Operations Memoranda (OM) - Overseas Processing

ISSUE

Changes to the immigration medical assessment (IMA) process resulting from the introduction of IRPA.

IRPA AND REGULATIONS

The Immigration and Refugee Protection Act (IRPA) is expected to be proclaimed on June 28, 2002.

IRPA, Section 38(1), incorporates Sections 19(1)(a)(i) and 19(1)(a)(ii) of the Immigration Act 1976, and breaks them down into three separate components: (a) public health; (b) public safety; and (c) excessive demand.

The major health-related change in IRPA is Section 38(2) that describes those individuals who are exempted from an excessive demand assessment.

The relevant health-related Act and regulations sections are included in Annex A.

APPLICANTS EXEMPTED FROM EXCESSIVE DEMAND ASSESSMENT

From an operational perspective, those applicants exempted from excessive demand assessment include the following:

1. Sponsored members of the Family Class:

• A sponsor’s spouse or conjugal partner and the sponsor’s dependent children (where conjugal partner includes common-law partner or same sex partner);
• A dependent child, legally adopted or biological (including adult dependants over 22, who are medically dependent);
• A child to be adopted by a sponsor.

2. Convention Refugees and in-Canada refugee claimants.
3. Persons in need of urgent protection.
4. The dependents of (a), (b) and (c) above.

THE NEW IMMIGRATION MEDICAL ASSESSMENT (IMA) PROCESS

It is the responsibility of the medical (health) officer to provide an IMA, which is an opinion regarding the admissibility of an applicant on health grounds.

Following proclamation, all medical assessments, including those pending or in progress will be governed by the IRPA.

• All applicants determined to require a medical examination will undergo the standard immigration medical examination, including routine laboratory tests.

• It is anticipated that the class of applicant will be indicated on the IMM1017 issued by a visa/immigration officer and then submitted by the Designated Medical Practitioner (DMP) for IMA.

• Applicants identified as being excessive demand exempt (EDE) should not be investigated by the DMP or furthered for additional information by a Medical Officer (MOF) in terms of excessive demand. Applicants who are EDE will still require assessment for public health and public safety. Such applicants may require further work-up for any public health or public safety concerns.

• When the class of applicant is not identified, the case will be assessed based on each of the three criteria required by IRPA Section 38(1):

• public health;
• public safety; and
• excessive demand.

On June 3, 2002, International Health Operations (HMI) e-mailed Overseas MOFs separate instructions to assist MOFs and DMPs in the identification and processing of EDE applicants. These instructions are called "Immigration and Refugee Protection Act: Instructions pertaining to certain classes of applicants exempted from the excessive demand determination".

IMMIGRATION MEDICAL ASSESSMENT (IMA) OUTCOME

The IMA outcome will be captured in two ways:

1. completion of a Medical Notification form IMM5365 (Annex B) which acts as a worksheet to capture the data for electronic entry. This form will become the official document for capturing data and notifying visa/immigration officers of inadmissible cases, replacing the MS1014; and
2. electronic entry in the Immigration Medical System (IMS) computer database or into FOSS.

MEDICAL ASSESSMENT CODING

Following IRPA proclamation, there will be changes to the medical assessment coding system.

A new medical assessment coding system will be developed to capture only those components dictated by IRPA. In the meantime, the H T and E criteria have been redefined. Until a new coding system is created, H, T and E should be entered as "1" into IMS for all applicants.

The key medical assessment components will be a D criterion, an S criterion and an M category to reflect the components of IRPA.

Note: There are new definitions for some of the H, D, T, S, E and M codes – see below and Annex C.

All EDE applicants will have D8 and M7 as part of the assessment coding. EDE cases where the applicant is a Danger to Public Health and/or a Danger to Public Safety will have a Dual M Coding - see below.

M Category

Assessment codes are M1 through M7.

• M1 - no public health risk or danger, no public safety danger and no excessive demand.

Note: M1 must not be used for EDE cases which will be coded M7.

• M2 - Potential risk to public health. Medical surveillance required. Conditional entry recommended if granted entry to Canada.

Many applicants may not present a "danger" to public health (e.g. active infectious tuberculosis (TB)) but may be a "risk" if they have a communicable disease that could reactivate (e.g. inactive tuberculosis). These latter individuals require medical surveillance and conditional entry, and hence require the S2.nn notification.

• M3 – A health condition(s) is present but is not expected to place an excessive demand on health or social services.

Note: All significant health conditions identified should be documented on the medical notification form along with the relevant ICD code(s) and an appropriate narrative.

