Operational Bulletins 063B (Expired) – July 29, 2009

Assessing Excessive Demand on Social Services

This Operational Bulletin has expired.

Background

This operational bulletin (OB) clarifies the roles of the medical officer, the immigration or visa officer and the applicant in cases where the medical officer has indicated that the applicant or dependent family member has a health condition which might reasonably be expected to cause an excessive demand on social services in Canada.

This OB  should be read in conjunction with OB 063, issued on September 24, 2008. Where there is any conflict, the guidelines provided in OB 063B supersede those provided in OB 063.

Guiding principle

Citizenship and Immigration Canada (CIC) immigration and visa officers are required to exercise procedural fairness. This includes stating the case to be met and reviewing all the information provided by the applicant in a fair and impartial manner. The applicant in turn is responsible for providing all the information requested by the CIC officer and any additional information which they would like to have considered.

When more information is required to render a medical opinion by the medical officer

In cases where the applicant or a dependant family member has a medical condition that may require social services, the medical officer may ask for more information (by way of furtherance) to clarify the diagnosis, treatments and any other services that may be needed.

It is the responsibility of the applicant to obtain further evaluations and to provide all the information required by the medical officer. The information provided by the applicant must be of a quality and standard that permits an appropriate assessment. If the information provided within the allowed period of time is not satisfactory or if no information is provided, the medical officer may render an opinion that the applicant or family member is inadmissible due to the medical condition.

When it is the opinion of the medical officer that a health condition involves an excessive demand on social services

The procedures section of OB 063 provides some information on situations where the medical officer is of the opinion that a health condition might reasonably be expected to cause an excessive demand on social services. However, OB 063 does not provide sufficient details regarding the responsibilities of the medical officer, immigration/visa officer and applicant, each of whom has an identifiable role.

A) The medical officer will:

• write a medical narrative followed by a list of the required social services and the overall anticipated costs. The list of social services should be based on a detailed assessment, recommendations provided by a recognized specialist in the field and the experience and knowledge of the medical officer. The medical officer may consult colleagues or Canadian experts, as necessary;
• provide a statement as to the probable costs of anticipated health and social services which would likely exceed the average Canadian per capita health and social services costs over a period of five consecutive years immediately following the applicant’s most recent medical examination. There is no obligation to detail the costs at this stage; and
• use up to ten consecutive years if they are concerned that significant costs are likely to be incurred beyond five consecutive years following the applicant’s most recent medical examination. The period considered should be stated in the medical officer’s opinion to the visa officer.

B) The immigration/visa officer will:

• on receipt of an opinion from the medical officer (with accompanying narrative report, list of social services and overall expected costs), forward or send the procedural fairness letter (OB 063 Annex 4), the relevant sections of the Immigration and Refugee Protection Regulations (OB 063 Annex 5) and the Declaration of Ability and Intent (OB 063 Annex 6) to the applicant;
• ensure the procedural fairness letter explicitly informs the applicant of the required care and social services that are critical to the individual being assessed as medically inadmissible (M05); and
• ensure the procedural fairness letter explains that the applicant must demonstrate they have a plan to obtain all the services and manage the costs associated with the services as outlined in the letter and/or provide an alternate detailed plan with costs.

C) The applicant may then decide to:

• challenge the medical condition;
• accept the medical opinion and submit a proposed plan which details where they will secure the essential services, the cost of these services, and how they will pay for the services; or
• accept the medical opinion and not respond to the procedural fairness letter.

Reviewing the response from the applicant to the procedural fairness letter

The response from the applicant to the procedural fairness letter must include a detailed care plan, the associated costs and a cost mitigation strategy.

