Western Cape Forum for Intellectual Disability 26 October 2010 1
Content of Presentation This presentation covers: • Legal Framework – § Disclosure Various Grant Types § § Care dependency grant § Grant-in-aid § Responsibilities of Medical Officer § General Information § Means Test § § Grant for the Disabled Review SGDM Model § Background 2
Content of Presentation • SGDMM § § Brief Description of the SGDMM § Progress § § SGDM Model Challenges Reviews § Types of review § Procedure to be followed § Decisions from reviews § Life certification § Suspension, lapsing, decrease § Representation § Suspension, lapsing § Application for restoration 3
Content of Presentation • Reviews § § Appeals Customer Centric Services § Background § Purpose of customer care network § Customer care management framework § Customer enquiries and feedback management § Integrated community registration outreach program (ICROP) § § § Prioritized elements Stakeholder definition Payment Options 4
Legal Framework: Grants § Social Assistance provided in terms of the following legal frameworks § Constitution: Section 27(1)(c) – Right to Access § South African Social Security Agency Act (Act 9 of 2004) § Social Assistance Act, 2004 (Act 13 of 2004) § Regulations, 2008 § Promotion of Access to Information Act (Act 2 of 2000) § Promotion of Administrative Justice Act (Act 3 of 2000) § Promotion of Equality and Prevention of Unfair Discrimination Act (Act 4 of 2000) § Public Finance Management Act (Act 1 of 1999) § Social Assistance is non- contributory fund § Social Assistance is means tested to ensure that the most needy do qualify – not universal system 5
Various Grant Types § Social Assistance Act makes provision for the following grant types – § Grant for the Aged § Grant for the Disabled § War Veteran’s Grant § Foster Child Grant § Care Dependency Grant § Child Support Grant 6
Disclosure • Section 14(2) of Social Assistance Act stipulates the following: – In considering an application made in terms of subsection (1), the Agency may conduct an investigation and request additional information • Section 14(4) stipulates the following: – No person may divulge any personal information of an applicant furnished in respect of an application except • To a person who requires it in order to perform a function in terms of this Act; • When required to do so by law or an order of court; or • With the consent of the applicant. 7
Disclosure • Section 14(5) stipulates the following: – If any information supplied by a beneficiary to the Agency in an application for a grant materially changes after that beneficiary has submitted that application, he or she must as soon as is reasonable possible after the change occurs, inform the Agency thereof. • Section 21(1) – (3) stipulates the following: – A person is guilty of an offence if such person, when applying for social assistance, furnishes information which he or she knows to be untrue or misleading in a material respect or makes a representation which to his or her knowledge is false, in order that he or she or another person may • Obtain or retain social assistance to which he or she is not entitled in terms of this Act; or 8
Disclosure • Obtain social assistance in excess of that to which he or she is entitled in terms of this Act. – If any person receives social assistance knowing that he or she is not entitled thereto, or is not entitled to the full amount which he or she is receiving, and he or she fails to inform the Agency thereof, he or she is guilty of an offence. – A beneficiary who knowingly fails to inform the Agency of any material change of information contemplated is section 14(5), is guilty of an offence. 9
Disclosure • Section 16(1) of South African Social Security Agency Act stipulates the following: – Subject to the Constitution of the Republic of South Africa, 1996 (Act No. 108 of 1996), and the Promotion of Access to Information Act, 2000 (Act No. 2 of 2000), no person may disclose any formation submitted in connection with any application or instruction for or in respect of a grant, payment or assistance made available by the Agency, unless he or she is ordered to do so by court of law or unless the person who made such application consents thereto in writing. 10
Various Grant Types § Grant for the Disabled • DEFINITION A disabled person is any person who has attained the prescribed age of 18 and is owing to a physical or mental disability unfit to obtain by virtue of any service, employment or profession the means needed to enable him or her to provide for his or her maintenance. • The disability must be confirmed by a medical report of a medical officer. 11
Grant for Disabled • The medical assessment must confirm whether the disability is- – Permanent in that the disability will continue for more than 12 months; – Temporary in that the disability will continue for a continuous period of not less than six (6) months or for a continuous period of not more than twelve (12) months; • The medical report has to confirm that the person has a physical or mental impairment that limits or prevents the person from doing any work in order to maintain him or herself. 12
Grant for Disabled § Degree of disability – makes incapable of entering labour market § Does not without good reason refuse medical or other treatment recommended § SA citizen or permanent resident or a refugee residing in SA at the time of application § Complies with the means test § Not maintained in one of the institutions indicated 13
