Compliance Review

Overview

This topic provides information about the review process and the requirements for assistance.  Compliance reviews ensure a recipient’s case information is accurate and up to date, and the correct amount of assistance is provided.  Compliance reviews help ensure the ministry is correctly applying policy and legislation to the recipient's unique situation.

Reviews confirm the recipient's current and past eligibility and ensure the recipient is receiving all assistance for which they are eligible.

Cases are selected for review based on either:

  • random selection
  • information from other sources such as fraud allegations or data matches (for example: Canada Revenue Agency).

Throughout the review process, the ministry applies the principles of Administrative Fairness and Duty to Accommodate [for more information, see Related Links – Original Decisions and Individual Case Management – Policy – Duty to Accommodate]. With all information and verification requests, the ministry strives to provide respectful service while balancing its obligation to verify a client’s circumstances and respect for their privacy [for more information see Related Links - Information & Verification].

Reviews may result in:

  • no change to assistance
  • an increase or decrease to, or discontinuation of assistance
  • an underpayment or overpayment.

Policy

Effective:  April 1, 2019

Compliance Reviews confirm cases are accurate and up to date.  Reviews confirm the recipient's current and past eligibility; and, ensure the recipient is receiving all assistance for which they are eligible. Reviews only request information necessary to verify eligibility.  During a review, the ministry:

  • requests information necessary to confirm eligibility and assists recipients to gather information when requested
  • reviews a recipient’s case
  • records the outcomes of the review on the recipient’s case
  • identifies and advises the recipient of services and supplements they may be eligible for and/or resources that may be available in their community
  • communicates the review outcome, in writing, to the recipient
  • adjusts the recipient’s assistance, if required
  • interviews recipient, if required
  • calculates overpayments or underpayments, if required
  • records debt, if required [for more information, see Related Links - Recoveries].

Effective:  April 1, 2019

The principles of Administrative Fairness guide the entire ministry decision making process, including the Compliance Review process. Ministry staff are expected to follow these principles at all times, not only when they are in the role of a decision maker, but also when they are providing other types of ministry services to recipients.

When the review process is complete, the ministry will communicate, in writing, the outcome of the review, including whether there is:

  • no change to assistance
  • an increase, decrease or discontinuation of assistance
  • an underpayment or overpayment.  

Where eligibility has changed, the recipient will be provided with information that details:

  • the reason for the change and the information used to make the decision the relevant legislation applied to their case
  • their right to a review (reconsideration) of the original decision and how to request one [for more information see Related Links – Original Decisions and Reconsideration].

While the outcome of the review is provided in writing (e.g. mail or My Self-Serve), the ministry may also try to contact the recipient by phone to verify information or discuss the recipient’s circumstances.

The ministry follows established time frames in order for clients to be able to ask questions and provide the necessary documentation.

Timelines include:

  • 16 business days for each request for information. Two consecutive information requests of 16 business days each are generally required before an assistance payment can be held
  • For discontinuation of assistance, the ministry will attempt to notify the recipient of the decision by phone. A letter will be sent the same day to provide written confirmation of the decision. The case will remain open for 26 business days from the date of the discontinuation letter. 
  • Note: the number of business days starts from the date on the letter or in the case of a client with no fixed address, the day they pick up the letter.

If a client requires more time they can contact Prevention and Loss Management Services (PLMS) to ask for an extension.

It is a client’s responsibility to provide all information and documents necessary to demonstrate eligibility for assistance, however, staff can assist a client in obtaining or requesting documents from other agencies. 

Effective: April 1, 2019

The British Columbia Human Rights Code (the Code) protects British Columbians from discrimination.  The ministry is committed to providing accommodation to recipients for needs related to the grounds protected under the Code (for example, accommodating the needs of a recipient with disabilities). The ministry has processes that support recipients who need help accessing services.

The nature and extent of the accommodation depends on the recipient's unique situation. The recipient and the ministry share responsibility for working toward a reasonable solution.

The ministry will make these accommodations in accordance with duty to accommodate policy and procedures. Staff will review each case to determine if accommodation is required.  If during the course of the compliance review staff identify an accommodation not yet documented on the case, they will add a duty to accommodate alert.

If at any point a recipient has questions or requires help obtaining or submitting documents, they can contact Prevention and Loss Management Services (PLMS). 

[For more information, see – Related Links – Individual Case Management – Policy - Duty to Accommodate.]

