Supplementary Health Benefits Authority

1. Summary

2. Objectives and results

The Canada Health Act requires that provinces and territories provide coverage for "insured services" (medically necessary hospital and physician services) to all eligible residents including First Nations and Inuit. Individuals may have access to other health-related goods and services through other publicly-funded programs or through private insurance plans. ISC through its Non-Insured Health Benefits (NIHB) Program is a national program that provides registered First Nations and recognized Inuit in Canada with coverage for a range of medically necessary health-related goods and services not provided through other private or provincial/territorial programs.

The benefits covered by the NIHB Program include: pharmacy benefits (prescription drugs and some over-the-counter medication), medical supplies and equipment, dental care, vision care, mental health counselling, and medical transportation benefits to access medically required health services not available on reserve or in the community of residence.

The objectives of the NIHB Program are to provide non-insured health benefits to First Nations and Inuit people in a manner that:

• is appropriate to their unique health needs
• contributes to the achievement of an overall health status for First Nations and Inuit people that is comparable to that of the Canadian population as a whole
• is sustainable from a fiscal and benefit management perspective
• facilitates First Nations/Inuit control at a time and pace of their choosing

3. Eligible recipients and annual maximum amount payable

The following classes of recipients are eligible for funding under the Supplementary Health Benefits Authority categories of contribution. The following table lists the different classes of eligible recipients and the annual maximum amount payable for this Authority^{Footnote 2}.

The annual amount for the Supplementary Health Benefits Authority for each recipient will not exceed the following dollar values listed in Table 1 of this document.

4. Eligible expenditures

As a result of the unique and complex nature of ISC-FNIHB transfer payments, ISC will include a generic list of specific eligible key activities which fall under the Supplementary Health Benefits Authority. See Appendix C. Generally, eligible expenditures will include administration of the program, staff salaries and benefits, contracts related to program planning, delivery and evaluation, staff travel, office supplies, accommodation, printing, staff training, operation and maintenance of health facilities, utilities such as broadband connectivity and telecommunications, minor equipment and furniture for eligible program activities. Other expenditures may be considered eligible based on program plans provided. These are subject to ISC review and approval. While these are the broad expenditure categories, considerations may be given to allow other expenditures related to cultural and traditional activities. However, each approved plan will describe the eligible activities to be undertaken and a clause which states that all expenditures must be related to the delivery of health programs and services as defined in the agreement.

5. Stacking provisions

The maximum level (stacking limits) of total Canadian government funding (federal, provincial, territorial and municipal assistance for any one activity, initiative or project) for recipients will not exceed 100% of eligible expenditures. The stacking limits must be respected when assistance is provided.

Recipients of contribution agreements are required to disclose any other government funding received for the same activity, initiative or project. Based on the provision of financial statements, financial reports and contribution audits, Indigenous Services Canada establishes whether stacking has occurred and if funds provided need to be recovered.

6. Basis and timing of payment

Payments are based on the achievement of predetermined performance expectations or milestones and/or a risk based approach. In ISC specific context and in order to provide cash flow to the recipient for delivering ongoing health programs and services, advance payments will be issued following a cash flow requirement forecast established in the contribution agreement. This may include, but is not limited to: historical funding levels, per capita, population/geographic indices, and the cost to deliver programs.

The method to be used to determine the amount of a contribution is based on a review of historical funding levels and/or utilization data, the Multi-Year Work Plan or Health Plan submitted, as well as the Program Plan.

For the purposes of putting in place (separate) contribution agreements with the Government of Nunavut the Government of Northwest Territories, and the Government of Newfoundland and Labrador, respectively, for the delivery of NIHB benefits to eligible First Nations and Inuit clients, the department may, when it considers it appropriate, reimburse the Government of Nunavut, the Government of Northwest Territories, and the Government of Newfoundland and Labrador, respectively for eligible expenses that each recipient has incurred from April 1st 2023 to the date of execution of the contribution agreement with the department. Eligible expenses may only be reimbursed following the submission of documentation to the satisfaction of the department. Canada's reimbursement of pre-agreement eligible expenses will be subject to the parameters specified in both the program terms and conditions and the contribution agreement.

