Western Cape Forum for Intellectual Disability
26 October 2010
1
Content of Presentation
This presentation covers:
•
Legal Framework
–


Disclosure
Various Grant Types

Grant for the Disabled

Care dependency grant

Grant-in-aid

Responsibilities of Medical Officer

General Information

Means Test

Review
SGDM Model

Background
2
Content of Presentation
•

SGDMM

SGDM Model

Brief Description of the SGDMM

Progress

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
However, 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 R129 600.00
 Income of parent's – married must not exceed R259 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 Thresholds\INCREASE 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 – R518 400.00 single person & R1 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 – R31 296.00 per annum for a single person and
R62 592.00.00 per annum for a married person
24
Means test
• Grant amounts
Minimum amount for
grants for the aged,
disabled and war
veteran’s is R100.00
Other grants fix
amount
GRANT TYPE
GRANT
AMOUNT
Old Age Grant
R1 080.00
Grant for Disabled
R1 080.00
War Veteran’s
Grant
R1 080.00 +
R20.00
Grant-in-Aid
R250.00
Child Support
Grant
R250.00
Foster Child Grant
R710.00
Care-dependency
Grant
R1 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:
 Gatekeeping and Medical Assessment Process;
 Booking System;
 Medical Assessment Form Management;
 Contracts management;
 Claims Procedure;
 Training;
 Quality Assurance and
 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
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 alive32
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
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