2022 to 2023 Canada-Manitoba 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:

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

PREAMBLE

WHEREAS, on August 21, 2017 Canada and Manitoba agreed to targeted federal funding over 10 years, beginning in 2017-18, for investments in home and community care and mental health and addictions, in addition to the existing legislated commitments through the Canada Health Transfer;

WHEREAS, Canada and Manitoba agreed to a Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the "Common Statement", attached hereto as Annex 1) on August 21, 2017, which articulated their shared vision to improve access to home and community care as well as mental health and addictions 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 addictions 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 Manitoba agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;

WHEREAS, the Executive Government Organization Act authorizes the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Manitoba for the provision of health services which includes home and community care, and mental health and addictions initiatives;

WHEREAS, Manitoba makes ongoing investments in home and community care and mental health and addictions services, consistent with its broader responsibilities for delivering health care services to its residents;

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

NOW THEREFORE, Canada and Manitoba agree as follows:

1.0 Objectives

1.1 Building on Manitoba'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 addictions services (listed in the Common Statement, attached as Annex 1).

2.0 Action Plan and Expenditure Plan

2.1 Manitoba 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 addictions services in the Common Statement and the Action Plan (Annex 2 of the Canada-Manitoba Home and Community Care and Mental Health and Addictions Services Funding Agreement (herein the "Previous Agreement")).

2.2 Consistent with the Initiatives in the Action Plan, Annex 2 sets out the expenditure plan for funding provided through this Agreement. Annex 2 may include a description of any new initiatives.

3.0 Term of Agreement

3.1 The term of this Agreement is one year, from April 1, 2022 to March 31, 2023 ("the Term").

3.2 Renewal of Agreement

3.2.1 Manitoba'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, could be provided upon the renewal of an agreement, subject to appropriation by Parliament, and the Parties' agreement on a new Action Plan. A future agreement would provide the Parties an opportunity to review and course correct, if required, and realign new priorities based on progress made to date.

4.0 Financial Provisions

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

4.2 Allocation to Manitoba

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. Furthermore, this funding is in addition to, and not in lieu of, those funds that Canada has already provided or already provides towards home and community care and mental health and addictions services.

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

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

Mental Health and Addictions Services

• $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 is 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 2022-23;
• K is the total population of the particular province or territory, as determined using the annual population estimates on July 1st 2022 from Statistics Canada; and
• L is the total population of Canada, as determined using the annual population estimates on July 1st 2022 from Statistics Canada.

4.2.4 Subject to annual adjustment based on the formula described in section 4.2.3, Manitoba's estimated share of the amounts will be:

Table 1: Manitoba's estimated share amounts

Fiscal Year	Home and community care Estimated amount to be paid to ManitobaFootnote *	Mental health and addictions services Estimated amount to be paid to ManitobaFootnote *
2022-2023	$21,719,392	$21,719,392
Table 1 Footnote * Amounts represent annual estimates based on Statistics Canada's July 1st 2022 population estimates. Return to table 1 footnote * referrer

4.3 Payment

4.3.1 Canada's contribution will be paid as follows:

1. The full amount as set out in section 4.2.3 funding formula will be paid within approximately 30 business days of execution of this Agreement by the Parties. Canada shall withhold the payment if Manitoba has failed to provide its annual financial statement for the previous Fiscal Year pursuant to the Previous Agreement or to provide data and information related to home and community care and mental health and addictions to the Canadian Institute for Health Information (CIHI) for the previous Fiscal Year in accordance with section 5.1.
2. This constitutes a final payment and is not subject to any further adjustment once the installment has been paid.
3. 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 of section 3.2.1, and at the request of Manitoba, Manitoba may retain and carry forward up to 10 percent of funding provided in this Agreement that is in excess of the amount of the eligible costs actually incurred and use the amount carried forward for expenditures on eligible areas of investment incurred in Fiscal Year 2023-24. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Designated Officials via an exchange of letters. The exceeding funds will be subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis, in accordance with the quarterly reporting form provided by Canada.

4.5 Repayment of overpayment

4.5.1 In the event payments made exceed the amount to which Manitoba 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, Manitoba 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 Annex 2.

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, Manitoba agrees to participate in a Federal-Provincial-Territorial process, including working with stakeholders and experts, through CIHI, to continue the development of common indicators and to share relevant data in order to permit CIHI to produce annual public reports that will measure pan-Canadian progress on home and community care and mental health and addictions services.

1. Manitoba 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 addictions services.

5.1.2 By no later than October 1, 2022 and October 1, 2023, in respect of the previous Fiscal Year, Manitoba agrees to:

1. Provide to CIHI data and information (based on existing and new indicators) related to home and community care and mental health and addictions services annually. 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 an annual financial statement, with attestation from the Manitoba Health Financial Officer, of funding received the preceding Fiscal Year from Canada under this Agreement or the Previous Agreement 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 this Agreement during the Fiscal Year;
   2. The total amount of funding used for home and community care and mental health and addictions 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 Manitoba will ensure that expenditure information presented in the annual financial statement is, in accordance with Manitoba's standard accounting practices, complete and accurate.

