Designated Medical Practitioner Handbook

Chapter 10: DMP Activities in Canada

While the majority of Canadian immigration medical examinations are performed outside of the country, a significant number of individuals have their immigration processing undertaken in Canada. Many of those who are examined for immigration purposes in Canada do so as part of the refugee determination process. Performing IMEs within the country, combined with the practices related to the domestic refugee determination system, creates issues and situations specific to DMPs in Canada.

This chapter of the DMP Handbook provides information, reference and instruction for DMPs operating in Canada. It does not apply to DMPs who perform Canadian immigration medical examinations in other countries, including those in the United States.

10.1 Providing Primary Care to IME Applicants

Some newly arrived individuals in Canada may not have primary-care providers and may seek to use the IME encounter as an opportunity to begin a provider-patient relationship with the DMP. If DMPs agree to provide care to those who have visited them for IME services, it is recommended that they ensure that the individual understands the differences between the provider’s role as a DMP and as a personal health-care provider. It must also be clearly understood that any medical activities or services other than those related to or required for the IME have no relationship or involvement with CIC or the Health Management Branch.

10.2 Providing Services for Culturally Diverse Clients

The evolving diversity of Canada’s immigration program creates situations where people who require immigration medical services in Canada may have cultural characteristics that differ from those of the DMP. Cultural backgrounds and characteristics influence behavior, values and institutions.

One of the goals of Canadian immigration medical activities is the effective performance and provision of services in culturally diverse environments. This is often referred to as “cultural competency.” It is based on the understanding and acceptance of and respect for cultural differences that may include religious beliefs, family responsibilities, sexuality and dress codes.

Through their interest in becoming DMPs, health-care professionals involved with IMEs in Canada have already indicated their readiness to function in situations of cultural diversity. The following comments provide general guidance for those who may be new to such situations. In terms of the immigration medical examination, the most commonly encountered challenges include those related to the sex of the examiner and aspects of the physical exam that may be new or novel to applicant.

• DMPs should ensure that applicants are aware of the sex of the examiner who will be undertaking their IME before the examination begins. Some female applicants may wish to be accompanied by relatives or husbands during the examination process.
• Applicants who refuse to be examined by a practitioner of a particular sex should be offered referral to a DMP of the other sex, or approval should be obtained from CIC to have the IME completed by a nearby practitioner of the other sex who is not a DMP.
• In some locations, undressing for medical examinations is unusual. Applicants may request to be palpated or oscultated through the examination gown or sheet. In these situations, DMPs are to record those events on the immigration medical examination form.
• Similarly, breast, genital or rectal examinations may be refused. When they are, DMPs should indicate that the applicant refused the examination in the appropriate sections of the immigration medical examination form. Applicants should then be referred to an appropriate physician, acceptable to the applicant, for a report on the examination findings, as described in Chapter 9.

The Use of Translators in Canada

During the performance of IMEs in Canada, DMPs may frequently encounter applicants who speak neither of the two official languages. In some cases, the DMP may have linguistic capacities that meet the applicants’ needs. Occasionally, however, translation services will be required. In many circumstances, non-professional translators are utilized.

The use of non-professional translators, particularly family members, can be a sensitive issue for questions or topics involving personal health. Applicants may be uncomfortable providing this information in the presence of family member or friends. For this reason, the use of professional translation services is recommended. The fee policy for translation services is described in Chapter 7.

10.3 The Refugee Determination System in Canada

Description of the Process in Canada

One of the pillars of Canadian immigration policy is the humanitarian and refugee protection component of the immigration program. This program fulfils Canada’s international legal obligations with respect to refugees and affirms Canada’s commitment to international efforts to provide assistance to those in need of resettlement.

The selection of refugees for permanent residence in Canada takes place in one of two ways. Individuals already determined to be refugees under existing international standards and who are residing abroad can be selected and admitted to Canada. They undergo their immigration processing, including medical examination, abroad.

