Calculating the Treating Health Professional score for a child under 16 years on or after 1 July 2010 009-05010040

Calculate the THP score as part of the DCLAD (2020), which is part of the claim and review process for CP (child) and/or CA (child).

If there are multiple occurrences of THP reports for the same Initial Date of Receipt, select the report required using the THP ID as the Treating Health Professional Assessment (CDTT) screen is able to validate the correct THP responses.

The Receptive language skills to the Gross Mobility questions on the medical report must all be answered, as it is possible to receive a negative score from these questions.

Examine the Medical Report form (SA422*, SA431, SA397*, SA427, SA333TDR*, SA426).

This procedure assumes that the child does not have a recognised disability and that this is the appropriate procedure to follow.

Has the THP given more than one response to questions on functional ability, excluding behaviour and special care needs?

• Yes, go to Step 2
• No, see Step 1 in Table 2

Note: * denotes system generated version of that form

Where the THP selects more than one response in the developmentally linked functional assessment (questions 1 to 8 inclusive) of the medical report, the following applies where:

• the 'age appropriate' response and another response are selected, the specific response (not the age appropriate response) is taken to be the child's best ability, or
• two responses (not including the 'age appropriate' response) are selected the response indicating the best ability is to be taken as the child's best ability Note: this is different to coding the Care Needs Assessment (CNA).

Use system type of ISS, CDA or PEN:

• in the carer's record, 'S'elect the care receiver from the Care Receiver Summary (CRS) screen. Press [Enter] to view the Care Receiver Task Selector (CETS) screen
• 'S'elect the Disability Assessment Tool. Press [Enter] to view the Child Disability Assessment Tool Summary (CDAS) screen
• a previous eligible THP is within limits to be re-used for CAR, X CDA, X displays. If there is data that can re-used for a new claim, ‘Y' will show in either or both fields

If eligible THP cannot be used:

• key 'Y' in the Add a new THP assessment? field to create a new assessment. For a:
• CA claim, the system will select either the CDAT (2001) or the THP (DCLAD 2020) screens
• CP claim only, use the THP (DCLAD 2020) screens. The Ver field on the CDAS screen will display either CDAT 2001 or DCLAD 2020 accordingly
• CP or CA review, the system will determine the correct version to use
• complete Source and DOR fields
• press [Enter] to view the Child Medical Details (CDMD) screen

The CDMD screen in the carer's record is the Medical Details screen where information from the medical report is keyed. The fields on this screen are:

• Care Rcvr, CRN, Birth Date. If the care receiver is:
• not a customer in their own right, these fields will display
• is a customer in their own right (child is under 16 and independent), these details will display in the screen header only
• Effect date is a mandatory field to record the date from which the medical information will take effect for the assessment. For a:
• new claim, the date of effect will be the date on which the medical condition commenced, but not before the introduction of the qualification.
  Note: if the child becomes qualified due to a change in qualification criteria, the payment cannot be backdated beyond the date of the new qualification criteria, unless the child qualifies with another recognised disability and/or has been assessed under the THP assessment with a qualifying score
• review, the effect date for a payment that is continuing is the date of receipt of the review forms. If payment is not continuing due to an insufficient THP or carer score, the effect date is the date of the determination
• Initial DOR is a display only field showing the date of receipt of the first activity used to key details of the THP assessment. If the carer assessment details have:
• been keyed, this field defaults from the initial date of receipt keyed on the Carer Assessment (CDTC) screen
• not been keyed, this field will be empty until the CDMD screen is redisplayed after updating
• THP ID is a number allocated to the THP assessment once the CDMD screen is updated. It is display only
• Name of THP is the name of the THP who completed the assessment
• Provider number is optional to record the Medicare Provider Number. If the number is unknown, key 'U' which will be expanded to 'Unknown' when the updated CDMD screen is redisplayed
• Qualifications requires a three character code for the qualifications of the THP who completed the assessment. When the updated CDMD screen is redisplayed, the code will be expanded. Use field help (?) for valid values
• Period of Cond field. Processing staff are expected to manually assess this as part of the claim process. See Coding a paper claim for Carer Allowance (CA) where the care receiver is under 16. Use field help (?) for valid codes.
  The SA427 - Carer Payment Medical Report including functional assessment (for a child under 16 years) does not ask if the condition is permanent or temporary for at least 12 months. If this form has been lodged, processing staff must consider the condition and previous medical reports (if any). If unsure, refer to the Level 2 Policy Help Desk
• Contact Number is mandatory for recording the phone number of the THP who completed the assessment. The first part is for the 2-digit area code. For mobile phone numbers, leave the area code blank. THP contact numbers starting with 1300 or 1800 cannot be recorded in Process Direct and must be recorded as follows:
• in Process Direct, record a temporary phone number (such as a fax number) for the THP
• after finalising the claim, go to the CDMD screen in Customer First and update the correct phone number
• Date signed. Key the date the THP signed the medical assessment. If not dated, use the date it was received or the date of effect. If signed more than 3 months before the claim was lodged and the Service Officer:
• determines it is an accurate reflection of the child's condition, record the date signed by the THP as the date the form was received or the date of effect. Clearly document this on the customer's record
• determines it is not an accurate reflection of the child's condition, do not record the medical report and request a new medical report. Clearly document this on the customer's record
• is unsure if it is an accurate reflection of the child's condition, refer the case to the Level 2 Policy Help Desk

THP signature

An electronic signature can be accepted, however if there are any concerns about the validity of the signature the THP should be contacted to verify they completed the medical report.

