Accommodation in an intermediate resource
What are intermediate resources?
Québec society recognizes that persons living in a structured environment need to remain in the community and require assistance with their reintegration into society.
To this end, accommodation resources known as "intermediate resources" have been created in order to offer these persons a residential environment as close as possible to a home environment and in which they receive the support and assistance they require.
What is an intermediate resource?
An intermediate resource consists of one or more persons who act as an intermediary between a public facility to which they are bound by contract and the users entrusted to them by the facility.
Types of residences
There are currently 4 main types of residences operated by intermediate resources:
- supervised apartments,
- rooming houses,
- reception homes and
- group homes.
The administrative staff of longterm care facilities have access to online services for registering persons taken charge of by intermediate resources or making changes in their files. These services are available in French only.
Who covers the cost of services provided by intermediate resources?
The cost of the services is covered both by the public facility that has a contract with the intermediate resource and by the person receiving the services. The public facility pays the intermediate resource monetary compensation corresponding to the cost of the services stipulated in the contract. The resident helps cover the cost of his or her accommodation by paying a contribution to the public facility.
The Régie de l'assurance maladie du Québec determines the amount of the financial contribution paid by persons under the care of intermediate resources, by applying the rules consistently, equitably and impartially.
How is the required contribution established?
The contribution paid by a person who is under the care of an intermediate resource is established on a monthly basis and takes into account 3 factors:
- Whether or not the person is a recipient of last-resort financial assistance.
- The duration of the person's accommodation:
- the person is expected to return to his or her home environment within 2 years after having been taken charge of by the intermediate resource;
- the person will not return to his or her home environment within 2 years.
- The person's age:
- under age 65;
- age 65 or over.
The contribution is calculated by the Service de la contribution et de l'aide financières of the Régie de l'assurance maladie du Québec.
The simulation tool for calculating the financial contribution allows you to estimate a user's contribution.
When must the contribution be paid?
The contribution is payable as of the first day of accommodation and is calculated pro rata to the number of days of accommodation. The day of arrival is included but not the day of departure.
The financial contribution must be paid on the first day of each month at the place determined by the accommodating resource.
What are the products and services provided by intermediate resources to users?
Accommodation services and support or assistance services are offered by recognized intermediate resources. Accommodation services consist in offering residents a home adapted to their needs. Support and assistance services consist of "basic" or "intervention" services:
Basic services aimed at providing users with adequate sanitary conditions
(e.g. housekeeping, laundering of bedding and clothing), a balanced diet and an adapted environment.
Intervention services aimed at giving residents the support they need for overcoming the difficulties they encounter or for preventing their situation from deteriorating (e.g. stimulating, encouraging or eliminating a certain type of behaviour).
Application for review
If you disagree with a decision of the Régie, you can apply for an administrative review. You have 6 months, from the date the letter of decision is deposited in your mailbox or handed to you in person, to contest the decision.
Form to fill out
First, you must fill out an Application for review.
To appeal a decision regarding healthcare received outside Québec, a technical aids program or a financial assistance program, you must use the form also.
It is important that you enclose the relevant original documents (bills, proof of payment, medical documents, etc.) and you specify the matter being contested, and any facts and dates to be corrected. If you need more space than that provided on the form, attach a separate, signed sheet.
Send your application for review to the following address:
Direction de la révision
Régie de l'assurance maladie du Québec
Case postale 6600
Québec (Québec) G1K 7T3
We recommend that you keep copies of the documents provided.
Analysis of your application for review
The agent of the Régie who analyzes your application for review will contact you, if required, to clarify your expectations. If necessary, the agent will assist you in the process of gathering relevant information to complete the file.
The review of your application is based on the new information provided by you and the documents already on file. Those documents must cover the entire period at issue. Missing information may delay the processing of your file.
After the agent has reviewed your file, he/she will notify you in writing of the Régie's new decision.
The Régie's commitment
We will process your application in keeping with our values: respect, integrity and equity.
We also undertake to follow up on your application for review within 40 days of receiving it, if your file is complete.
The Régie's decision
Under the Health Insurance Act, the Régie has 90 days to render its decision following an application for review.
If, after you've filed your application, you wish to provide supporting documents or comments, the 90-day time limit will run from the date the Régie receives the documents.
Moreover, if the Régie deems that it needs additional documents or information, it may extend the time limit by another 90 days.
Finally, if the Régie does not meet the deadlines, you may wait for its new decision, or contest the previous decision before the Tribunal administratif du Québec (TAQ).
Do you disagree with the Régie's new decision?
If you believe that the decision rendered in follow-up to your application for review does not respect your rights, you have 60 days (from the date the decision is delivered to your address) to contest it before the TAQ.
For further information about this program, contact the facility concerned.