Were you aware that when receiving financial assistance through the PEI Government, you are entitled to certain benefits. Foe example, when reentering the work force, there is a $100 dollar allowance for clothing, or work related expenses. Also the program will also reimburse any out of pocket expenses associated with training or work related materials you require to start a job. They will also help with transportation costs associated with getting to and from your employment.
When you so start working and generating an income, the program will allow you to transition from unemployment status to employed status. Meaning, there is a benefit called the Transition to Employment benefit. This is where you start working, but the program will still give you your entitlement for that month and you may also be eligible for some assistance in future months. It's a way of helping people get a head start, so hopefully it will get you off Welfare.
Sunday, July 11, 2010
Sunday, July 4, 2010
Transfer of Clients Between Social Assistance Area
7-7 Transfer of Clients Between Social Assistance Area
PURPOSE
To facilitate efficient, effective case planning with applicant’s moving from one office to another.
PRINCIPLE
1. Applicants may choose to live wherever they wish.
2. Applicants are responsible for the consequences of their decisions.
3. Social Assistance should not be used to support situations that result or are likely to result from poor or non-existent planning.
4. Decision making on how applicants move from one office to another should be based on sound planning.
5. The involvement, cooperation and expectation of staff regarding transfer of applicants between offices are the same as exist when applicants are transferred between workers in the same office.
POLICY
6. Applicant requests for relocation will initiate a planning and consultative process to ensure that all parties involved, including the applicant, current office and receiving office, recognize the implications of the proposed change and support the plan.
7. Case planning should include, but is not limited to, the following considerations:
1) What advantages to the applicant are anticipated as a result of the proposed relocation?
2) Is relocation warranted for health and safety reasons?
3) What is the probability that the anticipated advantages will be realized?
4) Will the case plan result in greater applicant self-sufficiency?
5) Are adequate services available in the receiving office area?
6) What is the applicant’s contribution to the case plan?
7) Do the anticipated advantages to the applicant justify the degree of resource expenditure by the Social Assistance Program?
8) Can continuity of services be maintained?
8. Case planning and cooperation should be paramount in dealing with multi problem, crisis prone individuals or families, in order to decrease risk.
9. Deviation from Social Assistance Policy, if necessitated by extenuating circumstances, requires negotiation and agreement of all parties.
10. Decisions to support or not support applicant plans to move from one office to another should be the logical outcome of the Case Planning process involving all active services.
PROCEDURE
11. Case Planning.
The objective of case planning is to most efficiently utilize resources in the best interest of applicants
1) Referring Office Responsibilities
a) contact the Supervisor designated authority of the receiving office by telephone to discuss the applicant’s proposal and arrange case consultation, if necessary;
b) prepare a case summary including the applicants’ proposed plan prior to conferencing;
c) conference to discuss the proposed transfer, if warranted. Ideally, this conference should involve all parties;
d) implement the decisions reached at the case conference with the applicant.
2) Receiving Office Responsibilities
a) upon being contacted by the referring office and after preliminary discussion, the Supervisor will participate in arranging a conference site, date and time, if required;
b) the Supervisor arranges for appropriate staff to attend the case conference;
c) staff attending the case conference represent the office related to decision making regarding the proposed plan;
d) agreement on the case plan must be negotiated between the respective offices;
e) if the applicant has not been included in the initial case conference, a transfer interview which includes the two Primary Workers and the applicant should be arranged, if warranted.
12. Unplanned Moves
1) On occasion, applicants will move from one office to another without consultation and with questionable planning. Applicants in these circumstances occasionally present themselves to staff in crises demanding immediate service. To whatever degree feasible, applicants should be left to deal with the consequences of their behavior.
2) It is the responsibility of the applicant to notify his/her present worker of the change in circumstances and ask to have the service transferred.
3) Staff are not bound to support applicant plans that are poorly conceived or unplanned. In those instances, where an applicant presents him/herself without the proper transfer the applicant should be referred back to his/her current worker.
PURPOSE
To facilitate efficient, effective case planning with applicant’s moving from one office to another.
PRINCIPLE
1. Applicants may choose to live wherever they wish.
2. Applicants are responsible for the consequences of their decisions.
3. Social Assistance should not be used to support situations that result or are likely to result from poor or non-existent planning.
4. Decision making on how applicants move from one office to another should be based on sound planning.
5. The involvement, cooperation and expectation of staff regarding transfer of applicants between offices are the same as exist when applicants are transferred between workers in the same office.
POLICY
6. Applicant requests for relocation will initiate a planning and consultative process to ensure that all parties involved, including the applicant, current office and receiving office, recognize the implications of the proposed change and support the plan.
7. Case planning should include, but is not limited to, the following considerations:
1) What advantages to the applicant are anticipated as a result of the proposed relocation?
2) Is relocation warranted for health and safety reasons?
3) What is the probability that the anticipated advantages will be realized?
4) Will the case plan result in greater applicant self-sufficiency?
5) Are adequate services available in the receiving office area?
6) What is the applicant’s contribution to the case plan?
7) Do the anticipated advantages to the applicant justify the degree of resource expenditure by the Social Assistance Program?
8) Can continuity of services be maintained?
8. Case planning and cooperation should be paramount in dealing with multi problem, crisis prone individuals or families, in order to decrease risk.
9. Deviation from Social Assistance Policy, if necessitated by extenuating circumstances, requires negotiation and agreement of all parties.
10. Decisions to support or not support applicant plans to move from one office to another should be the logical outcome of the Case Planning process involving all active services.
PROCEDURE
11. Case Planning.
The objective of case planning is to most efficiently utilize resources in the best interest of applicants
1) Referring Office Responsibilities
a) contact the Supervisor designated authority of the receiving office by telephone to discuss the applicant’s proposal and arrange case consultation, if necessary;
b) prepare a case summary including the applicants’ proposed plan prior to conferencing;
c) conference to discuss the proposed transfer, if warranted. Ideally, this conference should involve all parties;
d) implement the decisions reached at the case conference with the applicant.
2) Receiving Office Responsibilities
a) upon being contacted by the referring office and after preliminary discussion, the Supervisor will participate in arranging a conference site, date and time, if required;
b) the Supervisor arranges for appropriate staff to attend the case conference;
c) staff attending the case conference represent the office related to decision making regarding the proposed plan;
d) agreement on the case plan must be negotiated between the respective offices;
e) if the applicant has not been included in the initial case conference, a transfer interview which includes the two Primary Workers and the applicant should be arranged, if warranted.
12. Unplanned Moves
1) On occasion, applicants will move from one office to another without consultation and with questionable planning. Applicants in these circumstances occasionally present themselves to staff in crises demanding immediate service. To whatever degree feasible, applicants should be left to deal with the consequences of their behavior.
2) It is the responsibility of the applicant to notify his/her present worker of the change in circumstances and ask to have the service transferred.
3) Staff are not bound to support applicant plans that are poorly conceived or unplanned. In those instances, where an applicant presents him/herself without the proper transfer the applicant should be referred back to his/her current worker.
Credit/Service Authorization
7-6 Credit/Service Authorization
PURPOSE
1. To provide urgently needed items or services to the applicant, or on the applicants behalf.
2. To provide authorization for an applicant to purchase special need items or services where there are limits according to regulation or policy.
3. To provide assistance in lieu of a cheque to ensure that an applicant acquires the intended items or services.
PRINCIPLE
4. A cheque is to be issued to an applicant, if at all possible, through the regular cheque-producing system.
5. Credit/Service Authorizations (C/SA) are to be used where:
(a) a delay, waiting for a cheque to be processed, would cause hardship; or
(b) because of limits to a special need, the applicant is to be restricted in the type and cost of the goods or service; or
(c) because of the applicant’s inability to handle money, it is determined to be the best method for the applicant to acquire the goods or service.
6. Issuance of a C/SA should be discussed with the applicant as the use of it tends to identify the individual as a recipient of Social Assistance.
POLICY
7. The use of the C/SA for the above three purposes is to be considered when completing the C/SA. For example, a C/SA for emergency food does not include the purchase of tobacco products, which are not considered food or an emergency need. When the C/SA is issued to provide an item or service of special need, the restrictions according to regulation or policy apply.
8. The vendor to whom the C/SA is designated shall be the choice of the applicant. Staff are not to encourage the support of any particular vendor but staff could suggest vendors where the best value may be gotten, considering such factors as the cost of food, cost of transportation to shop for the food, etc.
9. Staff should be aware that some vendors do not accept a C/SA. There also may be some limitations by some vendors. For example, the minimum delivery for most fuel companies is 100 gallons.
10. A C/SA is to be considered as a substitute for a cheque and is to be completed as such. It is to be filled in completely, including all limitations to the C/SA value such as expiry date, volume, dollar value, one-time-only, etc.
11. Because the C/SA is a substitute for a cheque, the vendor should honour the limitation the worker has authorized. However, in the case of buying groceries, clothing and oil, it is possible to exceed the limitation by a few dollars. In these cases, the Department may pay up to 10 percent or $5.00 (whichever is less) of the original limit. Staff should keep in mind that, if a cheque were issued for $100, the applicant would not be able to receive $102 worth of goods.
12. If, after a C/SA is issued, circumstances change and the resulting bill is higher than the approved limit, the worker should document the reasons and give authorization for the amount to be paid, whether that is the original limit or any or all of the amount of the invoice. This documentation should be attached to the C/SA and invoice to be sent for payment.
13. Signing authority limits for staff with Social Assistance authorization as outlined in Instruction 6-1 also apply to the issuance of a C/SA.
PROCEDURE
14. A C/SA for emergency food is populated with "No Tobacco Purchase".
15. If the cost is unknown, the applicant will be asked to get an estimate on the item(s) and present it to the worker before the C/SA is issued.
16. The C/SA is to be processed for payment only if a bill, invoice, or delivery slip is returned by the vendor with a copy of the C/SA. A statement is not acceptable. A C/SA should be returned to the vendor if the supporting documentation is not acceptable. If proper documentation is not available from the vendor, a written reason should accompany the C/SA when processed for payment.
CROSS REFERENCE
3-13 Emergency Assistance
5-1 Shelter - Rent/Mortgage
5-7 Prescription Drugs
6-1 Special Need Expenditures - General
6-3-2 Transportation - Child Restraint Seats
6-4-1 Medical Supplies
6-7 Optical Care
6-8 Dental Benefits
6-10 Furniture and Appliances - Purchase or Repair
6-11 Repairs to Property
6-12 School Allowance
7-1 Misappropriation of Assistance by Applicants
PURPOSE
1. To provide urgently needed items or services to the applicant, or on the applicants behalf.
2. To provide authorization for an applicant to purchase special need items or services where there are limits according to regulation or policy.
3. To provide assistance in lieu of a cheque to ensure that an applicant acquires the intended items or services.
PRINCIPLE
4. A cheque is to be issued to an applicant, if at all possible, through the regular cheque-producing system.
5. Credit/Service Authorizations (C/SA) are to be used where:
(a) a delay, waiting for a cheque to be processed, would cause hardship; or
(b) because of limits to a special need, the applicant is to be restricted in the type and cost of the goods or service; or
(c) because of the applicant’s inability to handle money, it is determined to be the best method for the applicant to acquire the goods or service.
6. Issuance of a C/SA should be discussed with the applicant as the use of it tends to identify the individual as a recipient of Social Assistance.
POLICY
7. The use of the C/SA for the above three purposes is to be considered when completing the C/SA. For example, a C/SA for emergency food does not include the purchase of tobacco products, which are not considered food or an emergency need. When the C/SA is issued to provide an item or service of special need, the restrictions according to regulation or policy apply.
8. The vendor to whom the C/SA is designated shall be the choice of the applicant. Staff are not to encourage the support of any particular vendor but staff could suggest vendors where the best value may be gotten, considering such factors as the cost of food, cost of transportation to shop for the food, etc.
9. Staff should be aware that some vendors do not accept a C/SA. There also may be some limitations by some vendors. For example, the minimum delivery for most fuel companies is 100 gallons.
10. A C/SA is to be considered as a substitute for a cheque and is to be completed as such. It is to be filled in completely, including all limitations to the C/SA value such as expiry date, volume, dollar value, one-time-only, etc.
11. Because the C/SA is a substitute for a cheque, the vendor should honour the limitation the worker has authorized. However, in the case of buying groceries, clothing and oil, it is possible to exceed the limitation by a few dollars. In these cases, the Department may pay up to 10 percent or $5.00 (whichever is less) of the original limit. Staff should keep in mind that, if a cheque were issued for $100, the applicant would not be able to receive $102 worth of goods.
12. If, after a C/SA is issued, circumstances change and the resulting bill is higher than the approved limit, the worker should document the reasons and give authorization for the amount to be paid, whether that is the original limit or any or all of the amount of the invoice. This documentation should be attached to the C/SA and invoice to be sent for payment.
13. Signing authority limits for staff with Social Assistance authorization as outlined in Instruction 6-1 also apply to the issuance of a C/SA.
PROCEDURE
14. A C/SA for emergency food is populated with "No Tobacco Purchase".
15. If the cost is unknown, the applicant will be asked to get an estimate on the item(s) and present it to the worker before the C/SA is issued.
16. The C/SA is to be processed for payment only if a bill, invoice, or delivery slip is returned by the vendor with a copy of the C/SA. A statement is not acceptable. A C/SA should be returned to the vendor if the supporting documentation is not acceptable. If proper documentation is not available from the vendor, a written reason should accompany the C/SA when processed for payment.
CROSS REFERENCE
3-13 Emergency Assistance
5-1 Shelter - Rent/Mortgage
5-7 Prescription Drugs
6-1 Special Need Expenditures - General
6-3-2 Transportation - Child Restraint Seats
6-4-1 Medical Supplies
6-7 Optical Care
6-8 Dental Benefits
6-10 Furniture and Appliances - Purchase or Repair
6-11 Repairs to Property
6-12 School Allowance
7-1 Misappropriation of Assistance by Applicants
Prosecutions
7-5 Prosecutions
PURPOSE
1. To ensure that situations involving suspected fraud are reported for further investigation and possible prosecution.
PRINCIPLE
2. Persons should not be allowed to fraudulently receive Social Assistance benefits to which they are not entitled.
3. Workers shall report, but not accuse, persons suspected of obtaining benefits fraudulently.
POLICY
4. Section 8 of the Social Assistance Act states:
"Every person who knowingly
(a) makes a false or misleading statement in any application or report under this Act or makes any application or report that by reason of any non-disclosure of facts is false or misleading;
(b) provides any person employed in the administration or enforcement of this Act with any statement or information that is false in any material part;
(c) cashes any cheque for an assistance to which the person is not entitled;
(d) fails to report that the circumstances which caused the person to qualify for assistance have changed;
(e) contravenes section 6 by communicating or allowing to be communicated to any person privileged information or by allowing any person to inspect or have access to any statement or other writing containing any such information;
(f) persistently refuses or neglects to maintain any other person for whose maintenance the person is liable;
is guilty of an offence and liable on summary conviction to imprisonment for a term not exceeding six months or to a fine not exceeding $2,000 or to both."
5. Every instance of suspected intent to fraudulently obtain Social Assistance benefits shall be reported by the employee to the Area Overpayment Coordinator.
PROCEDURE
6. The Area Overpayment Coordinator shall forward the completed Overpayment Record along with a written summary of the case to the Supervisor/Area Coordinator.
7. The Supervisor will review the documentation to ensure it contains the appropriate information.
8. Consultation between the Supervisor/Area Coordinator, Director of Social Programs and local office designated authority will determine if further investigation and possible prosecution is warranted. If a decision to refer for further investigation and possible prosecution is made, the region will contact the local police.
9. Subsequent to their investigation, after consultation with the Crown Prosecutor, police authorities will withdraw from the case or lay charges.
10. When the police investigation results in charges against an applicant, the Crown Prosecutor will line up witnesses, advise them of their schedule, brief them and ensure their attendance at Court with the correct documents.
11. Supervisor/Area Coordinator will advise the Director of Social Programs the outcome of prosecutions.
12. In order to keep the file up to date, the Supervisor/Area Coordinator will request an updated status report on cases referred for prosecution on a six month basis and inform the Director of Social Programs of case disposition.
13. When the charges result in a conviction, and repayment is ordered by the court, recovery becomes the responsibility of the Probation Officers in the Provincial Court. Payments are made to the Provincial Court Clerk who will maintain a record of payments. It is a regional responsibility to follow up with probation services to ensure payment.
PURPOSE
1. To ensure that situations involving suspected fraud are reported for further investigation and possible prosecution.
PRINCIPLE
2. Persons should not be allowed to fraudulently receive Social Assistance benefits to which they are not entitled.
3. Workers shall report, but not accuse, persons suspected of obtaining benefits fraudulently.
POLICY
4. Section 8 of the Social Assistance Act states:
"Every person who knowingly
(a) makes a false or misleading statement in any application or report under this Act or makes any application or report that by reason of any non-disclosure of facts is false or misleading;
(b) provides any person employed in the administration or enforcement of this Act with any statement or information that is false in any material part;
(c) cashes any cheque for an assistance to which the person is not entitled;
(d) fails to report that the circumstances which caused the person to qualify for assistance have changed;
(e) contravenes section 6 by communicating or allowing to be communicated to any person privileged information or by allowing any person to inspect or have access to any statement or other writing containing any such information;
(f) persistently refuses or neglects to maintain any other person for whose maintenance the person is liable;
is guilty of an offence and liable on summary conviction to imprisonment for a term not exceeding six months or to a fine not exceeding $2,000 or to both."
