2022 to 2023 Canada-Alberta Home and Community Care and Mental Health and Addictions Services Funding Agreement

Table of Contents

• Funding Agreement
• Annex I - Common Statement of Principles on Shared Health Priorities
• Annex II - Expenditure Plan

Funding Agreement

BETWEEN:

HIS MAJESTY THE KING IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health and the Minister of Mental Health and Addictions and Associate Minister of Health (herein referred to as the "Federal Ministers")

- and -

HIS MAJESTY THE KING IN RIGHT OF ALBERTA (hereinafter referred to as "Alberta" or "Government of Alberta") as represented by the Minister of Health and the Minister of Mental Health and Addiction (herein referred to as the "Alberta Ministers")

REFERRED to collectively as the "Parties", and individually as a "Party"

PREAMBLE

WHEREAS, on March 10, 2017 Canada and Alberta agreed to targeted federal funding over 10 years, beginning in 2017-18, for investments in home and community care and mental health and addiction, in addition to the existing legislated commitments through the Canada Health Transfer;

WHEREAS, Canada and Alberta agreed to a "Common Statement of Principles on Shared Health Priorities" (the "Common Statement"), attached as Annex 1 to this Agreement, on August 21, 2017, which articulated their shared vision to improve access to home and community care and mental health and addiction services in Canada;

WHEREAS, Canada authorizes the Federal Ministers to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake in home and community care and mental health and addiction services, based on a menu of common areas of action and in keeping with the performance measurement and reporting commitments, consistent with the Common Statement;

WHEREAS, Canada and Alberta agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities;

WHEREAS, the Government Organization Act authorizes the Alberta Ministers to enter into agreements with Canada under which Canada undertakes to provide funding toward costs incurred by Alberta for the provision of home and community care, and mental health and addiction initiatives;

WHEREAS, Alberta is responsible for the design and delivery of health care in Alberta. Alberta is also responsible for the planning, determining the objectives of, defining the contents of, setting the priorities for, and evaluating its programs and services in home and community care and mental health and addiction. In this respect, Alberta makes ongoing investments in home and community care and mental health and addiction services, consistent with its broader responsibilities for delivering health care services to its residents;

WHEREAS, the Government of Canada makes ongoing investments in home and community care and mental health and addiction services for Indigenous communities and other federal populations;

AND WHEREAS, Alberta and Canada concluded a Canada-Alberta Home and Community Care and Mental Health and Addiction Services Funding Agreement effective April 1, 2018 (the "Previous Agreement");

NOW THEREFORE, Canada and Alberta agree as follows:

1.0 Objectives

1.1 Building on Alberta's existing investments and initiatives, the Parties commit to work together to improve access to home and community care and strengthen access to mental health and addiction services, as further described in the Common Statement, attached as Annex 1 to this Agreement.

2.0 Action Plan and Expenditure Plan

2.1 Alberta will invest federal funding provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addiction services in the Common Statement and with the "Alberta action plan: Federal funding contributions for home and community care and mental health and addiction services" (the "Action Plan") that was attached to the Previous Agreement.

2.2 Consistent with the initiatives in the Action Plan, "Alberta's Expenditure Plan on Home and Community Care and Mental Health and Addiction Services 2022-2023" (the "Expenditure Plan"), attached as Annex 2 to this Agreement, sets out the funding provided for this Agreement. The Expenditure Plan may include a description of any new initiatives.

3.0 Term of Agreement

3.1 Notwithstanding the dates of the signatures below, this Agreement, once signed by both Parties, shall be in effect from April 1, 2022 and will remain in effect until March 31, 2023 (the "Term"), unless terminated earlier in accordance with section 9 of this Agreement.

3.2 Renewal of Agreement

3.2.1 Alberta's share of the federal funding for 2023-24 to 2026-27, based on the federal commitment in Budget 2017 of $11 billion over ten years, will be provided upon the renewal of this Agreement, subject to appropriation by Parliament, and the Parties' agreement on a new action plan.

3.2.2 If both Parties ultimately agree to renew, Alberta and Canada may choose to review and, if required, agree to realign the action plan in a future agreement based on the priorities in the Common Statement.

4.0 Financial Provisions

4.1 The contributions made under this Agreement are in addition to and not in lieu of those that Canada currently provides under the Canada Health Transfer to support delivering health care services within jurisdictions.

