Reassessment of CA Health Care Card (HCC) only entitlement to payment level Carer Allowance (CA) for a child 009-03040040

Confirm with the carer if they are contacting about the child for whom they receive CA HCC only, and not another child in their care. Ask the carer whether there has been a change in circumstances or another condition diagnosed for the child care receiver. For example:

• if the child's condition deteriorated
• if the child has a new condition recently diagnosed
• if the care load for the child has increased
• whether the carer accurately answered the care load questions; that is, their responses may not reflect the level of care required for the child's condition

If the contact is about:

• another child, help the carer claim CA. Procedure ends here
• a CA HCC only Child Medical Review:
• See Child Medical Reviews for Carer Allowance (CA) (child)
• Procedure ends here
• the child for whom the carer receives CA HCC only, go to Step 2

Service Officers who are not Carer Processing staff must:

• create an open work item using Fast Note - select Auto text, use Generic > Claims > Reassess Rejected Claim
• select Confirm
• advise the carer has had a change in circumstance(s) and is requesting a re-assessment of CA HCC only for payment level CA. A detailed explanation of the request by the carer is required

Procedure ends here for non-Carer Processing staff.

Carer Processing staff must check the carer's record to confirm if the carer is receiving CA HCC only for the child, and:

• has not recently provided a new medical report and/or a Care Needs Assessment (CNA), go to Step 3
• has lodged a new medical report and/or CNA for the child recently that has not been actioned, go to Step 4
• a reassessment of CA HCC only to payment level CA has recently taken place for the child, go to Step 8

After checking the carer's record and it is confirmed they are receiving CA HCC only for the child and have not recently lodged a new medical report and/or CNA for the child, check these screens:

• Child Disability Assessment Tool Summary (CDAS) screen: this displays the most recent medical report completed for the care receiver
• Care Load Summary (CLS) screen: this displays the most recent CNA completed for the care receiver

The following combinations from the CDAS and CLS screens determine if re-use provisions can be applied for the THP score or the CNA score. Also, which forms need to be issued to the carer for reassessment. If the THP score is:

• 0 or less (that is, negative), and the CNA score is less than 85 and the response is 'Y' for 14 hours additional care, no re-use provisions apply and both SA431 and SA394 forms need to be issued to the carer
• greater than 0 (that is, positive) and the CNA score is less than 85 and response is 'Y' for 14 hours additional care, re-use provisions apply to the THP score and only the SA394 form needs to be issued to the carer
• 0 or less (that is, negative), and the CNA score is greater than 85 and the response is ''Y' for 14 hours additional care, re-use provisions apply to the CNA score and only the SA431 form needs to be issued to the carer

See Re-use and re-claim provisions for Carer Payment (CP) (child) and Carer Allowance (CA) (child) claims.

Where the carer requests a reassessment of CA HCC only for payment level CA, issue the following form(s) to the carer via the Mail Forms guided procedure:

• SA431 - Carer Payment and Carer Allowance Medical Report, and/or
• SA394 - Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16)

Once the form(s) have been returned, go to Step 5.

Check the carer's record.

The carer has provided a new medical report and/or CNA, ensure the carer has provided all the information required to reassess CA HCC only for eligibility to payment level CA.

Note: when an appropriate document is scanned to a customer's record (for example, SA394), the system may automatically create a new claim activity/SOA from this scanned document. This new claim activity is to be cancelled to allow the reassessment of the CA HCC only to occur.

• If the carer has submitted a new claim with a new medical report and/or CNA, set the claim to 'not required'
• Include in DOC that new claim is not required as this is a reassessment of CA HCC only to payment level of CA. Go to step 5
• If the form(s) provided are sufficient to complete a reassessment, go to Step 5
• If the form(s) provided are not sufficient to complete the reassessment (for example, medical report received but a CNA is also required) use the Mail Forms guided procedure to request the extra form. Once the form(s) have been received, go to Step 5.
• If the carer does not return the requested form(s) CA HCC should not be cancelled, Failed to reply to correspondence (FRC). Go to step 8

In the carer's record (or care receivers record if they have their own), go to the Care Receiver Summary (CRS) screen and 'S'elect the relevant care receiver:

• press [Enter], the Care Receiver Task Selector (CETS) screen displays
• 'S'elect these fields and press [Enter]:
• Disability Assessment Tool (Child)
• Care Load Summary
• Care Receiver Benefit Action
• Assessment Results
• the screen flow continues to the Child Disability Assessment Tool Summary (CDAS) screen and then the Care Load Summary (CLS) screen. On the:
• CDAS screen add the new medical details (if required)
• CLS screen add the CNA details (if required). See Calculating the total Disability Care Load Assessment Determination (DCLAD) (2020) score

To grant payment level CA (child), the THP score from the medical report must be greater than 0 and the CNA requires a score of 85 or greater.

Does the carer now qualify for payment level CA?

• Yes, go to Step 6
• No, go to Step 8

Payment level CA to eligible carers commences from the date of reassessment, or the date they first contacted Services Australia about the change in circumstances.

Example: a child care receiver has been diagnosed with a new condition and the carer contacts the agency on 2 June to notify the change in circumstance. Review forms are sent to the carer, and the carer lodges the review forms on 15 June. On 2 August, a determination is made that the carer does not qualify for payment level CA.

On the same day, the delegate contacts the carer by phone to notify of the outcome. The carer applies for a formal review of the decision, another Medical Report is sent to the carer. The carer lodges the Medical Report on 20 August.

A determination is made on 28 August that the carer qualifies for payment of CA. The start date or date of effect for payment of CA would be 2 June as the carer applied for a formal review within 13 weeks after being advised of the outcome. The date of effect of the favourable determination is the date of effect of the original decision.

Go to Step 7.

On the CJBA screen, key:

• 'CDA' in the Svc Rsn field
• 'REA' in the Action field
• '?' in the Reason field and select the appropriate reason from the list
• the new date for the assessment in the Effect Date field

Press [Enter] and finalise the activity on the Assessment Results (AR) screen.

Go to Step 8.

Record all details of the reassessment on a DOC in the carer's record. The DOC should contain details of the decision and the Act reference. If there is no change to the carers' entitlement to CA HCC only no letter will be sent to the carer. Service Officers must make genuine attempts to contact the carer to advise of the decision.