5. Every instance of suspected intent to fraudulently obtain Social Assistance benefits shall be reported by the employee to the Area Overpayment Coordinator.
PROCEDURE
6. The Area Overpayment Coordinator shall forward the completed Overpayment Record along with a written summary of the case to the Supervisor/Area Coordinator.
7. The Supervisor will review the documentation to ensure it contains the appropriate information.
8. Consultation between the Supervisor/Area Coordinator, Director of Social Programs and local office designated authority will determine if further investigation and possible prosecution is warranted. If a decision to refer for further investigation and possible prosecution is made, the region will contact the local police.
9. Subsequent to their investigation, after consultation with the Crown Prosecutor, police authorities will withdraw from the case or lay charges.
10. When the police investigation results in charges against an applicant, the Crown Prosecutor will line up witnesses, advise them of their schedule, brief them and ensure their attendance at Court with the correct documents.
11. Supervisor/Area Coordinator will advise the Director of Social Programs the outcome of prosecutions.
12. In order to keep the file up to date, the Supervisor/Area Coordinator will request an updated status report on cases referred for prosecution on a six month basis and inform the Director of Social Programs of case disposition.
13. When the charges result in a conviction, and repayment is ordered by the court, recovery becomes the responsibility of the Probation Officers in the Provincial Court. Payments are made to the Provincial Court Clerk who will maintain a record of payments. It is a regional responsibility to follow up with probation services to ensure payment.
Case Audits
7-4 Case Audits
PURPOSE
1. To provide cost control and accountability feedback in relation to the provision of Social Assistance benefits.
PRINCIPLE
2. Applicants and workers must be held accountable for the expenditure of public funds.
3. Case audits confirm the accuracy of information given by an applicant and entitlement to Social Assistance benefits and also to ensure workers apply only approved policies.
4. Case audits provide useful information for the development or refinement of policies and procedures, relevant staff training, improved case management and service delivery.
5. Information related to apparent attempts to defraud may be more appropriately gathered by an independent third party with special skills and knowledge in this area.
POLICY
6. The case auditor will conduct both random and requested case audits which shall include:
(a) Financial Case Audit - To verify income and expense statements; to confirm that eligibility was established in accordance with regulations and policy; to ensure the appropriate benefit was awarded.
(b) Administrative Case Audit - To check for required documentation; completion of appropriate forms; and content quality.
7. Case Audit Reports shall indicate the findings of the audit plus any related corrective recommendations. Comments regarding, but not limited to, the following may be made:
(a) Termination or adjustment of awards or benefits;
(b) The desirability of a referral for prosecution consideration;
(c) Observation in relation to worker error;
(d) The need for new or revised procedures;
(e) Improved case administration.
8. In situations where the Case Auditor has reasonable grounds for doing so, he/she may recommend the holding of an applicant’s cheque until the concern is resolved. "Reasonable grounds" may include but are not limited to:
(a) Situations in which Social Assistance abuse is evident;
(b) Situations in which contact with the applicant cannot be made, after reasonable efforts;
(c) Situations in which major discrepancies between actual and allowable expenses and income are indicated.
(d) Situations in which the applicant refuses to participate in the case audit process.
PROCEDURE
9. Routine case audit procedure is as follows:
(a) The Case Auditor shall contact the Social Assistance office (with or without advance notice) and request the files to be audited;
(b) Upon completion of the audit, the Case Auditor shall prepare his/her audit report. 124, retain one copy with copies of relevant supporting documentation and send the original to the designated authority.
(c) Appropriate Social Assistance staff shall further inquire or review and respond by completing the appropriate section on the form and returning it to the Case Auditor within 30 days of receipt of the Audit Report form. If a response cannot be made within the above time frame, the reason(s) for delay will be documented and forwarded to the Case Auditor before the expiration of the 30 day period.
(d) The Case Auditor shall log the returned audit forms and forward them, along with a copy of the related Case Status Sheet, to the Financial Services Manager, Department of Social Services and Seniors, with a copy to the appropriate Area Coordinator once per month.
(e) The Financial Services Manager shall enter any comments and return the forms to the Case Auditor, who in turn will log them again and forward the original to the appropriate office for inclusion in the client file.
10. In situations where the Case Auditor recommends that an applicant’s cheque be held, immediately he/she shall inform the region, giving the reason for that request. Notification may be provided in writing or verbally.
11. More generalized audit observations related to regulation, policy, procedure, case administration and service delivery shall be reported by the Case Auditor to the Financial Services Manager who in turn shall forward the report to the Director of Social Programs and the Deputy Minister of Social Programs and Seniors.
PURPOSE
1. To provide cost control and accountability feedback in relation to the provision of Social Assistance benefits.
PRINCIPLE
2. Applicants and workers must be held accountable for the expenditure of public funds.
3. Case audits confirm the accuracy of information given by an applicant and entitlement to Social Assistance benefits and also to ensure workers apply only approved policies.
4. Case audits provide useful information for the development or refinement of policies and procedures, relevant staff training, improved case management and service delivery.
5. Information related to apparent attempts to defraud may be more appropriately gathered by an independent third party with special skills and knowledge in this area.
POLICY
6. The case auditor will conduct both random and requested case audits which shall include:
(a) Financial Case Audit - To verify income and expense statements; to confirm that eligibility was established in accordance with regulations and policy; to ensure the appropriate benefit was awarded.
(b) Administrative Case Audit - To check for required documentation; completion of appropriate forms; and content quality.
7. Case Audit Reports shall indicate the findings of the audit plus any related corrective recommendations. Comments regarding, but not limited to, the following may be made:
(a) Termination or adjustment of awards or benefits;
(b) The desirability of a referral for prosecution consideration;
(c) Observation in relation to worker error;
(d) The need for new or revised procedures;
(e) Improved case administration.
8. In situations where the Case Auditor has reasonable grounds for doing so, he/she may recommend the holding of an applicant’s cheque until the concern is resolved. "Reasonable grounds" may include but are not limited to:
(a) Situations in which Social Assistance abuse is evident;
(b) Situations in which contact with the applicant cannot be made, after reasonable efforts;
(c) Situations in which major discrepancies between actual and allowable expenses and income are indicated.
(d) Situations in which the applicant refuses to participate in the case audit process.
PROCEDURE
9. Routine case audit procedure is as follows:
(a) The Case Auditor shall contact the Social Assistance office (with or without advance notice) and request the files to be audited;
(b) Upon completion of the audit, the Case Auditor shall prepare his/her audit report. 124, retain one copy with copies of relevant supporting documentation and send the original to the designated authority.
(c) Appropriate Social Assistance staff shall further inquire or review and respond by completing the appropriate section on the form and returning it to the Case Auditor within 30 days of receipt of the Audit Report form. If a response cannot be made within the above time frame, the reason(s) for delay will be documented and forwarded to the Case Auditor before the expiration of the 30 day period.
(d) The Case Auditor shall log the returned audit forms and forward them, along with a copy of the related Case Status Sheet, to the Financial Services Manager, Department of Social Services and Seniors, with a copy to the appropriate Area Coordinator once per month.
(e) The Financial Services Manager shall enter any comments and return the forms to the Case Auditor, who in turn will log them again and forward the original to the appropriate office for inclusion in the client file.
10. In situations where the Case Auditor recommends that an applicant’s cheque be held, immediately he/she shall inform the region, giving the reason for that request. Notification may be provided in writing or verbally.
11. More generalized audit observations related to regulation, policy, procedure, case administration and service delivery shall be reported by the Case Auditor to the Financial Services Manager who in turn shall forward the report to the Director of Social Programs and the Deputy Minister of Social Programs and Seniors.
Appeals
7-3 Appeals
PURPOSE
1. To facilitate the processing of an applicant’s appeal request, and to clarify responsibility for tasks in the appeal process.
PRINCIPLE
2. All applicants have the right of an appeal by an independent authority should they not be satisfied with the decisions made with respect to their application for assistance.
3. An applicant should be able to have a response to his/her appeal request without undue delay.
4. The formal appeal process should not negate the role of the supervisor to ensure staff are making decisions consistent with the regulations, policy and good judgment.
POLICY
5. The Act, at s.5.1(1), allows for a formal appeal hearing before the Board of disputed decisions:
A person who is dissatisfied with a decision respecting the provision of Social Assistance under this Act may appeal the decision by notice to the chairperson of the Board not later than 30 days from the date the decision was made known to the person.
Regulation 45(1) sets out the possible grounds for an appeal:
Pursuant to subsection 5.1(1) of the Act, an applicant may appeal a decision of the Department respecting the provision of Social Assistance under the Act or these regulations on the following grounds:
(a) the Social Assistance office refused to accept an application for Social Assistance;
(b) the application for Social Assistance was denied;
(c) the amount of Social Assistance granted was not in accordance with these regulations or the written policies; or
(d) the applicant’s Social Assistance was reduced, suspended, cancelled or withheld.
6. Regulation 47 requires that:
(1) Where an appeal is made against a decision to reduce, suspend or cancel financial assistance,
(a) for an appellant who was receiving assistance under Part I, the amount of financial assistance authorized by the Social Assistance office as emergency assistance shall be paid to the appellant; and
(b) for an appellant who was receiving assistance under Part II, the amount of Social Assistance previously granted shall continue to be paid, until the Board renders its decision.
(2) Where an appeal is made against a refusal by the Department to grant assistance, no Social Assistance shall be paid to the appellant unless the Board grants the appeal.
PROCEDURE
7. Appeals
(a) The applicant or other persons acting on his/her behalf (the "appellant") shall request an appeal of his/her case by writing to the Social Assistance Appeal Board, P. O. Box 2000, 11 Kent Street, Jones Building, Charlottetown, P.E.I., C1A 7N8.
(b) The Appeals Administrative Assistant reviews and documents the information contained in the appellant’s letter to ensure that the particular case is consistent with the provisions of the Social Assistance Act, Regulations and Policy.
(c) The Appeals Administrative Assistant will forward a Notice of Appeal and the original letter of appeal on all appeals to the Chairperson of the Appeal Board.
(d) The Appeals Administrative Assistant will forward to the appropriate office, an Appeal Information Summary form, and attach a copy of the letter of appeal from the appellant.
8. Social Assistance Appeal Board Hearing:
The Appeal Board will ensure:
(a)Upon receipt of a notice of appeal, the Chairperson of the Board shall cause a hearing to be held as soon as possible, and not later than fifteen calendar days after the receipt of the notice by the Appeals Administrative Assistant.
(b) A Notice to Appear letter is sent by registered mail, to the appellant by the Chairperson of the Social Assistance Appeal Board to the address on the Notice of Appeal form notifying the appellant of the date, time and place the appeal hearing is to be held.
(c) The Chairperson will notify the appropriate designated staff member for each Social Assistance office, the other Board Members that will be attending the hearing and the Appeals Administrative Assistant, of the date, time and place the appeal hearing is to be heard.
d) Prior to the hearing date, the Appeals Administrative Assistant will:
(i)notify the Appellant by telephone that a Notice to Appear letter has been sent by registered mail and verbally confirm with the appellant the date, time and place of the appeal hearing and his/her attendance;
(ii) notify the Chairperson, Area Office and/or others of any changes or cancellations.
(e) The Board will only hear evidence and information that pertain to the appeal at hand from both the appellant and the respondent.
(f) The Chairperson shall determine the conduct of the hearings in accordance with the Protocol for Recorded Social Assistance Appeal Board hearings which shall, when possible, include recording the proceeding on CD in its’ entirety. (See Appendix A)
(g) When proceedings recorded on CD, the Chair will ensure record protection by:
(i) including the CD as part of an official appeal hearing process;
(ii) sealing the CD in an envelope with the appellants name, file number and date of the hearing, and forward, along with other appeal documents, to the Appeals Administrative Assistant.
(h) All information or evidence to be presented on appeal shall be heard prior to the conclusion of the hearing. The Board shall not hear further or additional evidence after the conclusion of the hearing except with the consent of all parties involved.
(i) The Appeals Administrative Assistant shall maintain accurate files and a log of all Social Assistance Appeal Board hearings to ensure prompt and consistent processing by departmental staff. He/she will also be prepared to gather accurate statistics on these activities, the causes, and the steps that have been taken to reduce or eliminate them in the future.
The Area Office will ensure that:
(a) The applicant has been properly informed of the rationale for the office’s decision. This includes citing the section(s) of policy or regulations, and, if necessary, a copy of the policy cited, and clear written details as to the rationale that has been used in coming to this decision.
(b) They prepare to present their case at the Appeal Hearing.
(c) The Appeal Information Summary form is fully completed by a Social Assistance worker, reviewed signed and dated by the Supervisor, and presented to the Board and the appellant not less than 15 minutes prior to the start of the hearing.
(d) They prepare and compile any additional documents/evidence that they wish to present at the hearing. This includes, making copies of all documents to be presented and giving these documents to both the Board and the Appellant not less than 15 minutes prior to the start of the hearing.
(e) They notify the Appeals Administrative Assistant of any changes or cancellations that may have been reported to the region.
(f) They make available secretarial services for the Board, which includes forwarding a signed copy of the Decision to the Appellant, the Appeals Administrative Assistant (including all other appeal documents and the original CD, and to the Area Files.
(g) Suitable accommodations are provided to the Board at the time of the appeal.
APPENDIX ‘A’
Protocol for the Conduct of Recorded (Social) Assistance Appeal Board Hearings
As with most administrative tribunals, there is no formal requirement for recording Social Assistance Appeal Board proceedings. From a practical standpoint, however, it can prove extremely beneficial for purposes of:
* clarifying information presented at the hearing;
* eliminating any possible errors in memory or disputes as to what was said; and
* providing an official record for further appeal or review.
There may be a perception that the proceedings become somewhat more formal with the introduction of recording mechanisms and this is not the intention, nor is it the desired result. Appeals are intimidating enough for an Appellant without making them more so. Therefore, it is beneficial to establish a protocol for the opening and general conduct of a hearing which will serve several purposes including the maintenance of consistency from one hearing to the next, clarification of the process for the client, and ensuring that the basic procedural requirements have been met in the event the appeal should be taken further.
The development of a standard protocol may also serve to eliminate some common misconceptions about the Social Assistance Appeal Board and the process generally. Perhaps the most common of these is the notion, on the part of some Appellants, that the Board members have decided the case before the Appeal is even heard. For this reason, it is crucial that several points get made at the commencement of the hearing including the fact that the Appeal Board is an independent body and separate from the Department. Some explanation should also be given to the Appellant with respect to the fact that the Appeal documents have been reviewed but that the hearing is the forum for the Appellant to present his/her case.
Another common misconception is the expectation on the part of the Appellant that he/she should have the opportunity to re-tell his/her whole case, rather than just deal with the specific issue(s) under appeal. Part of this is perhaps due to the notion that the Appeal Board has sweeping and unlimited authority to grant the Appellant whatever he/she is seeking rather than be limited by the parameters of the governing Act, Regulations and Policy. It is, therefore, useful to make it clear to the Appellant that it is only the issue under appeal that will be decided upon and, further, impress upon the Appellant that the Board must act within the confines of the legislation.
Procedurally, there are advantages to following a standard protocol. If the process is clearly set out at the beginning of the hearing, an "all cards on the table" approach, the hearings may be expedited in that there will be less time spent on non-relevant issues. The Appellant will be aware of his/her rights with respect to the appeal. And it could also eliminate any perception of bias on the part of the Appellant if he/she is aware that the Board is a separate entity from the Department. Finally, but equally important, a standard protocol can serve to protect the interests of the Board in the event the appeal is taken further, such as to judicial review. If the record of the hearing establishes that principles of procedural fairness were followed and also that the Appellant was not misled by anything said, there is less chance of the issues being clouded by procedural attacks.
What follows is a general guide for the opening and conclusion of an appeal hearing. Clearly, there will be an element of discretion involved. Depending upon the circumstances of each case, it may be necessary to elaborate on some points. In any event, there are basic steps which may be followed to ensure fair and efficient conduct of Appeal Board hearings.
At the beginning of the Appeal Board hearing:
10. The Chairperson should welcome the Appellant and his/her representative, if one is present, as well as the representative(s) for the Department.
11. The Chairperson should introduce him/herself as well as the other Board members present. Any observers present should also be introduced and any witnesses present should be noted for the record.
12. The hearing should then be opened with a statement to the effect that the Board has convened to hear submissions with respect to a decision of the Department and give particulars and the date of that decision. The specific issue under appeal should be identified, clarified and stated for the record. The Appellant should be asked to confirm that this is her/her understanding of the issue as well.