Grant for Disabled • Non compliance patients are not eligible • Impairment – The alteration of normal functional capacity due to medical condition, assessed by medical means, after a diagnosis is established and appropriate and optimal treatment has been applied. • Disability – The alteration of capability to meet personal and occupational demands due to impairment. – Medical model is applicable 14
Grant for Disabled • • • Where evidence exists that changes in the medical or financial circumstances of a permanent disabled person have or may be have occurred, a review can be done Agency may at any time from date of application for a disability grant request the beneficiary to undergo an assessment Temporary disability may be for six or twelve months and will be terminated after the period expired All beneficiaries must be informed of the outcome/result of their application Legally no obligation to sent out a reminder of the intention to lapse/cancel the grant ïHowever, three (3) months in advance notice of intention of cancellation will be sent out Patients must be rehabilitated whenever possible 15
Grant for Disabled • • Alcohol and substance abusers must be referred for rehabilitation Subnormal intelligence must be graded Lack of motivation to work or to participate in a rehabilitation programme is not a reason for a disability grant: – unless there is a psychiatric condition – this must be substantiated by a psychiatric report Obese patients must receive a diet plan and weight loss must be monitored – Patients with insulin resistance often have great difficulty in loosing weight 16
Various Grant Types § Care Dependency Grant § Qualifying criteria § The child is under the age of 18 years § Child must receive permanent care or support services due to his/her severe mental or physical disability § Disability confirmed by medical report § Parent or a foster parent or primary care giver must be resident in the Republic at the time of the application for the grant § Parents must be South African citizens or Permanent RSA residents § Child must not be in an institution (including special schools) § Complies with the prescribed conditions and the means test § Income of parent – single must not exceed R 129 600. 00 § Income of parent's – married must not exceed R 259 200. 00 17
Various Grant Types § Grant-in-aid § Qualifying criteria § Person in such a physical or mental condition that he or she requires regular attendance by anther person § Medical practitioner must certify that the person require regular attendance by another person § He or she is in receipt of an older person’s grant, disability grant or a war veteran’s grant § A grant-in-aid is not payable to a person maintained in any institution subsidized by the State § Complies with all other the prescribed conditions and the means test 18
RESPONSIBILITIES OF MEDICAL OFFICER • • Medical report to be completed in legible handwriting Patient must be considered/assessed globally Patient must be assessed according to objective criteria Patient/Applicant must be identified by ID document The patient must be present at the time of completing the form The patient must be medically assessed by the medical officer Statements made by the patient needs to be verified by observation and or examination Determine whether referral for work assessment at an assessment unit or workshop is needed 19
RESPONSIBILITIES OF MEDICAL OFFICER • The completed medical report must not be handed to the patient – A letter must be given to the patient as proof that a medical assessment report was completed – The medical assessment report must be signed by the patient – The declaration must be explained to the patient – The patient must also sign on the lists on which his/her name appears – The staff from the local district office will collect the completed medical forms on a regular basis 20
Various Grant Types § Documentation required – critical § Bar coded identity document § Alternative documentation § Thirteen digit ID number for child/ren (birth certificate) § Proof of assets and income § Last three months bank statement § Discharge papers – war veteran’s grant § Medical certificate – disability and care dependency § Marriage certificate (if married) § Death certificate (deceased spouse) § School attendance certificate (child support and foster) § Court order/extension order (foster child) § Any other document (s) which may affect outcome of application 21
Various Grant Types § General information § At some local offices there is a one day turn-around at the specific office. Service points linked to these offices have a ten day turn-around § Norm of 21 working days set by SASSA: WC for processing of applications for social assistance (except disabilities) § If a grant is refused or rejected the applicant will be informed in writing thereof in writing by registered post or hand delivered against a signature of the beneficiary § In respect of grants for the disabled, the beneficiary will also be informed of the classification and when the medical coverage will expire. This is done to ensure that the beneficiary will have enough time to obtain an appointment at a medical facility for a medical assessment § Three months prior to the suspension of a grant the beneficiary will be informed thereof in writing. This is not compulsory 22
