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Assessing a claim for Carer Allowance (CA) using the combined assessment scores of two children 009-03040010

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Assessing CA claims using the combined assessment scores of two children

Finalising CA claims using the combined assessment scores of two children

Assessing CA claims using the combined assessment scores of two children

Table 1:

Step	Action
1	Claim received + Read more ... When a claim for Carer Allowance (CA) under the combined assessment scores of 2 children' qualifications is received, check whether the carer has previously tested eligibility for CA individually for one or both of the children in this claim. Have the previous individual claim(s) been rejected? Yes, go to Step 2 No, go to Step 3
2	Check for previous claims rejected in the last three months + Read more ... Has the previous individual claim(s) been rejected in the last 3 months? Yes, go to Step 3 No, if the individual claim were rejected more than 3 months ago the carer must provide: A new Carer Allowance Medical Report for a child under 16 years (SA333TDR/SA426) A new Carer Payment and/or Carer Allowance – Care Needs Assessment (SA394) (CNA). A new CNA will be required if the previous care load score recorded was less than 20 This information is required for the child(ren) previously rejected more than 3 months ago before this combined assessment claim can be assessed Advise the carer that the combined assessment claim cannot proceed until this information is provided When the new information is received, go to Step 3
3	Check if care is provided in carer and care receiver’s home + Read more ... Is the care provided in the carer and care receiver’s home? Yes, go to Step 5 No, go to Step 4
4	Check if one or both care receivers are hospitalised + Read more ... Is the absence because one or both care receivers are absent from the home as they are hospitalised and the carer is participating in their treatment? See Hospitalisation provisions for Carer Payment (CP) and Carer Allowance (CA) and Carer Allowance (CA)/Carer Payment (CP) absences where qualification is from the combined disabilities of more than one care receiver. Yes, go to Step 5 No, the carer cannot qualify for CA The claim should be rejected Procedure ends here
5	Check if Carer Allowance Medical Reports (and CNAs) have been returned + Read more ... Has the Carer Allowance Medical Report for a child under 16 years (SA333TDR/SA426) for each care receiver been returned? Yes, go to Step 6 No, Processing cannot continue until the Carer Allowance Medical Report for a child under 16 years (SA333TDR/SA426) forms are returned When forms have been returned, go to Step 6
6	Check if either of the care receivers have a recognised disability + Read more ... Do either of the care receivers have a recognised disability? Yes, that care receiver is individually medically qualified to attract CA for their carer. Code the claim for the child with the recognised disability. See Coding a claim for Carer Allowance (CA) where the care receiver is under 16 the carer may still be able to qualify for payment of C A in respect of the second child, or a Health Care Card only CA See Eligibility for Carer Allowance (CA) (child) when a customer is claiming or receiving CA only Procedure ends here No, go to Step 7
7	Calculate the Treating Health Professional (THP) score for each child + Read more ... For claims, see Calculating the Treating Health Professional (THP) score for a child under 16 years on or after 1 July 2010.

Finalising CA claims using the combined assessment scores of two children

Table 2:

Step	Action
1	Calculate the Care Needs Assessment (CNA) score for each child + Read more ... When calculating the CNA score, if the Care Load Validation (CLVL) screen is displayed, a process called validation will need to occur. See Calculating the total Disability Care Load Assessment Determination (DCLAD) (2020) score for more information on the validation process. Note: for care receivers under 3 years of age, a workaround is required. The DCLAD questions from 'Domain B - Behaviour 2' are questions 9–20 on the PDF version of the CNA. These questions are not applicable to care receivers under 3 years of age If validation is triggered for a care receiver under 3 years of age, the following questions, from 'Domain B - Behaviour 2' will incorrectly display on the CLVL screen: Q11 - the child wanders, escapes or runs away from home, school or community settings Q13 - the child becomes physically aggressive and harms others by hitting, pushing, kicking, biting or throwing objects Q18 - the child behaves in ways that result in injury to himself/herself. This may include head-banging, hand-biting or other self-harming behaviours Where validation is triggered for a care receiver under 3 years of age, the value 'a' should be recorded in the CNA: field against the above questions Document the validation entries made to one or all of these questions and record that they are a workaround to address incorrect functionality of the validation process If the CNA Score is 85 or greater: For only 1 child, go to Step 2 For each child, go to Step 3 For neither child, go to Step 4
2	One child individually meets the medical qualification + Read more ... Where the Treating Health Professional (THP) score is greater than zero and a DCLAD score of 85 or greater for only one child: That care receiver is individually medically qualified to attract CA for their carer. See Coding a claim for Carer Allowance (CA) where the care receiver is under 16 This means the carer cannot be granted payment under the combined assessment qualification criteria. However, the carer may still be able to qualify for CA HCC only level for the second child. See Coding a claim for Carer Allowance (CA) where the care receiver is under 16 Procedure ends here.
3	Both children individually meet the medical qualification + Read more ... A THP score greater than zero and a DCLAD score of 85 or greater for each child. Where both children each have a THP score greater than zero and a CNA score of 85 or greater, they are both individually medically qualified to attract CA for their carer. Code the claims for Carer Allowance (CA) where the care receiver is under 16 Procedure ends here.
4	A THP score greater than zero for each care receiver but a CNA score of 85 or greater for neither child + Read more ... If each child has a THP score of greater than zero, but each child has a CNA score that is less than 85, then combine the 2 CNA scores. Are the combined CNA scores 85 or greater, with each child having a contributing score of at least 20 or more? Yes, payment can be granted under the combined assessment provision. Go to Step 5 No, the carer cannot be granted under this provision. However, they may still qualify for Health Care Card only CA (child). See Coding a claim for Carer Allowance (CA) where the care receiver is under 16 years
5	Coding the CDCA screen for a combined Carer Allowance assessment + Read more ... Code all information for the claim for both child care receivers, to the point where the claim can be taken to Assess (resolve all warnings, errors and edits). Go to the CDCA screen in the carer’s record to link the scores On the CDCA screen, select the ‘+’ icon to add a new entry, the ‘Add Child Combined Assessment’ modal presents For the field ‘First Child’ select the appropriate first child from the drop menu For the field ‘Second Child’ select the appropriate second child from the drop menu The CNA Combined Score field will automatically populate with the combined CNA score for the 2 child care receivers Select Save Take the claim to Assess On the ELD screen, the customer will be granted Carer Allowance at the rate of one care receiver. To ensure this has assessed correctly check the CJAR screen. This will display the 2 care receivers that have contributed to the combined assessment Note: The customer will receive a HCC for each of the child care receivers as they individually meet this criteria. Finalise the claim