Hospitalisation reviews for Carer Payment (CP) and Carer Allowance (CA) for a child under 16 years 009-08040030

Carers of hospitalised children will be reviewed to make sure they are continuing to participate in caring for the child. These reviews happen:

• every 84 days (12 weeks) of continuous hospitalisation for up to 2 years (24 months)
• at 24 months of continuous hospitalisation, full care load reviews are conducted
• every 12 months after 2 years of commencing hospitalisation, further full care load reviews are conducted

The carer must be advised to notify Centrelink within 14 days of the care receiver returning home or leaving hospital.

If the carer is receiving both CP and CA, including CA (auto), for the same care receiver(s), then only one hospitalisation review will be created.

All absences are coded on the Absences Details (ABSN) screen and reviews register on the Future Activity List (FAL). See Carer or care receiver is absent from care for Carer Payment (CP) and/or Carer Allowance (CA). If hospitalisation absences recorded on the ABSN screen are non-consecutive but exceed 12 weeks, there is no requirement for a review.

When a review matures, the system automatically sends a notification letter to the carer with the pre-populated form Review of Carer Payment and Carer Allowance while your child is in hospital (SA396).

If the carer is:

• advising of a change in circumstances, see Table 2 > Step 4
• requesting replacement form(s), go to Step 2
• lodging form(s) for the review, go to Step 3
• contacting after receiving a reminder and forms have already been returned, go to Step 4
• contacting after suspension of CP, see Restoration of Carer Payment (CP)
• contacting after cancellation of CA, see Restoration of Carer Allowance (CA)

If none of the above, see Table 2.

Is it necessary to re-issue the form(s)?

• Yes:
• Reprint the letter and system generated form(s) via the History Summary (HS) screen, and record details on a DOC. If unavailable, use Mail Forms to issue fillable versions. For form(s), see the Resources page
• A reminder is automatically registered on the Future Activity List (FAL) screen and will be issued after 28 days
• Remind the carer if forms are not returned after 56 days, the customers:
  - CA will cancel, and
  - CP will suspend
• No, procedure ends here

Check the relevant review form is being lodged. The Resources page lists the relevant review forms issued to carers with a child under 16 years who is in continuous hospitalisation.

Carers can lodge documents by:

• uploading forms using online services
• taking them to their nearest service centre, or
• posting them to Services Australia
  Carers Services
  PO Box 7805
  CANBERRA BC ACT 2610

Tell the carer when uploading forms to select the document type: Centrelink form, then enter the form title or code, which is on the bottom left side of the form.

Carers can access a guide to Upload your Centrelink documents online on the Services Australia website. See the link on the Resources page.

Check the review form(s) that:

• both forms are signed
• all questions have been answered, including:
• Customer Reference Number (CRN)
• carer name
• carer's address
• phone number(s)

Are both parts of the review fully completed and returned?

• Yes, go to Step 4
• No, go to Step 5

If required, scan the documents to the carer's record:

• individually - do not scan forms together
• do not select the 'Store only' option

When scanning, check the first scanned page of the document shows the barcode. See Scanning Centrelink documents using an MFD.

If an SA417 or SA418/SA430 has been scanned as an incorrect Form Type, update the document details, see Moving, copying or updating Centrelink digital image.

Register the return of the review. Check the review has been removed from the FAL screen on either the care receiver's (if the care receiver has their own record) or carer's record. If not, mature the review on the FAL screen manually by:

• 'S'electing the review
• keying the source code and receipt date

The review status will change to 'STA'rted and display on the Activity List (AL) screen.

Reminder received in error

If the carer has received a medical review reminder, and the medical review is scanned on the carer's or care receiver's record, register the review by maturing it on the FAL screen.

For:

• processing staff, see Table 2
• all other staff, procedure ends here

When only one part of the review has been returned:

• do not register the return of the review
• tell the carer to return the required form(s) as soon as possible. Check the HS screen and select the appropriate letter for the due date
• ask the carer when they will return the missing form
• create and record details on a DOC for the Processing Team

For:

• processing staff, see Table 2
• all other staff, procedure ends here

All absences are coded on the Absences Details (ABSN) screen and reviews register on the Future Activity List (FAL). See Carer or care receiver is absent from care for Carer Payment (CP) and/or Carer Allowance (CA). If hospitalisation absences recorded on the ABSN screen are non-consecutive but exceed 12 weeks, there is no requirement for a review.