Means test § Apart from other criteria for eligibility, material means available to potential recipients are taken into consideration in determining whether they qualify for benefits, or what levels the benefits should be § Sliding scale utilized – as the income increases above a certain level, the benefit level decreases until a point where no further benefits are paid § Irrespective of whether a couple is married in or out of community of property, the means of a married person and his/her spouse shall be taken into account § Means test consist of two elements, namely: § Assets § Income . . Means Test Income ThresholdsINCREASE as from 1 April 2010. xls 23
Means test § Assets § The market related value of any immovable property owned and not occupied by the applicant or his or her spouse § Any assets (property, etc) relinquished § Investments § Maximum value – R 518 400. 00 single person & R 1 036 800. 00 married person § Income derived from – § Salaries and wages § Income from trust § Any pension or annuity § Rent receive from boarders § Any profits or withdrawals § Any other income – including interest and dividends from assets § Maximum value – R 31 296. 00 per annum for a single person and R 62 592. 00 per annum for a married person 24
Means test Minimum amount for grants for the aged, disabled and war veteran’s is R 100. 00 Other grants fix amount GRANT AMOUNT Old Age Grant • Grant amounts GRANT TYPE R 1 080. 00 Grant for Disabled R 1 080. 00 War Veteran’s Grant R 1 080. 00 + R 20. 00 Grant-in-Aid R 250. 00 Child Support Grant R 250. 00 Foster Child Grant R 710. 00 Care-dependency Grant R 1 080. 00 25
Background Disability Management Unit is the entity within SASSA and its purpose is to: Provide strategic direction and leadership pertaining to the administration and management of disability related grants. Main Functions: § To standardise and ensure uniformity of all disability related activities incl. medical assessment process. § The co-ordination of disability management functions across the regions. § To design and maintain training programmes for various stakeholders § To design and maintain guidelines and criteria for medical assessments. Prior to the Establishment of DMU, there had been different disability assessment methods used by different regions and lack of uniform standardised assessment tool. In order to bring about uniformity, DMU: HO in consultation with the regions consolidated these methods into one standard business model that will be implemented across all regions. 26
New Social Grants Disability Management Model Overall objective: To align and standardise systems and processes in order to improve access and the quality administration of disability related social assistance. It consists of the following elements: Ø Gatekeeping and Medical Assessment Process; Ø Booking System; Ø Medical Assessment Form Management; Ø Contracts management; Ø Claims Procedure; Ø Training; Ø Quality Assurance and Ø Risk & Fraud management. 27
Brief description of elements of the SGDMM Element Gatekeeping and Medical Assessment Process Description • 3 months validity period for medical form • Referral Booking System • Entry point for DG application at SASSA Medical form Management Tracking & control of medical assessment form from procurement to application. Contracts Management SLA with Department of Health Training Doctors/Medical Assessors SASSA staff Claims Procedure Payment for Assessments conducted. Verification Quality Assurance Random Sampling of 25 % assessments conducted Risk & Fraud Suspected fraudulent medical assessment form 28
Progress Implementation of the SGDMM § It has been partially implemented at 3 rural districts of the Western Cape and in the Metro § West Coast – Vredenburg § Boland Overberg – Paarl § Eden/Karoo – Beaufort West § Metro – Bellville; Eerste Rivier. - To be fully implemented by end March 2011 29
Challenges Action Plan to address challenges Medical Assessments backlogs at some health facilities Engagements with DOH to avail more doctors for rendering medical assessment services. Implementation of Gatekeeping element to reduce influx Untrained doctors conducting medical assessments result in cases being referred for QA Ongoing training of doctors across the region. Fraudulent Activities No “walk –ins” (medicals brought by client from the assessing doctor) will be accepted. Embark on awareness-raising campaigns 30
BMU – Reviews • Regulation 27(8)(a) stipulates the following: – Where evidence exist that changes in the medical or financial circumstances of a permanently disabled person have or may have occurred, the review of the social grant may be done in accordance with subregulation 8(b). • Reviews will be done as follows: – Medical review – Administrative review – Will be given notification of the intention to review – Will be informed of documentation required – Will be informed of the place and time when he or she must review – Will be informed of outcome and right to make representations/ appeal 31
Types of Reviews Administrative reviews Foster Child Grant Reviews • Cover the review of general or personal information • Extension of foster placement, court orders in addition to normal administrative review • Changes to residential and postal addresses, marital status, • Financial information and • Pay point information Medical reviews • Reassessment of medical status in addition to a normal administrative review Refugees Status • Legal residence in the country • Court orders gave them access to FCG and DG • Permission to live in country for 2 years, have to reapply • Review examine the status Life certificate • Certifies that beneficiary is alive 32 and remains in the republic
