Position Profile


Job Title:  AISH Generalist

Work Unit:  Disability Supports Division, AISH Delivery Services

Ministry:   Alberta Children’s Services / Community and Social Services

Competition Number:  1042654

Date:  June 2017
 

Purpose

 

As part of a team of professionals, the AISH Generalist is responsible for assisting applicants and reviewing applicant assessment reports to determine whether the applicant is eligible for the Assured income for the Severely Handicapped (AISH) program. The position is responsible for determining applicant eligibility based on age, residence, income and assets and for assessing and categorizing applications according to their complexity. The incumbent reviews AISH assessment reports for eligibility in the following categories:

  • Applicant meets AISH eligibility criteria-AISH Generalist determines eligibility.
  • Applicant does not appear to meet AISH eligibility criteria-AISH Generalist refers application to an AISH Administrator for adjudication.
  • Application is determined by the incumbent to be complex-AISH Generalist refers the application to an AISH Administrator for adjudication.

The position assesses alternative medical assessment reports submitted by the applicant and has the authority to accept these in lieu of a stai1dard AISH Medical Report, if the incumbent determines that the alternative information is sufficient to determine AISH eligibility.

For complex cases, the AISH Generalist may be required to participate in a joint case review process with the AISH Administrator, AISH medical consultant or contracted service providers when appropriate.

The incumbent is responsible for assessing and managing situations where an AISH applicant's financial resources exceed AISH income eligibility requirements but are insufficient to meet their basic living needs due to the high medical costs associated with their severe handicap. This includes preparing and submitting an application to the Minister or designate for health benefits to be granted to the applicant on an exceptional basis.

For approved applications, the incumbent calculates benefit entitlements and issues the AISH Living Allowance, Modified AISH Allowance and Personal Income Support Benefits (PISB) to eligible clients. The incumbent also reviews ongoing client eligibility (i.e. income, assets and degree of impairment) of AISH clients.

The AISH Generalist is the primary contact for AISH clients or persons acting on their behalf.

The AISH Generalist facilitates the AISH application process by providing advice and support to applicants having difficulty completing their AISH application due to mental illness, cognitive impairment or physical incapacity. This may include individuals with significant communication challenges who require alternative communication methods and may involve identification and coordination of resources to assist the applicant to complete AISH application requirements. The AISH Generalist is also responsible for assisting approved AISH clients to meet their basic living needs and to achieve a level of independence. This may involve needs assessment and research into available community resources to meet those needs. If community resources are not available, the AISH Generalist is responsible for determining whether Personal Income support Benefits (PISB) may be an option to address need.

The AISH Generalist is also responsible for advising applicants who are denied AISH of their right to appeal, explains the appeal process, prepares detailed documentation for the consideration of the Citizens' Appeal Panel and may be required to make oral presentations to the Panel at AISH appeal hearings.

The AISH Generalist must be knowledgeable of a wide variety of medical conditions and their potential effects upon clients' daily functioning and have the ability to communicate effectively and sensitively with individuals with complex needs. The primary client group consists of persons with severe physical, mental or developmental disabilities, including persons with significant communication barriers who may require alternative c01m1mnication methods. Secondary client groups consist of family members, including persons acting as the client's Court-appointed Guardian or Trustee or persons appointed by AISH to act as the client's Financial Administrator. Other secondary client groups may include staff from other government programs (e.g. Alberta Works, PDD, etc.), community resource representatives, client advocates, physicians, psychologists, lawyers, financial planners and other persons who may be working with clients.

Responsibilities and Activities

  1.

Intake Responsibilities

Activities:

