Finance Committee on Nov. 23rd, 2017

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you.

Mr. Hamilton, in addition to the information you'll provide to this committee in terms of these numbers as you find them out, I'd also like you to include how much money the Conservatives saved by getting rid of this committee in 2006. Also, I'd like to know how much was cut by previous governments in the training for the administration of disability tax credits. I'd like to know how much money was reduced over the last 10 years in the training of CRA employees, specifically in the administration of disability tax credits.

My time is very limited. The other thing I'd like to get to—

[The Chair, Liberal, Wayne Easter]

This will be the last other thing.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

No problem.

You mentioned, Mr. Hamilton—or maybe, Madam Minister, you both did—the technology in regard to the phone system and the Auditor General's report. It is 20-year-old technology. The action plan is already in place, and the new phones or the new technology has already been ordered. I am assuming that this wasn't in reaction to the Auditor General's report of this week, because you couldn't have possibly ordered brand new technology in a couple of days, but if it's 20-year-old technology, I'm curious. When did the CRA first ask for updated technology, and was it ever approved in previous budgets?

[Bob Hamilton]

I'll take that one, but only to say that I'm not sure of the answer to the last part, and maybe just to correct a bit the perception on the first part.

I will endeavour to find out when we first asked for it. I know that it predated my arrival, which was a year ago.

I wouldn't quite characterize it as “the phones have been ordered”. We are in negotiation on how we can put this new system into place. It has been agreed what it would look like; it's a technology that has been proven in other areas. We hope to put it into place next year, at the beginning of 2018. It's not there, but the point you made is absolutely right. The AG flagged this concern, but we already knew we had antiquated technology and it needed to be replaced.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

When did CRA know?

[Bob Hamilton]

I don't know.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Can you get back to us?

[Bob Hamilton]

As I said, it predated me, and that was a year ago, so I would imagine two or three years ago at least, but I can't say that for sure. We will find out—Frank may know in the second hour—but it wasn't new.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you.

[The Chair, Liberal, Wayne Easter]

Could the commissioner get back to us with that information?

Before I let you go, on the internal look you're having at disabilities, which includes diabetes, I would certainly hope that it includes professionals in the field who deal with type 1 diabetes patients. Some of the ones we talked to would tell us that their son or daughter has an insulin pump, and there is the new technology, but still, the effort they have to go through in terms of diet and everything else really does get them up to the 14 hours. I can tell you, based on what we've heard, that some decisions need to be made on this particular application process pretty urgently.

With that, we will suspend.... I guess we don't have to suspend; the other witnesses are at the table.

Thank you, Madam Minister and Commissioner Hamilton, for answering our questions and for your presentations.

We will go to another round of questions with the officials from CRA. We'll keep Mr. Vermaeten, Ms. Caron, and Mr. Gallivan here. I don't think they have any more opening statements.

Mr. Fergus, I believe you're starting the second round.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Thank you very much.

I'm not certain who would be appropriate, but I would like to follow a little further along the same line of questions that I had for the commissioner.

I'll let them get into place first, Mr. Chair, if that won't count against my time.

[The Chair, Liberal, Wayne Easter]

Go ahead, Mr. Fergus.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Mr. Vermaeten, the commissioner raised the possibility, to be confirmed after you take a look at it, that perhaps there are more modern procedures that someone who is diabetic could use to administer insulin shots, which would bring the number of hours below 14. I have to admit that beyond what I've heard from my constituents, I'm not familiar with what is involved.

Can you give me a sense as to whether or not that information about a new approach has been shared with the employees of CRA, the ones who are doing the evaluation of the requests for approval or denial of the DTC?

[Frank Vermaeten, Assistant Commissioner, Assessments, Benefits, and Services Branch, Canada Revenue Agency]

I would say it's common knowledge that medical technology improves over time. Certainly the people who are administering the disability tax credit have that awareness, including the nurse practitioners who are there. Certainly, they're aware.

You have things like wireless insulin pumps and glucose meters that make the management of diabetes quite a bit easier. There are a range of improvements. You're going to have people who are impacted by diabetes in a range of different ways. I think we all know people who, in some cases, manage it quite well, and it doesn't impact their day-to-day life as much, although certainly it always does. In other cases, people are very severely impacted. The question is, does the eligible part of that therapy take 14 hours?

[Greg Fergus, Liberal, Hull—Aylmer, QC]

We're now going down a path. I understand that you're going to be taking a look at this more closely, but what is sort of new now is that perhaps there's a different way of evaluating what procedures people follow to provide themselves with insulin injections to save their lives.

Is this common, standard practice amongst Canadians? If it is standard practice, how has that been shared with CRA? How does CRA then interpret that or make that a part of its policies in the evaluation of whether or not someone qualifies for the DTC?

What I'm really trying to say is that if this has been a change, this evaluation or this assessment by CRA, based on the professional advice they've received, is this professional advice widely shared with Canadians? Is this current and common practice among Canadians?

It would appear to me that there are a lot of people who aren't aware of these changes, or they are using the old methods, and the doctors are certifying that they are still taking 14 hours or more a week to provide the necessary medical treatment.

[Frank Vermaeten]

That are a lot of different questions in there.

The applicant brings the application to the medical practitioner, and the medical practitioner provides this information.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Does the medical practitioner provide the information confidentially to CRA, or does it go back to the person who's applying, and then they provide it to the department?

[Frank Vermaeten]

Usually the individual gives the application to the doctor, who fills it out right on the spot, and it's usually the individual who then mails it back to us.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Then the individual would have seen what the doctor put on it and there wouldn't have been any surprises. If their doctor says it takes 14 hours, it takes 14 hours.

[Frank Vermaeten]

Well, we look at each one on a case-by-case basis. If a doctor simply says it takes 14 hours, that's not going to be sufficient information.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Was it sufficient before?

[Frank Vermaeten]

It's never been sufficient. In most cases, we would want a listing of what takes 14 hours. I'm not going to say we do that in each and every case, because sometimes there are complicating factors, or there are other interactions with other medical complications that makes it so obvious that we don't need to ask those follow-up questions, but in many cases we do need follow-up answers.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

It would appear you have been briefed or that the public lines of the commissioner and the minister have been briefed that nothing has changed in the legislation or the regulations or the criteria, but there seems to be a suggestion that a different evaluation is going on, based on some new information.

[Frank Vermaeten]

You're absolutely right that the legislation hasn't changed. The folio, which is the interpretation of the legislation, hasn't changed for years with respect to life-sustaining therapies. The criterion has always been 14 hours, so that part has remained identical.

Over time, though, we continue to make improvements and modifications to how we administer the program, how we communicate to the medical community with the information that's sent and the information that's sent back. That's evolved. For example, the form was greatly simplified in November 2015.

Am I getting cut off?

[Greg Fergus, Liberal, Hull—Aylmer, QC]

No, continue, but I need to say something to the chair.