Effective: April 1, 2019

The ministry conducts Compliance Reviews under the authority of:

  • Section 34 of the Employment and Assistance Regulation
  • Section 30 of the Employment and Assistance for Persons with Disabilities Regulation

The ministry requests information or verification of information under the authority of:

  • Section 10 of the Employment and Assistance Act
  • Section 10 of the Employment and Assistance for Persons with Disabilities Act

The ministry may request and collect information to confirm current or past eligibility. The request and collection of information from third parties, including, but not limited to, banks, employers, and landlords, is in accordance with legislation and policy. 

 

Procedures

Effective:  April 1, 2019

Step 1:  Information Request

The compliance review process begins when the recipient is provided a letter requesting documentation related to eligibility. 

Recipients are advised to submit documents by a set date, which will be at least 16 business days from the date of the letter. 

Should the recipient require more time or need help to obtain or submit documentation, they can contact the ministry.  

For recipients with no fixed address who do not have MySS set as their preferred method of contact, the letter will be attached to the recipient’s next payment at a ministry office.  The 16 business days begins on the date the client picks up the letter.

If the recipient’s mail is returned and the recipient has not submitted verification of a new address, the ministry will attempt to contact the recipient through MySS or phone.  If the ministry is unable to reach the client the ministry may hold the recipient’s assistance payment to verify shelter costs.

For recipients with a legal representative or who receive service through a Third Party Administrator, the ministry will connect with the third party to complete the review.

Step 2:  Reviews Case

If a recipient does not respond to the information request, the ministry will review the case to determine if there are any circumstances that may have impacted the recipient’s ability to respond and act according to ministry policy [see Related Links – Individual Case Management – Policy - Duty to Accommodate].

If some, or all, of the requested documents are submitted by the document submission due date the ministry proceeds by reviewing case notes, documents, and payment history. This includes:

  • confirming required identification and valid consent
  • completing third party checks
  • verifying shelter expenses
  • reviewing income and asset information
  • assessing current and past eligibility
  • updating the case, as needed

Depending on circumstances, the review may also involve:

  • completing new consents
  • clarifying information with the recipient
  • requesting additional information from the recipient
  • referrals for other services, programs or supplements

Step 3:  Additional Letters (if required)

If only some of the requested documents are submitted by the document submission due date, a follow up letter is sent which outlines documents still required and provides due dates for documents to be submitted.

Additional request for information letters may be sent when other documents are required to confirm information during the review.

All information requests follow ministry policy [for more information, see Related Links - Information & Verification].

Step 4:

Cheque Hold (if required)

If no documents are submitted by the submission date of the first request letter, the ministry will attempt to contact the recipient by phone (minimum of 2 attempts). 

The ministry will then send a second request letter with a cheque hold notification for the next reasonable cheque following the document submission due date in the second letter and minimum of 16 business days from the date the letter is sent.

In many cases, cheque holds can be released by any authorized staff (EAW, CSW or Service BC agent) with the submission of at least one of the required documents. If staff has any questions in regards to the cheque hold, they can contact Prevention and Loss Management Services (PLMS) [see Contacts].  In some cases the client will need to speak with a Quality Compliance Specialist (QSC) to have the cheque hold released; for example, the QSC needs to have a conversation with the client in order to establish eligibility.

Should the recipient require more time or need help to obtain or submit documentation, they can contact the ministry.  

If some, or all, of the requested documents are submitted by the document submission due date the ministry proceeds with the review (see Step 2).

If there is still no contact from the recipient, the ministry will proceed with a discontinuation letter (see Step 6).

Step 5:  Notify recipient of Decision

When the review is complete, the ministry will communicate, in writing, the decision resulting from the review, including whether there is:

  • no change to assistance
  • an increase, decrease or discontinuation of assistance
  • an underpayment or overpayment

If there is a change to a recipient’s assistance, they will be provided with information that explains:

  • the substantive reason for the change and the specific information used to make the decision
  • the relevant legislation applied to their case
  • their right to and how to request a review of the decision (reconsideration)

[For more information, see Related Links – Original Decisions.]

Step 6:  Discontinuation of Assistance letter (denial, right to reconsideration)

If the requested information has not been submitted, the ministry will attempt to call the recipient (2 attempts).

The ministry sends a discontinuation of assistance letter which includes the date the recipient’s case will close (26 business days from discontinuation letter), information on their right to a review (reconsideration) of the decision and how to request one.

Should the recipient require more time or need help to obtain or submit documentation, they can contact the ministry.  

If some or all of the requested documents are submitted by the document submission due date the ministry proceeds with the review (see Step 3).