Refugee claimants constitute another group of people who access the humanitarian pathway to enter Canada (frequently known as asylum seekers in other areas of the world). Refugee claimants are individuals who, following their arrival in Canada, make a formal claim to an immigration or Canada Border Services Agency officer requesting protection on the basis of fear of persecution if they return to their country of origin. Those eligible for determination under this process are referred to the Immigration and Refugee Board (IRB) for a decision on their claim for refugee status. The IRB is an independent administrative tribunal responsible for making decisions on who needs refugee protection among the thousands of claimants who come to Canada annually. Further information about the IRB can be obtained at www.irb-cisr.gc.ca/Eng/Pages/index.aspx.

Immigration Medical Requirements for Refugee Claimants in Canada

Canada’s immigration legislation requires all persons claiming protection as refugees to undergo an immigration medical examination. The examination uses many of the same medical forms and requires the same investigations as IMEs for other immigrants, although its intent and nature are slightly different.

As noted earlier in this handbook, immigrants are examined with the intent to identify medical conditions that could affect their admissibility to Canada under IRPA (see Section 2.1). However, those applying for refugee status are examined only with the intent of identifying conditions related to risks to public health and public safety. Aspects of the IME related to identifying conditions that might be associated with excessive demand, do not apply to refugee claimants. As a result, refugee claimants will present for their examination with the immigration medical examination form IMM 1017 EDE-EFE (see Appendix II) DMPs are to complete this form when examining refugee claimants.

Individuals claiming refugee status in Canada are referred for their IME when they file their claim. They are given medical instructions and a list of DMPs. The medical examination is to be undertaken within 30 days following the claim for refugee status.

10.4 The Interim Federal Health Program

Eligibility and Service Coverage

Most refugee claimants in Canada do not have access to provincial/territorial health insurance and may not have personal funds to meet needed expenses. CIC’s Interim Federal Health Program pays for health care for claimants who are unable to pay for expenses related to urgent and essential health-care needs. Coverage is provided pending their qualification for other means of payment. For those eligible, the IFH Program also pays for the costs of the immigration medical examination. The CIC determines fees for the immigration medical examination under the IFH Program. The current IFH Program fees for the IME can be found in Appendix XVII.

Important notes:

• DMPs cannot refuse to provide immigration medical examinations to persons covered by the IFH Program.
• DMPs should not ask refugees or refugee claimants to pay surcharges, supplemental costs, a deposit or any other fee in connection with the IME.
• DMPs may charge for missed appointments in accordance with local standards of practice.
• DMPs billing for IME-related services must use the appropriate codes for services under the IFH Program (see Appendix XVII). If DMPs use other codes (such as provincial/territorial codes for the same service) they will be reimbursed according to the rate of the code submitted, which may be less than the IME-related code for the same service.

When refugee claimants qualify for the IFH Program, they receive a form (IMM 1442B) which contains identification information, the individual’s photograph and the following eligibility paragraph:

The above-mentioned person is eligible for benefits under the Interim Federal Health (IFH) program as described on the attached list. Eligibility will continue until… (day/month/year)… but may be revoked before, should the holder qualify for private or public health insurance or otherwise cease to be eligible.

I, the undersigned, declare that I require assistance for medical care and that should my circumstance change or should I qualify for any other form of medical coverage, I will no longer seek to obtain benefits under the IFH Program.

A copy of this form is included as Appendix XV.

Coverage is normally valid for 12 months from the date of issue or until provincial, territorial or private health insurance coverage is obtained. The validity of program coverage is indicated in the text above, which is printed on the certification documents. Extensions of coverage under the IFH Program are possible, and new forms are issued for those occurrences. Information on how DMPs can verify the validity of IFH Program coverage is described in the section “How the IFH Program Operates” below.

An “OPM” designation in the “Category of Applicant” box on the IMM 1017 Medical Report form indicates that the immigration medical examination is payable by the IFH Program. This designation is for refugee claimants who have been granted protected person status by the Canadian authorities and now qualify for provincial/territorial health insurance. Since these persons must undergo another immigration medical exam as part of their application for permanent residence, the IME fee will be borne by the IFH Program.