M3 must not be used for EDE cases which will be coded M7.

• M4 - Inadmissible due to Danger to Public Health, e.g. Active Infectious TB.

• M5 - Inadmissible due to Excessive Demand on health and social services.

Note: All cases likely to create excessive demand, regardless of the potential response to treatment, will now be assessed M5.

• M6 - Inadmissible due to Danger to Public Safety, e.g. psychopathic personality.

• M7 - Excessive Demand Exempt (EDE)

Note: M7 will always be combined with D8 to reflect that the medical assessment is based on the fact that the applicant is EDE.

Applicants who are EDE, but have health conditions which would otherwise be assessed M5, will be assessed M7. The narrative should highlight that:

• the applicant has identified health condition(s) (specify the condition(s) and provide ICD code(s)),
• the applicant has been assessed as EDE, and
• a new medical assessment is required if the category of application changes.
• the medical validity date – this must be indicated (see Medical Validity section below).

This information will assist in resettlement planning for refugees and persons in need of protection, as well as indicate the need for issuing health follow-up handouts.

Narrative Example:

"Diabetes mellitus ICD: 250

The applicant has diabetes mellitus which may require significant Canadian health or social services if applicant were granted entry to Canada. This applicant has been assessed as excessive demand exempt (EDE) and will require a new medical assessment if the applicant’s immigration category changes."

The medical is valid until [dd/mmm/yyyy].

 

Medical Validity

Owing to the use of M7 for EDE cases, the medical validity does not currently upload from IMS into CAIPS. Thus, for EDE cases, it is critical that medical validity be captured in the medical narrative, as indicated in the example above.

Note: It is imperative that visa office staff manually enter the medical validity date for EDE applicants into CAIPS to support the CAIPS generation of immigration documents, e.g. IMM1000/Permanent Resident Card.

 

Dual M Coding

The M code can have two numerical values when more than one component of the assessment criteria is present.

Applicants who are M3 and require medical surveillance will be coded M2/3 as before.

For technical reasons, it is not possible to code EDE applicants who require medical surveillance as M2/7. Such applicants will have to be coded D8, S2.nn, and M7 with a narrative clearly stating the need for medical surveillance.

All EDE applicants will have D8 and M7 as part of the assessment coding. Those EDE applicants who are either a Public Health Danger or a Public Safety Danger will be D8 and M4/7 or D8 and M6/7.

Persons in need of protection who are M4/7 or M6/7 require special communication between the medical officer, visa officer and Port of Entry officers to ensure safe transportation of these individuals and appropriate management on entry to Canada.

Those EDE applicants assessed as both a Public Health Danger and Public Safety Danger should be assessed D8 and M4/7 with a strong narrative to flag the public safety concerns to the immigration officer. This is likely to be a very rare occurrence.

It is not possible to enter three M codes. In the rare instance that this is required, two M codes, one of which must be M7, should be entered in IMS or FOSS and the third M code highlighted in the narrative.

S Criterion

In all cases an S code is required.

• S1 - No requirement for medical surveillance.

• S2 - Requires medical surveillance if the applicant is granted entry to Canada.

S2 requires that the reason for medical surveillance be specified:

• S 2.02 for inactive TB.
• S 2.04 for adequately treated positive syphilis serology.

Note: Some applicants will be medically inadmissible and yet still be granted entry to Canada, e.g. M5 where a Temporary Resident Permit is issued. The S2 coding signals the need for medical surveillance on entry to Canada.

In certain rare circumstances, such as persons in need of urgent protection, an applicant may have active infectious TB and will be assessed M4 but still be permitted entry to Canada. These migrants will be coded D8 S2.01 and M4 and will require close cooperation with the visa officer to organize safe transportation and to coordinate public health management on arrival in Canada.

D Criterion

In all assessments, a D code will be required.

• D1 - Non EDE applicants.

Note: D1 no longer means no demand on health or social services. D1 now refers only to the category of applicant, i.e. not exempt from excessive demand assessment.

• D8 - Exempt from Excessive Demand Assessment

  Note: All other D codes (D2 through D7) will no longer be utilized.

It is important that visa/immigration officers check the medical profile and narrative screen in CAIPS in order to identify migrants who require medical surveillance and applicants who require the issuance of health follow-up handouts.

