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Benefit Arrangement (Veterans Independence Program)

Issuing Authority: Director General, Policy
Effective Date: May 29, 2015
Document ID: 2159

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 contains direction providing financial assistance to an individual who is eligible to receive home care, ambulatory health care, transportation and/or home adaptations or intermediate care under the Veterans Independence Program (VIP).

Policy

General

  1. For the purpose of this policy, a reference to the term “Veteran” is interpreted to include all individuals eligible for the Veterans Independence Program (VIP).
  2. If applicable, the term “Veteran” is deemed to include a duly authorized representative of the Veteran.
  3. The authority for Veterans Affairs Canada (VAC) to provide VIP services to a Veteran is contained in the Veterans Health Care Regulations. The Program is administered in conjunction with the VIP Terms and Conditions document, which is prepared in accordance with Treasury Board’s "Policy on Transfer Payments".
  4. If a Veteran satisfies the applicable eligibility criteria (see Health Care Eligibility policies), a Benefit Arrangement may be established only after an assessment is completed that indicates the provision of VIP services:
    1. is necessary for health reasons; and
    2. will assist the Veteran to remain self-sufficient at their principal residence (except in the case of intermediate care); or
    3. the provision of intermediate care is appropriate, i.e. an eligible Veteran cannot or should not be maintained in a home environment, and the type and degree of care provided addresses the Veteran’s health needs.
  5. There are various approaches to conducting an assessment as outlined in the Requirements for Decision Making and Determination of Need document, and the policy entitled Assessments (Veterans Independence Program).
  6. Veterans Independence Program services may only be authorized to the extent that:
    1. such services or care are not available under a provincial health care system (see policy entitled Requirement to Access Provincial Programs);
    2. the cost of such services or care is not recoverable from a third party (see policy entitled Costs Recoverable from Third Parties); and
    3. such services or care are not available from the Canadian Armed Forces.
  7. Veterans Independence Program services should only be authorized for as long as they are needed to address a Veteran’s health needs. Individuals in need of temporary support (e.g. acute health need, palliative) may access VIP services intermittently when it is needed for shorter periods. If a Veteran only requires a VIP service for a specified time period, the Benefit Arrangement should reflect this. 

Completing a Benefit Arrangement

  1. A Benefit Arrangement must be completed:
    1. for every new applicant; and
    2. when a follow-up/renewal is done for an individual identified in paragraph 11 or 12, even if there is no change in benefits.
  2. An existing Benefit Arrangement must be revised if:
    1. a new VIP service is added;
    2. there is a change in the cost of a VIP service;
    3. a recipient reports a change in need, which, upon review, may or may not result in a change in benefits (e.g. a minor change in need may not result in an increase in the results of the Grant Determination Tool); or
    4. a VIP service is suspended or terminated.
  3. A review process must be conducted periodically to confirm that the benefits the Veteran is receiving are appropriate and meeting his/her needs (see Business Process entitled Annual Follow-up with Veterans Independence Program (VIP) Clients).
  4. Individuals receiving VIP as a result of having exceptional health needs are required to reconfirm their income eligibility each year (see policy entitled, Exceptional Health Needs (Veterans Independence Program).
  5. Survivors are required to reconfirm eligibility for the Guaranteed Income Supplement or the Disability Tax Credit each year (see policy entitled, Survivors – Veterans Independence Program).

Restrictions to Benefit Arrangements

  1. An individual who is eligible for VIP services under more than one category (e.g. satisfies the criteria as both an Overseas Service Veteran and an Income-qualified Veteran) may only access VIP services through one eligibility gateway to meet his or her assessed health needs. For example, a Veteran may receive a financial contribution to obtain home care services as an Overseas Service Veteran or as an Income-qualified Veteran, but he/she may not receive two financial contributions for the same service at the same time.
  2. A Veteran must be resident in Canada to access VIP services. VIP-like services acquired while a Veteran is temporarily outside Canada (e.g. snowbirds) may not be reimbursed.

Benefit Arrangements in a Shared Residence

  1. Benefit Arrangements for two Veterans sharing a residence are based on separate needs assessments, one for each individual.
  2. If both individuals require VIP services, a separate Benefit Arrangement must be completed for each person.
  3. Each Veteran may be approved up to the maximum amount for VIP services, but both individuals cannot receive payment for the same VIP service in respect of cleaning shared living/common areas or grounds maintenance.

    For example, if each Veteran has their own bedroom, each may receive housekeeping services to clean their individual bedroom. If they share a bedroom, only one Veteran can receive housekeeping services for that bedroom.

