7B.1. Discretionary Benefits Overview

POLICY  

Authority OW Act: Sec. 2, 5 and 10 & OW Directives: Dir. 7.1, 7.2, 7.4, 7.5, 7.7 
 

DEFINITIONS - PROGRAM PURPOSE 

To complement and strengthen the Ontario Works and Ontario Disability Support Programs by providing funding for a specified list of socially necessary items and health related needs not funded through those programs. 

Some items provided are meant to facilitate normal family living and others, to assist with vital health needs. 

determined that the Manitoulin-Sudbury DSB may exceed the Provincial funding maximum for Discretionary Benefits.

The Ministry has regulated the maximum amount that can be spent at $10 per case effective July 1st, 2012 on combined health and non-health related discretionary benefits.  When approving discretionary items, staff will monitor expenditures to ensure that the Manitoulin-Sudbury DSB does not exceed the Provincial funding maximum on Discretionary Benefits.

This will mean that items that qualify under the Discretionary Benefits Policy will be denied when staff has determined that the Manitoulin-Sudbury DSB may exceed the Provincial funding maximum for Discretionary Benefits.
 

PROCEDURE

WHO QUALIFIES? 

Discretionary Benefits can only be provided to persons in receipt of Ontario Works & the Ontario Disability Support Program unless otherwise covered under Board policy at 100% municipal costs. 
 

DISCRETIONARY BENEFITS 

The following benefits are already approved by the Director and may be issued at the discretion of Manitoulin-Sudbury DSB for participants in receipt of Ontario Works and in some cases ODSP.

The following discretionary benefits are specified in legislation:

Health-related:

• dental care for adults
• vision care for adults
• prosthetic appliances
• funerals and burials
• heating payments and payments for low-cost heating energy conservation measures

Non-health-related:

• vocational training and retraining
• travel and transportation that is not for health-related purposes
• moving expenses
• any other special service, item or payment authorized by the Director 

Special Services, Items and Payments:

Administrators have the discretion to provide special services, items and payments where authorized by the Director of Ontario Works Branch, Ministry of Community & Social Services.

The following special services, items or payments are currently approved by the Director of Ontario Works Branch:

• chiropractic services
• northern allowance for communities south of the 50th parallel without year round road access
• wheelchair and mobility devices (e.g., lifts) batteries, replacement batteries and necessary repairs
• provision, replacement and repairs of hearing aids including batteries for the portion not covered by the Assistive Devices Program
• prescription drugs when not listed in the Ontario Drug Benefit Formulary
• certification of a learning disorder by a qualified medical doctor or psychologist
• costs of completing medical forms not covered by OHIP, as required to verify eligibility for assistance, benefits or other required purposes
• necessary repairs to homes owned by recipients
• replacement or repair of essential household furniture and appliances
• replacement or purchase of smoke alarms and batteries for recipients who own their homes and are not in receipt of the maximum shelter allowance
• replacement of household items and personal effects in emergency situations (e.g., fire, flood, storms)
• electric beds to avoid bedsores for persons confined to a bed
• air conditioners for severe asthmatics
• electric breast pumps
• layettes and baby supplies
• energy and Water Conservation Measures
• blood tests required for Applications for Support where the cost cannot be paid by some other means (e.g., Legal Aid)
• cost of preparing a will where the cost cannot be paid by some other means (e.g., Legal Aid)
• initial deposits required by landlords or others for rent, hydro and heating where necessary
• payments for continuation of hydro or heating service, or to prevent eviction
• payments for low-cost energy and water conservation measures
• alerting systems for the Deaf and hearing impaired
• blenders for specific special diets

In addition to the approved list, the Director has authorized the provision of special services, items or payments for:

• Health-related purposes where the Administrator has made a determination of need based on verifiable documentation, and failure to provide would result in a detriment to the health of the recipient or a member of the benefit unit. The provision of health-related special services, items and payments are based on actual cost.
• Non-health-related purposes on a case-by-case basis up to a maximum of $250. If a special service, item or payment costs more than $250 approval from the Director is required. 
   

EXPENSES INCURRED PRIOR TO AUTHORIZATION 

A participant who has purchased an item covered under Discretionary Benefits without prior approval will not be eligible for reimbursement. Exceptional circumstances may be discussed with a Supervisor.
 

AUTHORIZATION

Case Managers can approve on-going items in advance.

Where a Case Manager is providing prior authorization for any item via the use of an authorization letter, the Supervisor’s approval is required prior to the letter being sent out. 
 

ALLOWABLE LIQUID ASSETS 

Liquid assets allowable with respect to Discretionary Benefits shall be in accordance with the Ontario Works Asset Levels for OW participants. Case Managers should determine if the client has available assets to cover the cost of items required. 
 

PROCESS

1. Participant is required to obtain prior approval from the Case Manager by submitting verification that the Discretionary Benefit is required and an estimate of the cost (preferably two estimates where reasonably possible) (See each section for further details on what is required for verification)
2. Case Manager reviews need and documents the request and the cost in the Social Assistance Computer System Notes.
3. If the Case Manager is to pay the supplier directly, they must complete the requisition form for Discretionary Benefits as well as indicate that a Purchase Order is required.

1. It is on this form that the Case Manager will list the item requested, why it is needed and also note their own recommendation.
2. The Case Manager will also copy this information into the the Social Assistance Computer System notes.
3. The Case Manager will forward the completed request for approval to the Supervisor. The Supervisor will note in the Social Assistance Computer System if the item was approved or denied.
4. Once approved the request will be forwarded to the Integrated Program Assistant in Espanola.

4. The Integrated Program Assistant will:

1. Assign a P.O. number on the form and then mail it to the client.
2. Keep a copy of the P.O. in a pending file. 

5. When the original P.O. is returned from the supplier with an invoice attached, the Integrated Program Assistant will:

1. Match up the copy in the pending file, ensuring the client has not exceeded the maximum approved.
2. Request the benefit / payment via the payment tab in the Social Assistance Computer System. The payment will be requested in the Vendor’s name.
3. Enter a notation in the Social Assistance Computer System that the cheque was issued to_____ and for_____ in the amount of ______. 

6. The Supervisor will release the cheque via daily pay list reviews.

7. When a cheque is produced, the Integrated Program Assistant will:

1. Match the cheque with the P.O. Authorization Form ensuring it’s the same amount and that the cheque is issued directly to the vendor
2. Once verified, mail the cheque.
3. File the originals in a completed binder.
    

Where NO P.O. is required:

If the Case Manager is to pay the participant directly, the benefit / payment will be requested by the Case Manager/Integrated Program Assistant. Case Manager/Integrated Program Assistant will note in the Social Assistance Computer System the details of the request.