4.2 Allocation to Alberta

4.2.1 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

4.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative based on the allocation method outlined in subsection 4.2.3 for the Term of this Agreement.

Home and Community Care

1. $600 million for the Fiscal Year beginning on April 1, 2022

Mental Health and Addiction Services

1. $600 million for the Fiscal Year beginning on April 1, 2022

4.2.3 Funding will be allocated to provinces and territories on a per capita basis. The per capita funding amounts are calculated using the following formula: F x K/L, where:

• F is the total funding amount available under this initiative as outlined in section 4.2.2 in Fiscal Year 2022-2023;
• K is the total population of the particular province or territory, as determined using the annual population estimates on July 1^st, 2022 from Statistics Canada; and
• L is the total population of Canada, as determined using the annual population estimates on July 1^st,2022 from Statistics Canada.

4.2.4 Based on the formula described in section 4.2.3, Alberta's funding under this Agreement is (in millions of dollars):

4.3 Payment

4.3.1 Canada's contribution to Alberta will be paid as follows:

1. The total amount to be paid to Alberta, as set out in section 4.2.4, will be paid within forty (40) calendar days of execution of this Agreement.
2. Canada shall withhold the payment for Fiscal Year 2022-2023 until Alberta provides its annual financial statement for the previous Fiscal Year (2021-2022) and provides data and information related to home and community care and mental health and addiction to the Canadian Institute for Health Information ("CIHI") for the previous Fiscal Year (2021-2022) in accordance with section 5.1.2.
3. This constitutes a final payment.
4. Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.

4.4 Carry Over

4.4.1 In the event this Agreement is renewed in accordance with the terms under section 3.2, and at the request of Alberta, Alberta may retain and carry forward to the next Fiscal Year, the amount of up to ten (10) percent of the total funding paid to Alberta in this Agreement that is in excess of the amount of the eligible expenditures actually incurred by Alberta and use the amount carried forward for expenditures on eligible expenditures incurred in the renewed agreement for the next Fiscal Year, subject to the terms and conditions of that renewed agreement.

4.4.2 Any request to retain and carry forward an amount exceeding ten (10) percent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters between the designated officials identified under sections 11.5 and 11.6 of this Agreement (the "Designated Officials").

4.5 Repayment of overpayment

4.5.1 In the event payments made exceed the amount to which Alberta is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Alberta shall repay the amount within sixty (60) calendar days of written notice from Canada.

4.6 Use of Funds

4.6.1 The Parties agree that funds provided under this Agreement will only be used in accordance with the areas of action outlined in the Expenditure Plan, attached as Annex 2 to this Agreement.

4.7 Eligible Expenditures

4.7.1 Eligible expenditures under this Agreement are the following:

• capital and operating funding;
• salaries and benefits;
• training, professional development;
• information and communications material related to programs;
• data development and collection to support reporting; and,
• information technology and infrastructure.

5.0 Performance Measurement and Reporting to Canadians

5.1 Funding conditions and reporting

5.1.1 As a condition of receiving funding, Alberta agrees to participate in a Federal-Provincial-Territorial process, through CIHI, to continue the development of common indicators and to share relevant data to permit CIHI to produce annual public reports on pan-Canadian progress on home and community care and mental health and addiction services.

1. Alberta will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent its interests related to performance measurement and reporting for home and community care and mental health and addiction services.
2. Sharing of data with CIHI is subject to an appropriate agreement between Alberta and CIHI to enable the sharing of information as required by this Agreement, and subject to applicable law.

5.1.2 By no later than thirty (30) calendar days after the execution of this Agreement, in respect of the Fiscal Year 2021-2022, Alberta agrees to:

1. Provide to CIHI data and information (based on agreed-to indicators through the FPT process) related to home and community care and mental health and addiction services. This will support CIHI to measure progress on the shared commitments outlined in the Common Statement and report to the public.
2. Provide to Canada the annual financial statement, with attestation from Alberta's senior financial officer for the Ministry of Health, of funding received from Canada under the Previous Agreement during the Fiscal Year 2021-2022 compared against the Action Plan, and noting any variances between actual expenditures and the Action Plan:
   1. The revenue section of the statement shall show the amount received from Canada under the Previous Agreement during the Fiscal Year 2021-2022;
   2. The total amount of eligible expenditures actually incurred by Alberta for home and community care and mental health and addiction programs and services during Fiscal Year 2021-2022;
   3. If applicable, the amount of any amount carried forward under section 4.4 of the Previous Agreement; and
   4. If applicable, the amount of overpayment that is to be repaid to Canada under section 4.5 of the Previous Agreement.

