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Persons With Persistent Multiple Barriers (PPMB)


Procedures

Determining Eligibility for PPMB (New Cases): April 2, 2012

PPMB Reviews: April 2, 2012

Case Examples: August 30, 2004

Reapplication for Employment and Assistance: April 2, 2012

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Determining Eligibility for PPMB (New Cases): April 2, 2012
April 2, 2012

For procedural guidelines to assist the PPMB adjudication process, see Resources for Staff – PPMB Adjudication – Procedural Guidelines.

Persons with Persistent Multiple Barriers (PPMB) should be considered when there is some evidence that a recipient may meet the PPMB criteria or when a recipient requests an assessment for PPMB.  The following six steps are essential in assessing whether a recipient meets the criteria for PPMB and must be completed in order:

1.  Time on Assistance

A person has been a recipient for at least 12 of the immediately preceding 15 calendar months of one or more of the following:

  • income assistance or hardship assistance under the Employment and Assistance Act
  • disability assistance or hardship assistance under the Employment and Assistance for Persons with Disabilities Act

2.  Employability Screen (HR2797)

The Employability Screen (HR2797) [see Forms and Letters] assists in determining the existence of multiple barriers to employment. [For more information, see Related Links - Employability Screen]

An Employability Screen must be completed, or updated, any time a recipient is considered for PPMB, regardless of whether their medical condition is expected to seriously impede or preclude employment.

3.  All Interventions Tried

The Client Employability Profile (HR2865), in combination with the client's history and previous Employment Plans (HR2863), assist in identifying the severity of the barriers and in determining if the client has taken reasonable steps to overcome their barriers to employment, (excluding medical conditions). The EAW must complete the following steps:

  1. Review recipient’s history of referral and job search activity.
  2. Complete the Client Employability Profile (HR2865) with the recipient in the following circumstances:

    • if a recipient obtains a score of 15 or greater on the Employability Screen
    • if a recipient appears to have a medical condition that could preclude the recipient from searching for, accepting or continuing employment, regardless of their score on the Employability Screen 
      [see Related Links - Client Employability Profile]
  3. Determine if an appropriate service or program is available to address specific barriers.  For a complete list of interventions available in the community, see Appendix 1 of the PPMB Checklist that is available in each Employment and Assistance Office.

    [For examples of interventions that must be considered when determining PPMB, see Policy – Steps to Overcome Barriers.]
  4. If appropriate, amend the recipient’s Employment Plan (HR2863) to identify referral and required participation in specific services or programs to overcome the barrier(s) to employment. [see Related Links – Employment Plan]

4. Medical Report - Persons with Persistent Multiple Barriers (HR2892)

The Medical Report – Persons with Persistent Multiple Barriers (HR2892) [see Forms and Letters] confirms the diagnosis and duration of the recipient’s medical condition and the nature of any resulting restrictions that need to be considered in determining the impact of the medical condition on the recipient’s ability to participate in employment or employment-related training. Medical practitioners are compensated for the amount shown in Rate Table: Fees for Medical Practitioners for completing the HR2892.  Fees for medical practitioner completing the HR2892 are paid through the Medical Services Plan.

To confirm a recipient’s medical information, follow these steps:

  1. If a recipient is determined to meet all other PPMB criteria, and appears to have a medical condition that may seriously impede or preclude the client's ability to search for, accept or continue employment, provide the client with the Medical Report - Persons with Persistent Multiple Barriers (HR2892) for completion by a medical practitioner.  Use the Information Required – Medical Letter (HR3237) as a covering letter.  [see Forms and Letters].
  2. Review the Medical Report - Persons with Persistent Multiple Barriers (HR2892) to determine if the medical practitioner has confirmed both requirements:

    • the recipient has a medical condition (excluding addictions)
    • the condition has lasted for at least one year and in the opinion of a medical practitioner is likely to last for at least another two years; OR the condition is episodic, has occurred frequently in the past year and is likely to occur frequently in the next two years
  3. Gather any additional evidence from the recipient's file that may be relevant in determining the extent to which the recipient’s condition impacts their employability.  The following should be considered:

    • review the recipient’s reported income for the past 12 months (since the medical condition must have existed for at least the past 12 months, a review of income reported may help determine whether a medical condition impedes or precludes employment)
    • for recipients who score above 15, the medical condition must either seriously impede or preclude the recipient’s ability to search for, accept or continue employment
    • for recipients who score below 15, the medical condition must preclude the recipient’s ability to search for, accept or continue employment

[see Policy – Medical Condition: Seriously Impedes or Precludes]

5.  Preparing for PPMB Adjudication

In cases where a recipient appears to meet the PPMB criteria or the recipient has requested PPMB, the EAW must do the following, once the preceding steps 1-4 have been completed:

EAW   1. Complete all sections of the PPMB Checklist (HR2892A) [see Forms and Letters].
   2.

