Characteristics

Client Sub-type 43 Severe Handicap is applied to an individual who meets the criteria for severe handicap as defined in the Assured Income for the Severely Handicapped (AISH) General Regulation.

Under the AISH General Regulation, “Severe Handicap” is an impairment of mental and/or physical functioning, that in a Director’s opinion:

• After considering any relevant medical or psychological reports, causes substantial limitation in the person’s ability to earn a livelihood; and
• Is likely to continue to affect that person permanently because no remedial therapy is available that would materially improve the person’s ability to earn a livelihood.

Income Support (IS) workers have discretion to assign an individual, who meets IS financial eligibility criteria, to Sub-type 43 in the following circumstances:

• The client is designated AISH eligible by an AISH worker/Adjudicator; and it is determined (through consultation between AISH and IS staff) that the IS program is better able to meet the household’s financial needs; or
• The worker deems that the client has a ‘severe handicap’ (consistent with the AISH definition of severe handicap) and the client has an active AISH application (or satisfies the worker that they intend to apply for AISH).

1. Client is Eligible for AISH Program Benefits
   
   AISH workers/Adjudicators have sole authority to designate an individual AISH eligible. When an IS client is approved for AISH benefits, consultation occurs between AISH and IS staff to determine which program best meets the household’s financial need.  If it is mutually agreed upon that the AISH program best meets the household’s financial needs, the client file is transferred to AISH. If it is determined that the household’s needs are best met through the IS program, the individual is assigned to Client Sub-type 43. Consultation between AISH and IS staff should reoccur if there are significant changes in clients’ circumstances and/or amendments to program policy.

Note
For clients with an outstanding debt, workers must calculate the benefit level without considering the debt recovery rate prior to determining which program better meets the financial needs of the household.

1. Client’s Medical Substantiation is Consistent with AISH Medical Criteria and Client has an Active AISH Application (or intends to Apply for AISH).
   
   IS workers may assign a client to Sub-type 43 if convinced that medical documentation provided by the person’s physician meets AISH medical criteria and constitutes reasonable evidence of a severe and permanent handicap. The client must also be in the process of applying for AISH, awaiting an eligibility decision from an AISH Adjudicator, or satisfy the worker that they are preparing to apply for the AISH program.
   
   Clients in this circumstance who do not have an AISH medical code, must be assigned AISH medical code 606060 Income Support with Severe Handicap.

Note
Clients assigned to Sub-type 43 Severe Handicap by an IS worker are NOT considered to be AISH eligible. Each client is required to complete the AISH application process and can only be designated AISH eligible by the AISH program.

Note
If a client is adjudicated as medically ineligible for AISH by the AISH program, then it is established that the individual’s medical documentation does not constitute reasonable evidence of ‘severe handicap.’ The client should be assigned to a different client category. At the worker’s discretion, the client can remain assigned to sub-type 43 if they are pursuing an appeal of their AISH medical eligibility.

For clients who are assigned to Sub-type 43 but who have not yet submitted an application to the AISH program, the IS worker should review the client file each month to ensure that the AISH application is being actively pursued. The client should be assigned to a different client category if the client is not taking reasonable steps to apply to the AISH program. For more information see the Handicap Benefit policy.

Substantiation

• EMP 0207 Medical Information form,  or
• Note/report from a physician or nurse practitioner, or
• (DS2444B) AISH Application Part B Medical Report, and
• A completed assessment within a reasonable period of being assigned to Client Sub-type 43.

If uncertain whether a client’s medical documentation substantiates an impairment that is consistent with AISH medical criteria, the IS worker is advised to:

• Consult with an Adjudicator; and/or
• Solicit additional medical information and consult with the physician or nurse practitioner who completed the client’s medical report or EMP 0207 Medical Information form.

Clients in Sub-type 43, who are employed or attending part-time training, are NOT automatically re-categorized to BFE Client Sub-type(s) 44, 45 or 46.

Clients in Sub-type 43 who maintain full-time employment, over a twelve month period, at minimum wage rates (or higher) should be referred to a Career Employment Consultant (CEC) for a review of their assessment.  The client may be reassigned to a client sub-type that more accurately represents their current circumstances. If the client has previously been adjudicated as AISH eligible (by the AISH program), the CEC is advised to consult with an AISH adjudicator.