When a review matures, the system automatically sends a notification letter to the carer with the pre-populated form Review of Carer Payment and Carer Allowance while your child is in hospital (SA396).

For:

• 12 weekly review matures, go to Step 2
• 12 week review MFU for returned forms, go to Step 3
• 12 week review second MFU, go to Step 4
• 24 month review matures, go to Step 5
• 24 month review MFU for returned forms, go to Step 6
• 24 month review second MFU, go to Step 7
• Subsequent 12 monthly reviews from 36 months onwards, go to Step 8
• 36 month review MFU for returned forms, go to Step 9
• 36 month review second MFU, go to Step 10
• check and register the returned review forms, see Table 3 > Step 1
• requesting extension for form lodgement, see Extending the return date for Carer Payment (CP) and Carer Allowance (CA) medical review

The hospitalisation (H12) review is created on the CAR/CDA customer's record when all of the below are met:

• absences on the ABSN screen for CP/CA child care receiver are coded with reason 'HSP' (Hospitalisation)
• the hospitalisation duration is greater than 12 weeks
• the hospitalisation start date is not more than 12 weeks in the past

12 week hospitalisation reviews are carried out a total of 7 times if the customer remains in hospital for over 24 months.

Reviews after 12 weeks are to occur even if the 12 continuous weeks spans a calendar year.

For carers receiving CP

In the PEN system, the FAL screen will be coded automatically with the following codes:

• Review Reason Code: H12 Child 12 week hospital
• Keywords: 12WEEK HOSPITAL

For carers receiving CA

In the CDA system, the FAL screen will be coded automatically with the following:

• Review Reason Code: H12 - Child 12 week review set up
• Keywords: 12WEEK HOSPITAL

Upon review activity allocation, check the following:

• the carer and care receiver remain linked and are current at the time of review
• the carer still receives CA and/or CP at the time the review matures

Note: the review will cancel if it is reported that the child is no longer in hospital.

Is the above information correct?

• Yes:
• the system will send the carer an SA396 form
• a second H12 review or Manual Form Return (MFR) is set to mature 21 days after the first review maturation date
• see How to code and action a manual review
• No, see Table 3 > Step 2

The system automatically sends a SA396 form to the carer when the care receiver has been hospitalised for a continuous 12 week period. The carer has 3 weeks after this to return the SA396 form. When the second review matures, the system generates a MFU for action on the Activity List (AL) screen.

Confirm dates through the ABSN screen.

Note: if there is no end date on the ABSN screen or the date of the absence extends up to 21 weeks after admission to hospital, create a further 12 weekly hospitalisation review on the customer's record so that the next 12 weekly review can take place. See How to code and action a manual review.

Check the AL screen to confirm if the SA396 form has been returned by week 15 after hospital admission.

Has the SA396 form been returned by week 15 after hospital admission?

• Yes, see Table 3 > Step 1
• No:
• issue a Request for Information (RFI) letter
• issue another review form manually or reprint a copy from the History Summary (HS) screen
• record the progress of the review and due date on a DOC
• hold the MFU until the end of week 17 after hospital admission, or for subsequent reviews, 5 weeks after the 12 week review date. See Work Optimiser for staff

Has the SA396 form been returned by week 17 after hospital admission?

• Yes, see Table 3 > Step 1
• No:
• make a genuine attempt to contact the carer. This is to allow the carer an opportunity to provide any updated information which may change the outcome of the claim. See Advising verbally of an unfavourable decision
• payment of CP and/or CA (child) using reason code 'FRC' (failure to reply to correspondence). Note: if the carer receives CA for multiple care receivers, it is not possible to suspend payment at the care receiver level. See Cancellation or suspension of Carer Payment (CP) and Carer Allowance (CA)
• record the outcome of the review on a DOC
• if payment remains suspended11 weeks after the SUS effect date, it will auto-cancel

Procedure ends here.