For recipients who score 15+, complete the PPMB Checklist – Appendix 1, which includes the following information:

  • whether or not the recipient has been referred to each of the interventions on the list
  • if not referred, an explanation of why (e.g., program refused recipient based on their medical condition)
  • if referred, whether or not the intervention was successfully completed
  • in cases where an intervention was not successfully completed, an assessment as to why not (i.e., was it for reasons beyond the recipient’s control, such as the recipient was hospitalized or the program cancelled)

Note:  A copy of the PPMB Checklist – Appendix 1 that contains an up-to-date list of all interventions available in the community is available in each Employment and Assistance Office.
   3.

Gather all relevant documentation that is needed for an adjudicator to determine eligibility for PPMB, including:

  • PPMB Checklist
  • PPMB Checklist - Appendix 1
  • Client Employability Profile
  • Employment Plans
  • Employment Readiness Information Questionnaire (ERIQ)
  • Employability Screen
  • Voluntary Participation Plans
  • Medical Report - Persons with Persistent Multiple Barriers
  • Any other relevant information already on file or provided by the client unsolicited.  Examples include:

    • A letter from a social worker, probation officer, health professional with whom the recipient is involved, which describes circumstances of the client that could impact employability
    • Proof of earnings declared in the last 12 months
 4. Scan and profile all documents related to this Service Request (SR). There is no need to batch file any hard copies. Provide a copy of these documents to the client if requested.
   5. Forward the SR to the PPMB Adjudicator for adjudication. 

6.  Adjudication

PPMB Adjudicator   1.

Review the information in the SR forwarded from the EAW and determine if, based on the documentation, the recipient meets all eligibility criteria for PPMB as set out in the legislation.  The applicant must meet section 2(2) and either 2(3) or 2(4) of the Employment and Assistance (EA) Regulation.

[see Resources for Staff for access to a Medical Dictionary and information on ICD9 and DSM-IV codes used on the Medical Report- PPMB]

[For information on PPMB Reconsideration Adjudication procedures see Related Links – Reconsideration and Appeal – Reconsideration – Procedures]
   2.

Complete the adjudicator section of the PPMB Checklist that includes the following:

  • decision
  • reason for the decision
  • date of decision
  • review date (if applicable)
   3.

Enter the following information on the SD More Info applet:

  • decision date
  • decision code, eligible or ineligible
  • review date

If the recipient is eligible, complete the following steps:

  • ensure the Time Limit Manual Exclusion Reason (Code 12,13, 14, or 29) is removed, if appropriate, in the SD More Info applet
  • update the Case Details applet in More Info / More Info IA
  • change employability status from 03 to 01
  • close the Employment Plan (EP) if required
  • issue any required top-up as appropriate
   4.

Document all of the reasons for the decision on the SR for Application / PPMB.
PPMB Adjudicator or Regional Clerk  5.

Send the appropriate letter to the recipient advising them of the approval or denial of PPMB using one of the following:

  • PPMB Approval (Single Person) (HR3241)
  • PPMB Approval (Single Parent) (HR3242)
  • PPMB Approval (Both Applicant and Spouse Approved) (HR3243)
  • PPMB Approval (Applicant Approved and Spouse ETW) (HR3244)
  • PPMB Denial (New PPMB Applicant) (HR3245)

[see Forms and Letters]
PPMB Adjudicator or Regional Clerk  6. Close the PPMB SR.

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PPMB Reviews: April 2, 2012
April 2, 2012

Reviews are conducted at least every two years based on the recipient’s individual situation.

To conduct a review, follow these steps:

1.  Advise Recipient of PPMB Review

Upon receiving notification that a recipient’s review date is three months away, send the First Appointment - PPMB Review Letter (HR3232) [see Forms and Letters] to notify the recipient of the review. 

Note: Adjudication must be completed within the three-month period or the system will remove the PPMB decision code of eligible and additional rate and supplements will end.