13. An explanation should be given to the Appellant that the Appeal documents have been reviewed by the Board members prior to the hearing, but it should also be emphasized that the purpose is solely to be familiar with the circumstances of the case. Caution should be exercised so as not to give the erroneous impression that the Board members have pre-judged the case. The Appellant should be aware that the hearing is his/her opportunity to state his/her case and review any exhibits tendered.
14. The Chairperson should then outline the process that will take place during the hearing. This should include reference to the sequence of speakers, the fact that the proceedings are recorded, and the anticipated conduct of persons involved. It should be made clear to the Appellant that the Board members may take notes, ask questions and/or seek clarification on a point during the hearing, but it should be equally clear that the purpose of this is not to express opposition. Indicate to the Appellant that there will be an opportunity for him/her to add anything further at the end of the hearing.
15. The Chairperson may wish to indicate that the Social Assistance Appeal Board is an independent body and that the Board is not bound by the previous decision-makers’ findings. The Appellant should be assured that the Board will assess the evidence and submissions in accordance with the legislation and applicable regulations and policies, to arrive at its’ own conclusions on the matter. At a minimum, the Appellant should be aware that decisions of the Board cannot exceed the authority of the governing legislation.
During the Appeal hearing:
(a) The Appellant should be made to feel at ease with assurances that the process is an informal one, and even something as basic as the offer of a glass of water.
(b) Ensure that the Appellant has the opportunity to speak.
(c) Make certain that the Appellant and staff can hear and understand the Board members at all times.
(d) The Board should be respectful to the Appellant and staff at all times.
(e) Refrain from the use of words that could lead the Appellant to perceive that his/her case has already been decided.
(f) The use of discriminatory words such as references to age, gender, race, etc., should be avoided.
At the conclusion of the Appeal hearing:
(a) The Appellant should be given the opportunity to make any additional points or add anything that has not already been covered. If someone else has acted as a representative for the Appellant throughout the hearing, this offer should be extended specifically to the Appellant so that there is no risk of the Appellant feeling that his/her case was not fully presented.
(b) When the evidence is complete, the Chairperson should confirm the Appellant’s mailing address and advise the Appellant as to when he/she can expect a decision.
(c)The recording equipment can then be shut off. The CD should be removed with the Appellant and the Area representative present, the Appellant’s name, the date of the hearing, and the file number should be written on the face of the CD.
(d) Further evidence should never be heard after the close of a hearing, except with the Appellant and the Departmental designated authority representative present and consenting to the resumption of the hearing. If additional evidence is required, a new CD should be used and appropriate recitals made at the beginning of it to identify the CD as being the second CD for that particular hearing.
(e) It is possible that the fact of the proceedings being recorded will give rise to requests for transcripts of the hearings. The Social Assistance Appeal Board is not, nor should it be, in the business of providing a transcription service. Therefore, requests for a transcript should be addressed by providing the Appellant, or the Respondent as the case may be, with a copy of the CD. Given that there is no legislative requirement for recording proceedings, there is similarly no requirement to provide transcripts. Providing a copy of the CD, however, is a cost effective means of balancing interests.
PURPOSE
1. To facilitate the processing of an applicant’s appeal request, and to clarify responsibility for tasks in the appeal process.
PRINCIPLE
2. All applicants have the right of an appeal by an independent authority should they not be satisfied with the decisions made with respect to their application for assistance.
3. An applicant should be able to have a response to his/her appeal request without undue delay.
4. The formal appeal process should not negate the role of the supervisor to ensure staff are making decisions consistent with the regulations, policy and good judgment.
POLICY
5. The Act, at s.5.1(1), allows for a formal appeal hearing before the Board of disputed decisions:
A person who is dissatisfied with a decision respecting the provision of Social Assistance under this Act may appeal the decision by notice to the chairperson of the Board not later than 30 days from the date the decision was made known to the person.
Regulation 45(1) sets out the possible grounds for an appeal:
Pursuant to subsection 5.1(1) of the Act, an applicant may appeal a decision of the Department respecting the provision of Social Assistance under the Act or these regulations on the following grounds:
(a) the Social Assistance office refused to accept an application for Social Assistance;
(b) the application for Social Assistance was denied;
(c) the amount of Social Assistance granted was not in accordance with these regulations or the written policies; or
(d) the applicant’s Social Assistance was reduced, suspended, cancelled or withheld.
6. Regulation 47 requires that:
(1) Where an appeal is made against a decision to reduce, suspend or cancel financial assistance,
(a) for an appellant who was receiving assistance under Part I, the amount of financial assistance authorized by the Social Assistance office as emergency assistance shall be paid to the appellant; and
(b) for an appellant who was receiving assistance under Part II, the amount of Social Assistance previously granted shall continue to be paid, until the Board renders its decision.
(2) Where an appeal is made against a refusal by the Department to grant assistance, no Social Assistance shall be paid to the appellant unless the Board grants the appeal.
PROCEDURE
7. Appeals
(a) The applicant or other persons acting on his/her behalf (the "appellant") shall request an appeal of his/her case by writing to the Social Assistance Appeal Board, P. O. Box 2000, 11 Kent Street, Jones Building, Charlottetown, P.E.I., C1A 7N8.
(b) The Appeals Administrative Assistant reviews and documents the information contained in the appellant’s letter to ensure that the particular case is consistent with the provisions of the Social Assistance Act, Regulations and Policy.
(c) The Appeals Administrative Assistant will forward a Notice of Appeal and the original letter of appeal on all appeals to the Chairperson of the Appeal Board.
(d) The Appeals Administrative Assistant will forward to the appropriate office, an Appeal Information Summary form, and attach a copy of the letter of appeal from the appellant.
8. Social Assistance Appeal Board Hearing:
The Appeal Board will ensure:
(a)Upon receipt of a notice of appeal, the Chairperson of the Board shall cause a hearing to be held as soon as possible, and not later than fifteen calendar days after the receipt of the notice by the Appeals Administrative Assistant.
(b) A Notice to Appear letter is sent by registered mail, to the appellant by the Chairperson of the Social Assistance Appeal Board to the address on the Notice of Appeal form notifying the appellant of the date, time and place the appeal hearing is to be held.
(c) The Chairperson will notify the appropriate designated staff member for each Social Assistance office, the other Board Members that will be attending the hearing and the Appeals Administrative Assistant, of the date, time and place the appeal hearing is to be heard.
d) Prior to the hearing date, the Appeals Administrative Assistant will:
(i)notify the Appellant by telephone that a Notice to Appear letter has been sent by registered mail and verbally confirm with the appellant the date, time and place of the appeal hearing and his/her attendance;
(ii) notify the Chairperson, Area Office and/or others of any changes or cancellations.
(e) The Board will only hear evidence and information that pertain to the appeal at hand from both the appellant and the respondent.
(f) The Chairperson shall determine the conduct of the hearings in accordance with the Protocol for Recorded Social Assistance Appeal Board hearings which shall, when possible, include recording the proceeding on CD in its’ entirety. (See Appendix A)
(g) When proceedings recorded on CD, the Chair will ensure record protection by:
(i) including the CD as part of an official appeal hearing process;
(ii) sealing the CD in an envelope with the appellants name, file number and date of the hearing, and forward, along with other appeal documents, to the Appeals Administrative Assistant.
(h) All information or evidence to be presented on appeal shall be heard prior to the conclusion of the hearing. The Board shall not hear further or additional evidence after the conclusion of the hearing except with the consent of all parties involved.
(i) The Appeals Administrative Assistant shall maintain accurate files and a log of all Social Assistance Appeal Board hearings to ensure prompt and consistent processing by departmental staff. He/she will also be prepared to gather accurate statistics on these activities, the causes, and the steps that have been taken to reduce or eliminate them in the future.
The Area Office will ensure that:
(a) The applicant has been properly informed of the rationale for the office’s decision. This includes citing the section(s) of policy or regulations, and, if necessary, a copy of the policy cited, and clear written details as to the rationale that has been used in coming to this decision.
(b) They prepare to present their case at the Appeal Hearing.
(c) The Appeal Information Summary form is fully completed by a Social Assistance worker, reviewed signed and dated by the Supervisor, and presented to the Board and the appellant not less than 15 minutes prior to the start of the hearing.
(d) They prepare and compile any additional documents/evidence that they wish to present at the hearing. This includes, making copies of all documents to be presented and giving these documents to both the Board and the Appellant not less than 15 minutes prior to the start of the hearing.
(e) They notify the Appeals Administrative Assistant of any changes or cancellations that may have been reported to the region.
(f) They make available secretarial services for the Board, which includes forwarding a signed copy of the Decision to the Appellant, the Appeals Administrative Assistant (including all other appeal documents and the original CD, and to the Area Files.
(g) Suitable accommodations are provided to the Board at the time of the appeal.
APPENDIX ‘A’
Protocol for the Conduct of Recorded (Social) Assistance Appeal Board Hearings
As with most administrative tribunals, there is no formal requirement for recording Social Assistance Appeal Board proceedings. From a practical standpoint, however, it can prove extremely beneficial for purposes of:
* clarifying information presented at the hearing;
* eliminating any possible errors in memory or disputes as to what was said; and
* providing an official record for further appeal or review.
There may be a perception that the proceedings become somewhat more formal with the introduction of recording mechanisms and this is not the intention, nor is it the desired result. Appeals are intimidating enough for an Appellant without making them more so. Therefore, it is beneficial to establish a protocol for the opening and general conduct of a hearing which will serve several purposes including the maintenance of consistency from one hearing to the next, clarification of the process for the client, and ensuring that the basic procedural requirements have been met in the event the appeal should be taken further.
The development of a standard protocol may also serve to eliminate some common misconceptions about the Social Assistance Appeal Board and the process generally. Perhaps the most common of these is the notion, on the part of some Appellants, that the Board members have decided the case before the Appeal is even heard. For this reason, it is crucial that several points get made at the commencement of the hearing including the fact that the Appeal Board is an independent body and separate from the Department. Some explanation should also be given to the Appellant with respect to the fact that the Appeal documents have been reviewed but that the hearing is the forum for the Appellant to present his/her case.
Another common misconception is the expectation on the part of the Appellant that he/she should have the opportunity to re-tell his/her whole case, rather than just deal with the specific issue(s) under appeal. Part of this is perhaps due to the notion that the Appeal Board has sweeping and unlimited authority to grant the Appellant whatever he/she is seeking rather than be limited by the parameters of the governing Act, Regulations and Policy. It is, therefore, useful to make it clear to the Appellant that it is only the issue under appeal that will be decided upon and, further, impress upon the Appellant that the Board must act within the confines of the legislation.
Procedurally, there are advantages to following a standard protocol. If the process is clearly set out at the beginning of the hearing, an "all cards on the table" approach, the hearings may be expedited in that there will be less time spent on non-relevant issues. The Appellant will be aware of his/her rights with respect to the appeal. And it could also eliminate any perception of bias on the part of the Appellant if he/she is aware that the Board is a separate entity from the Department. Finally, but equally important, a standard protocol can serve to protect the interests of the Board in the event the appeal is taken further, such as to judicial review. If the record of the hearing establishes that principles of procedural fairness were followed and also that the Appellant was not misled by anything said, there is less chance of the issues being clouded by procedural attacks.
What follows is a general guide for the opening and conclusion of an appeal hearing. Clearly, there will be an element of discretion involved. Depending upon the circumstances of each case, it may be necessary to elaborate on some points. In any event, there are basic steps which may be followed to ensure fair and efficient conduct of Appeal Board hearings.
At the beginning of the Appeal Board hearing:
10. The Chairperson should welcome the Appellant and his/her representative, if one is present, as well as the representative(s) for the Department.
11. The Chairperson should introduce him/herself as well as the other Board members present. Any observers present should also be introduced and any witnesses present should be noted for the record.
12. The hearing should then be opened with a statement to the effect that the Board has convened to hear submissions with respect to a decision of the Department and give particulars and the date of that decision. The specific issue under appeal should be identified, clarified and stated for the record. The Appellant should be asked to confirm that this is her/her understanding of the issue as well.
13. An explanation should be given to the Appellant that the Appeal documents have been reviewed by the Board members prior to the hearing, but it should also be emphasized that the purpose is solely to be familiar with the circumstances of the case. Caution should be exercised so as not to give the erroneous impression that the Board members have pre-judged the case. The Appellant should be aware that the hearing is his/her opportunity to state his/her case and review any exhibits tendered.
14. The Chairperson should then outline the process that will take place during the hearing. This should include reference to the sequence of speakers, the fact that the proceedings are recorded, and the anticipated conduct of persons involved. It should be made clear to the Appellant that the Board members may take notes, ask questions and/or seek clarification on a point during the hearing, but it should be equally clear that the purpose of this is not to express opposition. Indicate to the Appellant that there will be an opportunity for him/her to add anything further at the end of the hearing.
15. The Chairperson may wish to indicate that the Social Assistance Appeal Board is an independent body and that the Board is not bound by the previous decision-makers’ findings. The Appellant should be assured that the Board will assess the evidence and submissions in accordance with the legislation and applicable regulations and policies, to arrive at its’ own conclusions on the matter. At a minimum, the Appellant should be aware that decisions of the Board cannot exceed the authority of the governing legislation.
During the Appeal hearing:
(a) The Appellant should be made to feel at ease with assurances that the process is an informal one, and even something as basic as the offer of a glass of water.
(b) Ensure that the Appellant has the opportunity to speak.
(c) Make certain that the Appellant and staff can hear and understand the Board members at all times.
(d) The Board should be respectful to the Appellant and staff at all times.
(e) Refrain from the use of words that could lead the Appellant to perceive that his/her case has already been decided.
(f) The use of discriminatory words such as references to age, gender, race, etc., should be avoided.
At the conclusion of the Appeal hearing:
(a) The Appellant should be given the opportunity to make any additional points or add anything that has not already been covered. If someone else has acted as a representative for the Appellant throughout the hearing, this offer should be extended specifically to the Appellant so that there is no risk of the Appellant feeling that his/her case was not fully presented.
(b) When the evidence is complete, the Chairperson should confirm the Appellant’s mailing address and advise the Appellant as to when he/she can expect a decision.
(c)The recording equipment can then be shut off. The CD should be removed with the Appellant and the Area representative present, the Appellant’s name, the date of the hearing, and the file number should be written on the face of the CD.
(d) Further evidence should never be heard after the close of a hearing, except with the Appellant and the Departmental designated authority representative present and consenting to the resumption of the hearing. If additional evidence is required, a new CD should be used and appropriate recitals made at the beginning of it to identify the CD as being the second CD for that particular hearing.
(e) It is possible that the fact of the proceedings being recorded will give rise to requests for transcripts of the hearings. The Social Assistance Appeal Board is not, nor should it be, in the business of providing a transcription service. Therefore, requests for a transcript should be addressed by providing the Appellant, or the Respondent as the case may be, with a copy of the CD. Given that there is no legislative requirement for recording proceedings, there is similarly no requirement to provide transcripts. Providing a copy of the CD, however, is a cost effective means of balancing interests.
Overpayments
7-2 Over payments
PURPOSE
1. To identify, recover or otherwise account for Social Assistance benefits received in excess of eligibility by applicants.
PRINCIPLE
2. To avoid future hardship to applicants, overpayments should be prevented by accurate information gathering, careful calculations, correct application of regulation and policy, and timely reviews.
3. Overpayments are cash or material benefits which the applicant was not entitled to receive.
4. Some Social Assistance benefits may not be considered overpayments when caused by an error in interpretation or judgement by the worker, or systems error.
5. The overpayment recovery rate should be realistically based upon the applicants ability to pay.
POLICY
6. All overpayments shall be documented on an Overpayment Record (HSS 127) by the assigned worker in consultation with the Area Overpayment Coordinator.
7. An attempt shall be made to recover all overpayments regardless of whether or not the person continues to receive Social Assistance benefits. (Refer to Sections 14 and 15)
8. Overpayment recoveries from persons with continuing eligibility may be negotiated as follows:
(a) Repayment in lump sum; or
(b) A reasonable deduction from the monthly cheque; or
(c) Termination of assistance until the applicant has expended an amount equivalent to the overpayment, considering both basic and special need expenses; or
(d) Some combination of the above.
9. Overpayment recoveries from persons no longer eligible for benefits may be negotiated as follows:
(a) Lump sum repayment; or
(b) Monthly payments of a reasonable amount, given the circumstances of the person and the size of the overpayment; or
(c) A combination of (a) and (b).
10. Where initial recovery attempts have been non-productive, the Overpayment Coordinator may agree to suspend further recovery action if the overpayment is:
(a) $100, or less and if the client is no longer in pay and recovery would cost more than it is worth;
(b) Against a person who is or is about to become a resident of a nursing home or manor as described in Section 1(1)(q) of the Social Assistance Regulations and whose only income is OAS/GIS.
11. Worker error, as determined by the overpayment coordinator, may be considered sufficient reason not to create an overpayment if:
(a) The error was a mistake or failure to act on the part of the worker; and
(b) It is reasonable to assume the applicant would not have recognized the error.
PROCEDURE
12. The Department shall designate an "Area Overpayment Coordinator" to supervise, monitor and control the documentation and recovery of overpayments, and to advise of necessary corrective action or staff training of each Social Assistance office.