Date of Application

  1. The date of the initial application for VIP services is the earliest of:
    1. the date the applicant or the applicant's representative requests an application (e.g. by telephone, in person);
    2. the date of the postmark, if the applicant or the applicant's representative requests an application in writing;
    3. the date of the visit, if the applicant is seen in person and the applicant or the applicant's representative signs the application (VAC 1305A / VAC 967 / VAC 753); or
    4. the date the application is submitted, if the applicant completes the application online through the My VAC Account portal.
  2. When contact with the Department is made in accordance with paragraph 18(a) or (b), it must be followed by receipt of a signed application (VAC 1305A / VAC 967 / VAC 753).
  3. When the Department must confirm eligibility for a program before VIP can be approved (e.g. a Canada Service Veteran), the date of application for VIP services is the date described in paragraph 19; not the later date when eligibility is confirmed. For example, if a Veteran submits an application to the Area Office on October 15, and an eligibility decision is made November 1; the date of application is October 15. This date is important when establishing the effective date of a Benefit Arrangement.

Date of Application for Survivors

  1. The effective date of application for survivors is as outlined in paragraph 18 however, all necessary supporting documents (e.g. proof of receipt of the Guaranteed Income Supplement or proof of eligibility for the Disability Tax Credit) must accompany the application in order to protect the initial application date. If the supporting documents do not accompany the application and are not provided within 120 days after the date the application is received, the application will be declared incomplete. The survivor will then be required to submit another application, including the necessary supporting documents. The effective date of the subsequent application will be established in accordance with paragraph 18.

Effective Date of a Benefit Arrangement (excluding Primary Caregivers)

  1. After an assessment is completed, the following circumstances determine the effective date of a Benefit Arrangement (i.e. when funding can start):
    1. Housekeeping and/or Grounds Maintenance Only
      1. The effective date of a Benefit Arrangement for housekeeping and/or grounds maintenance services is the date of application (see paragraph 18), whether or not the housekeeping and/or grounds maintenance services are in place at the time the individual applies.
      2. If a Benefit Arrangement already exists and additional housekeeping and/or grounds maintenance services are approved, the effective date for the additional services is the date the services are requested.
    2. All Services Excluding Housekeeping and/or Grounds Maintenance and Intermediate Care

      The effective date of a Benefit Arrangement for all VIP services, excluding housekeeping and/or grounds maintenance services and Intermediate Care, is:
      1. the date of application (see paragraph 18), if the required services are already in place (e.g. the individual has a personal care service provider in place and is paying for the service).
      2. the date the service is first delivered, if, on the date of application (see paragraph 18), the applicant does not have the service in place (e.g. the individual has been assessed as requiring personal care but has not yet obtained a service provider).
    3. Intermediate Care

      The effective date of a Benefit Arrangement for Intermediate Care is determined in accordance with the VIP Intermediate Care Application Process.

Effective Date of a Benefit Arrangement (Primary Caregivers Only)

  1. After an assessment is completed, the following circumstances determine the effective date of a Benefit Arrangement (i.e. when funding can start):
    1. If a qualified primary caregiver applies within one year of the date that the Veteran dies or is admitted to a health care facility, the effective date of the Benefit Arrangement will be the day following the Veteran’s death or admission to the facility; or
    2. If a qualified primary caregiver applies later than one year after the date that the Veteran dies or is admitted to a health care facility, the effective date of the Benefit Arrangement will be the date of application in accordance with paragraph 18.

Effective Date When Adding Additional Services to an Existing Benefit Arrangement (excluding Housekeeping and/or Grounds Maintenance)

  1. If a Benefit Arrangement already exists and additional services (either a new service or a change to an existing service) are approved, the effective date is:
    1. the date the additional service is requested, if the individual already has the service in place; or
    2. the date the service is first delivered, if the individual does not have the service in place on the date that it is requested.

Maximum Rates Payable

  1. Veterans Independence Program services are subject to yearly maximum rates. These rates are adjusted annually on January 1. Maximum rates may only be exceeded in accordance with the policy entitled, “Exceeding Rates for Veterans Independence Program (VIP) and Long-term Care (LTC)."

Benefit Arrangements in the Amount of $1

  1. A Benefit Arrangement may be made in the amount of $1 for Veterans, excluding survivors and primary caregivers, when: 
    1. an assessment indicates that a Veteran requires VIP services; and
    2. the Veteran is in receipt of services under a federal, provincial or community-based program that are comparable to the VIP services available from Veterans Affairs Canada.
  2. A Benefit Arrangement in the amount of $1 is made to ensure Veterans who access federal, provincial and community programs first are not denied the treatment benefits they would be eligible for as VIP recipients.
  3. A Benefit Arrangement in the amount of $1 is not to be established for a Primary Caregiver or Survivor.

