ARCHIVED — Vol. 146, No. 9 — April 25, 2012

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Registration

SI/2012-26 April 25, 2012

OTHER THAN STATUTORY AUTHORITY

Order Respecting the Interim Federal Health Program, 2012

P.C. 2012-433 April 5, 2012

His Excellency the Governor General in Council, on the recommendation of the Minister of Citizenship and Immigration, hereby

  1. (a) repeals Order in Council P.C. 157-11/848 of June 20, 1957; and

  2. (b) makes the annexed Order Respecting the Interim Federal Health Program, 2012.

ORDER RESPECTING THE INTERIM FEDERAL
HEALTH PROGRAM, 2012

INTERPRETATION

1. The following definitions apply in this Order.

“Act” means the Immigration and Refugee Protection Act. (Loi)

“condition of public safety concern” means a mental health condition in a person who has been examined by a physician licensed in Canada and for which the physician is of the opinion that the person will likely cause harm to others. (état préoccupant pour la sécurité publique)

“disease posing a risk to public health” means a communicable disease

  1. (a) that is on the list of national notifiable diseases of the Public Health Agency of Canada, as amended from time to time,

    1. (i) which is subject to human-to-human transmission and requires public health intervention in accordance with provincial legislation, or

    2. (ii) for which immunization has been recommended under Canadian medical standards; or

  2. (b) that is referred to in the Interim Federal Health Program Policy of the Department of Citizenship and Immigration, as amended from time to time. (maladie présentant un risque pour la santé publique)

“health care coverage” means coverage for the following services and products provided in Canada only if they are of an urgent or essential nature as defined in the Interim Federal Health Program Policy of the Department of Citizenship and Immigration, as amended from time to time:

  1. (a) hospital services;

  2. (b) services of physicians licensed in Canada and registered nurses licensed in Canada;

  3. (c) laboratory, diagnostic and ambulance services; and

  4. (d) immunization and medication, only if required to prevent or treat a disease posing a risk to public health or a condition of public safety concern. (couverture des soins de santé)

“immigration medical examination” means a medical examination requested under paragraph 16(2)(b) of the Act and has the meaning assigned to the term “medical examination” in section 29 of the Immigration and Refugee Protection Regulations. (visite médicale d’immigration)

“Minister” means the Minister of Citizenship and Immigration. (ministre)

“person whose refugee claim has been rejected” means a person

  1. (a) whose claim for refugee protection has been finally rejected by the Immigration and Refugee Board and whose right to judicial review, or any appeal of that judicial review, in respect of that claim has been exhausted; or

  2. (b) whose claim is deemed to be rejected under subsections 105(3), 108(3) or 109(3) of the Act. (personne dont la demande d’asile a été rejetée)

“protected person” has the same meaning as in subsection 95(2) of the Act. (personne protégée)

“public health or public safety health care coverage” means coverage for the following services and products provided in Canada, only if required to prevent or treat a disease posing a risk to public health or a condition of public safety concern:

  1. (a) hospital services;

  2. (b) services of physicians licensed in Canada and registered nurses licensed in Canada;

  3. (c) laboratory and diagnostic services; and

  4. (d) immunization and medication. (couverture des soins de santé pour la santé ou la sécurité publiques)

“refugee claimant” means a person whose claim for refugee protection is eligible to be referred to the Immigration and Refugee Board and who is awaiting a final determination of that claim by that Board, including a person whose right to judicial review of that determination, or appeal of that judicial review, has not been exhausted. This definition does not include a person whose refugee claim was determined to be abandoned or withdrawn. (demandeur d’asile)

“resettled refugee” means a person on whom refugee protection has been conferred under paragraph 95(1)(a) of the Act. (réfugié réétabli)

AUTHORIZATION

2. The Minister is hereby authorized to administer the Interim Federal Health Program in accordance with this Order.

POWERS OF MINISTER

3. (1) The Minister may pay the cost of health care coverage incurred for protected persons for a period set out in the Interim Federal Health Program Policy of the Department of Citizenship and Immigration, as amended from time to time.

