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Child Medical Reviews for Carer Allowance (CA) (child) 009-08060100

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This document includes details on how to help with enquiries about reviews for Carer Allowance (CA) (child) and how to process a review.

Responding to review enquiries

Table 1

Expand table

Step

Action

1

Child Medical reviews

Child Medical Reviews (CMR) start when a child care receiver is within 12 months of the development milestone review dates:

  • 4 years and 8 months
  • 10 years
  • 13 years

When the review starts, the system automatically sends a notification letter to the carer with the following forms:

  • Review of Carer Allowance - Care Needs Assessment for a child under 16 years (SA420)
  • Review of Carer Allowance Medical Report for a child under 16 years (SA403)

A reminder review registers on the Future Activity List (FAL) and is issued after 28 days.

If the carer has not returned the forms after 56 days, CA will auto-suspend.

If the carer does not respond after 13 weeks from issue of the review, CA will auto-cancel.

The reason the carer contacts is:

2

Carer requests forms reissue

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 DOC the record. If unavailable, use Mail Forms to issue fillable versions. See Resources page for form(s)
    Remind the carer of the outcome if the form(s) are not returned by the due date (see Step 1)
  • No, procedure ends here

3

Lodgement of review forms

Carer is lodging an SA420/SA423 and/or an SA403/SA429, online or has attended a service centre. However, an SA431 may also be accepted.

Note: a non-Services Australia medical report may be accepted instead of a Services Australia Medical Report for an Autism Spectrum Disorder diagnosis where certain criteria are met. See Assessing a recognised disability for Carer Allowance (CA) (child)

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 type the form title or code, which can be found on the bottom left side of the form.

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

Check the review form(s) that:

  • all questions have been answered including:
    • Customer Reference Number (CRN)
    • carer name
    • carer's address
    • phone number(s)
  • the medical report SA403/SA429 is signed and dated by the Treating Health Professional

Are both parts of the review forms fully completed and returned?

4

Both forms returned

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 SA420 or SA403 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 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 select the review. The review status on the Activity List (AL) screen will be ‘STA’rted.

Reminder received in error

If the carer has received a medical review reminder, and the medical review can be found scanned on the carer's or care receiver’s record, register the review by maturing from the FAL screen.

  • Processing staff, see Table 2
  • For all other staff, procedure ends here

5

Only one form returned

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. Refer to History Summary (HS) screen and select the appropriate letter for the due date

Ask the carer when they will return the missing form and note this in a DOC for the Processing Team.

  • Processing staff, see Table 2
  • For all other staff, procedure ends here

Processing Team

For Carer Payment/Carer Allowance New Claims Smart Centre Processing staff

Table 2

Expand table

Step

Action

1

Review received

A non-Services Australia medical report may be accepted instead of a Services Australia Medical Report for an Autism Spectrum Disorder diagnosis when certain criteria are met, see Assessing a recognised disability for Carer Allowance (CA) (child).

Is further information required to complete the review? For example, only one form lodged, forms are incomplete or missing pages.

Note: reviews for carers who are assessed under the CA (child) combined care rules must be referred to Level 2 Policy Helpdesk.

2

Follow up - Request for Information

Check the carer’s and care receiver’s records for all the requested information.

If the customer has:

  • provided all the requested information, go to Step 3
  • not provided the requested information. Decide if an extension to the due date is required and extra time for surface delivery

If the required information has not been provided within the time allowed to respond, cancel their Carer Allowance:

  • Cancel the (CRA/AAC) review activity. Key:
    • ‘C’ in the review activity on the Activity List (AL) screen
    • ‘C’ or ‘R’ to ‘cancel all provisional changes’ on the Activity Cancel (AYC) screen. The review status will change to ‘REG’istered
  • Outside of the review activity, select the care receiver from Care Receiver Summary (CRS) screen and go to Care Receiver Benefit Action (CJBA). Key the following:
    • Svc Rsn: field - CDA
    • Action: field - CAN
    • Reason:  field - FRC
    • Effect Date: field - date of cancellation

Note: the date of effect of the determination is generally the day following the expiration of the time allowed to respond. Where the customer has already been paid for this date, the date of effect for the cancellation will be Date Paid To plus 1.

  • Finalise the cancellation activity
  • ‘S’elect and finalise the (CRA/AAC) review activity
  • If a fully completed Treating Health Professional (THP) report has been received, code after the cancellation activity and the review activity has been completed. Code the Child Disability Assessment Tool Summary (CDAS), see Calculating the Treating Health Professional score for a child under 16 years on or after 1 July 2010.
  • If an incomplete form, or a Care Needs Assessment form (CNA) is received without the Treating Health Professional (THP) Report, do not code.
  • Finalise the activity on the Assessment Results (AR) screen and DOC the carer’s record with the outcome of the review. See Resources page for the DOC template.

Procedure ends here.