Where a care receiver has been continuously hospitalised for 24 months and the carer has been in continuous receipt of payment (inclusive of periods of suspension) for CP and/or CA (child), the carer and care receiver are to undergo a full care load and medical review.

For carers receiving CP and/or CA

In the PEN system, the FAL screen will be coded automatically with a MFU activity.

For carers receiving CA only

In the CDA system, the FAL screen will be coded automatically with a MFU activity.

Upon review activity allocation, check the following:

• the carer and care receiver remain linked and are current at the time of review
• the carer still receives CA and/or CP at the time the review matures

Note: the review will cancel if it is reported that the child is no longer in hospital.

Is the above information correct?

• Yes:
• manually issue a Request for Information (RFI) letter
• manually issue care load and medical review forms. See the Resources page
• a second Manual Form Return (MFR) is set to mature 21 days after the first review maturation date
• see How to code and action a manual review
• No, see Table 3 > Step 2

The system automatically sends a SA396 form to the carer when the care receiver has been hospitalised for a continuous 24 month period. The carer has 3 weeks after this to return the SA396 form.

Confirm dates through the ABSN screen.

If there is no end date on the ABSN screen, create a further 12 monthly hospitalisation review on the customer's record so the next 12 monthly review can take place. See How to code and action a manual review.

Check the AL screen to confirm all the review forms have been returned by 3 weeks after the 24 month review request was sent.

Have the forms been returned by the end of week 3 after the 24 months review?

• Yes, see Table 3 > Step 1
• No:
• issue another Request for Information (RFI) letter
• issue another review form manually or reprint a copy from the HS screen
• record the progress of the review and due date on a DOC
• hold the MFU until the end of week 5

Have the review forms been returned by week 5 MFU?

• Yes, see Table 3 > Step 1
• No:
• make a genuine attempt to contact the carer. This is to allow the carer an opportunity to provide any updated information which may change the outcome of the claim. See Advising verbally of an unfavourable decision
• payment of CP and/or CA (child) is to be auto-suspended and the MFU completed using reason code 'FRC' (failure to reply to correspondence). Note: if the carer receives CA for multiple care receivers, it is not possible to suspend payment at the care receiver level. See Cancellation or suspension of Carer Payment (CP) and Carer Allowance (CA)
• record the progress of the review on a DOC
  Note: if CP/CA is suspended the Service Officer must clearly document reasons for the suspension on the customer's record and include their logon ID and contact details
• if payment remains suspended 11 weeks after the SUS effect date, it will auto-cancel

Procedure ends here.

Where a care receiver has been continuously hospitalised for each additional 12 months after the initial 24 months (the child has now been continuously hospitalised for 36 months) and the carer has been in continuous receipt of payment (inclusive of periods of suspension) for CP and/or CA (child), the carer and care receiver will be required to undergo a full care load and medical review.

Note: repeat this step every 12 months from 36 months onwards, if the care receiver remains hospitalised continuously for this period of time.

Confirm continuous hospitalisation dates through the ABSN screen.

If there is no end date on the ABSN screen, create a further 12 monthly hospitalisation review on the customer's record so the second or subsequent 12 monthly review can take place. See How to code and action a manual review.

For carers receiving CP and CA

In the PEN system, the FAL screen will be coded automatically with a MFU activity.

For carers receiving CA only

In the CDA system, the FAL screen will be coded automatically with a MFU activity.

Upon review activity allocation, check the following:

• the carer and care receiver remain linked and are current at the time of review
• the carer still receives CA and/or CP at the time the review matures

Note: the review cancels if it is reported that the child is no longer in hospital.

Is the above information correct?

• Yes:
• manually issue Request for Information (RFI) letter
• manually issue care load and medical review forms. See the Resources page
• a Manual Form Return (MFR) is set to mature 21 days after the first review maturation date
• see How to code and action a manual review
• No, see Table 3 > Step 2

If the review forms have not been returned by the end of the 3 week period for return of form, an MFU will be generated. Check if the review forms have been returned.