(2) Despite subsection (1), the Minister may pay the cost of health care coverage incurred for protected persons who are resettled refugees only while they receive assistance under the Resettlement Assistance Program of the Department of Citizenship and Immigration or while they are under sponsorship under the Immigration and Refugee Protection Regulations.

4. (1) Subject to subsections (2) and (3), the Minister may pay the cost of health care coverage and immigration medical examinations incurred for refugee claimants.

(2) The Minister is not authorized to pay, under subsection (1), the cost of health care coverage incurred for refugee claimants while their refugee claims are suspended under subsection 103(1) or 105(1) of the Act.

(3) The Minister is not authorized to pay, under subsection (1), the cost of health care coverage incurred for refugee claimants who are nationals of a country that is, when services or products are provided, designated under subsection 109.1(1) of the Act.

5. The Minister may pay the cost of public health or public safety health care coverage incurred for persons whose refugee claims have been rejected except for those whose removal order has been enforced pursuant to section 240 of the Immigration and Refugee Protection Regulations.

6. The Minister may pay the cost of public health or public safety health care coverage and immigration medical examinations incurred for refugee claimants

  1. (a) while their refugee claims are suspended under subsection 103(1) or 105(1) of the Act; or

  2. (b) who are nationals of a country that is, when services or products are provided, designated under subsection 109.1(1) of the Act.

7. Despite sections 3 to 6, the Minister may, on his or her own initiative, pay the cost of health care coverage, public health or public safety health care coverage or immigration medical examinations incurred in Canada, in exceptional and compelling circumstances, including when the Minister exercises a power conferred under subsection 25.2(1) of the Act.

8. In order to protect the health and safety of Canadians, the Minister may, on his or her own initiative, in exceptional and compelling circumstances, pay the cost of immigration medical examinations, medication or immunization incurred outside Canada that are, in the opinion of the Minister, required prior to departure for Canada for the following persons:

  1. (a) resettled refugees; and

  2. (b) foreign nationals in respect of whom the Minister exercises a power conferred under subsection 25.2(1) of the Act.

9. The Minister may pay the cost of health care services and products incurred, in accordance with the Interim Federal Health Program Policy of the Department of Citizenship and Immigration, as amended from time to time, for foreign nationals or permanent residents who are detained under the Act.

RESTRICTIONS

10. (1) Despite sections 3 to 9, the Minister is not authorized to make a payment under this Order for persons who are or were eligible under any provincial health insurance plan or program, whether or not an application has been made to the plan or program.

(2) Despite subsection (1), the Minister may pay the cost of immunization and medication incurred for the following persons while they receive assistance under the Resettlement Assistance Program of the Department of Citizenship and Immigration or while they are under sponsorship under the Immigration and Refugee Protection Regulations, but only if required to prevent or treat a disease posing a risk to public health or a condition of public safety concern:

  1. (a) resettled refugees; and

  2. (b) foreign nationals in respect of whom the Minister exercises a power conferred under subsection 25.2(1) of the Act.

(3) Despite sections 3 to 9, the Minister is not authorized to make a payment under this Order for any services or products for which a person may make a claim under any private health insurance plan, without regard to the amount that may be recovered under that plan for those services or products.

(4) Despite sections 3 to 9, the Minister is not authorized to make a payment under this Order for persons who are Canadian citizens.

TRANSITIONAL PROVISIONS

11. For greater certainty, Order in Council P.C. 157-11/848 of June 20, 1957 continues to apply in respect of health care services and products provided until June 29, 2012 and the Minister may pay the cost of health care services and products provided after that date only in accordance with this Order.

12. Subsection 4(3) and paragraph 6(b) do not apply to a refugee claimant whose claim for refugee protection was made prior to the day on which section 12 of the Balanced Refugee Reform Act, chapter 8 of the Statutes of Canada, 2010, comes into force.