How the IFH Program Operates

CIC coordinates and manages the IFH Program. Coverage and eligibility for services, including the fees for specific services such as the IME, are determined by the Department.
The adjudication and payment of claims for the program is provided by Funds Administrative Service Inc. (FAS). DMPs performing immigration medical examinations need to forward invoices for their services to FAS for reimbursement. Individuals covered by the IFH Program should not be charged directly. The program will pay for the IME and related approved costs through the FAS.

The IFH Program provides coverage for much more than the IME, and there is a comprehensive handbook for health-care providers describing how the program functions. This providers’ handbook contains specific references for DMPs. The manual is available electronically at: www.fasadmin.com/IFH%20Client%20Info%20english.asp?language=english&page=pdf. DMPs who routinely perform IMEs for refugee claimants will find the IFH Program manual an important and useful reference.

Verifying IFH Program Eligibility

Currently, the document that confirms an applicant’s eligibility for the IFH Program is issued on the IMM 1442 (the form number is printed in the bottom left-hand corner). An eligibility paragraph stating the eligibility period is printed under “Remarks.” The document may be in French or English and may have differently worded titles.

For services to be reimbursed, the eligibility paragraph must be present on the immigration document. This paragraph confirms eligibility for the coverage period and includes the expiry date. The expiry date indicates the date that benefits expire and is the only date to be used to confirm eligibility.

Note: The eligibility information found on the IMM 1442 is subject to change and there may be situations where the DMP or the applicant may be unsure if IFH coverage is current. In these situations, DMPs may verify the client’s eligibility by telephone or through the FAS website.

DMPs regularly seeing IFH clients can arrange to obtain an IFH Program provider number and password from FAS, and then electronically assess the eligibility of clients through the FAS website or by automated telephone response at 1-800-770-2998.

Billing for Services

To be reimbursed for services, DMPs must complete the IFH Program medical services claim form, a copy of which can be found in Appendix XVI or online at www.fasadmin.com/IFH%20Client%20Info%20english.asp?language=english&page=pdf. The completed form must include the physician’s signature, the date of service, the relevant procedure and fee codes, and all relevant patient information, including the client ID number.

The completed form should then be mailed or faxed to FAS at the coordinates below.

IFH Program Priority Processing
FAS Benefit Administrators Ltd.
9707–110 Street, 9th Floor
Edmonton, AB  T5K 2W8
Fax: 1-780-452-5388
www.fasadmin.com

Payments

There are two payment methods offered by FAS for reimbursements related to the IFH Program. Each method provides a corresponding reconciliation statement to explain the payment.

• Payment by cheque is available to all providers. If this method is selected, payments are generated bi-monthly and mailed to the provider. The reconciliation details are noted on the cheque stub.
• Electronic Funds Transfer (EFT) is available to providers whose financial institution is capable of accepting electronic funds transfers, and to providers who have Internet access. Payment by EFT is made twice a month directly into the specified bank account. The electronic reconciliation statement (ERS) is updated on the Internet within five business days of the payment.

To apply for an EFT/ERS payment, DMPs must complete an Electronic Funds Transfer Authorization, which is available on the FAS website at www.fasadmin.com.
The claims submission process does not change with the method of payment. Providers must submit invoices by mail or fax, accompanied by the appropriate eligibility documents.

Requests for Approval of Additional Costs/Charges

Fees for services provided under the IFH Program are determined by CIC and reviewed periodically. Should DMPs encounter particular situations where additional or supplemental charges may be warranted, approval should be sought before the services are provided.

Approval for these services should be requested from:

Citizenship and Immigration Canada
Interim Federal Health Program
IFH/CIC
219 Laurier Ave. West, 3rd Floor
Ottawa, ON K1A 1L1
Toll-free fax: 1-800-362-7456
No charges or penalties should be levied for cancelled or missed appointments.

