Eligibility for Essential Medical Equipment Payment (EMEP) 008-01040020

For claim requirements and actioning lodged claims, go to Claiming EMEP.

EMEP claims can be made by a person with medical needs (or their carers who live at the same residence) for each item of essential medical equipment and/or medically required heating/cooling. Claims can be made:

• online via MyGov > Payment and Claims > Claims > Make a claim > Disabled, ill or injured > Essential Medical Equipment Payment
• by phone via the Disability, sickness and carers line, or
• in person at a service centre

If the customer is unable or unsuitable to complete an online claim, they can lodge a paper claim for EMEP:

• Claim for Essential Medical Equipment Payment (SA440):
• customers must use this form if they use 1 or more items of essential medical equipment
• the SA440 is a  combined  form (and includes the Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation (SA449))
• the SA440 form is available on the  Services Australia website
• Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation (SA449):
• medical practitioners must use this form to confirm and certify the customer’s need for essential medical equipment and/or medically required heating or cooling in their home
• the SA449 form is available on the  Services Australia website
• Essential Medical Equipment Payment – Equipment User Declaration (SA450):
• this consent form must be signed by the person who uses the essential medical equipment
• the form authorises EMEP to be paid to the person’s carer
• the SA450 is available on the  Services Australia website
• Claim for Essential Medical Equipment Payment - Multiple Claim (SA451):
• customers must use this form to claim for multiple items of essential medical equipment and/or multiple equipment users who live at the same residence
• each equipment user listed on the SA451 is considered an individual claim and each claim is assessed and processed separately
• the SA451 is a  combined  form (and includes the SA449)
• the SA451 form is available on the  Services Australia website

EMEP is paid in relation to the customer’s current residential address. Customers only need to claim EMEP once for their current residence and qualifying essential medical equipment.

Once an eligible customer receives their initial EMEP payment for an item of essential medical equipment and/or medically required heating/cooling being used at a given residence, they do not need to lodge another claim to receive the subsequent 12 month EMEP for the same item(s) of equipment being used at that residence.

Eligibility for the payment will be confirmed on the 12 month anniversary date of the initial grant date of EMEP.

If the customer has lost qualification or a change of circumstances causes them to lose qualification (such as a change of residential address), EMEP will automatically cancel.

If a new EMEP claim is lodged for the new residence and the customer is eligible to be paid another EMEP, a new anniversary date is set in relation to the latest grant.

See the Resources page for scenarios.

An equipment user can claim EMEP if they can prove they:

• use essential medical equipment and/or medically required heating/cooling, and
• hold or are listed on a qualifying concession card

Note: the equipment user must provide their Identity Confirmation documents. Claims lodged by carers must include identity documents for themselves and the equipment user.

To qualify for payment, other requirements as outlined in Table 2 also apply:

• proof of medical needs
• energy account and payment
• not exceed maximum EMEPs in a 12 month period
• dependent child status
• reside in Australia
• live in a valid residence
• different residences (if applicable), and
• shared equipment at same residence (if applicable

A carer can claim EMEP if they can prove they provide care and attention on a regular and ongoing basis for a person with medical needs (equipment user) who uses

• essential medical equipment and/or medically required heating/cooling, and
• either the carer or the equipment user holds or is listed on, a qualifying concession card

The carer and equipment user must live together at the same residence.

The carer does not need to be a formal carer or be receiving Carer Payment and Carer Allowance to qualify for EMEP. There are no minimum standards of care required to qualify someone who is a carer for EMEP.

Note: claims lodged by carers must include Identity Confirmation documents for themselves and the equipment user.

To qualify for payment, other requirements as outlined in Table 2 also apply:

• proof of medical needs
• energy account and payment
• not exceed maximum EMEPs in a 12 month period
• dependent child status
• reside in Australia
• live in a valid residence
• different residences (if applicable), and
• shared equipment at same residence (if applicable

For new claims, proof is required that the equipment user:

• requires essential medical equipment, and/or
• has a medical condition that results in an inability to regulate their body and they require additional medically required heating/cooling

Medical information provided for the initial claim cannot be more than 2 years old.

Medical evidence from a Treating Health Professional (THP) must include a signed Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation (SA449). This medical confirmation declaration form is:

• provided as a link to customers who submit an online EMEP claim
• combined with the SA440 and SA451 for paper claims
• available for download on the Services Australia website

The SA449 may also be used for new claims to verify that the equipment user:

• requires specified essential medical equipment, or
• has a medical condition that means they cannot regulate their body temperature and medically requires heating/cooling in their home

Once eligibility for EMEP is established, proof of medical needs is not required again if:

• the customer changes address but the claim is for the same person with the same medical equipment/requirements
• a new carer claims, with no other changes to medical requirements

See the Resources page for scenarios.