7. Applications requirements

ISC offers a variety of consolidated contribution agreements to First Nations and Inuit recipients that vary in the level of control, flexibility, authority, reporting requirements and accountability. At a minimum, recipients have a set funding agreement which offers no flexibility, recipients deliver the programs and services as set out (prescribed) by the branch. First Nations and Inuit communities interested in having more control of their health programs and services can decide among different approaches based on their eligibility, interests, needs and capacity. It is at this time that a recipient undergoes a recipient readiness assessment for a more flexible funding approach. Recently the branch has also implemented the Risk Tolerance Strategy and this is another layer of assessing the recipient.

ISC has established relationships with First Nations and Inuit communities and other institutions through formal agreements to work together to develop, sustain and enhance their health, well-being and capacity to design, deliver and manage their health programs and services. By assuming control of their health programs and services, First Nations and Inuit are in a better position to meet their basic health needs. The long-term relationship established with eligible recipients impacts on the nature of the application requirements as well as on the level of flexibility of the financial arrangements chosen by both parties.

First Nations and Inuit interested in having more control of their health programs and services, have access to various types of funding approaches based on the demonstration of their eligibility, interests, needs and capacity. Based on need and capacity a recipient enters into the following funding approaches: set, fixed, flexible or block. Discussions between ISC and the eligible recipient are conducted to form a decision on the approach that is best for the recipient; however fixed, flexible or block contribution agreements under the Supplementary Health Benefits Authority require the explicit approval of the Assistant Deputy Minister (ADM), Regional Operations and the Senior ADM-FNIHB.

For initial contribution agreements, the recipient must provide:

• For First Nation bands and/or Inuit organizations, or a group formally mandated by Band Council Resolution or other formal mandate: Legal Entity Address and Telephone Number, Band Contract Person and Title, Legal Quorum to sign an agreement and Number of Councillors
• For Corporations: incorporating documents (Articles of Incorporation or Letters Patents), by-laws
• Disclosure of any involvement of former public servants who are subject to the Conflict of Interest and Post-Employment Code for Public Office Holders or the Conflict of Interest and Post-Employment Code for the Public Service
• For municipal, provincial and territorial governments, agencies and health authorities: legal act or letter of registration

The following requirements will apply to all community-based contribution agreements:

• A mandate, as evidenced by a Band Council Resolution (BCR), or other formal mandate for initial agreements, upon renewal of agreements or for the addition of any new initiatives, as required by the program
• A plan: The Health Plan, Multi-Year Work Plan, or Multi-Year Program Plan is the Recipient's primary document that identifies the community's health needs, defines its capacity to respond, and outlines its programs and services to address health priorities. The Health Plan has the additional requirements of identifying all available resources, describing how various services will be integrated, and indicating how success will be measured. The plan becomes the focus for establishing priorities, building capacity, and enhancing accountability for program delivery. Additional details on the planning process are included in Appendix B
• Evidence of demonstrated capacity in areas such as financial and administrative experience to deliver the programs and services. Successful experience in the management of programs and finances does not necessarily have to be in the area of health; it can also be in such areas as education, social services, and economic development

In the interests of promoting program coordination and avoiding reporting burden, ISC will support consolidation of the contribution agreement planning and reporting requirements among programs that are delivered under the same contribution agreement with different funding approaches. The consolidation of the contribution agreement planning and reporting requirements will be established based on the most flexible funding approach used by the recipient.

Renewal of contribution agreements

The decision to enter into subsequent contribution agreements will be based on:

• evidence that a plan has been implemented and updated
• discussions between the ISC and the recipient to determine if the agreement will be renewed
• all required reports and audits
• risk assessment

ISC may sign agreements with eligible recipients in partnership with other Branches/Sectors of Indigenous Services Canada and/or other federal departments for the provision of health services, specific programs and/or block-funded services. All other aspects of the terms and conditions will remain applicable under these agreements while trying to ensure seamless requirements between funders.

