Grants to the Government of the Northwest Territories and the Government of Nunavut for Health Care of Indians and Inuit: Terms and Conditions

Table of contents

1. Introduction

Since the early 1950s the Government of Canada has been involved with ensuring the delivery of health care programs in the territories. The original intent was for the federal government and the territories to share equally (50%) in assuming health care costs pursuant to the Acts; however, territorial governments could not meet their commitments because of large aboriginal populations. In 1959 Canada made provision for annual grants to the Northwest Territories for hospital and health services, administered by the Department of Northern Affairs and Natural Resources. A June 25, 1959, Cabinet decision stipulated:

… that approval in principle be given for the payment to the Northwest Territories of a special annual grant (in addition to amounts payable pursuant to the Hospital Insurance and Diagnostic Services Act) so calculated that the Federal Government will continue to bear the total cost of hospital care for Indians and Eskimos, having due regard for indigency, and that the amount of such grants be provided annually in the estimates of the Department of Northern Affairs and Natural Resources.

In 1966 the program was transferred to the newly created Department of Indian Affairs and Northern Development. In 1970 the grant terms and conditions were expanded to include physician services. In 1977 changes to the Canadian Financial Administration Act, led to the conversion of the 'special grant' arrangements into Contribution Agreements. In 2004, Treasury Board approved the use of a grant authority in place of a contribution authority. This change to grants respects the intent of the funding originally approved by Cabinet in 1959.

These terms and conditions are specifically targeted to other orders of government.

2. Legal and Policy Authority

3. Purpose, Program Objectives and Expected Results

The purpose of the grant is to support the Government of the Northwest Territories and the Government of Nunavut in providing Hospital Services and Physician Services for Indian and Inuit residents. The grant allows the territorial governments to deliver health services to their residents as stipulated in the Northwest Territories Act (Canada), 1985 and the Nunavut Act, 1993.

The activities funded through this grant contribute to program-level outcomes in DIAND's program activity architecture. The program activity "Healthy Northern Communities" seeks to achieve individual and family well-being through various factors, such as the improved health of northerners. The range of hospital and physician services offered by the two territorial governments are designed to lead to better health outcomes for Indian and Inuit residents in the territories and their communities.

In the Program Activity Architecture, this authority is listed under: The North / Healthy Northern Communities.

4. Eligibility

The Government of the Northwest Territories and the Government of Nunavut are the sole recipients.

5. Type and Nature of Eligible Expenditures

Eligible expenditures include the following:

Hospital Facilities: The Hospital Facilities within the territories are named in each agreement; and, outside the territory can include any facility or portion thereof that provides Hospital Services, including acute, rehabilitative or chronic care, but does not include: a) a hospital or institution primarily for the mentally disordered; or b) a facility or portion thereof that provides nursing home intermediate care service or adult residential care service or comparable services for children.

Hospital Services: Hospital services means any of the following services provided to in-patients at a hospital, if the services are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness or disability, namely: accommodation and meals at the standard or public ward level and preferred accommodation if medically required; nursing service; laboratory, radiological and other diagnostic procedures, together with the necessary interpretations; drugs, biological and related preparations when administered in the hospital; use of operating room, case room and anesthetics facilities, including necessary equipment and supplies; medical and surgical equipment and supplies; use of radiotherapy facilities; use of physiotherapy facilities; and, services provided by persons who receive remuneration there fore from the hospital. It does not include services that are excluded by the regulations to the Canada Health Act, R.S.C. 1985. c. C-6.

Physicians Services: Physicians services include any medically required services rendered by Medical Practitioners to the status Indian and Inuit residents of the Northwest Territories and Nunavut in a manner consistent with the terms and conditions of the Canada Health Act, R.S.C. 1985. c. C-6 and the Medical Care Act, R.S.C., R.S.N.W.T., 1988, c.M-8.

Medical Practitioner: Medical Practitioner is a person lawfully entitled to practice medicine in the place in which the practice is carried on by that person.

6. Total Canadian Government Funding and Stacking Limits

Stacking limits do not apply as DIAND provides 100% of the funding for these activities.

7. Method for Determining the Amount of Funding

With the creation of Nunavut, effective April 1, 1999, DIAND's appropriation for hospital and physician services for Indians and Inuit was divided between the Government of the Northwest Territories and the Government of Nunavut through the Annual Reference Level Update, with the former receiving approximately fifty-six percent (56%) and the latter forty-four percent (44 %).

8. Maximum Amount Payable

Under the Hospital and Physician Services Grant program, the maximum amount payable to the two territorial governments is calculated as the $42.867 million base as of April 1, 2004. Annual increases, over the duration of the terms and conditions of the grant, are consistent with those in the Indian and Inuit Envelope currently set at two percent (2%) annually or after adjustments that the federal government may provide to DIAND in relation to health expenditures for Aboriginal people in the Northwest Territories and Nunavut.

9. Basis on Which Payments will be Made

The annual maximum limit will be attained through twelve (12) monthly payments from DIAND. Actual payment will be made at the end of each month.

The payment schedule is a follows: The territories will receive 2/12 of the funds at the end of April; and 1/11th of the amount at the end of each month, May to March.

DIAND will enter into a 5-year Grant Agreement with each of the Government of the Northwest Territories and the Government of Nunavut. The Grant Agreement will contain the following Terms and Conditions:

  1. Program Objectives
  2. Eligible Expenditures
  3. Basis and timing of payments
  4. Accountability Requirement. (DIAND will require each government to report the actual expenditures for hospital and physician services for Indian and Inuit residents in their Public Accounts. The Public Accounts are reviewed annually by the Office of the Auditor General).

10. Application Requirements and Assessment Criteria

No special application is required. DIAND deems the Government of the Northwest Territories and the Government of Nunavut to have applied for this grant through the administrative arrangements that evolved from the 1959 Cabinet decisions for a "special annual grant" and subsequent operations. The 1999-2000 Annual Reference Level Update (ARLU) approved authority for the calculations for the Government of the Northwest Territories and the Government of Nunavut to reflect the creation of Nunavut, with approximately fifty-six percent (56%) of the maximum level going to the Government of the Northwest Territories and forty-four percent (44%) to the Government of Nunavut.

The Grant Agreements will contain the Government of the Northwest Territories' and the Government of Nunavut's Expenditure Plans and the cash flow arrangements from DIAND. The cash flow accounts for expenditure needs as demonstrated by the recipients. DIAND reviews the Expenditure Plans and if it is accepted, DIAND subsequently establishes the monthly payment schedule.

11. Due Diligence and Reporting

Performance Measurement Strategies are being developed for all programs, consistent with the requirements in the Policy on Transfer Payments, as part of the phased-in approach to implement the renewed Policy on Transfer Payments.

12. Official Languages

Where a program supports activities that may be delivered to members of either official language community, access to services from the recipient will be provided in both official languages where there is significant demand and Part IV of the Official Languages Act is applicable. In addition, the department will ensure that the design and the delivery of programs respect the obligations of the Government of Canada as set out in Part VII of the Official Languages Act.

13. Intellectual Property

Where a grant is provided for the development of material in which copyright subsists, conditions for shared rights between the recipient and the crown will be set out in the funding agreement.

14. Other Terms and Conditions


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