Procedure to be followed Notification • Notify beneficiary within 90 days • Called to office to complete form • Notification letter should inform him/her of the required information and documents • Consequences of failure to comply • Use of Registered Mail is required, additional notices on pay slips and sms allowed where available Administrative Review • Annually for beneficiaries who declared means • Necessity for review can arise from: – Changes in circumstances – Abuse of grant, fraud, errors, dormant accounts, absence from RSA • Full review is the same as life certificate 33
Procedure to be followed (continued) Foster Child Review • Supervision requirements are stipulated by the Children’s Act • Review upon expiry of the court order or extension order (generally every 2 years) • If court order period is shorter than 2 years, review accordingly • If court order is awarded for longer period (eg. until 18 years) review must be conducted every 2 years, involve the social worker Medical Reviews • Only permanent disability grants are reviewed • Complete medical re-assessment 5 years after initial or subsequent assessment • Medical officer may state that a disability may have to be assessed in shorter time period, review accordingly • Medical reviews– also administrative 34 • Care dependent child is not subject to medical reviews
Procedure to be followed (continued) Refugees review • • Review on expiry of refugee ID (generally 2 years) Same 90 days notice as other reviews Liaise with Home Affairs managing delay in provision of ID Adopt a case management approach Temporary Disability Grant (TDG) • • • Not subject to review Awarded for short period Letter of award must state period and termination date Letter 90 days prior to termination warning of lapsing Letter must inform beneficiary of right to reapply 35
Decisions from reviews No change in value or status • • • If no change, the status will remain the same, grant will continue Records are complete, relevant, current No means Medical assessment indicates that no future changes are anticipated No further review may be required Request future life certificates if he/she is not collecting personally Decrease (Increase) in value of grant • Grant amount may be increased or decreased depending on change in means Suspension of social grant • • Beneficiary no longer eligible Medical indicates no longer disabled Means too high Other reasons 36
Life certification Notification for completion and submission of life certificates • • • Forward letter together with life certificate Posted to intended beneficiary 3 months (90 days) in advance Process and details for the return of LC must be specified Failure to comply leads to suspension Certificate or affidavit can be completed in the presence of commissioner of oaths Posted or delivered to relevant SASSA offices (details of office appear on the notice) Beneficiary can also call at the nearest SASSA office Beneficiary can make arrangements to extend period Incomplete, incorrect life certificatesare returned to beneficiary with written explanation Give beneficiary 30 days to resubmit 37
Suspension, Lapsing, Decrease • The Regulations stipulate when to suspend or lapse, under what conditions • May be due to changes in circumstances following review (no longer medically unfit, increased means) • May be due to failure to review or provide life certificate • Regulations make provision for representation by the beneficiary prior to suspension, lapsing, decrease (any action detrimental to the beneficiary) • Pre-notification to make representation is necessary • Inform beneficiary he/she may apply for restoration if grant is suspended 38
Representation: Suspension, Decrease Representation by the beneficiary • Inform beneficiary in writing the grant is to be suspended (decreased, lapsed) • Notification must be 90 days prior to suspension • He/she can make representation personally or in writing, why grant should not be suspended (form being designed) • PAJA 3(2)(b)(ii), also Social Assistance Regulations 2008 • Include evidence supporting the beneficiary’s claim, such as: – Incorrect assessment of means, incorrect identification, incorrect disability assessment, proof of submission of life certificate or review • Designated official to hear / adjudicate, must consider all the facts, finding must be recorded • Cannot suspend until representation is considered and processed 39 • Written response to beneficiary
Suspension, Lapsing • After representation is unsuccessful, or if beneficiary does not choose to make representation • Interim manual procedure to manage representation and suspension • To acquire system support which will permit normal capturing and verification, eventual suspension • Letter produced by SOCPEN to verify the suspension or decrease • Letter must indicate the right of the beneficiary to apply for restoration of the grant or grant amount 40
Application for Restoration • If grant is decreased, suspended, lapsed • If application for representation was unsuccessful, or if beneficiary did not make representation • Beneficiary may apply within 90 days to internal remedy unit • Decision will be made on behalf of the CEO (delegated) • Unit must be autonomous to the officials that made the original decision • Prescribed form (form being designed) • Must be accompanied by SASSA letter of suspension, giving reasons • Attach any documentary evidence in support of claim • IRU must assess and make decision within 30 days • May hear verbal evidence from beneficiary • Inform beneficiary in writing of outcome • If successful, reinstate back to date of suspension 41