Financial Contributions - General

  1. When an assessment has been completed and the health needs of a Veteran have been identified, a Benefit Arrangement is established to provide funds for services required to meet those health needs. Once a Benefit Arrangement is established, a third-party contractor is responsible for processing any claims and providing any payments (i.e. reimbursements, advance payments or grants) associated with the Benefit Arrangement on behalf of Veterans Affairs Canada.

Financial Contributions via Reimbursement (Excludes Housekeeping and Grounds Maintenance Services)

  1. The normal preferred payment method for VIP services (excluding payments for housekeeping and grounds maintenance services) is reimbursement. Exceptions are permitted only in those circumstances described in paragraph 34.
  2. There are four variations of the reimbursement payment method:
    1. The recipient pays the invoice and is reimbursed.
    2. The recipient submits the invoice unpaid with a request that the payment be sent directly to the service provider (registered providers only).
    3. A service provider submits the invoice, including any supporting documentation needed to confirm the services were provided, directly for payment.
    4. The recipient submits the unpaid invoice with a request that payment be issued to both the recipient and the service provider (for non-registered providers).
  3. A claim for reimbursement must be submitted within 18 months of the day on which the expenditure was incurred.
  4. A Veteran whose Benefit Arrangement is based on the reimbursement method must submit receipts or provide the appropriate signed documentation to prove an expenditure was incurred before receiving reimbursement. If invoices or receipts are not available, reimbursement may be made upon receipt of a statutory declaration signed by, or on behalf of, the Veteran attesting to the validity of the claim.

Financial Contributions via Advance Pay (Excludes Housekeeping and Grounds Maintenance Services)

  1. A Veteran may be placed on the Advance Pay payment method only in the following exceptional circumstances:
    1. there is a lack of registered service providers in the Veteran’s area of residence; and
    2. the Veteran is experiencing financial hardship (see paragraph 35).
    Both conditions must exist in order for the Veteran or other qualified person to receive advance pay.
  2. To meet the financial hardship requirement, clear evidence (e.g. VAC 1369 Statement of Income and Financial Status) must exist and be documented that the cost of the service would impede the Veteran’s ability to access VIP services. If a Veteran can access the services of a registered provider in their area, they are not eligible for Advance Pay. Each application is examined on its own merit.
  3. If a Veteran is eligible to receive Advance Pay, the payment may be issued monthly, semi-annually, or annually, based on need.
  4. Recipients whose funding is based on the Advance Pay method must retain receipts and, when asked, account for expenditures. If invoices or receipts are not available, the recipient must provide a statutory declaration signed by, or on behalf of, the recipient attesting to the validity of the claim.

Payment Conditions (Grants or Contributions)

  1. Veterans Independence Program services are purchased under a fee-for-service arrangement between the VIP recipient and the service provider; there is no employer-employee relationship between VAC and the service provider. Therefore, payments cannot be made to cover Employment Insurance, Canada Pension Plan, or other similar premiums for the service provider.

Financial Contributions via Grants for Housekeeping and Grounds Maintenance Services

  1. The exclusive payment method for VIP housekeeping and/or grounds maintenance services is the grant method; wherein the recipient receives an annual grant provided in two installments, subject to continued eligibility of the recipient.
  2. The Department determines the amount of the grant for housekeeping and/or grounds maintenance services using the Grant Determination Tool, based on the needs of the recipient, the need for services, the determination of required number of hours for services, the scope of services required, and the rates for services in the recipient’s geographical area.
  3. The recipient is not required to obtain or retain receipts for housekeeping and grounds maintenance services.

Terminations

  1. Details on how and when a Benefit Arrangement must be terminated are outlined in the policy entitled Termination of Benefits, Services or Care.

Overpayments

  1. The policy entitled Overpayments – Health Care Programs provides direction on the recovery, remission or write-off of VIP overpayments. Such actions are conducted in accordance with the Treasury Board’s Guideline on Collection of Receivables.

References

Veterans Health Care Regulations 

Assessments (Veterans Independence Program)

Requirement to Access Provincial Programs

Costs Recoverable from Third Parties

Exceptional Health Needs (Veterans Independence Program) 

Survivors – Veterans Independence Program 

Primary Caregivers (Veterans Independence Program) 

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

Overpayments - Health Care Programs

Termination of Benefits, Services and Care  

Treasury Board’s “Policy on Transfer Payments"

Treasury Board’s Guideline on Collection of Receivables

Maximum Rates Payable for Veterans Independence Program and Long Term Care Program Services 

Canadian Armed Forces Health Services 

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