Canadian Armed Forces Military Personnel Instruction 03/09 – Enhanced Access Health Care Services

1. Identification

Date of Issue: 2008-12-12

Date of Modification: 2024-12-01

Application: This Instruction applies to officers and non-commissioned members (NCM) of the Canadian Armed Forces (CAF Members) and other persons entitled to CF health care as detailed in Queen's Regulations and Orders (QR&O) Chapters 34 and 35.

Approving Authority: Chief Military Personnel (CMP)

Enquiries: Administrative Response Center (ARC)

2. Abbreviations

3. Policy Direction

General

3.1 Enhanced Access Health Care Services describe medical and dental diagnostic and treatment services that are provided more rapidly than standard, publicly provided services. This enhanced access is often through private health care facilities and is obtained at higher cost than the standard access services the CAF would normally utilize when the CFHS cannot provide a service directly. Enhanced access can also be procured through referring members to other provinces or even out of country for health care services, which adds Temporary Duty costs to the cost of the service itself.

When Authorized

3.2 Enhanced Access Services will be authorized when it can be clearly demonstrated that there is either a clinical or an operational health care requirement that cannot be met through the use of standard access services.

Operational requirement

3.3 Operational requirement must normally refer to situations where:

1. The member’s medical limitations prevent the member from fulfilling their operational duties; and
2. The member is required for an imminent deployment and cannot be reasonably replaced; or
3. The member fills a mission critical role within the unit and an extended absence from full duties would have a negative impact on necessary in-country operations. Other members of the unit are not able to fulfill the role on the injured/ill member’s behalf without putting unit operations at risk.

Not Normally “Operational requirement”

3.4 “Operational requirement” does not normally include situations where:

1. The argument is strictly one of general unit workload;
2. The desire for expedited service is based on an administrative or career requirement (e.g. a course or a posting); or
3. The member is able to be employed performing their normal role within the unit and arguments for expedited services are based on the requirement to maintain or improve general quality of life or physical fitness.

Additional Authority Required

3.5 Additional authority is required for the use of Enhanced Access Services where those services cost more than 120% of the cost of the equivalent standard access services. Additional authority is also required when sending members for treatment beyond the normal referral centres for enhanced access purposes.

4. Process

Requirement Based on Clinical Need

4.1 In situations where the requirement for Enhanced Access Services is predicated on a clinical need that, in the opinion of the member’s GDMO or CAF clinician, cannot be met through standard access services, the request and clinical justification must be forwarded to the applicable Formation or Regional Surgeon for approval. (See Annex A.)

Requirement Based on Operational Need

4.2 In situations where the requirement for Enhanced Access Services is predicated on an operational need, the member’s Commanding Officer must confirm the operational requirement. The B/W Surg of the member’s supporting CF H Svcs C must provide confirmation that the member has MELs assigned that preclude the performance of the operationally necessary duties and confirms the wait time for standard access services. The request and justification must be forwarded to the applicable Base/Wing/Formation Commander for approval. (See Annex A.)

Appeals

4.3 Appeals of denied requests must be forwarded for resolution to the next level in either the CFHS professional-technical chain for clinical cases, or the member’s Chain of Command for operational cases.

5. Responsibilities

Responsibility Table

5.1 The following table identifies the authorities responsible for activities relating to this instruction.

6. References

Acts, Regulations, Central Agency Policies and Associated DAOD

• Not Applicable

Other References

• CF Spectrum of Care
• Minutes CF Spectrum of Care Committee meeting, 4 Feb 2008 (this document can only be accessed on the DWAN)

7. Annex

1. Annex A – Authorization for Enhanced Access Health Care Services