13. All overpayments shall be documented on an Overpayment Record, including opinions about the cause of the overpayment, by worker and Area Overpayment Coordinator. Generally, the cause will relate to one or more of the following:
(a) Failure to report a change in circumstances, income or expenses;
(b) Misunderstanding by applicant or worker;
(c) Possible attempts by applicant to defraud by withholding information or by providing incorrect information;
(d) Calculation or processing error by staff;
(e) Procedural error by worker;
(f) Error in applying regulation or policy;
(g) Misappropriation of funds (Refer to Policy 7-1);
(h) Advances where eligibility doesn’t exist;
(i) Retroactive payments received by applicant from any source, including CPP, EI, Worker’s Compensation, insurance settlements and pay equity settlements;
(j) Deposits such as required by Maritime Electric or Island Tel; and
(k) Monies paid for home repair, in excess of $5,000.
14. The following action is required if the person continues to receive benefits:
(a) The applicant shall be informed of the exact amount of the overpayment, the repayment obligation, and the repayment options available;
(b) The Area Overpayment Coordinator shall send a letter to the applicant confirming the amount and the method of the overpayment recovery,
(c) If an applicant is terminated from Social Assistance benefits before collection is completed, refer to Paragraph 15.
15. The following action is required for those persons no longer receiving benefits:
(a) The Overpayment Coordinator will attempt to obtain a repayment agreement by contacting the former applicant by mail within sixty days of the termination date. (Appendix "A");
(b) If the letter is returned, the Overpayment Coordinator will make a best effort to obtain a current address from: the former worker, the telephone book, the Common Client Index, etc. If a current address cannot be obtained by the coordinator, then the file will be referred to the Investigation and Auditing Services Section of the department.
(c) If there is no response from the first letter, the Overpayment Coordinator will send a second letter signed by the Manager of Finance and Audit. (Appendix "B").
(d) If there is no agreement reached within ninety days of the termination date, then the file will be referred to the Investigations and Auditing Services Section of the Department.
(e) The Overpayment Coordinator will monitor repayment commitments and payments and if an agreement is in default for two consecutive months will refer the file to the Investigations and Auditing Services section of the department.
(f) All outstanding overpayments shall remain on file so that the balance may be recovered from any future Social Assistance benefits until such time as the debt is written off as per sub-section (g) below.
(g) An annual review of accounts shall be completed by the Department in order to determine a list of accounts to be recommended for a write-off by the Lieutenant Governor in Council on the approval of Treasury Board. The current criteria (subject to change each year) for these write-offs are:
a) Applicants whose accounts have been inactive for a minimum of 6 years;
b) Applicants who are deceased and there is no possibility of collection from an estate;
c) Applicants who have declared bankruptcy and have not named the region or department as a creditor;
d) Applicants whose accounts are for less than $100.00 and have been inactive for more than 3 years.
16. Investigation and Auditing Services on receipt of referrals will:
a) Send a demand letter (Appendix C)
b) For returned letters, check for an updated address through the Common Client Index or similar means of locating address and then resend the letter to the new address.
c) Document responses and repayment schedules including the method of payment amount and location of payment.
d) Follow up by phone on those that do not respond and then document those that cannot be contacted as well as those not in a position to make payments.
e) Where necessary, make initial efforts to explain overpayments from the computer records and reports on file in the Social Assistance offices.
f) Receive and enter payments, send receipts and on a monthly basis, copies to the respective Social Assistance offices.
g) Monitor agreements, payments, and reports from the regions on a monthly basis, and contact by phone, those persons in default.
h) Proceed to judgment (Writ of Execution) with the issuance of a certificate in the Supreme Court and service on former applicants that are in default or have sufficient assets to warrant such action.
i) Report monthly to the Social Assistance office including repayment agreements, list of clients that cannot be contacted, and applicants that are at present, unable to make payments.
j) Notify the Social Assistance office when Investigation and Audit services are closing a file in terms of their activities to pursue an overpayment.
17. Where it appears that the overpayment has resulted from possible fraud by the recipient, refer to Instruction 7-5 (prosecutions).
18. OVERPAYMENT CONTROL:
(a) The Area Overpayment Coordinator is responsible for ensuring an up-to-date account of all overpayments including a history of all overpayment recoveries.
(b) Each Social Assistance office shall keep a separate record of overpayment numbers and their assignment to individual overpayments as they are discovered. Four items of data should be kept in this list:
(i) Overpayment numbers in sequence
(ii) Date assigned
(iii) Applicant’s name
(iv) Applicant’s file number
CROSS REFERENCES
3-14 Changes in Circumstances
7-5 Prosecutions
7-1 Misappropriation of Funds
Appendix “A”
(Regional Letterhead)
1st Letter
Date
Name and Address of
Former Client
Dear _____________:
Re: File # ______________
On review of your financial assistance file, it has come to my attention that there is an overpayment with a balance of ____________ owing to the Department of Social Services and Seniors.
As you are no longer receiving assistance, we need to discuss how the balance of the overpayment can be recovered. Please contact me (name) at (phone number).
Your cooperation in this matter will prevent this office from taking further action.
Sincerely,
Name
OP Coordinator
Appendix "B"
(Letterhead)
2nd Letter
Date
Name and Address of
Former Client
Dear _____________:
Re: File # ______________
It has come to my attention that you have not contacted Income Support to make arrangements to pay the overpayment that is on your Social Assistance file.
I urge you to contact (name of O/P Coordinator) at (phone number) to make arrangements to repay this debt.
If we have not heard from you within 15 days, your account will be passed on to Investigation and Auditing Services for collection. This action could include obtaining through the courts liens against your property, garnishment of income or other appropriate legal action.
Sincerely,
(name)
Supervisor of Finance and Audit
Department of Social Services and Seniors
Appendix "C"
(Letterhead)
Date
Name & Address of
Former Client
Dear:
Re: Social Assistance File # _____________
The Department of Social Services and Seniors is in the process of reviewing all inactive Social Assistance files that contain an unpaid debt. This debt is commonly referred to as an overpayment. Our records indicate an overpayment exists in your inactive file.
This overpayment is in the amount of $__________. Our records also indicate no payments are presently being made on this debt.
You are now required to contact __________ at __________ to discuss repayment of this debt. It is important that a plan be put in place to bring about an agreeable repayment method.
Failure to contact this office within fourteen days from the date of this letter could result in an action being filed in the Supreme Court of PEI. This action could result in a lien against your property, garnishment of income and a judgment being reported by the Credit Bureau of PEI.
We await your response within the 14 days.
Sincerely,
Case Auditor
PURPOSE
1. To identify, recover or otherwise account for Social Assistance benefits received in excess of eligibility by applicants.
PRINCIPLE
2. To avoid future hardship to applicants, overpayments should be prevented by accurate information gathering, careful calculations, correct application of regulation and policy, and timely reviews.
3. Overpayments are cash or material benefits which the applicant was not entitled to receive.
4. Some Social Assistance benefits may not be considered overpayments when caused by an error in interpretation or judgement by the worker, or systems error.
5. The overpayment recovery rate should be realistically based upon the applicants ability to pay.
POLICY
6. All overpayments shall be documented on an Overpayment Record (HSS 127) by the assigned worker in consultation with the Area Overpayment Coordinator.
7. An attempt shall be made to recover all overpayments regardless of whether or not the person continues to receive Social Assistance benefits. (Refer to Sections 14 and 15)
8. Overpayment recoveries from persons with continuing eligibility may be negotiated as follows:
(a) Repayment in lump sum; or
(b) A reasonable deduction from the monthly cheque; or
(c) Termination of assistance until the applicant has expended an amount equivalent to the overpayment, considering both basic and special need expenses; or
(d) Some combination of the above.
9. Overpayment recoveries from persons no longer eligible for benefits may be negotiated as follows:
(a) Lump sum repayment; or
(b) Monthly payments of a reasonable amount, given the circumstances of the person and the size of the overpayment; or
(c) A combination of (a) and (b).
10. Where initial recovery attempts have been non-productive, the Overpayment Coordinator may agree to suspend further recovery action if the overpayment is:
(a) $100, or less and if the client is no longer in pay and recovery would cost more than it is worth;
(b) Against a person who is or is about to become a resident of a nursing home or manor as described in Section 1(1)(q) of the Social Assistance Regulations and whose only income is OAS/GIS.
11. Worker error, as determined by the overpayment coordinator, may be considered sufficient reason not to create an overpayment if:
(a) The error was a mistake or failure to act on the part of the worker; and
(b) It is reasonable to assume the applicant would not have recognized the error.
PROCEDURE
12. The Department shall designate an "Area Overpayment Coordinator" to supervise, monitor and control the documentation and recovery of overpayments, and to advise of necessary corrective action or staff training of each Social Assistance office.
13. All overpayments shall be documented on an Overpayment Record, including opinions about the cause of the overpayment, by worker and Area Overpayment Coordinator. Generally, the cause will relate to one or more of the following:
(a) Failure to report a change in circumstances, income or expenses;
(b) Misunderstanding by applicant or worker;
(c) Possible attempts by applicant to defraud by withholding information or by providing incorrect information;
(d) Calculation or processing error by staff;
(e) Procedural error by worker;
(f) Error in applying regulation or policy;
(g) Misappropriation of funds (Refer to Policy 7-1);
(h) Advances where eligibility doesn’t exist;
(i) Retroactive payments received by applicant from any source, including CPP, EI, Worker’s Compensation, insurance settlements and pay equity settlements;
(j) Deposits such as required by Maritime Electric or Island Tel; and
(k) Monies paid for home repair, in excess of $5,000.
14. The following action is required if the person continues to receive benefits:
(a) The applicant shall be informed of the exact amount of the overpayment, the repayment obligation, and the repayment options available;
(b) The Area Overpayment Coordinator shall send a letter to the applicant confirming the amount and the method of the overpayment recovery,
(c) If an applicant is terminated from Social Assistance benefits before collection is completed, refer to Paragraph 15.
15. The following action is required for those persons no longer receiving benefits:
(a) The Overpayment Coordinator will attempt to obtain a repayment agreement by contacting the former applicant by mail within sixty days of the termination date. (Appendix "A");
(b) If the letter is returned, the Overpayment Coordinator will make a best effort to obtain a current address from: the former worker, the telephone book, the Common Client Index, etc. If a current address cannot be obtained by the coordinator, then the file will be referred to the Investigation and Auditing Services Section of the department.
(c) If there is no response from the first letter, the Overpayment Coordinator will send a second letter signed by the Manager of Finance and Audit. (Appendix "B").
(d) If there is no agreement reached within ninety days of the termination date, then the file will be referred to the Investigations and Auditing Services Section of the Department.
(e) The Overpayment Coordinator will monitor repayment commitments and payments and if an agreement is in default for two consecutive months will refer the file to the Investigations and Auditing Services section of the department.
(f) All outstanding overpayments shall remain on file so that the balance may be recovered from any future Social Assistance benefits until such time as the debt is written off as per sub-section (g) below.
(g) An annual review of accounts shall be completed by the Department in order to determine a list of accounts to be recommended for a write-off by the Lieutenant Governor in Council on the approval of Treasury Board. The current criteria (subject to change each year) for these write-offs are:
a) Applicants whose accounts have been inactive for a minimum of 6 years;
b) Applicants who are deceased and there is no possibility of collection from an estate;
c) Applicants who have declared bankruptcy and have not named the region or department as a creditor;
d) Applicants whose accounts are for less than $100.00 and have been inactive for more than 3 years.
16. Investigation and Auditing Services on receipt of referrals will:
a) Send a demand letter (Appendix C)
b) For returned letters, check for an updated address through the Common Client Index or similar means of locating address and then resend the letter to the new address.
c) Document responses and repayment schedules including the method of payment amount and location of payment.
d) Follow up by phone on those that do not respond and then document those that cannot be contacted as well as those not in a position to make payments.
e) Where necessary, make initial efforts to explain overpayments from the computer records and reports on file in the Social Assistance offices.
f) Receive and enter payments, send receipts and on a monthly basis, copies to the respective Social Assistance offices.
g) Monitor agreements, payments, and reports from the regions on a monthly basis, and contact by phone, those persons in default.
h) Proceed to judgment (Writ of Execution) with the issuance of a certificate in the Supreme Court and service on former applicants that are in default or have sufficient assets to warrant such action.
i) Report monthly to the Social Assistance office including repayment agreements, list of clients that cannot be contacted, and applicants that are at present, unable to make payments.
j) Notify the Social Assistance office when Investigation and Audit services are closing a file in terms of their activities to pursue an overpayment.
17. Where it appears that the overpayment has resulted from possible fraud by the recipient, refer to Instruction 7-5 (prosecutions).
18. OVERPAYMENT CONTROL:
(a) The Area Overpayment Coordinator is responsible for ensuring an up-to-date account of all overpayments including a history of all overpayment recoveries.
(b) Each Social Assistance office shall keep a separate record of overpayment numbers and their assignment to individual overpayments as they are discovered. Four items of data should be kept in this list:
(i) Overpayment numbers in sequence
(ii) Date assigned
(iii) Applicant’s name
(iv) Applicant’s file number
CROSS REFERENCES
3-14 Changes in Circumstances
7-5 Prosecutions
7-1 Misappropriation of Funds
Appendix “A”
(Regional Letterhead)
1st Letter
Date
Name and Address of
Former Client
Dear _____________:
Re: File # ______________
On review of your financial assistance file, it has come to my attention that there is an overpayment with a balance of ____________ owing to the Department of Social Services and Seniors.
As you are no longer receiving assistance, we need to discuss how the balance of the overpayment can be recovered. Please contact me (name) at (phone number).
Your cooperation in this matter will prevent this office from taking further action.
Sincerely,
Name
OP Coordinator
Appendix "B"
(Letterhead)
2nd Letter
Date
Name and Address of
Former Client
Dear _____________:
Re: File # ______________
It has come to my attention that you have not contacted Income Support to make arrangements to pay the overpayment that is on your Social Assistance file.
I urge you to contact (name of O/P Coordinator) at (phone number) to make arrangements to repay this debt.
If we have not heard from you within 15 days, your account will be passed on to Investigation and Auditing Services for collection. This action could include obtaining through the courts liens against your property, garnishment of income or other appropriate legal action.
Sincerely,
(name)
Supervisor of Finance and Audit
Department of Social Services and Seniors
Appendix "C"
(Letterhead)
Date
Name & Address of
Former Client
Dear:
Re: Social Assistance File # _____________
The Department of Social Services and Seniors is in the process of reviewing all inactive Social Assistance files that contain an unpaid debt. This debt is commonly referred to as an overpayment. Our records indicate an overpayment exists in your inactive file.
This overpayment is in the amount of $__________. Our records also indicate no payments are presently being made on this debt.
You are now required to contact __________ at __________ to discuss repayment of this debt. It is important that a plan be put in place to bring about an agreeable repayment method.
Failure to contact this office within fourteen days from the date of this letter could result in an action being filed in the Supreme Court of PEI. This action could result in a lien against your property, garnishment of income and a judgment being reported by the Credit Bureau of PEI.
We await your response within the 14 days.
Sincerely,
Case Auditor
7. ADMINISTRATION/CONTROL
7. ADMINISTRATION/CONTROL
7-1 Misappropriation of Assistance by Beneficiaries
PURPOSE
1. To assist applicants who experience on-going problems managing their Social Assistance benefits.
PRINCIPLE
2. Social Assistance is provided for basic needs or authorized special needs and is expected to be used for this purpose.
3. Applicants are responsible for payment of their own bills and are expected to take responsibility for their own actions when they choose not to pay them.
4. As a helping agency, it is an obligation to assist applicants to improve financial management skills.
POLICY
5. When an applicant has not used his/her Social Assistance for the purpose intended, resulting in accumulated arrears, the worker shall discuss the problem with the applicant and encourage the applicant to work out a method of paying the arrears.
6. In situations where negotiations between applicant and creditor have not resolved the problem of arrears, it may be necessary to "advance" the funds and recover them from future Social Assistance. Such recovery should not exceed six months or the date of anticipated termination of benefits, whichever occurs first provided it does not create undue hardship for the applicant.
7. Repeated problems may result in providing future Social Assistance as follows:
a) Direct payments to vendors; or
b) Credit/service authorization payments; or
c) Appointment of an agent; or
8. Where the applicant has lost the right to manage his/her own finances and is deemed by the worker to be ready to re-accept responsibility for his/her financial commitments, the responsibility should be returned to him/her on a gradual basis. For example, at first he/she might be given the financial assistance for his/her personal requirements, and then household supplies, followed by his/her complete FCHP allotment, until he/she is once again assuming responsibility for his/her full range of financial needs.
9. In situations where one partner is irresponsibly managing the Social Assistance, payment should be made to the spouse. This is a judgment made by the worker, usually in consultation with the applicants. Where one partner has not been part of the consultation, he/she should be notified of the reason for the change.
PROCEDURE
10. Any action resulting in a change in the method of payment to applicants shall be accompanied by supporting documentation stating the reasons and the attempts to resolve the problem.