Have the forms been returned by the end of week 3 after the 12 monthly review?

• Yes, see Table 3 > Step 1
• No:
• issue another Request for Information (RFI) letter
• issue another review form manually or reprint a copy from the HS screen
• record the progress of the review and due date on a DOC
• hold the MFU until the end of week 5

Have the review forms been returned by week 5 after MFU has been sent?

• Yes, see Table 3 > Step 1
• No:
• make a genuine attempt to contact the carer. This is to allow the carer an opportunity to provide any updated information which may change the outcome of the claim. See Advising verbally of an unfavourable decision
• payment of CP and/or CA (child) is to be auto-suspended and the MFU completed using reason code 'FRC' (failure to reply to correspondence). Note: if the carer receives CA for multiple care receivers, it is not possible to suspend payment at the care receiver level. See Cancellation or suspension of Carer Payment (CP) and Carer Allowance (CA)
• record progress of the review on a DOC
  Note: if CP/CA is suspended the Service Officer must clearly document reasons for the suspension on the customer's record and include their logon ID and contact details
• if payment remains suspended 11 weeks after the SUS effect date, it will auto-cancel

Procedure ends here.

Check the review form(s) that:

• all questions have been answered including:
• Customer Reference Number (CRN)
• carer name
• carer's address
• phone number(s)

Go to Step 2.

If required, scan the documents to the carer's record:

• individually - do not scan forms together
• do not select the 'Store only' option

When scanning, check the first scanned page of the document shows the barcode. See Scanning Centrelink documents using an MFD.

If an SA396 has been scanned as an incorrect Form Type, update the document details, see Moving, copying or updating Centrelink digital images.

Register the return of the review. Check the review has been removed from the Future Activity List (FAL) screen on either the care receiver's (if the care receiver has their own record) or carer's record. If not, mature the review on the FAL screen by manually by:

• 'S'electing the review
• keying the source code and receipt date

The review status will change to 'STA'rted on the Activity List (AL) screen.

The record in which the review is created is determined by the type of medical review. The reviews will show as:

• Carer Payment - in the PEN system, Review Reason Code: H12 Child 12 weekly hospital, Keywords: HOSPITAL
• Carer Allowance - in system CDA, Review Reason Code: H12, Keywords: 12WEEK HSP#### *REVIEW - '####' is a count of the number of 12 weekly reviews a customer has had

For:

• processing staff, go to Step 3
• all other staff, procedure ends here

If the customer has provided all the requested information:

• 'S'elect the PEN/MFU activity from the AL screen
• The activity can be on the record of either the:
• carer, or
• care receiver (if they have their own record)
• If the error I003DL shows, the review must be completed in the care receiver's record

Record details in a DOC about the return of the review forms, including details about whether the:

• care receiver is still in hospital
• carer is continuing to provide care
• care receiver has returned to the carer's care and from what date

If the care receiver is:

• still in hospital, go to Step 4
• no longer in hospital, go to Step 5

Update the Absence Details (ABSN) screen with the new hospitalisation dates.

Will the care receiver remain in hospital for an additional 12 weeks or more?

• Yes:
• finalise the activity via the Assessment Results (AR) screen
• record details in a DOC
• after actioning the MFU, the system again generates a review to mature after 63 days (9 weeks - this takes into account the 3 week wait for the SA396 to be returned from the first MFU) and the cycle continues
  Note: for the 24 month and subsequent 12 monthly reviews, calculate the total Disability Care Load Assessment Determination (DCLAD) (2010) score
• No:
• finalise the activity via the AR screen
• record details in a DOC
  Note: an automatic advice will be sent to the customer notifying them of the review result

Procedure ends here.

If the carer advises the care receiver has returned to care:

• update the ABSN screen with the hospitalisation discharge date
• finalise the activity via the AR screen
  Note: any future hospitalisation (H12) reviews are auto-cancelled
• record details in a DOC
  Note: an automatic advice will be sent to the customer notifying them of the review result

Procedure ends here.