Carer Payment (CP) (child) episodic care 009-04070020

CP (child) - episodic care may apply when all of the following apply:

• a care receiver under 16 years of age has a severe medical condition or a severe disability that is episodic or recurring
• episodes are expected to be at least 3 months in duration and less than 6 months (as identified in a Medical Report or Medical Certificate), and must not begin before the person's start day
• the condition or disability must also be likely to result in care being required on and off (episodic) over a period of at least 24 months

In addition to the above, to be eligible for CP (child) under the episodic care provisions:

• the carer must personally provide constant care to the care receiver/s
• the care provided to the care receiver/s attains a qualifying rating of intense under the Disability Care Load Assessment (child) Determination (DCLAD) (2020)
• the provision of the care by the person must severely restrict the person's capacity to undertake paid employment
• the carer must complete the usual carer assessment process

A carer claiming episodic care CP (child) for the first time will be required to submit an online claim or complete relevant forms issued via the First Contact Service Offer (FCSO) workflow. See Claiming Carer Payment (CP) and/or Carer Allowance (CA)

• Between episodes the CP (child) will be cancelled, allowing the customer to claim other types of income support
• Severe medical conditions and/or disabilities listed from the previous Care Needs Assessment (CNA) must be checked whenever a subsequent re-claim or claim is lodged

If the carer reclaims CP (child) for a subsequent episode for the same condition (within 24 months of the most recent CNA), the carer can submit an online claim or complete relevant forms issued via FCSO. See Claiming Carer Payment (CP) and/or Carer Allowance (CA)

• There is no limit on the allowable number of episodes
• There is no limit on the number of times an extension can be granted for a single episode of the same condition if the carer provides a new medical certificate

If the carer re-claims and the disability or medical condition differs from the previous condition or the previous CNA is older than 24 months, the carer can submit an online claim or complete relevant forms issued via FCSO. See Claiming Carer Payment (CP) and/or Carer Allowance (CA)

• There is no limit on the allowable number of claims for related episodes
• Carers will also be asked if they require referral to support services
• Carers may lodge an early claim to test their eligibility for CP (child) for episodic care up to 13 weeks prior to the commencement of the period of care

Note: short term care may become episodic care if the care receiver has a repeat of the same condition, confirmed by a Treating Health Professional (THP).

• CA (auto) will automatically be paid to customers receiving episodic CP (child) for the same period, but only if the carer or another person is not already receiving CA (child) for that care receiver, or CA is not payable for another reason, e.g. cancelled due to respite bank exceeded
• CA (auto) child care receivers will be eligible for a Health Care Card (HCC) in their name in addition to any Pensioner Concession Card (PCC) or HCC held by the carer. Normal concession card hierarchy rules apply

A disabled adult and 1 or more children with a disability or medical condition (multiple care) may include 1 or more children assessed under the episodic care provisions. This would limit the grant to episodic care.

The system will ensure that the period of care advised by the Treating Health Professional (THP) is more than 3 months and that the actual period between the dates does not equal or exceed 6 months.

If it does, the Service Officer will be asked to confirm that the period of care exceeds six months and transfer the claim to long term mainstream care CP.

• A Medical Certificate for Carer Payment (for a child under 16 years) Extension and Reclaim of Episodic Care/Extension of Short Term Care (SA395) can be provided for subsequent episodes within 24 months of the previous CP - Care Needs Assessment (CNA), and for extensions of a current period of episodic care
• An extension can include an end date on or after the care receiver's 24 month anniversary of the previous CNA, as long as the period on the medical certificate starts before the care receiver's 24 month anniversary of the previous CNA
• A medical certificate cannot be provided for an extension if the medical certificate states a period starting on or after the care receiver's 24 month anniversary of the previous CNA
• Carers whose episode is extended beyond 6 months will qualify for long term mainstream care CP (child). In this case the initial period of payment for episodic care will be counted towards the long term care eligibility requirement of 6 months or more

To Code an Extension of Episodic/Short Term care:

• Go to the Child Medical Details (CDMD) screen
• Record the medical condition of the child care receiver as either Episodic or Short Term This is used to indicate whether the child care receiver has a short term or episodic condition as certified by the Treating Health Professional (THP)
• Code the end date of the condition. This is the care provided end date of the Short Term or Episodic condition. For extensions, this is the new end date of the extension period
• Code the Extension. This indicates whether or not the THP has certified that the child has an extension to a short term or episodic care period
• The Date of Event cannot be before 01/07/09 as this is the legislative start date

See Temporary cessation of care (respite) and hospitalisation.