COMING INTO FORCE

13. (1) Subject to subsection (2), this Order comes into force on June 30, 2012.

(2) Subsection 4(3), paragraph 6(b) and section 12 come into force on the day on which section 12 of the Balanced Refugee Reform Act, chapter 8 of the Statutes of Canada, 2010, comes into force.

EXPLANATORY NOTE

(This note is not part of the Order.)

Proposal

The Order in Council entitled Order Respecting the Interim Federal Health Program, 2012 amends the criteria for granting temporary coverage for health care services under the Interim Federal Health Program (IFHP). The new criteria provide for protected persons and refugee claimants who are not eligible for provincial or territorial (PT) health insurance plans, and where a claim cannot be made under any private insurance plan, to receive urgent and essential health care coverage. The new criteria provide for rejected refugee claimants and refugee claimants from countries considered Designated Countries of Origin (DCO) under the Balanced Refugee Reform Act and Protecting Canada’s Immigration System Act, who are not eligible for PT health insurance plans, and where a claim cannot be made under any private insurance plan, to receive more restrictive public health or public safety health care coverage. The Order authorizes the Minister to pay the cost of health care coverage, public health or public safety health care coverage or immigration medical examinations incurred in Canada, in exceptional and compelling circumstances. The Minister may pay the cost of health care services and products incurred for foreign nationals and permanent residents who are detained under the Immigration and Refugee Protection Act, and finally in order to protect the health and safety of Canadians, the Minister may, in exceptional and compelling circumstances, pay the cost of certain health care services incurred outside Canada for resettled refugees and foreign nationals in respect of whom the Minister has exercised a power conferred under subsection 25.2(1) of the Immigration and Refugee Protection Act.

Purpose

The Order ensures appropriate legal authority for the revised terms for eligibility and benefits under the reformed IFHP. The objectives of the reformed program are (1) to provide either health care coverage or public health or public safety health care coverage, on a temporary basis, to persons including refugee claimants, protected persons, persons detained under the Immigration and Refugee Protection Act, and rejected refugee claimants; (2) to provide coverage that is not more generous than what Canadians receive through government-funded benefit programs; and (3) to protect public health or public safety.

Implementation of IFHP reforms is planned for June 30, 2012.

Background

The IFHP began following the conclusion of World War II in the late 1940s, when Canada agreed to take in immigrants from displaced persons camps in Europe. It was envisioned as an emergency humanitarian response for individuals coming from “refugee-like” situations, although it predated the definition of a refugee in the 1951 United Nations Refugee Convention. The program was never meant to cover the full range of migrants who come to Canada (e.g. family class immigrants, temporary workers).

Some of the first displaced persons who arrived in Canada became ill at ports of entry and required health care. IFHP was designed as a program to pay temporarily for health care prior to these individuals taking up employment and earning the funds to pay for their health care. The program predated the creation of universal health care and the employment-based private health care insurance plans that today pay for the majority of health care services for residents of Canada. Since that time, the range and volume of health care services delivered in Canada has increased.

With the enactment of the 1984 Canada Health Act (CHA), provincial governments were required to ensure hospital and physician services for insured persons. According to the CHA, insured persons are residents of the province other than members of the Canadian Forces, ranking members of the Royal Canadian Mounted Police, persons serving terms of imprisonment in a penitentiary, or residents who have not completed the minimum period of residence or waiting period. Newcomers to a province, including permanent residents or Canadians returning from another country, may be subject to a waiting period, not to exceed three months.

While PT governments have paramount responsibility for delivering health care services, federal, provincial and territorial governments share responsibility for public health, including the management of infectious disease outbreaks and threats to public safety.

IFHP reform

The current IFHP operates pursuant to the authority of a 1957 Order in Council (OIC) and is a discretionary, ex gratia program, which is not based on statutory obligation. The new Order in Council, entitled Order Respecting the Interim Federal Health Program, 2012, replaces the 1957 Order on June 30, 2012, and is also a discretionary, ex gratia program not based on statutory obligation.

