Language selection

Ambulatory Health Care Service (Veterans Independence Program)

Issuing Authority: Director General, Policy
Effective Date: October 31, 2014
Document ID: 1227

Care has been taken to ensure these policies accurately reflect the acts and regulations. Should any inconsistencies be found, the acts and regulations will prevail.

Purpose

This policy provides direction on ambulatory health care service under the Veterans Health Care Regulations.

Policy

General

  1. Ambulatory Health Care Service refers to the provision of the following:
    1. health services such as health assessments, diagnostic services, and social and recreational activities (e.g. adult day care) provided by, or under the supervision of, a health professional (see Health Professionals Policy) in a health centre or other similar facility; and
    2. transportation of the client to receive the service.
  2. Contributions towards the cost of ambulatory health care service may be provided to eligible clients (see Eligibility for Health Care Programs – Eligible Client Groups to determine if a client is eligible for VIP Ambulatory Health Care Service) to the extent that those services are not available as an insured service under a provincial health care system if:
    1. they are resident in Canada; and
    2. an assessment indicates that the provision of these services will assist them to remain self-sufficient at their principal residence.

Acceptable Ambulatory Health Care Service Charges

  1. Under ambulatory health care service, the following costs may be paid:
    1. user fees or similar admission charges;
    2. the cost of meals not included in the user charge;
    3. user charges required in order to obtain provincially-insured adult day care service; and
    4. transportation to and from the health care centre or similar facility where the service is obtained.

Payment of Ambulatory Health Care Service in Facilities Considered the Client's Principal Residence

  1. Some clients live in facilities that are considered their principal residence, where ambulatory health care services are provided as part of the monthly fee agreement. Although the service is provided by the facility, the Department may compensate the client for the cost of the service if the service is performed as a direct, individual service to the client.
  2. Contributions towards the cost of ambulatory health care service may be considered if:
    1. a current assessment identifies a need for the service provided;
    2. the duration and cost of the service can be identified on an individual client basis; and
    3. the cost of the service is equal to or less than the standard rate for similar services in the area.
  3. If the service provider is unable to break down the cost of the ambulatory health care service, the Department may determine the amount of the benefit arrangement by taking the amount of hours that is deemed necessary to provide the service according to the current assessment, and multiply those hours by the standard rate for a similar service in the area.
  4. If a facility is considered a client's principal residence and ambulatory health care services are not provided by the facility, then eligible clients may be entitled to these services in the same manner as if they were in a traditional principal residence.

Institutionalized Clients - Type II Level or Higher

  1. Ambulatory Health Care Service may be provided, if required, to clients residing in an institution:
    1. if costs of these services are not included in the institution's per diem rate;
    2. during periods of absence from the institution (e.g. home visits, visiting friends or relatives); and
    3. if the services cannot reasonably be expected of the institution.
  2. Care should be taken to ensure that the Department is not, in effect, paying twice for the same benefit (i.e. once through the facility fee, and again for the benefit directly).

Costs of VIP Ambulatory Health Care Services

  1. Subject to exceeding rates (see Exceeding Rates policy), the maximum rates at which the cost of VIP ambulatory health care services are payable is outlined in Maximum Rates Payable for Veterans Independence Program and Long Term Care Program Services and shall be adjusted in the same manner and on the same day as pensions are adjusted under Part V of the Pension Act.

References

Pension Act

Veterans Health Care Regulations, paragraph 19 (b)

Health Professionals policy

Exceeding Rates for Veterans Independence Program (VIP) and Long Term Care (LTC) policy

Principal Residence (Veterans Independence Program) policy

Eligibility for Health Care Programs – Eligible Client Groups

Date modified: