service veterans;

  • (c) dual service veterans;

  • (d) overseas service 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 services or care provided under subsection (1) to or in respect of a client referred to in that subsection for any period of 12 months commencing on October 1 of any year, or for any lesser period within those 12 months, if

  • (a) the client is resident in Canada;

  • (b) the client has exceptional health care needs that require services or care referred to in paragraphs 19(a) to (e);

  • (c) 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 those services or that care; and

  • (d) an assessment indicates that the provision of those services would assist the client to remain self-sufficient at the client’s principal residence or the provision of that care is necessary for health reasons.

• (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 intermediate 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.

Services

19 The veterans independence program consists of the following services:

• (a) home care that is provided to or on behalf of a client at the client’s principal residence, namely,

  • (i) health and support services by a health professional, such as nursing care, therapy and personal care,

  • (ii) personal care services by a person other than a health professional,

  • (iii) housekeeping services, namely, those tasks or domestic chores to assist with daily living, which services normally include only routine housekeeping unless the health and safety of the client is at risk,

  • (iv) access to nutrition services, and

  • (v) maintenance of the grounds necessary to permit independent living at the principal residence, such as the mowing of lawns and the removal of ice, snow and leaves from the walkways, driveways and eavestroughs, providing:

    • (A) the maintenance is the responsibility of the client and would normally be performed by the client were the client’s ability to do so not impaired as a result of the health condition the assessment of which indicated the client’s eligibility for the service, and

    • (B) there are no relatives of the client living at the residence who are capable of performing such maintenance;

• (b) ambulatory health care, namely, health services such as health assessments, diagnostic services and social and recreational services that are provided by a health professional, and transportation between the client’s residence and the health centre or other similar facility where the health services are provided;

• (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

  • (i) the client requires home care or ambulatory health care, and

  • (ii) social isolation is harmful to the client’s health;

• (d) home adaptations to a client’s principal residence to enable the client to carry out the activities of daily living; and

• (e) intermediate care in a community facility, other than in a contract bed.

Costs

• 20 (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]

PART IIILong Term Care

Care in a Departmental Facility or a Contract Bed

• 21 (1) Subject to section 33.1, the following clients are eligible to receive adult residential care, intermediate care or chronic care in a departmental facility or 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 was in receipt of adult residential care, intermediate care or chronic care in a departmental facility or a contract bed on August 31, 1990 is eligible to receive care in a departmental facility or a contract bed after that day 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 pursuant to section 26 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 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.

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.

Chronic Care in a Community Facility

• 22 (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 Canadian Forces Members and Veterans Re-establishment and Compensation 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 and members or former members are eligible to receive the cost to them of chronic care in respect of a pensioned condition or a disability for which they are entitled to a disability award

  • (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.

When Income Insufficient for Chronic Care To Be Affordable

• 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:

  • (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.

Costs

• 23 (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]

Priority of Admission

• 24 (1) Priority of admission to the departmental facility or a contract bed shall be based on health need and, where 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 members or former members who need care for a condition in respect of which they are entitled to a disability award;

  • (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.

Therapeutic Duties

• 25 (1) Subject to the approval of the client’s attending physician, a client may perform light duties in a departmental facility as part of the therapeutic program of the client.

• (2) Where light duties are performed by a client in accordance with subsection (1), a gratuity may be paid to the client where it is appropriate in the circumstances.

Improper Conduct

26 The Minister may discharge a client from a departmental facility or recommend the discharge of a client from a contract bed if the client

• (a) commits a serious breach of the rules of the departmental facility or the community facility in which the contract bed is located;

• (b) wilfully retards the treatment;

• (c) wilfully disturbs patients or staff; or

• (d) fails to pay accommodation and meal fees within a reasonable period after the fees become payable.

PART IVGeneral

Premiums and Fees

27 Income-qualified veterans, income-qualified civilians, Canada service veterans and members or former members to whom a Canadian Forces income support benefit is payable under Part 2 of the Canadian Forces Members and Veterans Re-establishment and Compensation 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.

