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Exceptional Health Needs (Veterans Independence Program)

Issuing Authority: Director, Policy
Effective Date: November 12, 2014
Document ID: 2059

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 the provision of Veterans Independence Program (VIP) services to Veterans with exceptional health needs, as authorized under the Veterans Health Care Regulations.

Policy

Definition

  1. Exceptional health needs are health needs arising through some unfortunate circumstance, such as an illness or accident, which requires that a Veteran either receive intermediate care or clearly places a Veteran at risk of entering intermediate care if home care services, ambulatory health care, transportation and/or home adaptations under the VIP are not provided.

General

  1. For the purpose of this policy, a reference to the term “Veteran” is interpreted to include all individuals eligible for the VIP under the exceptional health needs provision (see paragraph 4), as well as their duly authorized representatives, if applicable.
  2. A Veteran who has exceptional health needs and insufficient income may receive VIP services or intermediate care if:
    1. the Veteran resides in Canada; and
    2. an assessment indicates that the provision of the services would assist the Veteran to remain self-sufficient at his/her principal residence; or
    3. the provision of intermediate care is necessary for health reasons.

Eligibility

  1. The following individuals are eligible to apply for VIP services or intermediate care under this provision:
    1. veteran pensioners (see policy entitled Eligibility for Health Care Programs-Veteran Pensioners);
    2.  overseas service veterans (see policy entitled Eligibility for Health Care Programs-Overseas Service Veterans);
    3. overseas service civilians (see policy entitled Eligibility for Health Care Programs-Overseas Service Civilians); and
    4. individuals who satisfy the war service and age requirements to qualify as a Canada Service Veteran (see policy entitled  Eligibility for Health Care Programs-Canada Service Veterans).

Approval Criteria

  1. An applicant would normally require care in response to a Type II health need, as identified through a nursing assessment, to be considered for VIP services or intermediate care under the exceptional health needs provision.  However, in certain cases (e.g. unavailability of community support services, social isolation, the existence of serious impairments/barriers to the performance of the activities of daily living, or risk of institutionalization), applicants who do not meet the Type II level of care criteria may also be considered.
  2. An applicant who is determined to have exceptional health needs may be provided VIP services, to the extent that:
    1. the cost (to the applicant) of the required VIP services or intermediate care would reduce their assessable income below the applicable War Veterans Allowance (WVA) ceiling in effect the preceding July 1; 
    2. such services or care are not available under a provincial health care system; and
    3. the cost of such services or care is not recoverable from a third party 

Benefit Arrangements

  1. Initial Benefit Arrangements, approved under the exceptional health needs provision, are to be established with an end date of September 30. This may result in a Benefit Arrangement being set up for a period of less than one year. Subsequent Benefit Arrangements are established for a one-year period commencing on October 1, and must be renewed annually on that date.
  2. The amount of the contribution for each VIP service element or intermediate care shall be either the cost of the service required by the Veteran, or the annual maximum limit, whichever is lower. The Department may only pay the portion of the costs which would reduce the Veteran’s assessable income below the applicable WVA ceiling in effect the preceding July 1. Responsibility for the remainder of these costs rests with the Veteran. (See Veterans Independence Program - Exceptional Health Needs business process.)

Assessable Income

  1. A Veteran’s assessable income encompasses “income” as defined in section 7 of the War Veterans Allowance Act (i.e. gross income less applicable deductions permitted under Division B of the Income Tax Act), current monthly benefits as defined in paragraph 4.(3)(c) of that Act, and any War Veterans Allowance benefit being paid to the Veteran. Refer to the Income Assessment –War Veterans Allowance Program policy for additional information.

Accommodation and Meals Contribution

  1. Veterans with exceptional health needs who are receiving Adult Residential Care (see Adult Residential Care in Community Facilities policy) or Intermediate Care are subject to accommodation and meal charges, as described in the Accommodation and Meals Contribution policy.  The accommodation and meals charge is deducted from the appropriate income ceiling after the income exemptions are applied.  (See Determination and Calculation of Accommodation and Meals Rates business process.)

Eligibility for Treatment and Supplementary Benefits

  1. Clients with exceptional health needs who are in receipt of any of the following VIP services:
    1. Home Care; 
    2. Ambulatory Health Care; 
    3. Intermediate Care in a community facility other than in a contract bed; or
    4. continued adult residential care in a community facility,

may also receive treatment and supplementary benefits, to the extent that:

    1. such benefits are not available under a provincial health care system; and
    2. the cost of such benefits is not recoverable from a third party.

Rates

  1. Payments made under the exceptional health needs provision are subject to the current annual maximum limits. In cases where these amounts are insufficient, consideration may be given to exceeding the maximum limits in accordance with the policy entitled, Exceeding Rates for Veterans Independence Program (VIP) and Long Term Care (LTC).

Services to Primary Caregivers

  1. A primary caregiver of a Veteran who received housekeeping and/or grounds maintenance services by virtue of their exceptional health needs is eligible for these continued services if the services are required for a health reason. See policy entitled, Eligibility for Health Care Programs – Primary Caregivers.

References

War Veterans Allowance Act, section 7

Income Tax Act, Division B

Veterans Health Care Regulations, sections 18 and 31.2

Adult Residential Care in Community Facilities policy

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

Eligibility for Health Care Programs – Primary Caregivers policy

Accommodation and Meals Contribution policy

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