Adult medical reviews for Carer Payment (CP) or Carer Allowance (CA) 009-08050010

Carers receiving CP and/or CA for an adult care receiver may be selected for an Adult Medical Review. Adult Medical Reviews use Service Profiling to select carers for review. Adult Medical Reviews are for carers who are at risk of being paid CP and/or CA when they or their care receiver may no longer qualify for payment.

Service Profiling uses a set of rules called conditions and predictors to select carers for review. For example, a predictor may be when the customer has been paid incorrectly, not declared earnings correctly or has had several changes of address. Depending on the priority given to the predictors a customer could be selected for a high, medium or low risk review.

The purpose of carer reviews is to establish:

• that the care receiver’s care needs or medical condition continues to meet eligibility requirements
• that the carer continues to provide appropriate level of care
• if there are any changes in their circumstances

Carers are excluded from a medical review when:

• the care receiver:
• has an Adult Disability Assessment Tool (ADAT) score greater than or equal to 40 and the medical condition is permanent and not improving
• already has an initiated review
• has a terminal illness not longer than 3 months
• is permanently in an institution
• is currently overseas
• is deceased
• address matches an Exempt Emergency Area Postcode
• Home Office Code listed matches an Exempt Emergency Area Office Code
• Area Office Code listed matches an Exempt Emergency Area Office Code
• any of the linked carer's:
• most recent reviews has a finalised date less than 12 weeks before the current date
• have a current IRS review
• are currently overseas
• has a home address that matches an Exempt Emergency Area Postcode
• Home Office Code matches an Exempt Emergency Area Office Code

Adult medical reviews do not apply to CP (XWP) that is paid under grandfathering provisions for ceased Wife Pension carers. However CP (XWP) carers will have their CA reviewed as normal.

If a CP (XWP) carer’s only or last payment level CA is suspended, or cancelled or changed to CA HCC only, CP (XWP) will auto-cancel. This means a CP (XWP) carer may lose qualification for CP (XWP) permanently if they no longer qualify for CA after completion of a CA adult medical review. See Transfer from Wife Pension (WP) to Carer Payment (CP).