Appeals • All beneficiaries must first apply to SASSA at the local office for the restoration of grant • An acknowledgement of receipt of all the application for restoration of social grant can be done at the local office level • The acknowledgement must accompany the application form. • After due consideration and reasons for a particular decision if the beneficiary is still not satisfied with the outcome of the application for restoration • Appeal to the Minister 42
CCU – BACKGROUND § Our CUSTOMERS are central in the key strategic objectives of SASSA as we obligated to create a CUSTOMER CARE CENTRED BENEFICIARY ADMINISTRATION SYSTEM § The Constitution of the Republic of South Africa and the South African Social Assistance Act places an obligation on all SASSA employees to assist the poor and vulnerable to access social grants in a dignified manner § SASSA embraces the Batho Pele (People First) Transformation Framework in its First service delivery approach § This approach is consistent with the Agency’s vision of rendering a comprehensive social security service that assists people in being self-sufficient and supporting those in need § The vision highlights SASSA’s commitment to render a seamless service to the citizens of South Africa; STAKEHOLDER PARTNERSHIPS are instrumental in attainment of its vision: § § Directory of Services Defined Referral System mutually agreed upon 43
Customer Care Network PURPOSE § To promote the implementation of uniform practice standards § Contribute to the development of the regional Customer Care Management Framework § Promote collective responsibility for training in customer care policies and procedures § Shared responsibility for the rollout of the Customer Care Management Framework with employees, Citizens and Stakeholders § Establish accountability structure: Monitoring and Evaluation, Review of CCMF and upholding the Reporting Framework 44
Customer Care Management Framework (CCMF) PRIORITIZED ELEMENTS § SASSA Customer Care Charter § Customer Life Cycle Process • • Reception and Waiting room Management ( Intake/ Helpdesk) Queue Walking Grant Application Screening Grant Application Pre-screening Grant Application Communicating SASSA Decision on application Disengagement § Customer Enquiries and Feedback (Complaints and Compliments) Management 45
Customer Enquiries and Feedback Management NORMS AND STANDARDS • Written enquiries date-stamped, referenced, logged and scanned on receipt • Telephonic enquiries must be responded to on demand • Written enquiries acknowledged within 48 hours of receipt • Written enquiries must be attended to within 7 days • Enquiry must be finalized within 21 days • High level enquiry must be finalized within 3 days • Enquiries must be procedurally recorded • Quality of feedback to customers must be of a high standard • Make commitment to the customer 46
Integrated Community Registration Outreach Program (ICROP) PRIORITIZED ELEMENTS § Customer Care Stakeholder Partnership • Regional/Local Office Stakeholder Database • Stakeholder Institutional Arrangements (Governance Structures) • Stakeholder Segmentation (Roles and Responsibilities) § SASSA Outreach Programme Strategy • Service Delivery Programme with other Government and Non-Governmental Partners (Jamboree) • Public Participation Programme (Imbizo’s) • Door-to-Door Campaigns/Community Walkabouts 47
Integrated Community Registration Outreach Program (ICROP) PRIORITIZED ELEMENTS cont… § Citizen/Stakeholder Education-Empowerment • Marketing SASSA Grants and other products • Citizen Dialogues to get feedback of experiences and perceptions • Update citizens/beneficiaries on new service delivery developments/initiatives § Customer Care Assessment, Monitoring and Evaluation • Internal assessment of Local Offices by Regional office • External Feedback from customers and stakeholders through questionnaires and observation visits 48
Stakeholder Definition Stakeholders are those individuals/groups who are affected or could have an impact on Services rendered Stakeholder engagement is a crucial factor for success in realising the Constitutional rights of the poorest of the poor, by granting them access to social security especially in remote and rural areas Stakeholder support and partnership are essential to start the SASSA Referral service to ensure that a seamless service is rendered to those in need 49
Payments Options • Beneficiaries have three options of how to collect their monthly grants: – Banking System – ACB payments including Postbank – At homes for the aged and infirm or institutions – Through a computerized pay out system in cash – Biometric fingerprint images stored on a smart card – Other beneficiary details as well as procurator holder details encrypted on the same micro chip – Pay out schedules indicate when beneficiary can collect the grant – A receipt is printed with each payment containing all relevant payment information – Messages can also be printed on the receipts 50
Closure Thank you – Any comments or questions 51
The End SASSA Western Cape Regional Office 52
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