  • Responds to inquiries regarding the AISH program from prospective applicants, other involved parties and members of the public. Screens prospective applicants on the basis of age, residence, income and assets and proceeds with the AISH application for persons meeting these eligibility criteria. May also complete a preliminary needs assessment and assist the applicant to access available resources to meet those needs (e.g. Alberta Works program for interim financial assistance, mental health services, subsidized housing, support services for persons escaping an abusive relationship). Assesses and categorizes AISH applications according to their complexity and approves AISH applications where the applicant appears to meet AISH eligibility criteria. Determines which cases require referral to an AISH Administrator for adjudication because of case complexity or because the applicant, in the opinion of the worker, does not appear to meet AISH eligibility criteria.
  • Assesses and manages situations where the AISH applicant's financial resources exceed AISH income eligibility requirements but are insufficient to meet their basic living needs due to high medical costs associated with their severe handicap. Prepares and submits an application to the Minister or designated for health benefits to be granted to the applicant on an exceptional basis.
  • Reviews and interprets financial information submitted by applicants, including information related to farms, businesses or investment portfolios, May refer complex files for further review by an accountant if required.
  • Ensures that required application documents are received and follows up on missing documentation, Determines what information is required to make a decision on AISH eligibility.
  • Meets with applicants to review application documents. Has authority to accept appropriate alternative medical or assessment information (e.g. psychological assessments, medical reports used to establish eligibility for other programs, such as CPP-D) in lieu of the AISH Medical Report form. Explains AISH application process and provides support to applicants who are having difficulty completing their AISH application due to mental illness, cognitive impairment or physical incapacity. Completes a written assessment report of the applicant's medical condition and how it affects activities of daily living and capacity for employment.
  • For approved applicants, calculates and issues the AISH Living Allowance, AISH Modified Allowance or Personal Income Support Benefits (PISB) as appropriate.
  • Approves appointment of a Financial Administrator to assist applicants who are incapable of managing their AISH funds, after reviewing the Financial Administrator's suitability. Explains Financial Administrator responsibilities and record keeping requirements.
  • Informs ineligible AISH applicants of their right to appeal, explains the appeal process and may assist the applicant to locate community resources to assist with their appeal. Prepares documentation for the consideration of the Citizens' Appeal Panel and may make oral presentations at appeal hearings on behalf of the Ministry.
  • Informs ineligible applicants of alternative resources to meet their needs and assists applicants to access these services as required (e.g. Alberta Works program, mental health services, Labour Market Information Centres, student funding sources, etc.).
     
  2.

Support Services Case Management

Activities:

  • Periodically reviews assigned AISH files, to update client's financial circumstances, medical status, current situation and continuous or non-continuous needs. Prepares a Case Management Plan, makes necessary revisions in response to changing circumstances and needs and determines next steps for managing the case.
  • Assists recipients to identify needs, options for meeting those needs and reviews progress. Contact is through telephone discussions, written correspondence or in-person meetings. Periodic meetings with recipients are scheduled to discuss a wide range of topics including financial, personal and medical issues and where appropriate, employment and training issues. The intent of these meetings is to determine if a recipient requires further services, including Personal Income Support Benefits (PISB), referral to an AISH Client Support Advisor or referral to other resources for more complex cases. Typical situations requiring action by the AISH Generalist include clients who are incapable of independently managing their AISH funds and who may require a Financial Administrator or Trustee, clients having difficulty locating and maintaining suitable housing and clients expressing interest in pursuing employment or training. In addition, recipients who are in crisis may arrive unexpectedly at the AISH office and may require immediate support to address issues such as lack of food, medication or medical supplies suicidal thougl1ts, domestic violence, eviction and termination of utility service. In addition, some recipients may present as aggressive and potentially violent, due to mental health or addictions issues and the AISH Generalist must use skill when responding, to avoid potential escalation and to ensure personal safety.
  • Determines eligibility for and authorizes immediate/emergency benefits such as payment of utility arrears to restore service or other emergency assistance available through Personal Income Support Benefits (PISB) (e.g. assistance to escape an abusive relationship or funeral expenses for the client or dependents, etc.).
  • Assesses client capacity to independently manage AISH funds and may appoint a Financial Administrator to assist. Monitors Financial Administrator's records to ensure that recipient's interests are protected.
  • Makes referrals to a variety of programs offered by different levels of government (public housing, subsidized or special needs transportation programs, Albe1ia Mental Health, Public Guardian or Public Trustee, AADAC, PDD, Labour Market Information Centre, etc.) or community agencies (Canadian Mental Health Assoc., Distress Centre, Suicide Crisis Line, Food Bank, various disability organizations and support groups e.g. Multiple Sclerosis Society). With client's consent, may discuss client needs with community resource representative or other involved parties. Clarifies AISH program policies and procedures for community resource contacts.
  • Makes referrals of complex cases to senior AISH Delivery staff, Program and Policy resources, Financial Services resources for further assessment and support, if required.
  • Reviews and follows up on Case Management Plan, to assess client progress, determines next steps and if appropriate, modifies the Plan taking into account changing circumstances.
  • Encourages client to follow through on physician-recommended treatment and may initiate a review of recipient's medical status and ongoing eligibility for AISH.
  • Documents case management activities on electronic or hardcopy client files as required.
     
