Thank you, Mr. Chair. Yes, very difficult to forecast the need in this area. In 2019-2020, there was supplementary funding of about $13 million that was added to the budget, which was one-time funding, and then the following year the budget returned to its normal, and no request for supplementary funding has been made for this year. You see the budget has increased to $40 million for 2021-2022, though. That reflects a forecasted need based on a look at the past five years to determine where we forecast the use of out-of-territory hospitals and physicians to be for 2021-2022, but again, that is a forecast. Thank you, Mr. Chair.
Thank you. Member.
Thank you, Mr. Chair. I am guessing part of that uncertainty would then also be the fact that we are moving more towards telehealth. Will that impact this line item if more of our services are provided online versus having to send patients to the South? Thank you, Mr. Chair.
Thank you. Minister.
Thank you. I would like to refer this to the director of finance, please.
Director.
Thank you, Mr. Chair. Yes, that would for sure be an impact. As I think we discussed yesterday, between the interprovincial billing agreements, there is a year where provinces and territories have up to a year to bill each other. That also adds to some of the uncertainty, which is why I referenced that we look back at the past five years to be able to make our forecast moving forward. Thank you, Mr. Chair.
Thank you. Member.
Thank you, Mr. Chair. I would like to give the department a kudos in that, when I had surgery in Edmonton, I was actually told that we get in very high on the list over Albertans because the Northwest Territories pays their bills very well and on time, so I always thought that was kind of an interesting comment. I just want to know if maybe you could explain, if the department could explain to me or the Minister -- and this is just my own knowledge. We just have a line item here for the Health and Social Services Authority funding on page 190, and I am just curious to know: what function do the health authorities play in out of service, like what is this money used for with respect to out of service or out-of-territory services? Is it to administer getting patients out of territory? Because I would wonder if that would be captured under medical travel. I am not sure if that is a very clear question, but thank you.
Thank you. Minister.
Yes. Thank you. I do not think this has to do with medical travel. I think it has to do with the physician services and the hospital stays that happen out of territory, but for further clarification, I would like the question to go to the director of finance. Thank you.
Thank you. Director.
Thank you, Mr. Chair. This budget is actually for the adult southern placements program. The NTHSSA administers this program, so anytime an individual from the NWT needs to be sent south for those facilities that we were talking about not long ago, this is where that gets paid. Thank you, Mr. Chair.
Thank you. Member.
Thank you, Mr. Chair. That would be the facilities both for treatment and addictions as well as maybe for health and other related items or medical travel type situations?
Thank you. Minister.
Thank you. Back to the director of finance, please.
Director.
Thank you. This is specifically for the adult placements for supported type living arrangements. Thank you, Mr. Chair.
Thank you. Member.
Thank you, Mr. Chair. No. I think that I am good, Mr. Chair. Thank you.
Thank you. Mr. O'Reilly.
Thanks, Mr. Chair. I am just trying to understand a little bit more about the breakdown out of the three categories on the bottom part of page 189. I see the grants, contributions and transfers, that amount, and that seems to correspond with the money that is given to Health and Social Services Authorities. It's just a flat-line amount. Maybe I will start with that. There is no fluctuation whatsoever. How is this amount determined? The fact that it has just stayed the same over three years just seem a bit odd. Thanks, Mr. Chair.
Thank you. Minister.
Yes, thank you. I would like to refer this question to the director of finance.
Director.
Thank you, Mr. Chair. Yes, the Member is right in that that line does correspond directly to page 190, and that is all given to the NTHSSA. The budget there has not changed because it has not yet been needed. There has been no forecasted increase in funding required for adult southern placements in the South. Thank you, Mr. Chair.
Thank you. Member.
Okay. Thanks, Mr. Chair. Maybe it's been a long week. How does the money then flow from the department of health through the NTHSSA to provide out-of-territory services? Maybe I am just a little bit thick today. I'm trying to understand how that money flows or does not flow. Thanks.
Thank you. Minister.
Thank you. I would like to refer this question to the director of finance.
Director.
Thank you, Mr. Chair. The department gives the $26 million to the authority in a contribution agreement, and then the authority enters into individual contracts with each of the facilities in the South. Thank you, Mr. Chair.
Thank you. Mr. O'Reilly.
Okay, thanks. Yes. That helps me a lot. I appreciate that. The contract services line, can someone explain to me what that is? Thanks, Mr. Chair.
Thank you. Minister.
Yes. Thank you, Mr. Chair. I am not seeing that my page has any detail on it, so I would like to refer the question to the director of finance. Thank you.
Director.
Thank you, Mr. Chair. This is where the department enters into contracts directly for the child, for the southern placements for children. The authority currently administers the program for the adult southern placement, and the department does the children. Thank you, Mr. Chair.
Mr. O'Reilly.
Thanks, Mr. Chair. That is helpful to understand. I see back in 2019-2020 it was a little bit higher, by half a million dollars, but then it's just a constant amount. Do we sign, I don't know, two- or three- or five-year contracts or something? I just would have expected that this would fluctuate a bit more than the numbers here seem to show. Thanks, Mr. Chair.
Minister.
Thank you. That is another question for the director of finance, please.
Director.
Thank you, Mr. Chair. There has not been a forecasted need to further increase the budget in this area based on what we currently see. On the side for children, it does fluctuate between years and over months even because some children go in for a month and then they come back for short-term treatment periods, but the budget has not needed to be extended at this point. We did overspend, and we did forecast an over-expenditure in 2019-2020. I went for supplementary funding at the time. If we were to incur a similar situation at this point, it would be something that would be one-off, and so we would take that same approach next year. Thank you, Mr. Chair.
Thank you. Mr. O'Reilly.
Thanks, Mr. Chair. Now to the last line here, fees and payments, this one does jump around a fair bit. Back in 2019-2020, it was $15 million, which is $10 million more than what is anticipated next year. If I can get an explanation of what this covers, let's start with that. Thanks, Mr. Chair.
Thank you. Minister.
Yes. Thank you, Mr. Chair. The explanation is that we historically have shortfalls in this area where we exceed the budget. In 2019-2020, that shortfall was $11.8 million for hospital services and another $2.4 million for out-of-territory physician services. That combined shortfall was addressed through a supplementary appropriation. I don't see that that has been necessary in the current fiscal year that will end next month, but I think that further detail could be provided by the director of finance. Thank you.
Thank you. Director.