5.1.3 By no later than October 1, 2023, in respect of the Fiscal Year 2022-2023, Alberta agrees to:

1. Provide to CIHI data and information (based on agreed-to indicators through the FPT process) related to home and community care and mental health and addiction services. This will support CIHI to measure progress on the shared commitments outlined in the Common Statement and report to the public.
2. Provide to Canada the annual financial statement, with attestation from Alberta's senior financial officer for the Ministry of Health, of funding received from Canada under this Agreement compared against the Expenditure Plan, and noting any variances between actual expenditures and the Expenditure Plan:
   1. The revenue section of the statement shall show the amount received from Canada under this Agreement;
   2. The total amount of eligible expenditures actually incurred by Alberta for home and community care and mental health and addiction programs and services;
   3. If applicable, the amount of any amount carried forward under section 4.4; and
   4. If applicable, the amount of overpayment that is to be repaid to Canada under section 4.5.

5.2 Audit

5.2.1 Alberta will ensure that expenditure information presented in the annual financial statement is in accordance with Alberta's standard accounting practices, complete, and accurate.

5.3 Evaluation

5.3.1 Responsibility for evaluation of programs rests with Alberta in accordance with its own evaluation policies and practices.

6.0 Communications

6.1 The Parties agree on the importance of communicating with citizens about the objectives of this Agreement in an open and transparent manner through appropriate public information activities.

6.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

6.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

6.4 Canada, with prior notice to Alberta, may incorporate all or any part of the data and information in 5.1.2, or any part of evaluation and audit reports made public by Alberta, into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Canada agrees to give Alberta ten (10) calendar days' advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

6.6 Alberta reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Alberta agrees to give Canada ten (10) calendar days' advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

7.0 Dispute Resolution

7.1 The Parties are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

7.2 If at any time a Party is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, that Party may notify the other Party in writing of the failure or breach. Upon such notice, the Parties will endeavour to resolve the issue in dispute bilaterally through their Designated Officials.

7.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and Alberta responsible for Health and Mental Health and Addiction, and if it cannot be resolved by them, then the Federal Ministers and the Alberta Ministers shall endeavour to resolve the dispute.

8.0 Amendments to the Agreement

8.1 This Agreement (not including Annexes 1 and 2) may be amended at any time by mutual consent of the Parties. Any amendments shall be in writing and signed, in the case of Canada, by the Federal Ministers, and in the case of Alberta, by the Alberta Ministers.

8.2 The Expenditure Plan, attached as Annex 2 to this Agreement, may be amended at any time by mutual consent of the Parties. Any amendments to the Expenditure Plan shall be in writing and signed, in the case of Canada, by their Designated Official, and in the case of Alberta, by their Designated Officials.

9.0 Termination

9.1 Either Party may terminate this Agreement at any time if the terms are not respected by giving at least six (6) months' written notice of intention to terminate.

9.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments, and Alberta may reduce or cancel its commitments commensurately.

10.0 Notice

10.1 Unless otherwise specified, any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by mail or email to the following address(es).

1. The address for communication to Canada shall be:
   Health Canada
   8^th Floor, Brooke Claxton Building, AL 0908A
   70 Colombine Driveway
   Ottawa, Ontario
   K1A 0K9
   Email: david.jones@hc-sc.gc.ca
   Attention: Assistant Director, Strategic Policy
2. The address for communication to Alberta shall be:
   Intergovernmental Relations, Alberta Health
   13th Floor, ATB Place
   10025 Jasper Avenue NW
   Edmonton, Alberta
   T5J 1S6
   Email: mark.iocchelli@gov.ab.ca
   Attention: Director, Intergovernmental Relations

10.2 Either Party may change its information in subsections 10.1(a) and 10.1(b) by giving notice to the other Party in the manner described in section 10.1.

10.3 Any communication that is sent by email will be deemed to have been received upon delivery; and, except in periods of postal disruption, any communication that is sent by mail will be deemed to have been received eight (8) calendar days after being mailed.