If a recipient fails to attend a review appointment, attempt to phone to reschedule, or send the Second Appointment - PPMB Review Letter (HR3235) [see Forms and Letters].

If contact is established with the recipient, advise them:

  • the review of their eligibility for the PPMB category must be completed within the time remaining in the three-month period, including the return of a Medical Report
  • when the Medical report is due and that they must submit it to the EAO, and
  • if the information requested is not provided within the time frame indicated, they will be determined to be ineligible for PPMB

Document the verbal notification of consequences on the system.

If unable to contact the client by phone, use office caseload management protocols to follow up.  If the recipient does not contact the office at cheque issue, the standard file closure procedures would apply.  Should the recipient re-apply within 12 months of leaving income assistance as a PPMB, see Policy – Reapplication for Employment and Assistance.

If the recipient contacts the office at cheque issue, rebook the appointment and advise the recipient that they must attend the review appointment to determine continued eligibility for PPMB.

If a recipient does not attend this second appointment, then take the following steps:

  • send the PPMB No Contact – Missed Appointment Letter (HR3262)
  • update the SD More Info by changing the PPMB decision code to Ineligible
  • set a review date that is at least three cheque periods in the future
  • ensure that the recipient has an Employment Plan completed before the PPMB review date

Note: It is important to document all steps taken to complete the PPMB review in the system.

2.  Conducting a PPMB Review  

At the appointment follow these steps:

EAW 

1.

Ensure that a current Medical Report - Persons with Persistent Multiple Barriers has been received by the EAO. If not, request that the recipient have their medical practitioner complete a Medical Report – PPMB.  Advise the recipient that the Medical Report – PPMB must be returned within the time frame indicated, or they will be determined to be ineligible for PPMB.
 

2.

Update the Employability Screen to ensure that the recipient has an up-to-date score.
 

3.

For recipients who score 15+, complete the PPMB Checklist – Appendix 1 to determine if there are new resources that may be appropriate for the recipient.  The following information must be documented in Appendix 1:

  • whether or not the recipient has been referred to each intervention on the list
  • if not referred, an explanation of why (e.g., program refused recipient based on their medical condition)
  • if referred, whether or not the intervention was successfully completed
  • in cases where an intervention was not successfully completed, an assessment as to why not (i.e., was it for reasons beyond the recipient’s control, such as the recipient was hospitalized or the program cancelled)

Note:  A copy of the PPMB Checklist – Appendix 1 that contains an up-to-date list of all interventions available in the community is available in each Employment and Assistance Office.
 

4.

Complete all sections of a new PPMB Checklist (HR2892A) [see Forms and Letters].
 

5.

Set a signal for the month the review is due (two weeks before cheque issue) to ensure the Medical Report – PPMB has been returned (if not already received by the EAO).
 

6.

If the Medical Report – PPMB is not returned by the signal date complete the following steps before cut off of the month the review is due:

  • Send the PPMB Denial - No Contact Letter (HR3247) advising recipient that they are being denied PPMB for failure to submit verification.
  • Complete the following in the system:

    • update the SD More Info applet by changing the PPMB decision code to Ineligible
    • set a review date that is at least three cheque periods in the future
    • ensure the recipient has an Employment Plan completed before the PPMB review date

3.  Preparing for PPMB Adjudication

EAW 

1.

Gather all relevant documentation that is needed for an adjudicator to determine eligibility for PPMB, including:

  • PPMB Checklist
  • PPMB Checklist – Appendix 1
  • Client Employability Profile
  • Employment Plans
  • Voluntary Participation Plans
  • Medical Report - Persons with Persistent Multiple Barriers
  • Proof of earnings declared in the last 12 months
  • Any other relevant information already on file or provided by the recipient unsolicited (e.g., a letter from a social worker, probation officer, health professional with whom the recipient is involved, which describes circumstances of the client that could impact employability)
 

2.

Scan and profile all documents related to this adjudication. There is no need to batch file any hard copies. Provide a copy of these documents to the client if requested.
  3. Forward the Service Request (SR) to the PPMB Adjudicator for adjudication.

4.  Adjudication

PPMB
Adjudicator 

1.

Review the information in the SR forwarded from the EAW and determine if, based on the documentation, the recipient meets all eligibility criteria for PPMB.

[see Resources for Staff for access to a Medical Dictionary and information on ICD9 and DSM-IV codes used on the Medical Report- PPMB]
 

2.

