Pre-departure Medical Services under the IFHP Immigration, Refugees and Citizenship Canada Migration Health Branch March 30, 2017

Purpose To provide an overview of the pre-departure medical services offered under Canada’s Interim Federal Health Program (IFHP), which will be launched on April 1, 2017. To clarify the role of IRCC Panel Physicians and Panel Radiologists in the delivery of pre-departure medical services.

Background – Interim Federal Health Program The Interim Federal Health Program (IFHP) provides limited, temporary coverage of health-care benefits to resettled refugees, asylum claimants, and certain other individuals in Canada until they qualify for provincial/territorial health coverage or leave the country. In Canada, IFHP beneficiaries receive the following health-care coverage: basic health-care services, such as physician and hospital care; supplemental services, including limited vision and urgent dental care; prescription drug coverage. For certain groups of beneficiaries in Canada, the IFHP also covers the cost of one Immigration Medical Exam (IME).

Introduction to Pre-departure Medical Services The Government of Canada has expanded the scope of the Interim Federal Health Program to include coverage of pre-departure medical services for Canada-bound resettled refugees, to begin on April 1, 2017. Early intervention in the health-care of resettled refugees allows Canada to: effectively address health risks and improve the health outcomes of resettled refugees; reduce the longer-term health care costs for provincial and territorial health-care systems; and better protect the public health of Canadians.

Scope of Pre-departure Medical Services The scope of pre-departure medical coverage includes: Cost of Immigration Medical Examinations (IME) and follow-up treatment for diseases affecting medical admissibility of Canadian bound refugees (i.e. active tuberculosis, untreated syphilis).

Scope of Pre-departure Medical Services The scope of pre-departure medical coverage includes: Cost of Immigration Medical Examinations (IME) and follow-up treatment for diseases affecting medical admissibility of Canadian bound refugees (i.e. tuberculosis, syphilis). Communicable disease prevention and control, through the provision of selected vaccinations aligned with Canadian immunization guidelines.

Vaccinations: U.S./Canada Comparison Country Mandatory/Optional for Resettlement Eligibility Vaccines offered United States Optional US-bound refugees from selected countries DT/DTP/DTaP)*, Hep B*, Hib*, MMR, (OPV/IPV)*, PCV, Td/Tdap, Rota *Can be provided in combination with other vaccines Canada (Effective April 1, 2017) Optional – does not impact a refugee’s application for resettlement to Canada. Canada-bound refugees residing in countries with IOM presence (DTP/DTaP)*, Hep B*, Hib*, MMR, (OPV/IPV)*, Td /Tdap, Rota *Can be provided in combination with other vaccines

Scope of Pre-departure Medical Services The scope of pre-departure medical coverage includes: Cost of Immigration Medical Examinations (IME) and follow-up treatment for diseases affecting medical admissibility of Canadian bound refugees (i.e. tuberculosis, syphilis) Communicable disease prevention and control through the provision of selected vaccinations aligned with Canadian immunization guidelines Medical support during travel to Canada (e.g. wheelchairs, medical escorts)

Scope of Pre-departure Medical Services The scope of pre-departure medical coverage includes: Cost of Immigration Medical Examinations (IME) and follow-up treatment for diseases affecting medical admissibility of Canadian bound refugees (i.e. tuberculosis, syphilis) Communicable disease prevention and control through the provision of selected vaccinations aligned with Canadian immunization guidelines Medical support during travel to Canada (e.g. wheelchairs, medical escorts) Management and control of communicable diseases in refugee camps

Delivery of Pre-departure Medical Services The services covered under pre-departure medical services will be rendered by IRCC Panel Physicians, Panel Radiologists and non-empaneled secondary providers (such as specialists and facilities) that provide services in a country or region with overseas-refugee presence. The International Organization of Migration (IOM) is a key service provider in the delivery of all pre-departure medical services (PDMS) components and IOM affiliated Panel Physicians will be the sole providers of vaccination services. All PDMS providers will be reimbursed for the services rendered to eligible beneficiaries (resettled refugees) by submitting claims to the IFHP Claims Administrator, Medavie Blue Cross. In order to be reimbursed, health-care providers must first register with Medavie Blue Cross.