10.5 Conditions of Public Health Importance

The medical assessment of applicants for immigration to Canada includes provisions to notify provincial/territorial public health authorities of the arrival of persons who may require public health follow-up. This program, termed “Public Health Surveillance,” was designed to ensure that individuals processed abroad and noted to have conditions or diseases requiring public health attention systematically received appropriate management following arrival in Canada. Public health surveillance is also utilized for individuals who have IMEs in Canada, and provincial authorities are notified by CIC of individuals with inactive pulmonary tuberculosis and treated syphilis infection.

However, CIC’s Public Health Surveillance Program does not eliminate the requirement for DMPs to report and notify provincial authorities of conditions and diseases requiring notification or reporting under provincial or territorial public health legislation. DMPs should report to and notify provincial, territorial or regional public authorities according to the standards and guidelines of the jurisdiction in which they practice.

For conditions that require expedient management, such as active pulmonary tuberculosis, DMPs should not wait for the completion of the entire IME process, but should report the conditions and arrange for immediate care as they would for other patients.

10.6 Conditions and Situations for which Mandatory or Statutory Reporting is Required

Provincial/territorial legislation and/or professional college requirements define conditions and situations for which mandatory reporting and notification of appropriate authorities is required. These standards apply to the immigration medical examination.

10.7 Providing Government Services in Canada

The Canadian immigration process, including the IME, is defined and mandated by federal legislation and managed by a federal department, CIC. As such, the IME and DMPs’ services in this regard must meet some of the basic requirements for government services delivered in Canada. Specifically, individuals seeking these services should have the opportunity to receive them in their preferred official language where there is a significant demand.

Official Languages Policy and Dispensation

In Canada, CIC is committed to providing applicants with the opportunity to receive their immigration medical examination in their preferred official language. If these services are not available in a DMP’s office or clinic, information must be available about the location of the nearest DMP who can provide service in the official language requested by the applicant. If there are no DMPs with appropriate linguistic capacity available nearby, the DMP must advise applicants or their agents as follows:

If the nearest designated medical practitioner (DMP) offering services in your preferred official language is located more than 242 km (150 miles) from where you reside, please contact the CIC Call Centre at 1-888-242-2100 to find out how to access IME services in your preferred official language.

Clinic staff should be aware of and instructed on how to deal with such requests.
DMPs seeking additional information or clarification about this issue should contact:

Director of Operations
Health Management Branch
Citizenship and Immigration Canada
219 Laurier Ave. West, 3rd floor
Ottawa ON K1A 1L1

Official Language Self-Evaluation and Competencies

DMPs have to identify their level of competency concerning official languages on the application form. This requirement helps CIC fulfil its official language obligations and identify areas where additional services may be required. DMPs should identify the level at which they feel comfortable providing medical services. If their level of competency changes due to language training or any other factors, DMPs are required to inform CIC as soon as possible and send in a new application.

Process for Delivering Forms

CIC is making every effort to offer its services in the candidate’s preferred official language. Consequently, CIC offices have been told to give applicants the IMM 1017 in their preferred language. DMPs print or generate the IMM 5419 and should have the ability to generate both these forms in either official language. DMPs can assist the Department in maintaining this standard of service by informing the regional medical office whenever a situation arises in which it has been unable to fulfil this requirement.

10.8 Records Management

Medical Examinations Issued Abroad

Immigration medical examinations performed in Canada (and the United States) should normally be forwarded to the Health Management Branch in Ottawa when completed, no matter where the documents were issued.

Document Control

The forms, documents and results of investigations required for the completion of the IME are the property of CIC. DMPs in Canada should forward all documents related to the IME to the Health Management Branch. DMPs may be required to maintain their own copies and records in accordance with local regulatory and licensing requirements.

Applicants may request copies of this information under the Privacy Act, and their representatives who are Canadian residents may request copies under the Access to Information Act. See Section 2.2 for more information. Alternatively, they can contact the CIC office responsible for their application.

Information collected during the IME is for immigration medical purposes only. It may not be used for other purposes, including research, clinical studies or investigations, without the appropriate consent and approval. Requests to use information obtained during the IME process for any other purpose should be directed to:

Director of Operations
Health Management Branch
Citizenship and Immigration Canada
219 Laurier Ave. West
Ottawa, ON K1A 1L1

 

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