  3.

Financial Case Management

Activities:

  • Determines ongoing eligibility for the AISH Living Allowance or AISH Modified Allowance and assesses eligibility for Personal Income Support Benefits (PISB). Updates budget and issues benefits. Verifies financial circumstances including both income (currently over 60 different factors that may have impact on income calculation) and exempt or deemed assets as required.
  • Completes AISH annual reviews, including review of documents including Income Tax Returns and Canada Revenue Agency (CRA) Notices of Assessment and through meetings with clients. May assist clients who are having difficulty completing AISH Annual Report forms.
  • Reviews records kept by Financial Administrators appointed under the AISH Act, to ensure that AISH funds are appropriately managed on behalf of affected clients.
  • Responds to changes to a client's financial circumstances and determines if further financial assistance is required. May provide Personal Income Support Benefits to eligible clients.
  • Prepares documentation required for consideration of client requests for Director Approval under AISH PISB program and ensures that suppo1ting medical or other documentation is included with the request.
  • Responds to Error Detection and Continuous Improvement (EDCJ) observations by reviewing documentation, consulting with supervisor and taking corrective action as required.
  • In conjunction with the supervisor, may initiate a fraud investigation referral in cases where fraud is suspected. Completes referral documentation, outlining circumstances of the case. May be required to give sworn evidence in Court in cases where prosecution is pursued.
  • Calculates benefit overpayments and enters calculation into Recoveries System. 'Negotiates rate of recovery with client.
  • Advises clients of their right to appeal, explains the appeal process and provides appeal documentation to clients when requested. Prepares documentation for presentation at an appeal hearing and may make oral presentations to the Citizens' Appeal Panel on behalf of the Ministry.

Scope

 

The AISH Generalist is the key contact for the AISH applicant or client and has primary responsibility for processing AISH applications as well as ongoing case management of approved files. AISH Generalists report to a supervisor. Responsibilities are identically described; however, work assignments may vary somewhat at different times, in response to changing operational requirements, level of staff skill and experience, case complexity and work volume.

The AISH Generalist is responsible for determining program eligibility, including medical eligibility for straightforward AISH applications and is responsible for appropriate management of AISH appeals. The latter involves preparation of documentation for consideration by the AISH Citizens' Appeal Panel as well as oral presentations at the appeal hearing on behalf of the Ministry, if required. (The Citizens' Appeal Panel is a quasi-judicial body with the legislated mandate to review decisions of Ministry staff, including AISH eligibility decisions. The Panel can confirm, reverse or vary the decision of the Ministry.)

The AISH Generalist is also responsible for managing cases of otherwise ineligible AISH applicants who may be approved by the Minister or designate to receive coverage for health benefits on an exceptional basis. This involves provision of benefits as well as periodic review of client circumstances to determine whether a further review of the case is required. All persons served meet the medical and financial eligibility requirements for the AISH program or are eligible to apply for AISH (i.e. Alberta residents). Many clients have complex needs and difficulty living independently in the community. Clients may present with mental illnesses that are refractory to treatment, cognitive or sensory impairments resulting in significant communication challenges and the need for alternative communication methods. Some may be dependent on others for help with activities of daily living or may require someone to act on their behalf, including a Court-appointed Guardian or Trustee. In some cases, the AISH Generalist may appoint a Financial Administrator to manage the client's AISH funds. The AISH Generalist is responsible for assessing the Financial Administrator's suitability and for ensuring that the appointee acts in the client's best interests. The AISH Generalist is also required to periodically review the Financial Administrator's records to ensure that AISH funds have been used for the purpose intended.

The AISH Generalist is responsible for monitoring suspected abuse of prescription drugs in cases identified through prescription drug dispensing reports. Where there is evidence of abuse, the AISH Generalist is responsible for taking appropriate action including restriction of drug dispensing to a single pharmacy or other required measures.