Eligibility for Pre-departure Medical Services All overseas refugees found eligible for resettlement to Canada are eligible for pre-departure medical services rendered on or after April 1, 2017. Eligibility may also be extended to groups or individuals who have been specially designated by the Minister of IRCC. Verifying Eligibility Eligible clients who are instructed to present themselves to Panel Physicians who are not affiliated with the IOM will be provided with an Interim Federal Health Certificate (IFHC) by visa offices abroad. This certificate is proof of their eligibility for pre-departure medical services. Clients will show this document each time they require services from a non-IOM affiliated health-care provider. Eligible clients who are instructed to present themselves to an IOM-affiliated Panel Physician will not be issued an IFHC unless their situation requires that they be referred to a non-IOM affiliated provider.

Example of the PDMS Eligibility Document Client information, including name, client ID (UCI) and DOB.

Resettled Refugees: Immigration Levels On October 31, 2016, IRCC announced the 2017 Immigration Levels Plan, maintaining a strong commitment to protecting those in need with a target of 25,000 resettled refugees in 2017: Immigration Category 2017 Levels (Admissions Planned) Economic Immigrants 172,500 Family 84,000 Protected Persons in-Canada 15,000 Resettled Refugees* 25,000 Humanitarian and Compassionate* 3,500 * NOTE: PDMS is offered to Resettled Refugees and is not extended to other immigrant categories.

Resettled Refugees: Anticipated Source Countries IRCC anticipates that resettled refugees will be coming from the following top 10 source countries: *Statistics based on refugee processing inventories as of November 2016.

Administration of PDMS: Roles & Responsibilities Immigration, Refugees and Citizenship Canada Migration Health Branch Regional Medical Offices Visa Offices Funding pre-departure medical services by reimbursing the Claims Administrator (Medavie Blue Cross). Ensuring program integrity Reviewing and assessing prior authorization requests (medical aspects) from Panel Physicians/IOM for: medical support in transit outbreak management Providing resettled refugees with confirmation of eligibility for PDMS (IFHP certificate of eligibility).

Administration of PDMS: Roles & Responsibilities Claims Administrator Registering health-care providers, including Panel Physicians, Panel Radiologists, and other eligible providers to deliver pre-departure medical services. Maintaining a public list of registered health-care providers, including provider names, type/speciality and address, on the Medavie Blue Cross website. Supporting health-care providers by answering questions on program administration and reimbursement. Adjudicating claims according to the pre-departure medical services/products approved by IRCC (IFHP Overseas Benefit Grid) and issuing payment to providers. Conducting compliance verification (audits) of registered providers.

Administration of PDMS: Roles & Responsibilities Panel Physicians & Panel Radiologists Becoming IFHP providers through registration with Medavie Blue Cross and accepting the IFHP Terms and Conditions. Rendering services covered under PDMS to resettled refugees overseas and submitting claims to Medavie Blue Cross in accordance with the IFHP guidelines. Preparing prior authorization requests for certain services covered by PDMS (i.e. outbreak response, medical support in transit) and submitting requests to the Regional Medical Offices for review and approval. Panel Physicians: Referring clients to other (non-empaneled) health care providers (such as hospitals, laboratories, specialists) for further diagnostic investigations or treatment of conditions related to public health or public safety (i.e. TB, Syphilis, or psychiatric/mental health) if deemed necessary.

Administration of PDMS: Roles & Responsibilities International Organization of Migration (IOM) Partnership between IRCC and IOM to deliver all pre-departure medical services components. IOM Panel Physicians will be the sole providers of vaccination services in countries where refugees reside and IOM has a presence. Reimbursement of pre-departure medical services for IOM Panel Physicians and Panel Radiologists will be centralized through IOM and submitted to Medavie Blue Cross.

IOM / Non-IOM Providers Registration Service Delivery Invoicing IRCC provides a list of providers to Medavie for registration IME & follow-up treatment Vaccinations Outbreak Response* Medical Support in transit* Bulk billing through IOM Submission of claims directly to Medavie Non- IOM PPs provide IRCC with list of secondary providers to be registered with Medavie Follow-up treatment, upon referral from an empaneled provider Empaneled Providers (IOM affiliated) Empaneled Providers (non-IOM affiliated) Non-empaneled Providers (non-IOM affiliated) * Pre-departure medical services that require prior-authorization

Progress to Date & Next Steps Panel Physicians, Panel Radiologists and other eligible providers have been registered with Medavie Blue Cross. Medavie Blue Cross has provided health-care providers with information on the program, including an electronic copy of the IFHP Information Handbook for Pre-Departure Medical Health-care Professionals. Publically available information on PDMS will be has been posted on the IRCC and Medavie Blue Cross Websites. Next Steps: The official launch of PDMS will be on April 1, 2017.