The immigration/visa officer:

• will review the response to the procedural fairness letter;
• will verify, as needed, the authenticity of the plan, the validity of the associated costs and the cost mitigation strategy proposed by the applicant. This may mean the immigration/visa officer will need to contact social services agencies or provincial health or educational authorities as identified in the applicant’s plan;
• must be satisfied that the applicant has the ability and intent to mitigate the cost of the required social services;
• may send a follow-up request to the applicant if the applicant has not provided complete, detailed information in response to the list of required social services and the overall expected cost. The follow-up request should specify a time in which to respond to the request and inform the applicant that if no further information is received, a decision would be made using the information on file;
• should request the opinion of the medical officer if the applicant challenges the diagnosis or the required treatment; and
• if warranted, seek the opinion of the medical officer on the nature of the plan and whether the services proposed are acceptable, within the Canadian context, considering the medical condition.

Coding

At the end of the process, if the applicant has satisfied the immigration/visa officer that they have the ability and intent to mitigate the cost of the required social services, the immigration/visa officer will enter a positive medical decision code “1” in FOSS or CAIPS, as applicable. Although the medical assessment code will remain unchanged (M05), CAIPS will permit a Final Decision code “1” (visa issued).

New medical examination

If the immigration/visa officer renders a positive medical decision on an applicant or family member whose health condition was anticipated to cause an excessive demand on social services, a new medical examination is required if the current medical validation has expired. The medical condition anticipated to cause an excessive demand on social services will not be re-assessed; however all other medical conditions must be assessed.

Modifications to Annex 4 of OB 063

The second paragraph of the procedural fairness letter (Annex 4 of OB 063), has been modified to address determinations of inadmissibility with respect to health conditions which might reasonably be expected to cause excessive demands on social services in Canada, as opposed to health and social services. The average Canadian per capita health and social services costs have also been updated. The amended version of Annex 4 is as follows:

Annex 4

PROCEDURAL FAIRNESS LETTER

Medical inadmissibility - Excessive demand on social services

[INSERT LETTERHEAD]

Our Ref.:

[INSERT ADDRESS]

Dear [INSERT NAME]:

This letter concerns your application for an immigrant visa [or: application for permanent residence in Canada]. Based on a review of your file, it appears that you or your family member may not meet the requirements for immigration to Canada.

I have determined that you/your family member, [name], are/is a person whose health condition might reasonably be expected to cause excessive demand on social services in Canada. An excessive demand is a demand for which the anticipated costs exceed the average Canadian per capita health and social services costs, which is currently set at $5,143.00 per year. Pursuant to subsection 38(1) [and pursuant to section 42 in the case of a family member] of the Immigration and Refugee Protection Act, it therefore appears that you may be inadmissible on health grounds.

You/your family member, [name], have/has the following medical condition or diagnosis: [Insert name of disease or condition and diagnosis from IMM 5365.] In particular:

[Insert narrative from IMM 5365 – excluding the list of social services required and cost implications.]

In consultation with the Health Management Branch of Citizenship and Immigration Canada, I have determined that the following social services will be required:

[Insert list of social services required, cost implications and period indicated by the medical officer from IMM 5365.]

Before I make a final decision, you have the opportunity to submit additional information that addresses any or all of the following:

• the medical condition(s) identified;
• social services required in Canada for the period indicated above; and
• your individualized plan to ensure that no excessive demand will be imposed on Canadian social services for the entire period indicated above and your signed Declaration of Ability and Intent.

You must provide any additional information within 60 days of the date of this letter. If you choose not to respond, I will make my decision based on the information before me, which may result in your application being refused.

In order to demonstrate that you/your family member will not place an excessive demand on social services, if permitted to immigrate to Canada, you must establish to the satisfaction of the assessing officer that you have a reasonable and workable plan, along with the financial means and intent to implement this plan, in order to offset the excessive demand that you would otherwise impose on social services, after immigrating to Canada. The sections of the Immigration and Refugee Protection Regulations that define the meanings of “social services” and “excessive demand” are included for your reference.

Please ensure that you quote the file number indicated at the top of this letter on any information you submit.

Yours truly,

Officer
[Appropriate Signature Block].