Agencies use rules to apply legislation to a client's real life circumstances in order to make decisions regarding the client's eligibility and entitlement for care and protection programs. Typically a person must satisfy rules in order to qualify for benefits. For example, to be eligible for income support, a person's income must fall below an income threshold. Rules can also be used to make connections between different pieces of information, for example, to determine the members of a household based on sharing a common address.
Real world information is captured for clients as case evidence in order to determine their eligibility and entitlement. For example, when a person's income amount is recorded and eligibility is checked, a pre-defined eligibility and entitlement rule set that defines the income threshold amount that must be satisfied is applied to the income amount recorded. Based on these results and the results of other rules governing income assistance eligibility, the system determines the person's eligibility and calculates his or her entitlement.
When eligibility is checked, a determination is created that contains a set of decisions that are created over the lifetime of the case, each decision including an effective period of time, eligibility result and an entitlement amount and frequency (if eligible).
In addition to eligibility and entitlement results, the application allows agencies to provide decision details explaining decision results, and also provides the ability to display the key decision factors that were involved in determining eligibility such as a change to total household income. Any changes to the real world information referenced by the eligibility and entitlement rules will automatically result in the rules being re-run against the new information. This can result in a new set of eligibility and entitlement decisions over the lifetime of the case. This can also result in a new set of key decision factors and new decision details. For more information on decisions, key decision factors, and decision details, see Reading Decisions, Eligibility, Entitlement, and Explanation.