Complete the adjudicator section of the PPMB Checklist that includes the following:

  • decision
  • reason for the decision
  • decision date
  • review date (if applicable)
 

3.

Enter the following information on the SD More Info applet:

  • decision date
  • decision code, eligible or ineligible
  • review date

If the recipient is not eligible based on the available documentation, complete the following steps:

  • update the SD More Info applet by changing the PPMB decision code to Ineligible
  • set a review date that is at least three cheque periods in the future
  • ensure that the recipient has an Employment Plan completed before the PPMB review date

If the recipient is eligible, complete the following steps:

  • ensure the Time Limit Manual Exclusion Reason (Code 12,13, 14, or 29) is removed, if appropriate, in the SD More Info applet
  • update the Case Details applet in More Info / More Info IA
  • change employability status from 03 to 01
 

4.

 Document the reasons for the decision on the SR for Application / PPMB.
PPMB Adjudicator or Regional Clerk

5.

Send the appropriate letter to the recipient advising them of the approval or denial (giving review date of at least three cheque issues in the future) of PPMB using one of the following:

  • PPMB Approval (Single Person) (HR3241)
  • PPMB Approval (Single Parent) (HR3242)
  • PPMB Approval (Both Applicant and Spouse Approved) (HR3243)
  • PPMB Approval (Applicant Approved and Spouse ETW) (HR3244)
  • PPMB Denial (Clients Currently Receiving PPMB Rates) (HR3246)

[see Forms and Letters]
 

6.

 Close the PPMB SR.

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Case Examples: August 30, 2004
August 30, 2004

Eligible

In the following examples, the recipients do meet the PPMB criteria:

Assumptions:

Recipients have been in receipt of income assistance for at least 12 out of the last 15 months

Recipients have a medical condition that has existed for at least one year and is likely to last at least two years

  • Recipient does one to two hours of transcribing work a week from home and has a score of 15 on the Employability Screen. A review of the recipient’s history and Appendix 1 verifies that the recipient has made reasonable attempts to find employment using independent job search and employment programs, and has attempted two different types of training programs in the past year.  There are no other interventions that are appropriate for the recipient. Each time she has been unsuccessful at completing the programs or finding part- or full-time employment as a result of her medical conditions.  The Medical Report – PPMB states:

    • Primary condition: fibromyalgia and osteoarthritis

    • Treatment and Outcome
Treatment Outcome

antidepressants for fibro and anti-inflammatories for osteo,

plus regular exercise and keeping weight in normal range

Fibro was assisted somewhat but condition not stabilized.

OA will progressively worsen
  • Restrictions: extreme fatigue resulting in patient barely managing self care most days

REASON: Score of 15 or more, all steps tried, and medical condition seriously impedes employment.

  • Recipient has completed a university degree and has a good work history that ended as a result of late onset of Schizophrenia. Employability Screen score of 9. The Medical Report – PPMB shows the following:

    • Primary condition: Schizophrenia
    • Treatment and Outcome:
Treatment Outcome
Several medications have been tried
 None have been effective to date
Hospitalized twice in the past year for suicide attempts

 
  • Restrictions: not capable of focussing attention for any length of time, delusions regularly result in aggressive and suicidal behaviour

REASON: Medical condition precludes all types of employment and recipient cannot work for any amount of time.

  • Recipient was diagnosed with epilepsy as a child and has no work history. Employability Screen score of 16.  A review of the recipient’s history and Appendix 1 indicates that there are no interventions that are appropriate for the recipient.  The Medical Report – PPMB shows the following:

    • Primary condition: Epilepsy
    • Treatment and Outcome:
Treatment Outcome

Anti-epileptic medication (tegretol)

Reduces the number of seizures, still has daily seizures
  • Restrictions: unable to drive, extra time required to complete daily living activities

REASON: Score over 15, no interventions appropriate as per Appendix 1 of the PPMB Checklist (HR2892A), and medical condition seriously impedes all types of employment.

  • Recipient is a 40-year-old male with a grade 8 education.  Sporadic employment history mostly in labour type jobs.  He states that he is an alcoholic in recovery for 5 years and attends Alcoholics Anonymous meetings regularly. Recipient scores 12 on the Employability Screen. Medical Report – PPMB states:

    • Primary condition: hepatitis C
    • Treatment and Outcome:
Treatment Outcome
[no information provided] [no information provided]
  • Restrictions: malaise, reduced exercise/activity tolerance, nausea

  • Attachments to Medical Report – PPMB – lab report
  • Consultation with ministry medical practitioner – Lab report shows liver enzymes are high, this suggests that hepatitis C is in an advanced stage

REASON: Medical condition has been proven to preclude the recipient from participating in any type of employment for any length of time.