3

Process the review
  • 'S'elect the CRA/ACC activity from the AL screen
  • The activity can be on the record of either the:
    • carers, or
    • care receivers (if they have their own record)
  • If the error I003DL shows, the review must be completed in the care receiver’s record
  • If the review is to be completed in the:

4

Complete review activity in Carer’s record
  • Go to the Carer Medical Review (CDRV) screen and press [Enter]
  • Code the Child Disability Assessment Tool Summary (CDAS) screen. Key 'Y' in the Add a new THP Assessment field and press [Enter]
  • Code the Child Medical Details (CDMD) screen, overstriking previously recorded Treating Health Professional (THP) details with information from the medical report

Note: if the Service Officer completes the Child Medical Review (via CDRV screen) and the signed date is before the review forms issue date, the payment will cancel. Refer the case to the Level 2 Policy Helpdesk for help with coding before finalisation.

  • Code the Source and Date of Receipt fields. If forms have been lodged on different dates, use the earliest date of lodgement
  • Code the Effect date field (DOV) with the date of receipt (DOR) of the review

Note: DOV may need to change if the decision is an unfavourable decision, or the decision is due to a loss of qualification.

  • Key ‘I’ in the Action field and press [Enter] to continue coding functional assessment responses
  • Take note of the THP score and/or whether the care receiver has a Recognised Disability
  • Code responses provided by the carer in the Care Needs Assessment and press [Enter] to go to the Care Load (CLS) screen. Key 'Y' in the Add a new Care needs assessment and press [Enter]

See Coding the paper Carer Payment and/or Carer Allowance Care Needs Assessment for a child under 16 years.

Conduct further investigation if the CNA questionnaire is inconsistent with a qualifying health professional questionnaire. Contact with the customer is required to update responses to make sure the CNA questionnaire is an accurate reflection of the child's functional ability, behaviour, and special care needs.

Update (where required) the carer and care receiver circumstances including:

  • Contact details
    Note: updates are completed outside of the review activity and finalised before any further action is taken. This is if the review is not able to be actioned and must be held.
  • Temporary absence(s) (for example, hospitalisation, respite). See Carer or care receiver is absent from care for Carer Payment (CP) and/or Carer Allowance (CA)
  • Change in a child's condition or amount of care provided
  • Press [Enter] until the Carer Allowance Review (CDRV) screen shows again, select Complete Review? ‘Y’ and press [Enter] to go to AR screen
  • Before finalising the review, go to the Carer Allowance Action and Assessment Result (CJAA) screen to check that the outcome and Assessment Date is correct for the determination
  • Do not finalise the review, go to Step 6

5

Complete review activity in Carer Receiver’s record
  • Go to the Carer Medical Review (CDRV) screen and press [Enter]
  • If there are duplicate review activities on the record for the same review, use the earliest (check AMR) to process. 'C'ancel any other activities for the same review
  • Code the Child Disability Assessment Tool Summary (CDAS) screen, see Calculating the Treating Health Professional score for a child under 16 years on or after 1 July 2010. Key 'Y' in the Add a new THP Assessment field and press [Enter]
  • Code the Child Medical Details (CDMD) screen, overstriking previously recorded Treating Health Professional (THP) details with information from the medical report

Note: if the Service Officer completes the Child Medical Review (via CDRV screen) and the signed date is before the review forms issue date, the payment will cancel. Refer the case to the Level 2 Policy Helpdesk for help with coding before finalisation.

  • Code the Effect date field (DOV) with the date of receipt (DOR) of the review

Note: DOV may be different if the decision is an unfavourable decision, or the decision is due to a loss of qualification.

Conduct further investigation if the CNA questionnaire is inconsistent with a qualifying health professional questionnaire. Contact with the customer is required to update responses to make sure the CNA questionnaire is an accurate reflection of the child's functional ability, behaviour, and special care needs.

Update (where required) the carer and care receiver circumstances including:

  • Contact details
    Note: updates are completed outside of the review activity and finalised before any further action is taken. This is if the review is not able to be actioned and must be held
  • Temporary absence(s) (for example, hospitalisation, respite). See Carer or care receiver is absent from care for Carer Payment (CP) and/or Carer Allowance (CA)
  • Change in a child's condition or amount of care provided
  • Go to Child Medical Review (CDRV) screen
  • Do not finalise the review. The review activity will auto complete when 'Y' is coded as ‘Complete Review’ (will not go to AR) and the outcome will ripple to the carer’s record. Check that the outcome is as expected, and the date of event (DOV) is in line with the determination. Only code 'Y' when the review is ready to be finalised in these cases.
  • Before completing the review on the CDRV screen, go to Step 6.

6

Outcome of the review

Do not finalise the review at this stage.