7-1 Misappropriation of Assistance by Beneficiaries
PURPOSE
1. To assist applicants who experience on-going problems managing their Social Assistance benefits.
PRINCIPLE
2. Social Assistance is provided for basic needs or authorized special needs and is expected to be used for this purpose.
3. Applicants are responsible for payment of their own bills and are expected to take responsibility for their own actions when they choose not to pay them.
4. As a helping agency, it is an obligation to assist applicants to improve financial management skills.
POLICY
5. When an applicant has not used his/her Social Assistance for the purpose intended, resulting in accumulated arrears, the worker shall discuss the problem with the applicant and encourage the applicant to work out a method of paying the arrears.
6. In situations where negotiations between applicant and creditor have not resolved the problem of arrears, it may be necessary to "advance" the funds and recover them from future Social Assistance. Such recovery should not exceed six months or the date of anticipated termination of benefits, whichever occurs first provided it does not create undue hardship for the applicant.
7. Repeated problems may result in providing future Social Assistance as follows:
a) Direct payments to vendors; or
b) Credit/service authorization payments; or
c) Appointment of an agent; or
8. Where the applicant has lost the right to manage his/her own finances and is deemed by the worker to be ready to re-accept responsibility for his/her financial commitments, the responsibility should be returned to him/her on a gradual basis. For example, at first he/she might be given the financial assistance for his/her personal requirements, and then household supplies, followed by his/her complete FCHP allotment, until he/she is once again assuming responsibility for his/her full range of financial needs.
9. In situations where one partner is irresponsibly managing the Social Assistance, payment should be made to the spouse. This is a judgment made by the worker, usually in consultation with the applicants. Where one partner has not been part of the consultation, he/she should be notified of the reason for the change.
PROCEDURE
10. Any action resulting in a change in the method of payment to applicants shall be accompanied by supporting documentation stating the reasons and the attempts to resolve the problem.
Burial Expenses
6-14 Burial Expenses
PURPOSE
1. To provide the basic burial expenses for applicants.
PRINCIPLE
2. Funerals are to be arranged by family members.
3. Workers shall make family members aware of the limitations of the policy.
4. Where the family is expecting the expenses to be paid, in part or in full, through Social Assistance, the funeral director shall be so informed before arrangements are concluded.
POLICY
5. Assistance may be granted to meet the cost of burying or cremating a person:
(a) Whose estate is insufficient to cover the cost of his/her burial/cremation; and
(b) Where there are no other means of meeting such costs.
6. Funeral expenses for an individual qualifying for Social Assistance shall be paid at the following rates:
ADULTS AND CHILDREN 12 AND OVER.........................$2,500.00
CHILDREN UNDER 12................................................$1,320.00
STILLBORN............................................................$110.00
Which shall include the services of the Funeral Director of the families choice, who shall supply the following:
PROFESSIONAL SERVICE......................$2,500.00 or $1,320.00 (as applicable)
- Funeral Director's services for consultation, arrangement and coordination of details, along with support staff services; and
- Embalmers professional services.
- Cremation services may be provided at the discretion of the Funeral Director, provided the costs do not exceed the established maximums.
Facilities and Equipment
- Funeral Home facilities for visiting hours up to one afternoon and one evening;
- Chapel facilities or transfer of remains and equipment to a local Church for funeral services;
- Cemetery equipment (lowering device & covers);
- Guest book for visitation; and
- Two Funeral Director's Proof of Death Certificates (Additional certificates available at a fee).
Motor Equipment
- Service vehicle for LOCAL removal and delivery of equipment to cemetery;
- Clergy/Lead car to local cemetery; and
- Hearse to local cemetery.
In addition to the above services, the Funeral Director shall provide a basic, grey cloth-covered casket or a replacement casket acceptable to the family at no additional cost.
For children under 12, the appropriate cloth covered casket shall be provided.
STILLBORN...............................................$110.00
Which shall include:
- local removal from place of death;
- Funeral Director's consultation & necessary documentation;
- provision of an appropriate stillborn closed covered casket; and
- transportation to a local cemetery for grave side committal with family and clergy.
DIRECT DISPOSITION SERVICE...........$2,500.00 or $1,320.00 (as applicable)
Which Shall Include:
- Funeral Director's consultation and necessary documentation;
- Embalmers professional services;
- provision of shelter of remains while awaiting transportation to crematorium;
- provision of a basic container for cremation; and
- receiving and transportation of cremated remains to local cemetery for burial.
ADDITIONAL EXPENSES: (to be paid by Social Assistance Program, where applicable).
- Oversize casket (at cost) - difference of cost and with PRIOR Approval;
- Cost of transporting the body from the place of death may be paid at the rate of $1.00 km for every kilometre over and above 25 km.
- Cost of burial shroud or purchase of clothing (if required, at cost, and with PRIOR approval); and
- Cemetery fees to be negotiated directly with the Cemetery/Gravedigger and invoiced separately.
Death occurring of Island resident while out of province:
- Local Funeral Home charges at place oif death;
- Transportation of remains back to Island Funeral Home by Air or Land at going rate;
- Body pouch or hermetically sealed liner at cost (exceptional circumstances may be considered);
The following expenses are NOT covered by the Social Assistance Program:
- Winter vault storage;
- Hairdresser;
- Grave liner;
- Flowers;
- Organist; and
- Obituaries.
PROCEDURE
7. Where the cost of the funeral does not exceed the amounts authorized in paragraph 6, payment may be made by:
(a) The Department making full payment as per the rates in paragraph 6; or
(b) The Department supplementing the amount paid by the family/estate (i.e. if the family pays $300.00 towards a funeral for a 10 year child, the Department may pay the balance - $1,020.00).
8. It is permissible for a third party (ie. family member) to contribute toward the cost of a funeral where funeral costs are greater than the approved allowances. However, where a third party contribution is greater than 100 percent of the approved amounts in paragraph 6, the Department’s contribution shall be reduced by the amount that the party contribution exceeds 100 % of the approved allowances, e.g.:
Adults
(a) The Department will pay the full allowance of $2,500.00 toward a funeral costing up to a maximum of $5,000.00 which is 100 percent greater than the $2,500.00 allowance.
(b) Where funeral costs are $5,200.00, the Department’s contribution shall be reduced by $200.00 since the $5,200.00 cost exceeds the $2,500.00 allowance by more than 100 percent.
(c) Thus, when funeral costs reach $7,500.00, the Department’s contribution would be reduced to zero.
(d) The third party contribution of $5,000.00 is inclusive of GST.
In summary, if the cost for an adult funeral exceeds $5,000.00, the $2,500.00 allowance will be reduced by the amount in excess of $5,000.00. The same formula is to be used for funerals for children under 12 years of age and for stillborns.
9. Where the Department makes a payment against funeral costs, as per paragraph 6, 7 & 8, a receipt shall be obtained from the funeral director indicating that the payment has been accepted as "Payment in Full" for funeral costs. A copy of this receipt shall be given to the next-of-kin.
10. The cost of the grave sites and the opening and closing of graves will be paid directly, where applicable. Local rates will apply in each case.
11. The cost of transporting the body from the place of death to the place of residence may be paid at the rate of $1.00/km for every kilometre over and above 25 km return. Mileage will not be paid for the first 25 km (i.e., if total trip is 30 km return, the funeral director may be paid for 5 km at $1.00/km).
12. Funeral dress for the deceased is an item which should be the responsibility of the family. Ordinarily the deceased will have clothing used in his/her lifetime which should be adequate to be buried in. However, where special need occurs, a request for dress may be submitted to the regional office by the Funeral Director. Funeral dress should not be perceived as a routine funeral cost.
13. Application for Canada Pension and/or Old Age Security benefits shall be the family's responsibility and these benefits will be applied against the funeral costs to reduce the cost to the Social Assistance Program.
14. Where a worker deems it appropriate, or is requested by the family, to make application for the Canada Pension benefit on behalf of the family, it will be necessary to first determine whether or not the deceased had a Will, or if an Administrator of the estate has been appointed by the Court. If so, the only person who may make application for the CPP Death Benefit is the Executor or Administrator. If not, the worker may make the application. Documentation which must accompany the application is as follows:
- the funeral contract or funeral receipts;
- the deceased’s birth or baptismal certificate;
- the death certificate; and
- the SIN of the deceased must be indicated on all documents.
15. Social Assistance funeral rates shall be reviewed periodically to determine the adequacy of rates.
16. The cost of death notices in newspapers and on radio, clergy honorariums, flowers, grave marker etc., shall be the responsibility of the family or next-of-kin.
17. Copy of invoice with complete funeral expenses, signed by family member arranging funeral, shall be forwarded to the Social Assistance Program in the appropriate office.
18. Funeral bills for indigent persons shall be submitted for approval.
PURPOSE
1. To provide the basic burial expenses for applicants.
PRINCIPLE
2. Funerals are to be arranged by family members.
3. Workers shall make family members aware of the limitations of the policy.
4. Where the family is expecting the expenses to be paid, in part or in full, through Social Assistance, the funeral director shall be so informed before arrangements are concluded.
POLICY
5. Assistance may be granted to meet the cost of burying or cremating a person:
(a) Whose estate is insufficient to cover the cost of his/her burial/cremation; and
(b) Where there are no other means of meeting such costs.
6. Funeral expenses for an individual qualifying for Social Assistance shall be paid at the following rates:
ADULTS AND CHILDREN 12 AND OVER.........................$2,500.00
CHILDREN UNDER 12................................................$1,320.00
STILLBORN............................................................$110.00
Which shall include the services of the Funeral Director of the families choice, who shall supply the following:
PROFESSIONAL SERVICE......................$2,500.00 or $1,320.00 (as applicable)
- Funeral Director's services for consultation, arrangement and coordination of details, along with support staff services; and
- Embalmers professional services.
- Cremation services may be provided at the discretion of the Funeral Director, provided the costs do not exceed the established maximums.
Facilities and Equipment
- Funeral Home facilities for visiting hours up to one afternoon and one evening;
- Chapel facilities or transfer of remains and equipment to a local Church for funeral services;
- Cemetery equipment (lowering device & covers);
- Guest book for visitation; and
- Two Funeral Director's Proof of Death Certificates (Additional certificates available at a fee).
Motor Equipment
- Service vehicle for LOCAL removal and delivery of equipment to cemetery;
- Clergy/Lead car to local cemetery; and
- Hearse to local cemetery.
In addition to the above services, the Funeral Director shall provide a basic, grey cloth-covered casket or a replacement casket acceptable to the family at no additional cost.
For children under 12, the appropriate cloth covered casket shall be provided.
STILLBORN...............................................$110.00
Which shall include:
- local removal from place of death;
- Funeral Director's consultation & necessary documentation;
- provision of an appropriate stillborn closed covered casket; and
- transportation to a local cemetery for grave side committal with family and clergy.
DIRECT DISPOSITION SERVICE...........$2,500.00 or $1,320.00 (as applicable)
Which Shall Include:
- Funeral Director's consultation and necessary documentation;
- Embalmers professional services;
- provision of shelter of remains while awaiting transportation to crematorium;
- provision of a basic container for cremation; and
- receiving and transportation of cremated remains to local cemetery for burial.
ADDITIONAL EXPENSES: (to be paid by Social Assistance Program, where applicable).
- Oversize casket (at cost) - difference of cost and with PRIOR Approval;
- Cost of transporting the body from the place of death may be paid at the rate of $1.00 km for every kilometre over and above 25 km.
- Cost of burial shroud or purchase of clothing (if required, at cost, and with PRIOR approval); and
- Cemetery fees to be negotiated directly with the Cemetery/Gravedigger and invoiced separately.
Death occurring of Island resident while out of province:
- Local Funeral Home charges at place oif death;
- Transportation of remains back to Island Funeral Home by Air or Land at going rate;
- Body pouch or hermetically sealed liner at cost (exceptional circumstances may be considered);
The following expenses are NOT covered by the Social Assistance Program:
- Winter vault storage;
- Hairdresser;
- Grave liner;
- Flowers;
- Organist; and
- Obituaries.
PROCEDURE
7. Where the cost of the funeral does not exceed the amounts authorized in paragraph 6, payment may be made by:
(a) The Department making full payment as per the rates in paragraph 6; or
(b) The Department supplementing the amount paid by the family/estate (i.e. if the family pays $300.00 towards a funeral for a 10 year child, the Department may pay the balance - $1,020.00).
8. It is permissible for a third party (ie. family member) to contribute toward the cost of a funeral where funeral costs are greater than the approved allowances. However, where a third party contribution is greater than 100 percent of the approved amounts in paragraph 6, the Department’s contribution shall be reduced by the amount that the party contribution exceeds 100 % of the approved allowances, e.g.:
Adults
(a) The Department will pay the full allowance of $2,500.00 toward a funeral costing up to a maximum of $5,000.00 which is 100 percent greater than the $2,500.00 allowance.
(b) Where funeral costs are $5,200.00, the Department’s contribution shall be reduced by $200.00 since the $5,200.00 cost exceeds the $2,500.00 allowance by more than 100 percent.
(c) Thus, when funeral costs reach $7,500.00, the Department’s contribution would be reduced to zero.
(d) The third party contribution of $5,000.00 is inclusive of GST.
In summary, if the cost for an adult funeral exceeds $5,000.00, the $2,500.00 allowance will be reduced by the amount in excess of $5,000.00. The same formula is to be used for funerals for children under 12 years of age and for stillborns.
9. Where the Department makes a payment against funeral costs, as per paragraph 6, 7 & 8, a receipt shall be obtained from the funeral director indicating that the payment has been accepted as "Payment in Full" for funeral costs. A copy of this receipt shall be given to the next-of-kin.
10. The cost of the grave sites and the opening and closing of graves will be paid directly, where applicable. Local rates will apply in each case.
11. The cost of transporting the body from the place of death to the place of residence may be paid at the rate of $1.00/km for every kilometre over and above 25 km return. Mileage will not be paid for the first 25 km (i.e., if total trip is 30 km return, the funeral director may be paid for 5 km at $1.00/km).
12. Funeral dress for the deceased is an item which should be the responsibility of the family. Ordinarily the deceased will have clothing used in his/her lifetime which should be adequate to be buried in. However, where special need occurs, a request for dress may be submitted to the regional office by the Funeral Director. Funeral dress should not be perceived as a routine funeral cost.
13. Application for Canada Pension and/or Old Age Security benefits shall be the family's responsibility and these benefits will be applied against the funeral costs to reduce the cost to the Social Assistance Program.
14. Where a worker deems it appropriate, or is requested by the family, to make application for the Canada Pension benefit on behalf of the family, it will be necessary to first determine whether or not the deceased had a Will, or if an Administrator of the estate has been appointed by the Court. If so, the only person who may make application for the CPP Death Benefit is the Executor or Administrator. If not, the worker may make the application. Documentation which must accompany the application is as follows:
- the funeral contract or funeral receipts;
- the deceased’s birth or baptismal certificate;
- the death certificate; and
- the SIN of the deceased must be indicated on all documents.
15. Social Assistance funeral rates shall be reviewed periodically to determine the adequacy of rates.
16. The cost of death notices in newspapers and on radio, clergy honorariums, flowers, grave marker etc., shall be the responsibility of the family or next-of-kin.
17. Copy of invoice with complete funeral expenses, signed by family member arranging funeral, shall be forwarded to the Social Assistance Program in the appropriate office.
18. Funeral bills for indigent persons shall be submitted for approval.
Arrears - Property Tax
6-13-1 Arrears - Property Tax
PURPOSE
1. To prevent the loss of residence through tax sale.
PRINCIPLE
2. Where the sale of property is imminent and no other options exist, families should not be forced to relocate and lose their family home simply due to property tax arrears.
3. The negative implications of relocating are far greater for some families than for others.
4. Most applicants are able to solve tax arrears problems but many require information or assistance with that process.
POLICY
5. The payment of tax arrears on property owned by an applicant may be authorized only if the arrears involve the principal residence of the applicant and only if sale of that property by the Department of Finance is imminent.
6. Applicants are expected to explore and/or negotiate other options first, such as:
- Negotiate an acceptable repayment plan with Department of Finance;
- Borrow against equity in the home to repay tax arrears;
- Examining the economics of renting vs. retaining current residence.
7. In situations where applicants have had a tax expense included in the calculation of benefits, payment of such arrears constitutes an overpayment and shall be recovered at a reasonable rate.
PROCEDURE
8. The worker shall contact the Provincial Treasury, Property Assessment Services, to confirm that sale of the property is imminent and that negotiation of repayment is not possible.
9. The worker shall draw up a written agreement signed by the applicant with commitments to keep up future payments on a regular basis. Such an agreement may be useful in dealing with similar future requests.
10. Special Needs payments on behalf of new applicants are from the appropriate expense in the Integrated Services Management System and in accordance with Special Needs signing authority provisions.
11. All such payments are to be made in the form of third-party payments. New applicants with tax arrears, the worker should speak with a designated authority.
12. Where long-term applicants have demonstrated an inability to make their payments, consideration should be given to making future payments in the form of third-party payments.
PURPOSE
1. To prevent the loss of residence through tax sale.
PRINCIPLE
2. Where the sale of property is imminent and no other options exist, families should not be forced to relocate and lose their family home simply due to property tax arrears.