8. Due diligence in managing and administering the Transfer Payment Guidelines

Indigenous Services Canada ensures that FNIHB has financial resources for the effective, management, administration, and contribution audit activities related to programs under these terms and conditions.

9. Audit framework

10. Official languages

Where a program supports activities that may be delivered to members of either official language community, access to services from the recipient shall be provided in both official languages where there is sufficient demand. In addition, ISC 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 by ensuring that these projects provide benefits to all Indigenous Canadians, including French and English minority communities. ISC will ensure that it has the capacity to communicate with, and provide services to, members of the public in the official language of their choice. All communication with the public from ISC (in other words press releases, announcements) will be in accordance with the Official Languages Act.

11. Other terms and conditions

12. Non-monetary contributions

The minister may contribute goods, assets or services (rather than funding) to the recipient for health purposes. Non-monetary contributions may be employed in cases where the process would be of greater advantage to both parties and will not undermine long term objectives to increase First Nation and Inuit control of the delivery of health programs and services. Non-monetary contributions may consist of any good, asset or service that is required for, or can be used by, the recipient for health purposes, and may include, for the purposes of Supplementary Health Benefits: (i) any medical equipment or assets (and repairs thereto) for use by a recipient or that supports other health programs funded or delivered by the minister; (ii) goods or services required by the recipient to implement programs supporting Jordan's Principle.

The minister will use Vote 10 funds for all non-monetary contributions, including the contracting for and delivery of such contributions to the recipient's community or the location where the recipient delivers health programs and services. The minister will follow all federal contracting laws and policies for the purchase of non-monetary contributions. The minister will ensure that the recipient receives non-monetary contributions on the condition that they be used for health purposes and may require reporting and may audit for this purpose.

13. Funding approaches

The diversity of interests, needs and capacities of the recipients leads to the requirement for divergent methods of delivering health community programs and services. This requires adaptable vehicles for the administration and management of health programs and services, which vary in terms of level of control, flexibility, reporting requirements and accountability. ISC will be using the following types of funding approaches; Set, Fixed, Flexible or Block. The funding approach relevant to programs and services is defined in the program framework and is dependent on the capacity of the recipient to manage and deliver programs, the class of eligible recipient, and the nature of the program. Fixed, Flexible or Block Contribution Agreements under the Supplementary Health Benefits Authority require the explicit approval of the Assistant Deputy Minister (ADM), Regional Operations and the Senior ADM-FNIHB. The funding approaches are further described in Appendix B.

14. Terms and conditions effective date

These terms and conditions come into effect on February 28, 2024.

Appendix B: Funding approaches

Contribution agreements can be established by combining programs and services from the different authorities (Primary Health Care, Supplementary Health Benefits and Health Infrastructure Support). The funding approaches within these authorities can be applied in a way that best suits the needs and capacity of the recipients provided that the approach used is within the approved program and policy framework established for the Branch.

Programs or services that are aimed at specific health issues may receive special time-limited funding, and this funding will have to be accounted for separately, no matter which funding approach is used. Time limited and additional programs/services may also be considered to complement core programs.

Exceptions:

Project-based agreements
For contribution agreements which are not community-based, but support the improved capacity of First Nations and Inuit to take on the responsibility of program management and delivery of effective programs and services, recipients will need to meet the requirements as outlined in Table 2, but their plan will take the form of a project proposal, budget, forecast or equivalent planning documents.

The following table provides an overview of the funding approaches that ISC will be using as well as the distinct differences and reporting requirements.

Appendix C: Eligible activities

In addition to the eligible expenditures listed in Section 5, the following table lists additional examples of the eligible key activities that fall under the Supplementary Health Benefits Authority:

Appendix D: Summary of requirements for due diligence