This evaluation of the Health Care Benefits and Services Program was conducted in accordance with Veterans Affairs Canada's (VAC) approved multi-year, risk-based Evaluation Plan 2012-2017. The Health Care Benefits and Services Program, commonly referred to as the Treatment Benefits Program, provides Veteran recipients with access to extended health care. There are 14 benefits and services groups comprising a wide range of offerings. An overview of the benefits and services can be found in Appendix A. The evaluation examined the relevance and performance of the Program, and was conducted in accordance with Treasury Board policy requirements and related Treasury Board Secretariat guidance material. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

Healthcare professional service contractors are individuals with “significant training, qualifications and expertise in a professional field.” With the support of Public Works and Government Services Canada, these contractors are used to obtain expert knowledge and to complement the existing workforce. At Veterans Affairs Canada (VAC), these healthcare professional service contractors review or conduct assessments of Veterans' health needs for services or benefits as well as provide consultation with VAC staff. During the 2012/13 fiscal year, there were 55 healthcare professional service contracts for Occupational Therapists, Nurses, Doctors and a Dentist, excluding those at Ste. Anne’s Hospital. The purpose of the audit was to provide assurance that the departmental activities relating to healthcare professional service contracts were conducted in compliance with VAC procedures, and Treasury Board (TB) policies and regulations. Overall governance and the payment process were also assessed. Fieldwork was conducted from April to July 2013.

The Long Term Care Program works in cooperation with provinces/territories, health authorities and long term care facilities to financially support eligible Veterans in an appropriate long term care setting. Veterans Affairs Canada provides funding for qualified Veterans who occupy a contract bed or those in a community bed. As of March 31, 2011, there were 9,376 recipients of funding support from Veterans Affairs Canada in non-departmental institutions across Canada. 2,782 recipients were in contract beds and 6,594 were in community beds. These numbers are forecasted to decline between 2012 and 2020 when there will be a decline in demand for Long Term Care. Forecasts estimate that there will be 5,780 Veterans in long term care in five years (2016-2017). The purpose of this audit was to provide assurance that the management control framework governing the Long Term Care Program is effective and the internal controls surrounding the program are adequate and functioning well. The scope included Long Term Care recipients in community beds and contract beds governed by a Memorandum of Understanding with provincial health authorities, from April 1, 2010 to March 31, 2011.

The Evaluation of Commemorative Benefits and Services was conducted in accordance with Veterans Affairs Canada’s (VAC) approved Multi-Year Risk-Based Evaluation Plan 2012-17 and with the directive and standards specified in Treasury Board of Canada’s 2009 Policy on Evaluation. The evaluation covered three programs: Funeral and Burial, Cemetery and Grave Maintenance, and Honours and Awards. While the programs have differing objectives, they are all intended to reaffirm Canada's commitment to remember the sacrifices of the fallen, the Veterans, those who served our country on the home front, and those who served and will continue to serve our nation in the cause of peace throughout the world. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

This Rehabilitation Services Evaluation was conducted in accordance with Veterans Affairs Canada's (VAC) approved Multi-year Risk Based Evaluation Plan 2013-2018. Established in 2006, the Canadian Forces Members and Veterans Re-establishment and Compensation Act (hereinafter referred to as the New Veterans Charter or NVC), shifts the Department's focus from one of disability to one of wellness and responds to Canada's commitment to injured Canadian Armed Forces (CAF) members and Veterans. As part of the NVC, the Rehabilitation Services and Vocational Assistance Program (hereinafter referred to as the Program) provides eligible Veteran recipients and their spouse/survivor(s) with one or more of the following types of rehabilitation services: medical, psychosocial, or vocational. In fiscal year 2012-13, the Program funded $18.4 million in benefits and services. The intent of the Program is to support the reasonable restoration of functioning in the following five major areas: mental and physical functioning; social adjustment; family relationships; financial security, employment and personal productivity; and community participation. Recipients are primarily Veterans who were recently medically-released from the CAF, or CAF Veterans who have a health problem resulting primarily from service which is creating a barrier to their re-establishment in civilian life. Veterans often present with complex co-morbid conditions which require the use of the various available medical and psychosocial rehabilitation benefits and services. The evaluation examined the relevance and performance of the Rehabilitation Services and Vocational Assistance Program and was conducted in accordance with Treasury Board (TB) requirements and TB Secretariat guidance material. The evaluation findings and conclusions are based on the analysis of multiple lines of evidence.

