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1.0 Background

Since 1981, Veterans Affairs Canada (VAC) has administered a community-based, national program to eligible Veterans, their families, and other primary care-giversFootnote1 . These services include home care, home adaptations, ambulatory health care, and intermediate nursing home care. Now known as the Veterans Independence Program (VIP), it offers self-managed care in co-operation with provinces and regional health authorities. The program allows eligible Veterans to focus on maintaining their health, independence, and their quality of life. Every effort is made to integrate the VIP administration with provincial and local resources to ensure a cost-efficient choice of service is available and to avoid duplication of service delivery.

The VIP attempts to prevent or delay the need for long term care by supporting eligible recipients to remain self-sufficient in their homes and communities. Recipients use VIP services as a contribution, along with their own resources, to achieve as much independence as possible. The VIP also recognizes that staying at home is often the preferred alternative to institutional care and the benefits provided through the VIP are a cost-effective method of support when compared to the cost of a health care facility. However, when home care is no longer reasonable, VIP assists Veterans to remain in their communities by providing intermediate care service in community facilities rather than care in contract beds.

As of March 31, 2011, there were 108,000 participants in the VIP Program and the total VIP expenditure for the fiscal year 2010-2011 was $338 million. The following table presents VIP reimbursement claims processed during the scope of this audit.Footnote2

Table 1 - VIP Claims Processed
Period Veteran Provider Total
December 2010 52,208 38,238 90,446
January 2011 59,154 41,474 100,628
February 2011 49,545 29,650 79,195
March 2011 61,400 34,818 96,218
April 2011 64,860 43,713 108,573
Total 287,167 187,893 475,060

Source: Medavie Blue Cross – VAC Operational Reports

There are two information systems that are being used to capture information and to deliver the VIP. For program delivery, VAC uses the Client Service Delivery Network (CSDN) to set up contribution arrangements and record information. For processing payments the Federal Health Claims Processing System (FHCPS) is used by a third-party contractor, Medavie Blue Cross (MBC).

VAC is responsible for setting up contribution arrangements and entering into both CSDN and FHCPS. VAC is also responsible for making any reassessments or amendments to a current VIP contribution arrangement. MBC receives the claims directly from Veterans or providers and is responsible for processing the VIP claims. Three types of VIP payments are being processed: Advance Payments, Veteran Reimbursements and Provider Reimbursements.

Whenever MBC is unable to process a claim, an action item is referred to the respective VAC district office via the FHCPS. VAC staff address the action item and refer the action item back to the MBC staff to process the claim. Monitoring of any outstanding claims referred to VAC is the responsibility of the Client Services Team Managers (CSTM) and claims outstanding over 30 days are to be followed up by the CSTM.

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