To be eligible for an EMEP at the current residence where the essential medical equipment and/or medically required heating/cooling is being used:

• equipment users must:
• have a recent energy account in their (or their partner's) name, or
• state they contribute to payment of the energy account used to run essential medical equipment and/or medically required heating/cooling
• carers must:
• provide a recent energy account in the equipment user’s name, or
• state they contribute (full or in part) for the energy costs associated with running essential medical equipment and/or medically required heating/cooling used by the equipment user

Approved energy forms are:

• electricity
• natural or liquid petroleum gas
• diesel
• heating oil
• petrol, or
• kerosene

Evidence is not required for an EMEP claim except where an unacceptable proof of energy account was provided in an earlier energy account review. Acceptable proof must be provided if later requested.

Examples of evidence include a recent energy account at the relevant residence in the name of the equipment user, their partner or the carer. If an energy account is not available (or does not name the equipment user, their partner or the carer), the account holder can sign a declaration that the customer, their partner or the equipment user contributes to paying part or all of the energy account.

Note: medical evidence that is provided for a different Social Security payment (for example, Disability Support Pension or Carer Payment) cannot be used as evidence for an EMEP claim.

EMEP is not payable if, in the previous 12 months, the customer has received:

• an EMEP for the same medical equipment or for medically required heating/cooling at the same residence, or
• two EMEPs for the same medical equipment or for medically required heating/cooling at 2 separate residences

If replacing an item of equipment, for example, a new respirator for an old one, the person is considered to be using the same item of medical equipment.

If an EMEP is not payable due to the lodgement of a duplicate EMEP claim outlined in this step, cancel the claim activity (not the EMEP). See Processing Essential Medical Equipment Payment (EMEP) claims.

If the customer changes residential address, EMEP will automatically cancel and the customer will need to lodge a new claim to receive EMEP for the new residence. If the carer of the person using the same medical equipment, or the customer uses the same medical equipment at the new address, they will not need to provide medical evidence with the new claim. If another EMEP is granted, a new anniversary date is created and EMEP is automatically paid on their anniversary date at 12 month intervals.

See the Resources page for scenarios.

An EMEP is not payable if the person making the claim is a dependent child as defined under social security law. The claim will automatically reject if the customer is recorded as a dependent child. Explain any possible entitlements to other assistance for a person caring for a dependent child. For example, Family Assistance or Carer Payment and/or Carer Allowance.

If the person with medical needs (equipment user) is:

• a dependent child:
• their carer can make a claim for EMEP
• the child is not affected by percentage of care
• not a dependent child, the carer must obtain consent from the equipment user to claim their EMEP using the Essential Medical Equipment Payment – Equipment User Declaration (SA450) form

To be eligible for an EMEP, the customer must be physically present in Australia on the:

• date the EMEP claim was lodged, and
• 12 month anniversary date of their initial EMEP grant

The residence where the essential medical equipment and/or medically required heating/cooling is being used, must also be in Australia.

Although there is no requirement for the equipment user or carer to meet Australian residence requirements, the EMEP claim will automatically reject (or cancel on the anniversary date) if the customer is recorded as not in Australia on the relevant dates.

For EMEP, a valid residence can be a private residence (such as a term address) in Australia and includes:

• public housing
• share housing, or
• a residential address with no commercial care arrangements

Residential care facilities

A residential care facility is not a valid residence for EMEP and is not payable to the equipment user if they are ‘in residential care’ and submit a claim. Examples include:

• approved residential care (such as aged care facilities)
• hospitals and/or other medical facilities
• residential rehabilitation or treatment centres
• prisons or any place in which a person may be lawfully detained while under sentence for conviction of an offence and no on release on parole or licence

Up to a maximum of 2 EMEPs can be paid every 12 months for each item of essential medical equipment and/or for medically required heating/cooling at separate residences.

A separate claim must be lodged for each residence and the equipment user must be at the residence on the date the claim is lodged or on the EMEP anniversary date.

A change of address will automatically cancel EMEP. If an EMEP is paid for the new residence, a new anniversary date is set up.

Shared care of dependent children

If the equipment user is a dependent child, and a shared care arrangement exists so that the child spends time during the year at separate residences, separate claims must be made in relation to each residence.

Note: in these cases, separate anniversary dates will be set up according to the date the EMEP is paid for each residence. An EMEP can continue to be paid every 12 months for the equipment and/or medically required heating/cooling being used at each residence.

See the Resources page for scenarios.

If people use different items of medical equipment at the same residence, an EMEP can be paid to 1 or more customers for each separate item of essential medical equipment used at that residence.

If people at the same residence each medically require heating/cooling, only 1 EMEP can be paid for medically required heating/cooling at that residence.

The online and paper claims advise the customer not to record any equipment shared at their current residence for which an EMEP has been paid to another person. When they submit the online claim or sign the paper claim, they declare that to the best of their knowledge, no other person has been paid an EMEP for the same item of equipment they are claiming for.

Group homes

More than 1 EMEP can be paid where separate billing can be shown for each room/ unit. Each address is considered a separate residence.