Review will result in:

  • No change to current CA (child)/CA (child) HCC qualification, go to Step 7
  • Cancellation of CA payments due to not achieving score and CA (child) HCC to continue, go to Step 8
  • Cancellation of CA due to change in care/respite/carer activity/any other reason, go to Step 9
  • Cancellation of CA (child) HCC, go to Step 10
  • Cancellation of CA (child) HCC and CA (child) payments due to qualifying score, go to Step 11
  • Carer previously qualified for CA (child) HCC, now qualifying for CA (child) payments, go to Step 12

Note: if CA has been previously cancelled (for example, CAN/MRN) and further information is provided for a review of the cancellation, however the carer remains ineligible for CA due to another reason, the carer must be contacted, a manual letter (Q999) issued, and the carer's record updated with a DOC. For the Q999 text, see the Resources page in Adult medical reviews for Carer Payment (CP) and Carer Allowance (CA). The original date of cancellation is the original date of decision.

7

Carer remains qualified for CA (child) payments/CA (child) HCC only
  • The date of effect for continuation of payments is the date of receipt (date the form was lodged) of the review.
  • There is no requirement to contact the carer
  • Finalise the review and DOC the carer’s record with the outcome of the review. See the Resources page for the DOC template
  • A letter will be issued to the carer if the carer was eligible for CA (child) HCC only and is still eligible for CA (child) HCC only
  • A letter will not be issued to the carer if the carer is eligible for CA (child) payments and is still qualified for CA (child) payments.

8

Carer no longer qualifies for CA payments due to not achieving a qualifying score, CA to continue as HCC only

The date of effect for cancellation for not achieving a qualifying score is the date of determination of the review under Section 118 SSAA. Update the date of effect on the Child Medical Details (CDMD) screen and Care Load - Behaviour (CLBHA) screens.

Make a genuine attempt to contact the carer before finalising the review.

See Advising verbally of an unfavourable decision.

  • If the carer is providing more information:
  • If the carer is not providing more information:
    • discuss with them any possible entitlement
    • give them any relevant publications for payments and concessions
    • use Operational Blueprint for the life event
  • Finalise the review and DOC the carer’s record with the outcome of the review. See the Resources page for the DOC template
  • A letter about the continuation of HCC only will be automatically issued to the carer.

9

Carer no longer qualifies for CA due to change in care/respite exceeded/any other reason

Make a genuine attempt to contact the carer before finalising the review. See Advising verbally of an unfavourable decision.

  • If the carer is providing more information:
  • If the carer is not providing more information:
    • discuss with them any possible entitlement
    • give them any relevant publications for payments and concessions
    • use Operational Blueprint for the life event
  • Update the record with the change and DOC the carer’s record with the outcome of the review. Finalise the Medical Review (CRA/ACC) activity
  • If more support is needed for complex queries:

10

Carer receiving CA HCC no longer qualifies for CA HCC
  • The date of effect for cancellation for not producing a qualifying score is the date of determination of the review under Section 118 SSAA. Update the date of effect on the CDMD screen and CLBHA screens
  • Make a genuine attempt to contact the carer before finalising the review. See Advising verbally of an unfavourable decision
  • If the carer is providing more information:
  • If the carer is not providing more information:
    • discuss with them any possible entitlement
    • give them any relevant publications for payments and concessions
    • use Operational Blueprint for the life event
  • Finalise the review and DOC the carer’s record with the outcome of the review. See the Resources page for the DOC template
  • A letter about cancellation will be automatically issued to the carer

11

Carer receiving CA HCC and CA (child) payments no longer qualifies
  • The date of effect for cancellation for not producing a qualifying score is the date of determination of the review under Section 118 SSAA. Update the date of effect on the CDMD screen and CLBHA screens
  • Make a genuine attempt to contact the carer before finalising the review. See Advising verbally of an unfavourable decision
  • If the carer is providing more information:
  • If the carer is not providing more information:
    • discuss with them any possible entitlement
    • give them any relevant publications for payments and concessions
    • use Operational Blueprint for the life event
  • Finalise the review and DOC the carer’s record with the outcome of the review. See the Resources page for the DOC template
  • A letter about cancellation will be automatically issued to the carer

12

CA previously HCC only, carer now qualifies for CA payments
  • The date of effect is the date of receipt (date of lodgement of the forms) of the review.
  • In the review activity (CRA/ACC):
    • Select the care receiver from the Care Receiver Summary (CRS) screen
    • Press [Enter] to show the Care Receiver Task Selector (CETS) screen
    • Select the Care Receiver Benefit Action (CJBA) screen and press [Enter]
  • Code the following:
    • Svc Rsn: field - CDA
    • Action: field - REA
    • Effect date: field - Date the carer qualifies for CA payments
    • Go to the AR screen

Note: if the review activity is on the care receiver’s record, action on the carer’s record.

  • Check for any arrears payable
  • If the carer is entitled to Annual Child Disability Assistance Payment (CDAP) and Carer Supplement (CS) and the payments are not automatically paid, code them manually on the One-Off Payment (OOP) screen. For help with checking and manually issuing payments, see:
  • Finalise the review and DOC the carer’s record with the outcome of the review. See Resources page for the DOC template.
  • A letter is not sent if the carer is still qualified for CA (child). Before finalising the activity, make a genuine attempt to contact by phone with the carer to advise them of the outcome. Check the carer’s current details including payment destination details and make updates if needed. See Changing payment destination