The AISH Generalist authorizes or denies benefits according to AISH legislation, regulations and policy. In addition, the worker must exercise judgement in supporting recipients with complex, changing and emergent needs. Decisions made may have a significant impact on the lives of AISH recipients and their families. While the provision of financial benefits continues to be a significant aspect of the role, the focus of the work has shifted from routine financial processing to building relationships with individuals, including representatives of community support agencies, assessing and responding to individual needs, problem-solving, reviewing options and supporting individuals to achieve a higher level of independence and improved quality of life.

Knowledge, Skills and Abilities

 

Knowledge:

  • Assured Income for the Severely Handicapped Act, Regulations, policy and procedures as well as local/regional procedures adopted to address operational requirements.
  • Working knowledge of Alberta Works, Albe1ta Adult Health Benefit (AAHB), Alberta Aids to Daily Living (AADL), Office of the Public Guardian, Public Trustee, and Persons with Developmental disabilities (PDD) programs.
  • Working knowledge of other Ministry programs (e.g. Alberta Seniors Benefits, Housing), programs of other government ministries and levels of government (Canada Pension, Employment Insurance, Workers Compensation, special needs or subsidized transportation programs provided by municipalities, etc.)
  • Knowledge of a wide variety of external community resources, agencies and contracted services that provide services to persons with disabilities.
  • Knowledge of a wide variety of medical conditions and their ·effects upon functioning as well as treatment and rehabilitation approaches that may lessen the impairment caused by these conditions. Working knowledge of medical terminology.
  • Knowledge of social problems and barriers to successful community living.
  • Knowledge of case management techniques.
  • Knowledge of assessment, negotiation and problem-solving techniques.
  • Knowledge of information systems and how to utilize them.
  • Knowledge of computer software applications
  • Knowledge of occupational health and safety requirements, including Working Alone legislation.
  • Working knowledge of various investment vehicles, including mutual funds, RRSPs, annuities, etc.

Skills:

  • Effective communication skills and the ability to conduct interviews for the purpose of assessing client circumstances and needs. Ability to work with persons with significant communication challenges (e.g. persons with developmental disabilities or mental health problems), including persons requiring alternative communication methods (e.g. deaf and hard of hearing). Ability to negotiate effectively with individuals to find solutions to problems.
  • Strong report-writing skills and the ability to prepare clear and concise case summaries for presentation at appeal hearings.
  • Strong presentation skills are required in order to represent the Ministry at appeal hearings.
  • Strong needs assessment and problem-solving skills.
  • Ability to negotiate with clients (e.g. terms of Case Management Plan, rate of recovery in cases involving overpayment of financial benefits)
  • Ability to interpret medical and assessment documentation.
  • Ability to interpret complex financial documents, including bank statements, investment statements, etc.
  • Conflict resolution skills and the ability to work effectively with persons who may become angry, frustrated or depressed due to their circumstances.
  • Ability to motivate and provide encouragement to recipients to achieve their goals.
  • Strong organizational and time-management skills and the ability to balance routine tasks with complex, competing and urgent demands.
  • Ability to work independently and to make case management decisions that reflect sound judgement, sensitivity and good stewardship of resources.
  • Ability to work effectively within a fast-paced team environment and to contribute to the achievement of Ministry goals. Ability to actively participate in team meetings, project committees and work groups.

Contacts

 

Primary contacts are AISH applicants or clients and their families, including Court-appointed Guardians/Trustees or Financial Administrators appointed under the AISH Act. Purpose of these contacts is to provide AISH program info1mation, assess financial eligibility, process AISH applications, complete Intake assessment reports, assess client needs and eligibility for Personal Income Support Benefits (PISB) and discuss other options for meeting identified needs.

Additional contacts may include other Minist1y staff, client advocates, physicians, psychologists, lawyers, financial planners and other parties working with the client, representatives of other government programs and community resources. Purpose of these contacts is to provide AISH program information and/or achieve a more thorough understanding of client needs and to dete1mine resources available to meet those needs.

The AISH Generalist also has case-specific contact with MLA constituency office staff, staff of the Ombudsman's office, Human Rights Commission or the Citizens' Appeal Panel.

Supervision Exercised

 

Not applicable.


 

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