This evaluation of the Intermediate and Long Term Care Programs was conducted in accordance with the approved Veterans Affairs Canada Multi-Year Risk-Based Evaluation Plan 2012-2017. The Veterans Independence Program Intermediate Care (VIP IC) Program and the Long Term Care (LTC) Program, hereinafter referred to as "the Programs", support eligible Veterans and other individuals who require facility-based long term care. There are two types of beds under the Programs: community beds and contract beds. Community beds are beds in a facility operated by health authorities, private and not-for-profit sectors. Contract beds are beds that are set aside in a community facility pursuant to a contractual arrangement between the facility and VAC. Eligibility for these bed types varies. Community beds fall under both the VIP IC Program and the LTC Program, while Contract beds fall solely under the mandate of the LTC Program. The evaluation examined the relevance and performance of the Programs, and was conducted in accordance with Treasury Board policy requirements and guidance material. The evaluation findings and conclusions are based on the analysis of multiple lines of qualitative and quantitative evidence.

The Veterans Affairs Canada 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. Under the Veterans Health Care Regulations and Canadian Forces Members and Veterans Re-establishment and Compensation Act, eligible Veterans and other qualified individuals have access to benefits and services, such as medical, surgical and dental care, prosthetic devices and home adaptations. Related Health Services are services provided by health care professionals other than physicians, dentists and nurses. Examples of these types of services include occupational therapy, physiotherapy, massage therapy, chiropractic, acupuncture, speech language pathology and psychological counseling. The objective of this audit was to assess Veterans Affairs Canada’s management control framework, and compliance with applicable policies and processes, and to identify any potential opportunities to improve efficiency of decision making for Related Health Services. The scope covered transactions processed from April 1, 2012 to March 31, 2013.

As part of the ongoing monitoring and evaluation of service delivery, a cyclical audit was conducted to review the activities of the Quebec District Office (DO), the management control framework and the information used for decision making purposes. The Quebec DO was selected based on criteria set by senior management. The objectives of the 2009-2010 audit are: * Examine the application and implementation of new delegated authorities for Area Counsellors (ACs) (Fall 2009); * Verify the efficiency of the delivery of the rehabilitation program and the integrity of internal controls over its adjudication; * Verify internal controls over the award and delivery of Veterans Independence Program’s (VIP) home care services to Canadian Forces (CF) Veterans; * Assess the adequacy of the management control framework for long term care (i.e. oversight, functional direction, reporting and internal controls). The audit focussed primarily on the implementation of the new delegation of authority at the Quebec DO and on delivery of the Rehabilitation, VIP and Long Term Care (LTC) Programs.

Since 1981, Veterans Affairs Canada has administered a community-based, national program to eligible Veterans, their families, and other primary care-givers. These services include home care, home adaptations, ambulatory health care, and intermediate nursing home care. Now known as the Veterans Independence Program, it offers self-managed care in co-operation with provinces and regional health authorities. The program allows eligible Veterans, their families, and other primary care-givers to focus on maintaining their health, independence, and their quality of life. Every effort is being made to integrate the Veterans Independence Program administration with provincial and local resources to ensure a cost-efficient choice of service is available and to avoid duplication of service delivery. Veterans Affairs Canada is responsible for setting up and amending the contribution arrangements while an external Contractor, Medavie Blue Cross, is responsible for processing the claims. In the Spring of 2011, Senior Management requested an audit of the Veterans Independence Program reimbursement process to identify opportunities to further improve the process. This audit builds off the results of a 2010 audit of Veterans Independence Program and is focused on a single objective to assess the efficiency and effectiveness of the reimbursement process. The scope covered the period from November 2010 to April 2011.

The Federal Health Claims Processing System is the automated system that processes health claims for Veterans Affairs Canada, the Department of National Defence and the Royal Canadian Mounted Police. To administer this large and complex system, Public Works and Government Services Canada contracts the services of a private health insurer, Medavie Blue Cross. Of the three departments, Veterans Affairs Canada is the largest user accounting for 87% of the total volume of claims processed. In 2010/11, there were 13.5 million claims processed for Veterans Affairs Canada at a value of $640 million. To protect the financial integrity of the claims processed, Medavie Blue Cross is contractually obligated to conduct investigative services of the 170,000 health care providers registered to deliver benefits or services to Veterans. The National Investigative Unit, within Medavie Blue Cross, conducts various audit activities to ensure that the health care providers are complying with the requirements. These activities include: * analyzing claims data to identify providers whose billing practices may not comply with the requirements; * distributing letters to Veterans to verify that benefits and services billed were actually received; * mail audits requesting providers to submit additional documentation to support a claim submitted; and * on-site audits where investigators will travel to the health care provider's business to meet with the staff and review the supporting documentation on location. The purpose of these audit activities is to identify potential recoveries, educate health care providers on the billing requirements and act as deterrent to improper billing practices.