Miscellaneous Costs of Transportation

28 A veteran pensioner, a civilian pensioner, a special duty service pensioner or a member or former member 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 on an annual vacation or on other travel approved by the Minister;

• (b) the means of transportation is other than by automobile; and

• (c) the pensioner, member or former member has a pensioned condition, or a disability for which they are entitled to a disability award in respect of special duty service that is blindness or a disability that requires an escort when travelling.

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 the client when the client is transferred for medical reasons from one health care facility to another if the client is eligible to receive care in a departmental facility or a contract bed or is eligible to receive any part of the cost of intermediate care pursuant to Part II or chronic care pursuant to Part III.

30 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 member or former member who is entitled to a disability award.

Continuation of Benefits, Services and Care

31 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.

• 31.1 (1) Despite any other provision of these Regulations, an income-qualified veteran, income-qualified civilian or Canada service veteran who is in receipt of any benefit, service, care, premium or fee under subsection 3(4),(5) or (8) or 15(2), section 17 or 17.1, subsection 21(1) or 22(2) or section 27 is eligible to receive that benefit, service, care, premium or fee for life, regardless of any change in the income of the veteran or civilian or their spouse or common-law partner, in the veteran’s or civilian’s income factor or in the class of recipient to which the veteran or civilian belongs, provided that the veteran or civilian otherwise continues to meet the requirements set out in the provision under which that benefit, service, care, premium or fee is received.

• (2) Subject to subsection (3) but despite any other provision of these Regulations, a veteran or a civilian not referred to in subsection (1) who, at the time this section comes into force, is in receipt of any benefit, service, care, premium or fee referred to in that subsection is eligible to continue to receive that benefit, service, care, premium or fee for life, regardless of any change in the income of the veteran or civilian or their spouse or common-law partner, in the veteran’s or civilian’s income factor or in the class of recipient to which the veteran or civilian belongs, provided that the veteran or civilian otherwise continues to meet the requirements set out in the provision under which that benefit, service, care, premium or fee is received.

• (3) Subsection (2) does not apply if the veteran or civilian

  • (a) is in receipt of the benefit, service, care, premium or fee solely in respect of a pensioned condition;

  • (b) is in receipt of the benefit, service, care, premium or fee solely as a result of being eligible to receive, in respect of a pensioned condition, another benefit, service, care, premium or fee under these Regulations;

  • (c) is in receipt of the benefit, service, care, premium or fee as a result of a determination of insufficient income in accordance with paragraph 18(2)(c) or subsection 22.1(2); or

  • (d) is in receipt of adult residential care, intermediate care or chronic care in a departmental facility or contract bed under paragraph 21(1)(a), (c) or (d).

• (4) A veteran or civilian who, under subsection (1) or (2), receives any benefit, service, care, premium or fee set out in a provision referred to in subsection (1) is deemed, for the purposes of any other provision in these Regulations, to receive it under the provision referred to in subsection (1).

• (5) For the purposes of subsections (1) and (2), “income factor” and “class of recipient”, in relation to a veteran or civilian, means the income factor and class of recipient set out in the schedule to the War Veterans Allowance Act that are applicable to that person, or that would be applicable to that person if the person were a recipient under that Act.

Determination of When Income Insufficient

• 31.2 (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.

Referrals

• 32 (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

33 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

• 33.1 (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) a departmental facility;

  • (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 member or former member who is in receipt of the care for an illness or injury for which they are entitled to a disability award.

• (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) for care in a community facility, including a contract bed, the client shall pay the cost directly to the community facility, the method of payment and collection to be determined by those parties; or

  • (b) the cost shall be recovered by the Minister pursuant to an arrangement with the client or by other legal means

    • (i) where the cost has been paid directly to the community facility by the Minister in accordance with an arrangement with that facility, or

    • (ii) where the client is in a departmental 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.

Exceeding Rates

• 34 (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.

Limitation on Reimbursements and Payments

• 34.1 (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 Canadian Forces Members and Veterans Re-establishment and Compensation 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.

Payment Arrangements

35 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

35.1 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.

Review of Decisions

• 36 (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.

Reciprocal and Other Arrangements

37 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.