SUMMARY

1. The medical assessment will include D, S and M coding.
2. H T E will be coded as "1" for all applicants.
3. Non-EDE applicants will be coded D1.
4. Specified categories of applicants (EDE) will be exempt from an excessive demand assessment and will be assessed as D8 and M7.
5. Those EDE applicants who are assessed as a Danger to Public Health or a Danger to Public Safety will be coded D8 and M4/7 or D8 and M6/7.
6. Visa/immigration officers will need to review the profile and narratives for all M7 applicants. The medical validity date must be included in the narrative for EDE cases.
7. It is imperative that visa office staff manually enter the medical validity date for EDE applicants into CAIPS to support the CAIPS generation of immigration documents, e.g. IMM1000/Permanent Resident Card.
8. Applicants who are EDE and who require medical surveillance will be assigned the appropriate S code and narrative and provided with the appropriate health follow-up handout.

ANNEX A

KEY HEALTH-RELATED SECTIONS IN IRPA AND REGULATIONS

IRPA:

A38.(1) A foreign national is inadmissible on health grounds if their health condition

1. is likely to be a danger to public health;
2. is likely to be a danger to public safety; or
3. might reasonably be expected to cause excessive demand on health or social services.

A38.(2) Paragraph (1)(c) does not apply in the case of a foreign national who

1. has been determined to be a member of the family class and to be the spouse, common-law partner or child of a sponsor within the meaning of the regulations;
2. has applied for a permanent resident visa as a Convention refugee or a person in similar circumstances;
3. is a protected person; or
4. is, where prescribed by the regulations, the spouse, common-law partner, child or other family member of a foreign national referred to in any of paragraphs (a) to (c).

IRPA REGULATIONS:

Definitions

R1.(1) The definitions in this subsection apply in the Act and in these Regulations.

"Excessive demand" means

1. a demand on health services or social services for which the anticipated costs would likely exceed average Canadian per capita health services and social services costs over a period of five consecutive years immediately following the most recent medical examination required by these Regulations, unless there is evidence that significant costs are likely to be incurred beyond that period, in which case the period is no more than 10 consecutive years; or
2. a demand on health services or social services that would add to existing waiting lists and would increase the rate of mortality and morbidity in Canada as a result of the denial or delay in the provision of those services to Canadian citizens or permanent residents.

"Health services" means

any health services for which the majority of the funds are contributed by governments, including the services of family physicians, medical specialists, nurses, chiropractors and physiotherapists, laboratory services and the supply of pharmaceutical or hospital care.

"Social services" means

any social services, such as home care, specialized residence and residential services, special education services, special education services, social and vocational rehabilitation services, personal support services and the provision of devices related to those services,

1. that are intended to assist a person in functioning physically, emotionally, socially, psychologically or vocationally; and
2. for which the majority of the funding, including funding that provides direct or indirect financial support to an assisted person, is contributed by governments, either directly or through publicly-funded agencies.

Excessive Demand

R34. Before concluding whether a foreign national’s health condition might reasonably be expected to cause excessive demand, an officer who is assessing the foreign national’s health condition shall consider

1. any reports made by a health practitioner or medical laboratory with respect to the foreign national; and
2. any condition identified by the medical examination.

Public Health

R31. Before concluding whether a foreign national’s health condition is likely to be a danger to public health, an officer who is assessing the foreign national’s health condition shall consider

1. any report made by a health practitioner or medical laboratory with respect to the foreign national;
2. the communicability of any disease that the foreign national is affected by or carries, and
3. the impact that the disease could have on other persons living in Canada.

Conditions

R32. In addition to the conditions that are imposed on a foreign national who makes an application as a member of a class, an officer may impose, vary or cancel the following conditions in respect of any foreign national who is requested to and must submit to a medical examination under subsection 16(2) of the Act or section 30 of these Regulations:

1. to report at the specified times and places for medical examination, surveillance or treatment; and
2. to provide proof, at the specified times and places, of compliance with the conditions imposed.

Public Safety

R33. Before concluding whether a foreign national’s health condition is likely to be a danger to public safety, an officer who is assessing the foreign national’s health condition shall consider

(a) any reports made by a health practitioner or medical laboratory with respect to the foreign national; and

(b) the risk of a sudden incapacity or of unpredictable or violent behaviour of the foreign national that would create a danger to the health or safety of persons living in Canada.

Assessment of Inadmissibility on Health Grounds

R20. An officer shall determine that a foreign national is inadmissible on health grounds if an assessment of their health condition has been made by an officer who is responsible for the application of sections 29 to 34 and the officer concluded that the foreign national’s health condition is likely to be a danger to public health or public safety or might reasonably be expected to cause excessive demand.

ANNEX C
SUMMARY OF IMMIGRATION MEDICAL ASSESSMENT FOR USE WITH IRPA