Not Eligible

In the following examples, the recipients do not meet the PPMB criteria:

Assumptions:

Recipients have been in receipt of income assistance for at least 12 out of the last 15 months

Recipients have a medical condition that has existed for at least one year and is likely to last at least two years

  • Recipient has been on assistance for most of the past 15 years.  A review of the history shows that during most of his time on assistance this recipient was categorized as “unemployable” or “persons with a level one disability.”  Recipient scores 16 on the Employability Screen.   The recipient has not been to any employment-related interventions.  The Medical Report – PPMB shows the following:

    • Primary condition: HIV
    • Treatment and Outcome
Treatment Outcome

antiviral medications

 

Restrictions: none

REASON: This recipient has a serious medical condition, but the condition at this time does not seriously impede or preclude their ability to work.  Also, there is no indication that all interventions have been tried.

  • Recipient is 55 years old and scores 16 on the Employability Screen.  Employment history shows construction work (though not recently). The Medical Report – PPMB shows the following:

    • Primary condition: chronic back pain
    • Treatment and Outcome
Treatment Outcome
analgesia, regular exercise, weight loss

 

Restrictions: limited lifting, bending, walking, cannot do strenuous work

REASON: Medical condition may impede some types of employment but has not been proven to seriously impede any type of employment.  Also, there is no indication that all interventions have been tried.

  • Recipient is 38 and has been off and on assistance for over 10 years.  He scores 16 on the Employability Screen. The recipient has been to multiple addiction recovery programs in the past. The Medical Report – PPMB shows the following:

    • Primary condition: alcohol and drug addiction
    • Restrictions: none

REASON: Alcohol and drug addiction is not included as a medical condition for the purposes of PPMB eligibility criteria.

  • Recipient is 27 years old, has a grade 10 education, and very little employment history. She scores 10 on the Employability Screen.  Medical Report – PPMB states:

    • Primary Condition: Depression
    • Secondary Condition: Alcohol addiction
    • Treatment and Outcome:
Treatment Outcome

Zyban

 Patient not taking consistently, alcohol use interferes with treatment

needs alcohol and drug counselling

 

Restrictions: none

REASON: Medical condition, in the absence of addiction, has not been proven to preclude the recipient from participating in employment.  Recipient should be referred to alcohol treatment programs available in the community.

  • Recipient is a 40-year-old male with a grade 8 education.  Sporadic employment history mostly in labour type jobs.  He states that he is an alcoholic in recovery for 5 years and attends Alcoholics Anonymous meetings regularly.  Recipient scores 12 on the Employability Screen.  Medical Report – PPMB states:

    • Primary condition: hepatitis C
    • Treatment and Outcome: none
    • Restrictions: tired
    • Attachments to Medical Report – PPMB – lab report
    • Consultation with ministry medical practitioner –Lab report shows liver enzymes are within a normal range, this suggests that hepatitis C is not in an advanced stage, therefore employability would not be expected to be impacted at this time.

REASON: Medical condition has not been proven to seriously impede or preclude the recipient from participating in any type of employment.

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Reapplication for Employment and Assistance: April 2, 2012
April 2, 2012

Recipients in the PPMB category at the time when their file was closed can be reassessed for PPMB on reapplication without meeting the requirement to receive another 12 months of assistance.  However, the 12-month requirement is only waived if recipients reapply within 12 months of leaving income assistance as a person with persistent multiple barriers.

Applicants who were previously in the PPMB category are required to complete the three-week job search [see Related Links - Three-Week Work Search] and the intake application including the Employment Readiness Information Questionnaire [see Related Links - BC Employment and Assistance Application].  All regular intake procedures, such as completion of the Employability Screen, continue to apply.

Former PPMBs who reapply within 12 months of leaving assistance as PPMB but after their review date has passed, can still receive the PPMB rate if financially eligible.  However, the review process should be initiated immediately to determine their ongoing eligibility for PPMB.

Note: The only exception to PPMB being reviewed by the PPMB adjudicator upon reapplication is cases where the recipient has been off assistance for 2 months or less for non-employment-related reasons (i.e., family maintenance arrears, hospitalization, etc.).

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