Guidelines for Issuing (DS2444B) AISH Application Part B Medical Report to IS Clients

If more comprehensive medical information is required to determine whether a client should be assigned to Sub-type 43, an IS worker may issue the (DS2444B) AISH Application Part B Medical Report to the client for physician’s completion.

Prior to issuing the (DS2444B) AISH Application Part B Medical Report, IS workers MUST examine all available medical documentation. If sufficient medical evidence exists, it may be unnecessary to request additional information.

Providing the (DS2444B) AISH Application Part B Medical Report may be appropriate in situations where:

• The IS worker, after completing an assessment and reviewing available medical documentation, is confident that the client meets AISH medical criteria, but requires additional medical substantiation to support this decision; or
• There is insufficient detail on a client’s completed medical note/report or EMP 0207 Medical Information form and the IS worker cannot with reasonable certainty, determine the severity of the medical condition and its impact on the client’s ability to earn a livelihood; or
• The client’s file contains several short-term medical notes and/or EMP 0207 Medical Information forms which cumulatively deem the client unemployable, due to medical issues, for a period of 18 months or longer.

When issuing an (DS2444B) AISH Application Part B Medical Report, IS workers MUST advise clients that personal medical information provided by their physician via the completed the (DS2444B) AISH Application Part B Medical Report will be used by the Government of Alberta in the administration of the AISH program and other government benefits programs. This medical report may be shared with:

• AISH and IS program staff;
• The AISH Appeal Panel in any appeal regarding the applicant's medical eligibility;
• The Canada Pension Plan Disability  program to help determine the applicant’s medical eligibility for that program; and
• A medical consultant or psychological consultant on contract with Alberta Community and Social Services. 
  
  Note
  Section 40 (1) (l) of the FOIP Act gives the authority to share information for the purpose of determining or verifying an individual's suitability or eligibility for a program or benefit.

When applying for AISH, BFE clients may be asked to have their physician or specialist complete Part B Medical Report (DS2444B) of the AISH application. For BFE clients, Income Support will pay costs associated with completing an AISH medical report in accordance with established fee agreements. To confirm that the Income Support program will cover physicians or specialists’ cost for completing the medical, the IS worker can give the (EMP11587) Confirmation of Payment AISH Medical Report letter to clients applying for AISH.

Note
Expected to Work (ETW) clients should speak to their worker prior to applying for AISH.

Process for Transferring AISH Files to the Income Support Program 

AISH eligible clients whose financial needs are best met by receiving IS benefits, are to have their file transferred to the IS Program and are to be assigned to Client Sub-type 43 Severe Handicap. When transferring an AISH client file to the IS program, AISH staff:

1. Ensures that AISH payments owing to the client are issued and that outstanding overpayments are processed;
2. Informs IS staff that the file is set for transfer and initiates electronic file transfer; and
3. Forwards copies of AISH approval documents AISH Eligibility Decision & (DS2444B) AISH Application Part B Medical Report, and all other required documents to the IS program. 
   
   Note
   The remainder of the AISH client’s file is retained by the AISH office.  Normal disposition for closed files applies. Files to be reviewed for possible action are listed on the SCCP2230-4 File Disposition Report. Detailed instruction on File Transfers may be referenced under the Administrative Procedures section.

Process for Transferring Income Support Files to the AISH Program

Income Support recipients who are assessed as AISH eligible and whose financial needs are best met by receiving AISH benefits, are to have their file transferred to the AISH Program.  When transferring an IS client file to the AISH program, IS staff:

1. Ensures that IS payments owing to the client are issued and that outstanding overpayments are processed;
2. Informs AISH staff that the file is set for transfer and initiates electronic file transfer; and
3. Returns original AISH eligibility documents AISH Eligibility Decision & (DS2444B) AISH Application Part B Medical Report, etc. contained in the client’s IS file to the AISH Program.
   
   Note
   The remainder of the IS client’s paper file is retained by the IS office.  Normal disposition for closed files applies. Files to be reviewed for possible action are listed on the SCCP2230-4 File Disposition Report. Detailed instruction on File Transfers may be referenced under the Administrative Procedures section.