3. The negative implications of relocating are far greater for some families than for others.
4. Most applicants are able to solve tax arrears problems but many require information or assistance with that process.
POLICY
5. The payment of tax arrears on property owned by an applicant may be authorized only if the arrears involve the principal residence of the applicant and only if sale of that property by the Department of Finance is imminent.
6. Applicants are expected to explore and/or negotiate other options first, such as:
- Negotiate an acceptable repayment plan with Department of Finance;
- Borrow against equity in the home to repay tax arrears;
- Examining the economics of renting vs. retaining current residence.
7. In situations where applicants have had a tax expense included in the calculation of benefits, payment of such arrears constitutes an overpayment and shall be recovered at a reasonable rate.
PROCEDURE
8. The worker shall contact the Provincial Treasury, Property Assessment Services, to confirm that sale of the property is imminent and that negotiation of repayment is not possible.
9. The worker shall draw up a written agreement signed by the applicant with commitments to keep up future payments on a regular basis. Such an agreement may be useful in dealing with similar future requests.
10. Special Needs payments on behalf of new applicants are from the appropriate expense in the Integrated Services Management System and in accordance with Special Needs signing authority provisions.
11. All such payments are to be made in the form of third-party payments. New applicants with tax arrears, the worker should speak with a designated authority.
12. Where long-term applicants have demonstrated an inability to make their payments, consideration should be given to making future payments in the form of third-party payments.
Arrears - Shelter/Utilities
6-13 Arrears - Shelter/Utilities
PURPOSE
1. To prevent loss of shelter or utilities.
PRINCIPLE
2. The accumulation of arrears may constitute extreme hardship if loss of shelter or necessary utility is imminent.
3. Some persons, due to financial circumstance, could have qualified for assistance earlier than their actual date of application.
POLICY
4. A maximum of two months’ shelter or utility arrears may be paid without recovery where accrued prior to application for assistance.
5. Such arrears may be paid only if the health and safety of the applicant or his/her dependants are endangered, and only if his/her failure to pay them previously was because of a lack of financial resources.
6. Payment of shelter or utility arrears accrued while in receipt of assistance constitutes an "advance" to the applicant and shall be recovered as an "overpayment" from future assistance. Payments of this nature are also limited to two months’ arrears. Decision to "advance" assistance for arrears payments must be made in the context of Instruction 7-1.
PROCEDURE
7. Advance payments to cover accumulated arrears (Paragraph 6) are considered receivables and collected as an overpayment.
8. All such payments are to be made in the form of third-party payments.
PURPOSE
1. To prevent loss of shelter or utilities.
PRINCIPLE
2. The accumulation of arrears may constitute extreme hardship if loss of shelter or necessary utility is imminent.
3. Some persons, due to financial circumstance, could have qualified for assistance earlier than their actual date of application.
POLICY
4. A maximum of two months’ shelter or utility arrears may be paid without recovery where accrued prior to application for assistance.
5. Such arrears may be paid only if the health and safety of the applicant or his/her dependants are endangered, and only if his/her failure to pay them previously was because of a lack of financial resources.
6. Payment of shelter or utility arrears accrued while in receipt of assistance constitutes an "advance" to the applicant and shall be recovered as an "overpayment" from future assistance. Payments of this nature are also limited to two months’ arrears. Decision to "advance" assistance for arrears payments must be made in the context of Instruction 7-1.
PROCEDURE
7. Advance payments to cover accumulated arrears (Paragraph 6) are considered receivables and collected as an overpayment.
8. All such payments are to be made in the form of third-party payments.
Expenses Incidental to Education - Dependents
6-12 Expenses Incidental to Education - Dependents
URPOSE
1. To assist applicants with the extra costs of children attending school.
PRINCIPLE
2. Applicants are expected to use this allowance for actual school requirements such as supplies, fees and gym clothing.
3. Post secondary students are not eligible as they generally have part-time and/or summer employment income, student loans or bursaries from which to purchase school supplies.
POLICY
4. A semi-annual allowance to cover incidental expenses related to attending school shall be provided for dependants of applicants attending grades 1-12.
5. Since grade levels on each child cannot be determined for automatic distribution of cheques, ages as of August 1st and December 1st will be used. Children 10 years of age and under shall receive $75, and children 11 years of age and over shall receive $100.
PROCEDURE
6. Cheques will be issued automatically in August and in December to families of children who on August 1st or December 1st are between the ages of 6 and 15 years inclusive.
7. Workers are asked to contact clients of children under 6 years of age and 16 years of age or over to determine their plans to attend school and if so they are included in the cheque run.
8. Applicants in the month of August or September who are eligible for assistance for more than one month are eligible for the full school allowance. Similarly, applicants in the month of December or January who are eligible for assistance for more than one month are eligible for the full school allowance.
9. In all other circumstances, requests for school supplies should be dealt with as a special need request which is itemized and documented as any other special need.
URPOSE
1. To assist applicants with the extra costs of children attending school.
PRINCIPLE
2. Applicants are expected to use this allowance for actual school requirements such as supplies, fees and gym clothing.
3. Post secondary students are not eligible as they generally have part-time and/or summer employment income, student loans or bursaries from which to purchase school supplies.
POLICY
4. A semi-annual allowance to cover incidental expenses related to attending school shall be provided for dependants of applicants attending grades 1-12.
5. Since grade levels on each child cannot be determined for automatic distribution of cheques, ages as of August 1st and December 1st will be used. Children 10 years of age and under shall receive $75, and children 11 years of age and over shall receive $100.
PROCEDURE
6. Cheques will be issued automatically in August and in December to families of children who on August 1st or December 1st are between the ages of 6 and 15 years inclusive.
7. Workers are asked to contact clients of children under 6 years of age and 16 years of age or over to determine their plans to attend school and if so they are included in the cheque run.
8. Applicants in the month of August or September who are eligible for assistance for more than one month are eligible for the full school allowance. Similarly, applicants in the month of December or January who are eligible for assistance for more than one month are eligible for the full school allowance.
9. In all other circumstances, requests for school supplies should be dealt with as a special need request which is itemized and documented as any other special need.
Homeowners' Allowance
6-1--2 Homeowners' Allowance
Workers should identify the maintenance or repair work requested and attach or record the
itemized costs provided by the clients. Be sure taxes’ are included in the cost estimate.
PURPOSE
1. To provide applicant homeowners with resources to carry out minor maintenance and repairs on their property.
PRINCIPLE
2. Maintenance and minor repairs may prevent more costly alterations at a future date.
3. The ability to maintain a home in good repair can contribute to self esteem and community involvement. Wherever possible homeowners or family members should provide the labour required.
POLICY
5. For purposes of this Policy, homeowners must have been receiving assistance for more than twelve (12) months.
6. Upon request, up to $300 per fiscal year may be provided to applicant homeowners for maintenance and minor repairs.
7. Materials, tools and labour related to the maintenance or repair work may be included in costing a specific request.
8. The following list indicates maintenance and repair work that may be covered in this Policy but is not intended to exclude other reasonable items of maintenance and repair:
- annual maintenance of furnace and flue
- caulking, weatherstripping, screening
- minor repairs to siding, roofing, flashings
- replacement of broken glass
- repair/paint steps, fencing
- exterior paint/stain
- interior paint/wallpaper
- floor covering
- lawnmower/repairs
- replace/repair door locks, hinges, frames.
Where items of repair are covered by household insurance, the insurance coverage should be used to meet the need. However, the allowance may be used to cover the deductible costs that apply to insured items.
PROCEDURE
9. Workers should identify the maintenance or repair work requested and attach or record the itemized costs provided by the clients. Be sure taxes’ are included in the cost estimate.
Workers should identify the maintenance or repair work requested and attach or record the
itemized costs provided by the clients. Be sure taxes’ are included in the cost estimate.
PURPOSE
1. To provide applicant homeowners with resources to carry out minor maintenance and repairs on their property.
PRINCIPLE
2. Maintenance and minor repairs may prevent more costly alterations at a future date.
3. The ability to maintain a home in good repair can contribute to self esteem and community involvement. Wherever possible homeowners or family members should provide the labour required.
POLICY
5. For purposes of this Policy, homeowners must have been receiving assistance for more than twelve (12) months.
6. Upon request, up to $300 per fiscal year may be provided to applicant homeowners for maintenance and minor repairs.
7. Materials, tools and labour related to the maintenance or repair work may be included in costing a specific request.
8. The following list indicates maintenance and repair work that may be covered in this Policy but is not intended to exclude other reasonable items of maintenance and repair:
- annual maintenance of furnace and flue
- caulking, weatherstripping, screening
- minor repairs to siding, roofing, flashings
- replacement of broken glass
- repair/paint steps, fencing
- exterior paint/stain
- interior paint/wallpaper
- floor covering
- lawnmower/repairs
- replace/repair door locks, hinges, frames.
Where items of repair are covered by household insurance, the insurance coverage should be used to meet the need. However, the allowance may be used to cover the deductible costs that apply to insured items.
PROCEDURE
9. Workers should identify the maintenance or repair work requested and attach or record the itemized costs provided by the clients. Be sure taxes’ are included in the cost estimate.
Renovations to Property
6-11-1 Renovations to Property
PURPOSE
1. To improve substandard housing to minimum standards of health and safety.
PRINCIPLE
2. Applicants should be encouraged to take advantage of housing programs available through the P.E.I. Housing Corporation or Canada Mortgage and Housing Corporation.
3. Priority should be given to assisting families and long-term applicants.
4. Short-term applicants should be cautioned that mortgage expenses incurred while on assistance will be his/her own responsibility when assistance terminates.
POLICY
5. A monthly loan payment for property renovation may be included in the calculation of a shelter expense, where prior approval has been granted by the Department.
6. Payments should be calculated over a reasonable repayment period given the size of the loan.
7. The inclusion of such a payment in calculating the total shelter expense does not guarantee payment of such costs. The applicant may or may not be eligible for assistance depending on his/her other circumstances.
PURPOSE
1. To improve substandard housing to minimum standards of health and safety.
PRINCIPLE
2. Applicants should be encouraged to take advantage of housing programs available through the P.E.I. Housing Corporation or Canada Mortgage and Housing Corporation.
3. Priority should be given to assisting families and long-term applicants.
4. Short-term applicants should be cautioned that mortgage expenses incurred while on assistance will be his/her own responsibility when assistance terminates.
POLICY
5. A monthly loan payment for property renovation may be included in the calculation of a shelter expense, where prior approval has been granted by the Department.
6. Payments should be calculated over a reasonable repayment period given the size of the loan.
7. The inclusion of such a payment in calculating the total shelter expense does not guarantee payment of such costs. The applicant may or may not be eligible for assistance depending on his/her other circumstances.
Repairs to Property
6-11 Repairs to Property
PURPOSE
1. To provide essential home repairs.
PRINCIPLE
2. Repairs should be undertaken where property presents a health or safety risk to the applicant.
3. Applicants should be encouraged to provide the labour themselves or with family and community resources where it is reasonable to do so.
4. Applicants should be encouraged to take advantage of available programs through the P.E.I. Housing Corporation or local organizations.
POLICY
5. Repairs to homes owned by applicants may be authorized if such repairs are essential to the health and safety of the family and other commercial or government financing is either unavailable or insufficient.
6. Repair costs up to $5,000 may be authorized by the designated authority as a benefit. Amounts in excess of $5,000 shall be recovered in accordance with Section 6.1 of the Act.
7. In some situations, relocation should be encouraged as an alternative to carrying out substantial repairs.
8. Home "ownership" includes those properties that have come into the applicant’s possession and have been his/her established residence although clear title to the property/parcel cannot be established. However, it does not include rental property.
9. In situations where there is a dispute over the ownership of the property, substantial investments in repair work should be avoided.
PROCEDURE
10. Estimates shall be obtained before authorization. More than one estimate should be requested where there is uncertainty in determining reasonable cost.
11. Essential or emergency repairs completed without prior authorization shall require approval of the Department even though the costs may be within the worker’s authority.
PURPOSE
1. To provide essential home repairs.
PRINCIPLE
2. Repairs should be undertaken where property presents a health or safety risk to the applicant.
3. Applicants should be encouraged to provide the labour themselves or with family and community resources where it is reasonable to do so.
4. Applicants should be encouraged to take advantage of available programs through the P.E.I. Housing Corporation or local organizations.
POLICY
5. Repairs to homes owned by applicants may be authorized if such repairs are essential to the health and safety of the family and other commercial or government financing is either unavailable or insufficient.
6. Repair costs up to $5,000 may be authorized by the designated authority as a benefit. Amounts in excess of $5,000 shall be recovered in accordance with Section 6.1 of the Act.
7. In some situations, relocation should be encouraged as an alternative to carrying out substantial repairs.
8. Home "ownership" includes those properties that have come into the applicant’s possession and have been his/her established residence although clear title to the property/parcel cannot be established. However, it does not include rental property.
9. In situations where there is a dispute over the ownership of the property, substantial investments in repair work should be avoided.
PROCEDURE
10. Estimates shall be obtained before authorization. More than one estimate should be requested where there is uncertainty in determining reasonable cost.
11. Essential or emergency repairs completed without prior authorization shall require approval of the Department even though the costs may be within the worker’s authority.
Furniture/Appliances - Purchase or Repair
6-10 Furniture/Appliances - Purchase or Repair
PURPOSE
1. To purchase or repair essential appliance or furniture items.
PRINCIPLE
2. Some appliances and furniture items are more necessary than others for daily living.
3. Applicants are expected to explore family and other resources for such items of need.
4. Budget limitations require that repairs and purchases be limited to items of real need.
5. Social Assistance offices may elect to implement a system that will help determine priorities for approval.
POLICY
6. The purchase or repair of an item of furniture or major appliance may be authorized where that item is essential to the health, safety or well-being of the applicant.
7. Except in providing mattresses, only second-hand purchases, or an allowance equal to the cost of a second-hand purchase, shall be authorized, unless new items can be obtained in the same price range or unless health or safety would be jeopardized by waiting until a second-hand item is available. (e.g. crib).
8. The purchase of appliances shall be normally limited to ranges, refrigerators and washing machines.
9. Essential furniture items may include bed or box spring and mattress, chest of drawers, kitchen table/chairs, and living room sofa/chair.
10. Items not considered essential include televisions, dishwashers, dryers, microwave ovens, dining room furniture or bedroom accessory furniture.
11. Repairs of essential items may be allowed where the worker considers the repairs are warranted, and the cost reasonable.
PROCEDURE
12. All items must be pre-authorized by worker or appropriate designated authority before purchase commitments are made. Unauthorized emergency repairs made after hours may be approved by the Department. The reason for prior authorization is to prevent the client from committing to a purchase that will not be supported by the Department.
13. The applicant is expected to obtain estimates for items of repair, or a list of available items for price comparison when requesting an authorization to purchase.
PURPOSE
1. To purchase or repair essential appliance or furniture items.
PRINCIPLE
2. Some appliances and furniture items are more necessary than others for daily living.
3. Applicants are expected to explore family and other resources for such items of need.
4. Budget limitations require that repairs and purchases be limited to items of real need.
5. Social Assistance offices may elect to implement a system that will help determine priorities for approval.
POLICY
6. The purchase or repair of an item of furniture or major appliance may be authorized where that item is essential to the health, safety or well-being of the applicant.
7. Except in providing mattresses, only second-hand purchases, or an allowance equal to the cost of a second-hand purchase, shall be authorized, unless new items can be obtained in the same price range or unless health or safety would be jeopardized by waiting until a second-hand item is available. (e.g. crib).
8. The purchase of appliances shall be normally limited to ranges, refrigerators and washing machines.
9. Essential furniture items may include bed or box spring and mattress, chest of drawers, kitchen table/chairs, and living room sofa/chair.
10. Items not considered essential include televisions, dishwashers, dryers, microwave ovens, dining room furniture or bedroom accessory furniture.
11. Repairs of essential items may be allowed where the worker considers the repairs are warranted, and the cost reasonable.
PROCEDURE
12. All items must be pre-authorized by worker or appropriate designated authority before purchase commitments are made. Unauthorized emergency repairs made after hours may be approved by the Department. The reason for prior authorization is to prevent the client from committing to a purchase that will not be supported by the Department.
13. The applicant is expected to obtain estimates for items of repair, or a list of available items for price comparison when requesting an authorization to purchase.
Hearing Aids
6-9 Hearing Aids
PURPOSE
1. To ensure applicants receive professional hearing assessments and appropriate hearing aids. (Persons eligible for the Disability Support Program are not eligible for any of the following services.)
PRINCIPLE
2. Hearing assessments should be completed by a Certified Audiologist in consultation with a family physician or ear, nose and throat specialist.
POLICY
3. Hearing aids shall only be authorized if a prescription has been issued by a Certified Audiologist.
4. The level of hearing loss is determined by the average threshold or decibel level at four frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz. Funding shall be authorized if the average decibel level at these four frequencies is 50 dB or greater.
5. Funding for clients assessed below 50 dB shall only be approved in exceptional situations upon recommendation by the Audiologist and the Department.
