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1.0 Background

The Veterans Affairs Canada (VAC) Health Care Benefits Program provides eligible Veterans and other qualified individuals with benefits and services, such as medical, surgical and dental care, prosthetic devices and home adaptations, through 14 Programs of Choice (POC). Related Health Services includes services provided by health care professionals other than physicians, dentists and nurses. Examples of related health services include occupational therapy, physiotherapy, massage therapy, chiropractic, acupuncture, speech language pathology and psychological counseling. These services are provided to eligible VeteransFootnote 1 and other qualified individuals under the following two legislative authorities:

  • Veterans Health Care Regulations allows eligible Veterans to receive funding for treatment benefits for various reasons such as with respect to a pensioned condition. As illustrated in Table 1, during 2012-13, 30,583 Veterans accessed Related Health Services for a total cost of $32 million.
  • Canadian Forces Members and Veterans Re-establishment and Compensation Act allows eligible Veterans to receive funding for medical and psychosocial rehabilitation services focused on rehabilitation and re-integration to civilian life. As illustrated in Table 1, during 2012-13, 1,772 Veterans accessed these Related Health Services for a total cost of $4.7 million.
Table 1- Veterans and Expenditures (2012-13)
All Programs of Choice (POC) Related Health Services - POC 12
Treatment Benefits (VHCR)
Number of Veterans 125,647 30,583
Total expenditures (in millions) $244 $32
Rehabilitation Services (CFMVRC)
Number of Veterans 2,221 1,772
Total expenditures (in millions) $6.3 $4.7

Source: Analysis of Federal Health Claims Processing System data and Veterans Affairs Canada Facts and Figures Book September 2013

The Service Delivery and Program Management Division, within Head Office, is responsible for the overall management and oversight of Related Health Services. Analysts in the Treatment Authorization Centres (TAC) are responsible for approving treatment benefits under the VHCR and Case Managers in Area Offices (AO) are responsible for approving rehabilitation services, including related health services under the CFMVRC. VAC has a health claims processing contract for actioning requests for payments to health care service providers and reimbursements to program recipients for eligible benefits and services. The Federal Health Claims Processing System (FHCPS) contract with a third party by VAC was initiated to manage health claims processing and related services on its behalf. The contract provides a highly customized suite of applications specifically designed to administer their respective health care programs, health services, health care provider relations, management information, provider audits and program reporting.

Policies and directives for all POCs are further clarified in the benefit grids. The benefit grids describe the benefits and services which are available to eligible Veterans and prescribe the dollar maximums, frequencies, etc. The grids allow the expeditious processing of claims and establish controls and reasonable limits around related health services expenditures.

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