5.3 Evaluation

5.3.1 Responsibility for evaluation of programs rests with Manitoba 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, transparent, effective and proactive 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 Manitoba, 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 Manitoba 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 Manitoba 10 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 Manitoba reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Manitoba agrees to give Canada 10 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, at the Assistant Deputy Minister level ("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 Manitoba responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the provincial Minister(s) shall endeavour to resolve the dispute.

8.0 Amendments to the Agreement

8.1 The main text of this Agreement 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 Minister(s), and in the case of Manitoba, by the provincial Minister(s).

8.2 Annex 2 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 2 shall be in writing and signed by each Party's Designated Official.

9.0 Equality of Treatment

9.1 During the term of this Agreement, if another province or territory, except the province of Quebec, enters into a home and community care and mental health and addictions services agreement with Canada, or the Parties agree to an amendment to such an agreement and if, in the reasonable opinion of Manitoba, any provision of that agreement or an amended agreement is more favourable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement in order to afford similar treatment, upon request. This includes any provision of the Agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Agreement or the amendment to such an agreement with the other province or territory came into force. Manitoba's request must be in writing and provided by the representative identified in clause 11.1.

10.0 Termination

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

10.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments.

11.0 Notice

11.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter or email, postage or other charges prepaid. Any communication that is delivered will be deemed to have been received in delivery; and, except in periods of postal disruption, any communication mailed by post will be deemed to have been received eight calendar days after being mailed.

The address for communication to Canada shall be:

Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9
Email: jocelyne.voisin@hc-sc.gc.ca

The address for communication to Manitoba shall be:

Manitoba Health
300 Carlton Street
Winnipeg, Manitoba
R3B 3M9
Email: Louis.Barre@gov.mb.ca and Sandra.Henault@gov.mb.ca

12.0 General

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

12.2 This Agreement is based on the Common Statement of Principles on Shared Health Priorities, Annex 1, finalized on August 21, 2017.

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

12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of Manitoba shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom that is not otherwise available to the general public.

12.5 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.

Annex 1 to the Agreement

Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

Manitoba's Expenditure Plan on Home and Community Care and Mental Health and Addictions Services 2022-2023

Building on the Action Plan in Annex 2 of the previous Canada-Manitoba Home and Community Care and Mental Health and Addictions Services Funding Agreement's^{Footnote 1}, Manitoba is planning to use federal funding as follow:

Section 1: Expenditure Tables

Home and Community Care Funding allocation by initiative

Initiative	2022-23 ($M)
Expanding Manitoba's Proven Model of Home Care To provide seniors with the care they require in their home rather than moving into personal care home or other institutional settings, federal funds will be used to support service delivery expansion including by increasing the number of hours for nursing home care and home care attendant services to support service provision for approximately 1,000 additional Manitoba clients per year, as well as targeted services to meet specific population needs (e.g., home dialysis).	11.0
Priority Home & Pathways to Home Federal funds to expand existing evidence-based programs in Winnipeg and rural Manitoba to shorten hospital stays and provide clients with intensive at-home care and supports through Priority Home and Pathways to Home programs, which enhance the continuum of care.	18.9
Hospice and Palliative Care Services Federal funds will be used to expand end-of-life care service delivery for rural Manitobans, including increasing access to hospice services and after-hour's access to resources for palliative care clients (e.g. physical, emotional and spiritual supports with a focus on pain and symptom management, and quality of life) and their families (e.g. guidance and advice to address the burden of illness, including physical, emotional, cultural and psychosocial aspects).	3.7
Total Federal Funding - Home and Community CareFootnote *	$33.6
Table 2 Footnote * The total federal funding for 2022-23 includes the amount of funding carried forward from fiscal year 2021-22. Return to table 2 footnote * referrer

Mental Health and Addictions Services Funding allocation by initiative

Initiative	2022-23 ($M)
Increasing timely access and coordination of mental health and addictions services in Manitoba Funding will focus on ensuring more timely access and coordinated care across the lifespan, with a priority focus on children and youth and Indigenous peoples. Federal funds will be used to provide: culturally relevant services; early intervention and integrated youth services; trauma counselling; eating disorders treatment; supportive recovery housing; 24/7 Drop-In services; acute medical sobering services; increased access to child and youth mental health assessment and treatment; and expansion of Rapid Access to Addictions Medicine (RAAM) clinics.	19.9
Implementation of peer support in formal healthcare settings Funds will support community-based agencies to deliver formal peer and family support services in urban and rural emergency departments and crisis/urgent care centres, and to evaluate these services. This also includes the Community-Emergency Department Violence Intervention Program (CEDVIP), which provides: wraparound community supports with a focus on Indigenous youth; mentorship with a peer support worker; enhanced access to mental health/addictions support; employment and income assistance; and educational engagement.	1.8
Implementation of pregnancy and infant loss program The Pregnancy and Infant Loss Program, funding will assist women and families through the complexity of grief by increasing access to outreach services, group therapy, and one-on-one therapy for complex cases. It will also provide a network to share knowledge and best practices.	0.2
Total federal funding - Mental Health and Addictions ServicesFootnote *	$21.9
Table 3 Footnote * The total federal funding for 2022-23 includes the amount of funding carried forward from fiscal year 2021-22. Return to table 3 footnote * referrer