6. Funding may be approved up to a maximum of $1,500 per hearing aid.
7. Children receive priority in the Audiology Program and may be referred directly by staff of the Department. Adults with hearing problems shall be referred to their family physician.
PROCEDURE
8. The Certified Audiologist notifies the Social Assistance office of hearing assessment and specifies recommended hearing aid.
PURPOSE
1. To ensure applicants receive professional hearing assessments and appropriate hearing aids. (Persons eligible for the Disability Support Program are not eligible for any of the following services.)
PRINCIPLE
2. Hearing assessments should be completed by a Certified Audiologist in consultation with a family physician or ear, nose and throat specialist.
POLICY
3. Hearing aids shall only be authorized if a prescription has been issued by a Certified Audiologist.
4. The level of hearing loss is determined by the average threshold or decibel level at four frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz. Funding shall be authorized if the average decibel level at these four frequencies is 50 dB or greater.
5. Funding for clients assessed below 50 dB shall only be approved in exceptional situations upon recommendation by the Audiologist and the Department.
6. Funding may be approved up to a maximum of $1,500 per hearing aid.
7. Children receive priority in the Audiology Program and may be referred directly by staff of the Department. Adults with hearing problems shall be referred to their family physician.
PROCEDURE
8. The Certified Audiologist notifies the Social Assistance office of hearing assessment and specifies recommended hearing aid.
Dental Benefits
6-8 Dental Benefits
PURPOSE
1. To provide a limited range of dental benefits.
PRINCIPLE
2. Persons should not suffer pain or infection caused by dental problems.
3. Dental benefits are generally restricted to the most essential service to relieve pain or infection.
4. Any services not covered by this policy may be performed by the dentist/denturist and billed to the patient directly, if both parties agree, provided that no reimbursement is expected from Social Services.
5. A second dentist may be consulted where this appears to be appropriate.
6. All eligible children receive basic dental services, including some preventive orthodontic services, under the Children’s Dental Care Program.
POLICY
7. All applicants shall be eligible for a range of emergency dental benefits as provided by a dentist or dental surgeon for the relief of pain and infection only.
BENEFITS
8. Adults and Children Not Covered by Children’s Dental Care Program
(i) Diagnostic services
(ii) Emergency services
(iii) Prosthetic services
Persons with a Disability
(i) Diagnostic services
(ii) Emergency services
(iii) Prosthetic services
(iv) Preventive services
(v) Restorative services
Services to persons with a disability may be provided in a hospital when treatment in dental office is not possible.
9. Special Circumstances
Consideration for special circumstances not covered by the guidelines will be given, but only in rare instances will treatment be approved.
10. Diagnostic Services
Limited to the teeth affected by pain or infection, which includes:
(i) Oral examination
(ii) Radiographs
11. Emergency Services
(i) Extraction for toothache or periodontal infection;
(ii) X-rays for diagnosis of conditions causing pain and/or infection;
(iii) Treatment of abscesses, acute necrotic ulceration gingivitis and post-extraction complications (when provided by a dentist other than the one who did the extractions) such as hemorrhage or dry socket;
(iv) Emergency temporary treatment for teeth fractured as the result of an accidental injury (to alleviate pain);
(v) Palliative treatment for conditions causing pain and/or infection (e.g. temporary restoration);
(vi) Denture repairs are limited to items listed in the attached fee schedule (Appendix "A").
12. Preventive or restorative services are not included (except for persons with a disability), e.g. prophylaxis, fillings, restorations. Exceptions to this policy may be made with the approval of the Department when fillings would save a tooth in the smile area, the cost of an extraction and partial denture would exceed the cost of fillings required, and good dental hygiene practice on the part of the client is probable.
13. Persons with a disability that affects ability to provide for regular dental care may receive full basic dental care, including preventive and restorative services, and, if necessary, services may be provided in a hospital.
14. Prosthetic Services
(a) Complete upper or lower dentures may be provided where the extraction of all teeth is necessary to relieve pain and infection.
(b) Partial dentures may be provided in circumstances involving the replacement of lower posterior teeth when a complete upper denture is required, or in cases where teeth in the aesthetic regions need to be extracted.
(c) Approval of partial dentures shall be conditional upon a high probability of successful use for a lengthy period, based on consideration of the following:
(i) Age of patient
(ii) Comparative immunity to caries
(iii) Likelihood of proper hygienic care of the denture
(iv) Attitude of the patient towards wearing the denture
15. Orthodontic Treatment
(a) Some orthodontic treatment for children 12 years and under is provided by the Preventive Orthodontic Clinic of the Children’s Dental Program.
(b) Orthodontic treatment for applicants by a private specialist shall not be approved except where required for the correction of gross functional disability and not for aesthetic purposes. Orthodontic treatment by dentists in general practice will not be approved.
(c) Requests for orthodontic diagnosis or orthodontic treatment require the approval of a designated authority. It will be necessary to forward the dentist’s explanation of the gross functional disability.
PROCEDURE
16. Authorization
(a) Prior authorization is required for all dental benefits provided to clients and their dependents except for emergency services where immediate attention is required. A "Credit Service Authorization Form" is used to provide approval for three distinct types of dental benefits:
Dental Benefits "A" - Authorization for diagnostic and emergency services as outlined under 10 and 11 and Appendix "A" (sections 1 and 2);
Dental Benefits "B" - Authorization for an examination and estimate to be provided on the "Dental Estimate Form". Services are limited to those outlined in Appendix "A" under Diagnostic Services (section 1);
Dental Benefits "C" - Authorization for basic dental treatment or for denture services are limited to those outlined in Appendix "A" and are based on a previously submitted and approved estimate.
(b) Authorization for diagnostic and emergency services ("A") may be provided by the case worker to a maximum of $90 and for examination and estimate services ("B") to a maximum of $60. Authorization for basic dental treatment or for denture services ("C") requires the approval of a designated authority.
(c) The Department may obtain consultation from the Director of Dental Public Health (368-4915).
17. Estimate and Claim Form
(a) The "Social Assistance Dental Benefits Estimate and Claim Form" is a dual purpose form of four copies. Copies 1 and 2 should be submitted when claiming for services provided. Copy 3 is for estimate submission and copy 4 is for the dentist’s/denturist’s records. Instructions for use are listed on the back of the form.
(b) Following payment of claims, copy 2 will be placed in the client’s file at the Social Assistance office.
(c) Estimates must be submitted on the Social Assistance Dental Benefits Estimate and Claim Form (copy 3) to the appropriate office. The form requires the dentist to indicate teeth that are missing.
(d) In addition, information regarding oral hygiene, periodontal condition and long-term prognosis is required. A separate claim form (copies 1 and 2) is required when claiming for diagnostic services provided in relation to the estimate. This form should be submitted with the estimate form.
18. Payment of Claims
(a) Dentists/denturists and oral surgeons should bill the plan in accordance with the fees as set out in Appendix "A" or their usual and customary fees, whichever is the lower amount.
(b) Dentists/denturists who bill for authorized services shall not extra-bill the patient. The only exception when the dentist/denturist may bill the client (other than for services not covered under policy) is the client portion for prosthetic services.
19. Second Opinions
Where a second dentist is consulted to verify a diagnosis and/or treatment plan, any radiographs taken by the first dentist should be obtained to prevent unnecessary additional radiographs.
PURPOSE
1. To provide a limited range of dental benefits.
PRINCIPLE
2. Persons should not suffer pain or infection caused by dental problems.
3. Dental benefits are generally restricted to the most essential service to relieve pain or infection.
4. Any services not covered by this policy may be performed by the dentist/denturist and billed to the patient directly, if both parties agree, provided that no reimbursement is expected from Social Services.
5. A second dentist may be consulted where this appears to be appropriate.
6. All eligible children receive basic dental services, including some preventive orthodontic services, under the Children’s Dental Care Program.
POLICY
7. All applicants shall be eligible for a range of emergency dental benefits as provided by a dentist or dental surgeon for the relief of pain and infection only.
BENEFITS
8. Adults and Children Not Covered by Children’s Dental Care Program
(i) Diagnostic services
(ii) Emergency services
(iii) Prosthetic services
Persons with a Disability
(i) Diagnostic services
(ii) Emergency services
(iii) Prosthetic services
(iv) Preventive services
(v) Restorative services
Services to persons with a disability may be provided in a hospital when treatment in dental office is not possible.
9. Special Circumstances
Consideration for special circumstances not covered by the guidelines will be given, but only in rare instances will treatment be approved.
10. Diagnostic Services
Limited to the teeth affected by pain or infection, which includes:
(i) Oral examination
(ii) Radiographs
11. Emergency Services
(i) Extraction for toothache or periodontal infection;
(ii) X-rays for diagnosis of conditions causing pain and/or infection;
(iii) Treatment of abscesses, acute necrotic ulceration gingivitis and post-extraction complications (when provided by a dentist other than the one who did the extractions) such as hemorrhage or dry socket;
(iv) Emergency temporary treatment for teeth fractured as the result of an accidental injury (to alleviate pain);
(v) Palliative treatment for conditions causing pain and/or infection (e.g. temporary restoration);
(vi) Denture repairs are limited to items listed in the attached fee schedule (Appendix "A").
12. Preventive or restorative services are not included (except for persons with a disability), e.g. prophylaxis, fillings, restorations. Exceptions to this policy may be made with the approval of the Department when fillings would save a tooth in the smile area, the cost of an extraction and partial denture would exceed the cost of fillings required, and good dental hygiene practice on the part of the client is probable.
13. Persons with a disability that affects ability to provide for regular dental care may receive full basic dental care, including preventive and restorative services, and, if necessary, services may be provided in a hospital.
14. Prosthetic Services
(a) Complete upper or lower dentures may be provided where the extraction of all teeth is necessary to relieve pain and infection.
(b) Partial dentures may be provided in circumstances involving the replacement of lower posterior teeth when a complete upper denture is required, or in cases where teeth in the aesthetic regions need to be extracted.
(c) Approval of partial dentures shall be conditional upon a high probability of successful use for a lengthy period, based on consideration of the following:
(i) Age of patient
(ii) Comparative immunity to caries
(iii) Likelihood of proper hygienic care of the denture
(iv) Attitude of the patient towards wearing the denture
15. Orthodontic Treatment
(a) Some orthodontic treatment for children 12 years and under is provided by the Preventive Orthodontic Clinic of the Children’s Dental Program.
(b) Orthodontic treatment for applicants by a private specialist shall not be approved except where required for the correction of gross functional disability and not for aesthetic purposes. Orthodontic treatment by dentists in general practice will not be approved.
(c) Requests for orthodontic diagnosis or orthodontic treatment require the approval of a designated authority. It will be necessary to forward the dentist’s explanation of the gross functional disability.
PROCEDURE
16. Authorization
(a) Prior authorization is required for all dental benefits provided to clients and their dependents except for emergency services where immediate attention is required. A "Credit Service Authorization Form" is used to provide approval for three distinct types of dental benefits:
Dental Benefits "A" - Authorization for diagnostic and emergency services as outlined under 10 and 11 and Appendix "A" (sections 1 and 2);
Dental Benefits "B" - Authorization for an examination and estimate to be provided on the "Dental Estimate Form". Services are limited to those outlined in Appendix "A" under Diagnostic Services (section 1);
Dental Benefits "C" - Authorization for basic dental treatment or for denture services are limited to those outlined in Appendix "A" and are based on a previously submitted and approved estimate.
(b) Authorization for diagnostic and emergency services ("A") may be provided by the case worker to a maximum of $90 and for examination and estimate services ("B") to a maximum of $60. Authorization for basic dental treatment or for denture services ("C") requires the approval of a designated authority.
(c) The Department may obtain consultation from the Director of Dental Public Health (368-4915).
17. Estimate and Claim Form
(a) The "Social Assistance Dental Benefits Estimate and Claim Form" is a dual purpose form of four copies. Copies 1 and 2 should be submitted when claiming for services provided. Copy 3 is for estimate submission and copy 4 is for the dentist’s/denturist’s records. Instructions for use are listed on the back of the form.
(b) Following payment of claims, copy 2 will be placed in the client’s file at the Social Assistance office.
(c) Estimates must be submitted on the Social Assistance Dental Benefits Estimate and Claim Form (copy 3) to the appropriate office. The form requires the dentist to indicate teeth that are missing.
(d) In addition, information regarding oral hygiene, periodontal condition and long-term prognosis is required. A separate claim form (copies 1 and 2) is required when claiming for diagnostic services provided in relation to the estimate. This form should be submitted with the estimate form.
18. Payment of Claims
(a) Dentists/denturists and oral surgeons should bill the plan in accordance with the fees as set out in Appendix "A" or their usual and customary fees, whichever is the lower amount.
(b) Dentists/denturists who bill for authorized services shall not extra-bill the patient. The only exception when the dentist/denturist may bill the client (other than for services not covered under policy) is the client portion for prosthetic services.
19. Second Opinions
Where a second dentist is consulted to verify a diagnosis and/or treatment plan, any radiographs taken by the first dentist should be obtained to prevent unnecessary additional radiographs.
Optical Care
6-7 Optical Care
PURPOSE
1. To ensure essential visual and eye care needs of social assistance applicants are met.
PRINCIPLE
2. Applicants should be encouraged to obtain a visual assessment when experiencing vision problems.
3. Applicants may obtain necessary glasses from the optical dispensary of their choice.
4. The Social Assistance program only provides for necessary lenses, as prescribed.
POLICY
5. Assistance may be granted for essential vision or eye care, including:
(a) Optical/visual assessment fees;
(b) Basic frames and lenses when required; and
(c) Repair or replacement of glasses when necessary.
6. For most adults the normal recall time for optical/visual assessment is a two year period. Children under 14 years and adults age 50 and up may need more frequent re-examination because of physical changes they are undergoing. Staff may authorize reassessment in these exceptional cases if recommended by the optometrist or physician (See Appendix A for a guide to frequency of examinations).
7. For applicants with diabetic eye disease, glaucoma, macular degeneration or other eye diseases, more frequent and/or more comprehensive eye examination shall be authorized, including ophthalmoscopic examination through dilated pupils, where recommended.
8. Tinted lenses or super-size frames and lenses are ordinarily for cosmetic purposes and should only be approved when supported by the prescribers’s written recommendation.
9. Visual assessment fees shall be reimbursed to a maximum of $54 per basic assessment. Additional fees may be paid for dilation and/or cycloplegia where warranted and recommended by the optometrist.
10. Basic frames and lenses or contact lenses may be approved to a maximum total cost of $115 with single vision lenses and $145 with bifocal lenses.
11. Any estimates above these limits shall be accompanied by a written explanation from the dispenser prior to approval.
12. Applicants who are experiencing medical problems with their eyes such as infection, swelling or pain should be advised to consult their family physician who may refer them to an ophthalmologist. Ophthalmologists are medical doctors specializing in eye disease which they treat by medicine or surgery. Their fees are covered by Medicare.
13. Optometrists are specialists in all forms of vision care and are qualified in the detection of ocular abnormalities. Most applicants will seek their services when experiencing vision problems.
PROCEDURE
14. It will usually be necessary to complete two CSA forms; one for the visual assessment fee and the second for the purchase of lenses and frames.
15. Applicants will schedule an appointment for an optical/visual assessment. If visual correction is required a prescription for corrective lenses will be issued to the client by the prescribing specialist.
16. In emergency situations such as broken or lost glasses, the client should request a copy of his/her prescription from the prescribers. If the prescription is not available and/or an eye exam is required, C/SA’s may be authorized as indicated above.
17. The CNIB provides counselling to adults and children who experience serious vision problems. Field staff should ensure applicants are made aware of CNIB services available in the community.
Appendix A: Frequency of Examination
The need for periodic optometric examination has been recognized for many years. Vision and ocular health conditions are not always accompanied by recognizable symptoms. There is often an increased risk to the patient if treatment is not initiated. Relying on the occurrence of obvious symptoms in order to initiate an eye examination exposes the patient to an unnecessary risk.
Many factors will influence the frequency of optometric examinations and only the examining optometrist, upon the analysis of all factors, can determine when a particular patient should return for another examination. However, certain guidelines have been established which can assist the patient in determining the need for examination.
Patients in each age group may be classified as being at low risk or high risk for ocular or vision problems. The minimum frequency of examination for those at low risk is as follows:
Infants and Toddlers (birth to 24 months) - By age 6 months
Preschool (2 to 5 years) - At age 3 and prior to school entry
School Age (6 to 19 years) - Annually
Adult (20 to 64 years) - Every one to two years
Older Adult (65 years and older) - Annually
The frequency of examination for those at high risk should be determined by the examining optometrist on the basis of the patient’s health, ocular and visual status at the time of examination. Some of the factors which would indicate high risk are as follows:
Infants/Toddlers and Preschool - Premature birth; low birth weight; mother having rubella, sexually transmitted disease, AIDS-related infection, or other medical problems during pregnancy; mother having a history of substance abuse prior to or during pregnancy; family history of high refractive error or eye disease; turned eyes; or congenital eye disorders.
School Age - Children failing to progress educationally; children exhibiting reading and/or learning disabilities.
Adult - Diabetes; hypertension; family history of glaucoma; those who work in visually demanding or eye hazardous conditions.