11.0 General

11.1 This Agreement, including Annexes 1 and 2, comprise the entire Agreement entered into by the Parties.

11.2 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Alberta.

11.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Alberta shall be admitted to any share or part of this Agreement.

11.4 If for any reason a provision of this Agreement, that is not a fundamental term, is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be severed and deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

11.5 Canada designates the following Assistant Deputy Ministers to be Canada's Designated Official:

1. Assistant Deputy Minister of the Strategic Policy Branch, Health Canada.

11.6 Alberta designates the following Assistant Deputy Ministers to be Alberta's Designated Officials:

1. Assistant Deputy Minister of the Continuing Care Division, Ministry of Health; and
2. Assistant Deputy Minister of the Addiction and Mental Health Division, Ministry of Mental Health and Addiction.

11.7 Either Party may change its information in sections 11.5 and 11.6 by giving notice to the other Party in the manner described in section 10.1.

12.0 Survival of Term

12.1 All obligations of the Parties, which expressly or by their nature survive termination or expiration, including section 5.1.3 (Performance Measurement and Reporting to Canadians) and section 6 (Communications), shall survive expiration or earlier termination of this Agreement.

Annex 1 to the agreement

Common Statement of Principles on Shared Health Priorities

Annex 2 to the agreement

Alberta's Expenditure Plan on Home and Community Care and Mental Health and Addiction Services 2022 to 2023

Building on the previous Canada-Alberta Home and Community Care and Mental Health and Addiction Services Funding Agreement Action Plan, Alberta is planning to use federal funding as follows:

Section 1: Expenditure tables

Home and community care

Funding allocation by initiative

Initiative	2022-23 ($M)
Increase equitable access Implement a more equitable standard basket of care services by expanding the provision of basic home and community care services, especially for historically under-served populations such as rural, remote and Indigenous communities.	$40
Access to specialized and interdisciplinary care for complex needs Support clients with complex care needs to avoid hospitalizations and assist in transitioning to home care post-hospitalization by expanding access to specialized interdisciplinary programs, services and teams, such as Destination Home and the Virtual Hospital in Edmonton, and the Complex Care Hub in Calgary.	$10
Enhancing access to palliative and end-of-life services Enhance palliative and end-of-life home care programming and services across the province such as the Assess, Treat, Refer program and the Rural Palliative Care In-Home Funding program.	$10
Increasing support for caregivers through in-home respite and Adult Day Programs Enhance support for informal caregivers (for example family or friend caregivers) by: Increasing the provision of in-home and facility-based respite services; Providing adult day programs (ADP); and Expanding access to the Client-Directed Home Care Invoicing option which enables more flexibility and choice in how supports are provided to ensure supports are most aligned with the preferences and needs of clients and their caregivers.	$10
Total federal funding - Home and community care	$70

Mental health and addiction services

Funding allocation by initiative

Initiative	2022-23 ($M)
Community-based addiction and mental health services Improve and increase access to community-based addiction and mental health services for those with addiction and mental health concerns, including Indigenous communities, by: Implementing evidence-informed models of community care (e.g., North Zone Indigenous Travel Teams); Increasing access to specialized community treatment services; and Enhancing the appropriate use of crisis and emergency services to improve follow-up on care in the community, improve service access, reduce wait times and meet growing demand for services.	$11
Mental health and addiction services for children and youth Improve outcomes for children and youth at risk who are currently experiencing serious mental health and addiction issues by: Providing community day programs and residential services, such as the Rutherford Clinic in the Edmonton Zone; Providing crisis and emergency services for child, youth and their families, including expanding the number of Protection of Children Abusing Drugs Program beds in Calgary; and Providing intensive and specialized interventions for high-risk children and youth, including a mental health day program in the North Zone.	$17
Specialized addiction and mental health services Support adults with complex mental health needs and/or complex needs, recognizing vulnerable and underserved populations, by: Expanding access to housing and home supports, as well as improve upon existing intensive services to protect vulnerable populations while reducing acute hospital admission (e.g., enhancing detoxification services); and Expanding the range and type of services offered in key strategic areas (e.g., funding a specialized Mental Health Rehabilitation Facility for patients with severe mental health and addiction issues).	$42
Total federal funding - Mental health and addiction services	$70