The current IFHP provides temporary health care coverage of the cost of urgent or essential health care services for specified clients who are not eligible for PT health insurance or who are not covered under a private health insurance plan, and who lack financial means. It covers refugee claimants, rejected refugee claimants, resettled refugees, individuals detained under the Immigration and Refugee Protection Act, pre-removal risk assessment (PRRA) applicants and others in special circumstances, such as individuals covered under the public policies made pursuant to subsection 25.2(1) of the Immigration and Refugee Protection Act. In fiscal year 2011–12, the IFHP covered 128 000 clients.

The wording of the 1957 OIC is very broad in scope. As a result, the program has expanded over time in terms of both benefits covered and people eligible. Recent questions about the fairness of the IFHP highlighted the need to reassess the current IFHP to ensure that IFHP clients do not receive benefits that are more generous than those provided to Canadians.

Citizenship and Immigration Canada has thus proposed reforms that limit both the eligibility criteria and the benefits covered.

The objectives of the reform are to provide either health care coverage or public health or public safety health care coverage, on a temporary basis, to specified clients, to protect public health or public safety, and to provide coverage that is not more generous than benefits received by Canadians.

Under the reformed program, IFHP will provide either coverage, on a temporary basis, for specified clients who are not eligible for benefits under PT health insurance plans and where a claim cannot be made under any private insurance plan.

The reformed IFHP will focus on persons including refugee claimants, protected persons and persons detained under the Immigration and Refugee Protection Act, providing health care coverage of urgent or essential health services (e.g. hospital and physician services), the immigration medical examination, and immunization and medication for diseases posing a risk to public health and conditions of public safety concern.

The reformed IFHP will provide to rejected refugee claimants and to refugee claimants from Designated Countries of Origin, that is, countries designated by the Minister under subsection 109.1(1) of IRPA, limited public health and public safety health care coverage of urgent or essential health services for diseases posing a risk to public health or conditions of public safety concern, immigration medical examinations and immunization and medication for diseases posing a risk to public health or conditions of public safety concern. Specifically, the reformed policy includes measures to

  • ensure IFHP coverage is limited to urgent or essential health care services;
  • continue to provide health services (e.g. hospital and physician services) under the “Health Care Coverage” package to refugee claimants, resettled refugees and other protected persons;
  • end coverage of supplemental benefits (e.g. pharmaceutical, dental, or vision services), but will provide for immunization and medication needed to protect public health or public safety;
  • end all IFHP coverage to rejected refugee claimants, other than services and products that protect public health or public safety;
  • limit coverage to refugee claimants from Designated Countries of Origin by providing only services and products that protect public health or public safety;
  • end all IFHP coverage for Pre-Removal Risk Assessment (PRRA) applicants who have not applied for refugee status during their current stay, providing benefits only once protected person status is conferred; and
  • retain ministerial discretion to provide IFHP coverage in exceptional and compelling circumstances, including to individuals admitted under public policies.

The revised terms of eligibility and benefits in the 2012 Order in Council will apply to both current and new IFHP recipients as of the date of implementation on June 30, 2012. The IFHP will continue to be a “last payer of resort” program; therefore, it will not cover any health care service that another private insurance plan or program covers and it will not provide coverage for persons who are eligible for PT health insurance plans. Coverage under the IFHP is not available for Canadian citizens.

Financial implications

The reformed program is forecast to cost approximately $300 million over five years (fiscal year 2012–13 to fiscal year 2016–17). It is expected to save approximately $70 million in the first three years, with approximately $15 million in ongoing savings each year after 2014–15.

The reformed IFHP supports cost containment by restricting coverage for those whose refugee claims have been rejected and for refugee claimants from Designated Countries of Origin, by limiting the benefits covered and by ending coverage for PRRA applicants who have not made a refugee claim.

Departmental contact

Dr. Danielle Grondin
Director General
Health Branch
Citizenship and Immigration Canada
Telephone: 613-946-5597
Email: Danielle.Grondin@cic.gc.ca