Older Adult - Diabetes; hypertension; family history of glaucoma; those taking systemic medication with ocular side effects.
Diabetic eye disease, glaucoma and macular degeneration are among the leading causes of vision loss in Canada. Early detection and diagnosis with timely and appropriate treatment may significantly reduce the risk of visual impairment and blindness.
Therefore, patients known to have or at risk of developing these conditions should promptly receive an initial comprehensive eye examination, including ophthalmoscopic examination through dilated pupils (unless dilation is contraindicated).
The Canadian Association of Optometrists (CAO) recommends that patients with diabetes, glaucoma or muscular degeneration, after having obtained an initial examination, should receive annual eye examination, unless more frequent evaluations are indicated. In the case of diabetics, CAO recommends that a comprehensive dilated eye and visual examination should be performed annually for all patients who:
(a) are 12 years old or older and who have had the disease for 5 years, or
(b) are over the age of 30 regardless of how long they have had the disease, and
(c) have visual symptoms and/or abnormalities.
PURPOSE
1. To ensure essential visual and eye care needs of social assistance applicants are met.
PRINCIPLE
2. Applicants should be encouraged to obtain a visual assessment when experiencing vision problems.
3. Applicants may obtain necessary glasses from the optical dispensary of their choice.
4. The Social Assistance program only provides for necessary lenses, as prescribed.
POLICY
5. Assistance may be granted for essential vision or eye care, including:
(a) Optical/visual assessment fees;
(b) Basic frames and lenses when required; and
(c) Repair or replacement of glasses when necessary.
6. For most adults the normal recall time for optical/visual assessment is a two year period. Children under 14 years and adults age 50 and up may need more frequent re-examination because of physical changes they are undergoing. Staff may authorize reassessment in these exceptional cases if recommended by the optometrist or physician (See Appendix A for a guide to frequency of examinations).
7. For applicants with diabetic eye disease, glaucoma, macular degeneration or other eye diseases, more frequent and/or more comprehensive eye examination shall be authorized, including ophthalmoscopic examination through dilated pupils, where recommended.
8. Tinted lenses or super-size frames and lenses are ordinarily for cosmetic purposes and should only be approved when supported by the prescribers’s written recommendation.
9. Visual assessment fees shall be reimbursed to a maximum of $54 per basic assessment. Additional fees may be paid for dilation and/or cycloplegia where warranted and recommended by the optometrist.
10. Basic frames and lenses or contact lenses may be approved to a maximum total cost of $115 with single vision lenses and $145 with bifocal lenses.
11. Any estimates above these limits shall be accompanied by a written explanation from the dispenser prior to approval.
12. Applicants who are experiencing medical problems with their eyes such as infection, swelling or pain should be advised to consult their family physician who may refer them to an ophthalmologist. Ophthalmologists are medical doctors specializing in eye disease which they treat by medicine or surgery. Their fees are covered by Medicare.
13. Optometrists are specialists in all forms of vision care and are qualified in the detection of ocular abnormalities. Most applicants will seek their services when experiencing vision problems.
PROCEDURE
14. It will usually be necessary to complete two CSA forms; one for the visual assessment fee and the second for the purchase of lenses and frames.
15. Applicants will schedule an appointment for an optical/visual assessment. If visual correction is required a prescription for corrective lenses will be issued to the client by the prescribing specialist.
16. In emergency situations such as broken or lost glasses, the client should request a copy of his/her prescription from the prescribers. If the prescription is not available and/or an eye exam is required, C/SA’s may be authorized as indicated above.
17. The CNIB provides counselling to adults and children who experience serious vision problems. Field staff should ensure applicants are made aware of CNIB services available in the community.
Appendix A: Frequency of Examination
The need for periodic optometric examination has been recognized for many years. Vision and ocular health conditions are not always accompanied by recognizable symptoms. There is often an increased risk to the patient if treatment is not initiated. Relying on the occurrence of obvious symptoms in order to initiate an eye examination exposes the patient to an unnecessary risk.
Many factors will influence the frequency of optometric examinations and only the examining optometrist, upon the analysis of all factors, can determine when a particular patient should return for another examination. However, certain guidelines have been established which can assist the patient in determining the need for examination.
Patients in each age group may be classified as being at low risk or high risk for ocular or vision problems. The minimum frequency of examination for those at low risk is as follows:
Infants and Toddlers (birth to 24 months) - By age 6 months
Preschool (2 to 5 years) - At age 3 and prior to school entry
School Age (6 to 19 years) - Annually
Adult (20 to 64 years) - Every one to two years
Older Adult (65 years and older) - Annually
The frequency of examination for those at high risk should be determined by the examining optometrist on the basis of the patient’s health, ocular and visual status at the time of examination. Some of the factors which would indicate high risk are as follows:
Infants/Toddlers and Preschool - Premature birth; low birth weight; mother having rubella, sexually transmitted disease, AIDS-related infection, or other medical problems during pregnancy; mother having a history of substance abuse prior to or during pregnancy; family history of high refractive error or eye disease; turned eyes; or congenital eye disorders.
School Age - Children failing to progress educationally; children exhibiting reading and/or learning disabilities.
Adult - Diabetes; hypertension; family history of glaucoma; those who work in visually demanding or eye hazardous conditions.
Older Adult - Diabetes; hypertension; family history of glaucoma; those taking systemic medication with ocular side effects.
Diabetic eye disease, glaucoma and macular degeneration are among the leading causes of vision loss in Canada. Early detection and diagnosis with timely and appropriate treatment may significantly reduce the risk of visual impairment and blindness.
Therefore, patients known to have or at risk of developing these conditions should promptly receive an initial comprehensive eye examination, including ophthalmoscopic examination through dilated pupils (unless dilation is contraindicated).
The Canadian Association of Optometrists (CAO) recommends that patients with diabetes, glaucoma or muscular degeneration, after having obtained an initial examination, should receive annual eye examination, unless more frequent evaluations are indicated. In the case of diabetics, CAO recommends that a comprehensive dilated eye and visual examination should be performed annually for all patients who:
(a) are 12 years old or older and who have had the disease for 5 years, or
(b) are over the age of 30 regardless of how long they have had the disease, and
(c) have visual symptoms and/or abnormalities.
Special Resources for Supported Living
6-6-3 Special Resources for Supported Living
PURPOSE
1. To provide for the cost of training or additional supervisory care where existing community or program resources are insufficient to secure or maintain an adequate residential option for adults with a disability. Persons eligible for the Disability Support Program are not eligible for resources under this policy.
2. To define allowable expenses for live-in support persons.
PRINCIPLE
3. Supplementary resources should be based on an assessment of applicant, family, and community resources.
4. Supports provided should be the least intrusive to assist with daily living.
5. Attempts must first be made to access the required supports through existing community and service system resources.
POLICY
6. Special resources will be provided based on an assessment and a case plan completed by the appropriate Department staff.
7. Special resources for supported living may be applied as indicated in the following supported living options:
(a) Natural Family - Training costs of up to $100 per month to develop specific skills. Training dollars are not to be paid to family members. Supervisory care requirements are already covered by policy 6-6-1, Disability Allowance.
(b) Alternative Family - Training costs of up to $100 per month and supervisory care costs of up to $250 per month may be provided. The $250 maximum allows for increased recognition of behavioural factors in determining the supervisory care costs (i.e. up to $150 extra is allowed for behavioural factors). When applying the supervisory care costs, the basic room and board rate should be used.
(c) Commercial Room and Board - Both training costs of up to $100/month and supervisory care costs up to $150/month may be provided. When applying the supervisory care costs, the basic room and board rate should be used.
(d) Supported Apartment - Both training costs of up to $100/month and supervisory care costs up to $150/month may be provided. For shelter costs, apply policies’ 5-1 and 5-1-1.
(e) Live-In Supported Apartment - Training costs of up to $100/month may be provided. The maximum supervisory care costs of $150/month will be provided when live-in support is required. However, where two applicants share an apartment, the maximum supervisory care costs of $75/month per applicant will be provided, as well as training costs of up to $100/month per applicant.
For shelter costs, apply policies 5-1 and 5-1-1 counting the live-in support person when determining shelter ceilings. No rent is charged to the live-in support person. In addition, the food cost portion of the FCHP is allowed for the live-in support person.
8. The provisions of the Respite Care Policy 6-6-2 are extended to live-in support persons for purposes of this policy. Respite care provisions already apply to Natural and Alternative Families.
9. For purposes of this policy, natural family is defined as parents, spouse, grandparents, brothers, sisters, or children over the age of majority.
10. Training goals will be prioritized based on hierarchy of needs.
11. Training goals will be short term, measurable and skills oriented.
PROCEDURES
12. For adults with a disability, complete an assessment profile and scoring sheet to determine the supervisory care rate. For Alternate Family Placements the Behavioral Factor Score is considered (up to $150 per month) and the amount added to the total score (HSS701-back).
13. For young, single parents, complete a plan of care outlining training and supervisory needs. Allow training costs of $25 per month for each skill area being worked on up to a maximum of four skill areas at any one time.
14. Where a residential option is currently being provided any need for additional supports should be evaluated by completing a review of the case plan.
PURPOSE
1. To provide for the cost of training or additional supervisory care where existing community or program resources are insufficient to secure or maintain an adequate residential option for adults with a disability. Persons eligible for the Disability Support Program are not eligible for resources under this policy.
2. To define allowable expenses for live-in support persons.
PRINCIPLE
3. Supplementary resources should be based on an assessment of applicant, family, and community resources.
4. Supports provided should be the least intrusive to assist with daily living.
5. Attempts must first be made to access the required supports through existing community and service system resources.
POLICY
6. Special resources will be provided based on an assessment and a case plan completed by the appropriate Department staff.
7. Special resources for supported living may be applied as indicated in the following supported living options:
(a) Natural Family - Training costs of up to $100 per month to develop specific skills. Training dollars are not to be paid to family members. Supervisory care requirements are already covered by policy 6-6-1, Disability Allowance.
(b) Alternative Family - Training costs of up to $100 per month and supervisory care costs of up to $250 per month may be provided. The $250 maximum allows for increased recognition of behavioural factors in determining the supervisory care costs (i.e. up to $150 extra is allowed for behavioural factors). When applying the supervisory care costs, the basic room and board rate should be used.
(c) Commercial Room and Board - Both training costs of up to $100/month and supervisory care costs up to $150/month may be provided. When applying the supervisory care costs, the basic room and board rate should be used.
(d) Supported Apartment - Both training costs of up to $100/month and supervisory care costs up to $150/month may be provided. For shelter costs, apply policies’ 5-1 and 5-1-1.
(e) Live-In Supported Apartment - Training costs of up to $100/month may be provided. The maximum supervisory care costs of $150/month will be provided when live-in support is required. However, where two applicants share an apartment, the maximum supervisory care costs of $75/month per applicant will be provided, as well as training costs of up to $100/month per applicant.
For shelter costs, apply policies 5-1 and 5-1-1 counting the live-in support person when determining shelter ceilings. No rent is charged to the live-in support person. In addition, the food cost portion of the FCHP is allowed for the live-in support person.
8. The provisions of the Respite Care Policy 6-6-2 are extended to live-in support persons for purposes of this policy. Respite care provisions already apply to Natural and Alternative Families.
9. For purposes of this policy, natural family is defined as parents, spouse, grandparents, brothers, sisters, or children over the age of majority.
10. Training goals will be prioritized based on hierarchy of needs.
11. Training goals will be short term, measurable and skills oriented.
PROCEDURES
12. For adults with a disability, complete an assessment profile and scoring sheet to determine the supervisory care rate. For Alternate Family Placements the Behavioral Factor Score is considered (up to $150 per month) and the amount added to the total score (HSS701-back).
13. For young, single parents, complete a plan of care outlining training and supervisory needs. Allow training costs of $25 per month for each skill area being worked on up to a maximum of four skill areas at any one time.
14. Where a residential option is currently being provided any need for additional supports should be evaluated by completing a review of the case plan.
Respite Care
6-6-2 Respite Care
PURPOSE
1. To provide support and relief to families caring for adult applicants with a disability. (Persons eligible for the Disability Support Program are not eligible for benefits under this policy as this support is provided under that program.)
PRINCIPLE
2. The needs of adults with disabilities may most appropriately be met when living with their own families and/or in their own communities.
3. Most families providing care to adults with disabilities will need some measure of relief from that responsibility.
4. Respite services may be of a planned or unplanned nature.
POLICY
5. Respite care is defined as alternate care services provided to an adult with disabilities for the purpose of relieving his/her usual caregiver of parenting or supervision responsibilities for a specified period of time.
6. The worker will assess with the family the need for respite care. The use of respite care will be determined by the following criteria:
(a) level of care
(b) family’s support
(c) family’s coping ability/level of stress in family
(d) crisis situation that causes major change in family
(e) prevention of hospitalization.
7. Such services will usually be provided in the applicant’s home or in the residence of the respite care provider. In some specific situations, however, respite care may be provided in an alternative setting, such as an adult group home or a vocational day program.
8. Respite care services may be approved to a maximum of 24 days per fiscal year. Respite services over eight hours per day shall be considered one day for the purpose of calculating fiscal entitlement.
9. Regular sitting services may be approved, over and above the 24 day entitlement, to a maximum of four hours per week or the monthly equivalent.
10. Where it is difficult or inappropriate for the usual caregiver to use regular sitting services, it may be preferable to use the Special Care Allowance provision (6-4).
11. Where it appears a family will require more than 24 days respite care per year, a specific plan must be developed for approval by the designated authority.
12. Where the cost of camps or other activities offering the opportunity to live away from the applicant’s usual place of residence have been covered by this program, they are to be included in the calculation of respite entitlement.
13. Necessary transportation costs related to the provision of respite services may be provided where it would be an unreasonable financial burden on the family or usual caregiver.
14. Respite care services are not available to applicants who are residents of residential institutions. Staff of these facilities receive paid vacations and relief staff are part of the operational budgets.
PROCEDURE
15. Respite care rates are determined by completing an assessment profile.
16. Families will be responsible for making their own respite care arrangements. Workers will authorize and action payment of bills up to the 24 day limit. Approval from the departmental authority must be on file for any days beyond the 24 day limit.
17. Where a Special Care Allowance (6-4) is currently provided, the purpose must be reviewed to avoid paying twice for sitting services.
18. Where respite care is provided in an adult group home the group home will bill the applicant at a rate of $20.00 per day. The bills will be paid out of the applicant’s file and charged to Account Code W70. This daily rate is fixed by Agreement and does not depend on the functional level of the applicant.
PURPOSE
1. To provide support and relief to families caring for adult applicants with a disability. (Persons eligible for the Disability Support Program are not eligible for benefits under this policy as this support is provided under that program.)
PRINCIPLE
2. The needs of adults with disabilities may most appropriately be met when living with their own families and/or in their own communities.
3. Most families providing care to adults with disabilities will need some measure of relief from that responsibility.
4. Respite services may be of a planned or unplanned nature.
POLICY
5. Respite care is defined as alternate care services provided to an adult with disabilities for the purpose of relieving his/her usual caregiver of parenting or supervision responsibilities for a specified period of time.
6. The worker will assess with the family the need for respite care. The use of respite care will be determined by the following criteria:
(a) level of care
(b) family’s support
(c) family’s coping ability/level of stress in family
(d) crisis situation that causes major change in family
(e) prevention of hospitalization.
7. Such services will usually be provided in the applicant’s home or in the residence of the respite care provider. In some specific situations, however, respite care may be provided in an alternative setting, such as an adult group home or a vocational day program.
8. Respite care services may be approved to a maximum of 24 days per fiscal year. Respite services over eight hours per day shall be considered one day for the purpose of calculating fiscal entitlement.
9. Regular sitting services may be approved, over and above the 24 day entitlement, to a maximum of four hours per week or the monthly equivalent.
10. Where it is difficult or inappropriate for the usual caregiver to use regular sitting services, it may be preferable to use the Special Care Allowance provision (6-4).
11. Where it appears a family will require more than 24 days respite care per year, a specific plan must be developed for approval by the designated authority.
12. Where the cost of camps or other activities offering the opportunity to live away from the applicant’s usual place of residence have been covered by this program, they are to be included in the calculation of respite entitlement.
13. Necessary transportation costs related to the provision of respite services may be provided where it would be an unreasonable financial burden on the family or usual caregiver.
14. Respite care services are not available to applicants who are residents of residential institutions. Staff of these facilities receive paid vacations and relief staff are part of the operational budgets.
PROCEDURE
15. Respite care rates are determined by completing an assessment profile.
16. Families will be responsible for making their own respite care arrangements. Workers will authorize and action payment of bills up to the 24 day limit. Approval from the departmental authority must be on file for any days beyond the 24 day limit.
17. Where a Special Care Allowance (6-4) is currently provided, the purpose must be reviewed to avoid paying twice for sitting services.
18. Where respite care is provided in an adult group home the group home will bill the applicant at a rate of $20.00 per day. The bills will be paid out of the applicant’s file and charged to Account Code W70. This daily rate is fixed by Agreement and does not depend on the functional level of the applicant.
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