A carer who qualifies for CP (child) for episodic care will generally cease to be qualified for that payment when the care receiver turns 16 years of age.

• However, the payment of CP (child) and Carer Allowance (CA) (auto) will continue until the end of the episodic care period even if the episode continues past the care receiver's 16th birthday. If payment was granted the day before the child's 16th birthday and was for the maximum allowable period, the payment could continue until just before the 6 month anniversary of the child's 16th birthday
• Any extensions granted can apply to a period after the care receiver turns 16, but no extensions can be granted after the child turns 16
• Episodic care payments do not apply to CP (adult). The carer may test their eligibility for CP (adult) or another income support payment once the period of care has ended and the child has turned 16

Specific THP and carer care load cancellation, suspension and rejection reasons will apply. See Cancellation, suspension and rejection codes for Carer Payment (CP).

• See Claiming Carer Payment (CP) and/or Carer Allowance (CA) for forms that a carer can complete when claiming episodic care CP (child) for the first time. Episodic care and the period of care is determined by responses to specific questions on the CP medical report asking what the period of care will be and if the child is likely to have future episodes of the same or similar condition. The period of care must be for a minimum of 3 months and less than 6 months
• The Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16 years) (SA394 v1410/SA408) will include a specific question about the expected duration and nature of the care needed and confirmation that the condition is episodic. The form will be completed at the point of initial application for payment. There will be a question that will enable the Treating Health Professional (THP) to indicate that the care receiver requires constant daily care for a specific period which must be at least a minimum of 3 months and less than 6 months. This will be the period of the grant for the episodic care payment

• The carer will receive a letter with information about the new grant and the end date for payment of episodic care. If the episodic care is to be extended (but the care period does not exceed 6 months), a letter will be sent to the customer advising the new eligibility end date
• If the episodic care is to be extended for a period of 6 months or more, a reassessment letter advising continuation of CP is sent to the customer

• Episodic care receivers will receive a Health Care Card (HCC) with entitlement for the dates of the episodic care
• If there is an extension granted to the episodic care, the care receiver's HCC is to be reissued with an end date in line with the date the extension was granted
• If extensions occur for a total period of 6 months or more, then a reassessment to long term mainstream care Carer Payment (child) will occur and a Pensioner Concession Card (PCC) will be issued to the carer, and the care receiver will retain their HCC

Letters providing incorrect concession advice sent to carers granted Carer Payment under Episodic provisions - GRAPENPCC (grant, pension, pension concession card)

An issue has been identified where letters sent to carers who were granted CP under episodic provisions have been incorrectly advised that a PCC will be issued.

The letter issued to carers incorrectly includes the paragraph:

• 'You should receive your pension concession card within 14 days from when you receive your first payment. If you need to purchase prescription medicines prior to receiving your concession card, you should retain your receipt/s as you may be able to claim a refund from Medicare upon presentation of your new card.'

Details of a recipient's concession entitlement can be viewed on the Concession Entitlement Summary (MCCS) screen while the Card Issue Summary (CCIS) screen displays actual cards issued.

This is a known issue and no further reports to the ICT Service Desk are required.

Episodic care CP (child) carers will be eligible for all other standard pension entitlements including advance payment.

Episodic care information is displayed in Customer First on the Carers Summary page.

Carers will be offered voluntary referrals to provide support for carers who choose to increase their social and economic participation and support carers who are seeking assistance with their caring role.

The service offer to carers will ensure carers are aware of the referral options offered by Services Australia and assist in connecting carers to their chosen options in a seamless manner.

The 2 referral pathways are:

• Referral to employment service providers
• Referral to government and non-government organisations who can provide assistance to carers with various aspects of their caring role. Options may include referral to child care services, respite services and organisations that provide support to carers. See Support services for carers