Finance Committee on Nov. 23rd, 2017

[Frank Vermaeten]

We exchange information with doctors. We send letters to make sure that we have information on an individual case and about whether or not it takes more than 14 hours to manage it. This is sometimes a difficult form for doctors to answer. Why? If you take a look at some types of therapy, like dialysis, it often takes place in a hospital setting, so it's quite easy to monitor in—

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

We're not talking about dialysis. We're talking about diabetics who inject themselves with insulin.

[Frank Vermaeten]

That's right. It's more difficult for the physician to respond because the physician doesn't actually witness that, as opposed to a hospital setting. It's fairly clear when dialysis takes 14 hours a week and whether it's more than three times a week. That becomes very clear.

In the case of diabetes, it's much more complicated, so that's why that back-and-forth interaction with the doctors happens much more. You add to that the complexity of the therapy, which is becoming modernized and easier to manage in some cases, but not all.That's why those clarification letters are required and why we continually evolve with the communications to make sure that we are getting the specifics of that individual.

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

In the revised forms that they fill out, do the doctors take into account their travel time in those 14 hours?

There is also loss of the amenities of life. The sugar level of a diabetic can vary from day to day. For example, if a person with diabetes has flu symptoms and is taking antibiotics, the sugar levels can fluctuate, even if the person has insulin injections. They may also experience a temporary loss of vision.

Is all that factored in those 14 hours?

[Frank Vermaeten]

At CRA, we administer the Income Tax Act, and it sets out pretty clearly what an eligible activity is and what an ineligible activity is with respect to the counting of those 14 hours. You mentioned a whole range of things. The travel back and forth to the doctor would not be eligible as part of this 14 hours, for example.

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

I am familiar with the criteria you're talking about.

I'm not talking about transportation, I'm not talking about wait times in the hospital, I'm not talking about wait times for drugs or about ordering drugs online. It is none of that.

I'm talking about the consequences that were not taken into account in the form. I'm talking about the consequences of being diabetic, living with diabetes every day, and the fact that there may be daily changes, such as missing a day of work, and so on.

Are those factored in? I'm not talking about the list on the T2201 form.

[Frank Vermaeten]

We take into account only those things that are set out in the Income Tax Act. We administer the program. Something such as exercise, as you said, to stay healthy, is not considered part of that. When there are complications and other health impacts, sometimes that does come into the application, because a person can suffer from multiple afflictions. It can come into account. However, if you're talking about simply an application that is only life-sustaining therapy, the legislation sets out what is eligible and what isn't eligible. It's fairly clear and it hasn't changed for years.

[The Chair, Liberal, Wayne Easter]

We will have to leave it at that. We do have to vote on supplementary estimates.

Mr. Vermaeten, there may be a big debate between different parties and different members on how we got here, but I think you can see from every member, including me, that there's a huge concern over the type 1 diabetes approval and disapproval. I want to outline to you that sometimes there's lobbying by an organization, but I can tell you on my own part that it isn't just Diabetes Canada that we hear from; it's individuals on the ground in all our ridings. I'd just ask you as assistant commissioner to keep that in mind in your deliberations, and we hope the advisory committee will help in that regard.

Our thanks to all three of you for your appearance and for answering questions.

Committee members, we need to vote on supplementary estimates (B). You have them before for you.

CANADA REVENUE AGENCY Vote 1b—Operating expenditures..........$44,941,394

(Vote 1b agreed to)

Shall I report the supplementary estimates (B), 2017-18, under Canada Revenue Agency, to the House?

[Some hon. members]

Agreed.

On division.

[The Chair, Liberal, Wayne Easter]

Thank you. We will do that.

The meeting is adjourned.