The THP score will not calculate correctly if the amended THP signed date falls within any of the following age milestone brackets. Refer these cases to the Level 2 Policy Help Desk to determine appropriate action:

• 5 years and 9 months and 6 years
• 8 years and 9 months and 9 years
• 11 years and 9 months and 12 years
• 14 years and 9 months and 15 years

Continue coding CDMD screen:

• Medical condition requires a 3-digit code for the medical condition of the care receiver. Up to 4 conditions may be recorded. Use field help ('?') for valid values. When the updated CDMD screen is redisplayed, the code expands:
• A message will display if a recognised disability is keyed into this field. If this is the case, this procedure is not appropriate. Go to Assessing a recognised disability for Carer Allowance (CA) (child)
• Class is display only and shows the international classification code for the medical condition. The field is blank until a medical condition is keyed. When the screen is redisplayed, the class code is displayed:
• Recognised Disability is only used in the assessment of child care receivers. Use field help ('?') for a list. Y in this field indicates the care receiver has a recognised disability, in which case the child automatically meets the definition of a disabled child, however care details must still be investigated. Leaving this field blank indicates that the child does not have a recognised disability.
  Note:
  Y or N may be manually keyed by the Service Officer
  Y will automatically default if the condition keyed in the Medical Condition field is identified by the system as a recognised disability and a warning will be presented which states 'The Recognised Disability field for Med Cond ### has been changed' (where ### is the medical condition coded).
  The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides criteria for the classification of mental disorders. The latest version is the DSM-5 (published 18 May 2013) and autism spectrum disorder (ASD) now encompasses the previous DSM-IV autistic disorder (autism), Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified.
  
  Autistic disorder and Asperger's disorder currently appear in the LoRD and medical conditions on Carer Allowance (CA) medical reports and are still to be processed as Recognised Disabilities. See Assessing a recognised disability for Carer Allowance (CA) (child).
  If the field is left blank and the condition is identified by the system as one which may be a recognised disability, a warning will be presented which states '### may be a recognised disability' (where ### is the medical condition coded). This warning must be investigated. If the Service Officer ignores the warning, the system will default N and the full THP process must be performed
• Terminal illness Ind, Number of carers req, Short Term/Episodic, End Date and Extension relate to CP (child) eligibility and must be recorded if provided
• 14 or More Hrs Extra Care Weekly? must be keyed with Y or N. Keying 'Y' indicates the carer provides 14 hours or more per week of extra care to the care receiver. If the carer does not qualify for Carer Allowance, this field must be keyed Y for them to qualify for Health Care Card only.
  The SA427 - Carer Payment Medical Report including functional assessment (for a child under 16 years) does not ask if 14 hours of care or more is required. If this form has been lodged, processing staff must consider the response to significant care and previous medical reports (if any). If unsure, refer to the Level 2 Policy Help Desk
• Source, DOR and Action in the footer. The Action field is optional and will accept 'I' for Insert or 'C' for Correct on this screen
• press [Enter] to view the CDMD screen
• press [Enter] to view the Treating Health Professional Assessment (CDTT) screen

Key the relevant information from the medical report into the CDTT screen fields:

• Care Rcvr, CRN, Birth Date. If the care receiver is:
• not a customer in their own right, this fields will display
• is a customer in their own right, these details show in the screen header only
• Age Milestone is protected. The child's age milestones are calculated by comparing the child's date of birth with the date signed
• Adjusted. In some circumstances the THP score is adjusted to the next milestone age and shows where a 'cusp adjustment' occurs
• Score is protected and represents the system calculated THP score associated with the assessment provided by the THP
• Initial DOR is protected and displays the Date of Receipt of the first activity used to key details of the THP assessment and is defaulted from the Initial DOR field on the CDMD screen
• Effect Date is protected and shows the date from which the medical information takes effect. It is defaulted from the CDMD screen
• THP ID is protected and shows the system generated number allocated to the THP assessment. It defaults from the CDMD screen
• Name of THP shows the name of the THP defaulted from the CDMD screen
• Date Signed is protected and is the date the THP assessment was signed and is defaulted from the CDMD screen.
• THP Version is protected and shows the version date of the THP
• Information Source is determined by the system and defaults to CUS'. If the THP and CNA are validated on the Care Load Validation (CLVL) screen, the field will show VLD
• Functional Assessment items 1 - 10 are used to input the responses received from the THP. Questions 1-8 are mandatory. For Questions 9 and 10, the THP can mark as many statements as required to describe the child's behaviour. If none of the statements are relevant to this child, Questions 9 and 10 do not need to be answered. Blank fields default to N. Use field help ('?') for valid values for these responses (these items commence from Question 11 on the SA426 (SA333TDR*) & SA431 (SA422*) and Question 3 of the SA427 (SA397*)
• Question 27 (SA431) or Question 19 (SA427) if the THP has not provided a response or has ticked no or unsure, contact the THP to discuss. If the THP cannot be contacted or does not want to comment, the Service Officer, as the decision maker, can determine significant daily care based on discussion with carer and/or scores. See Carer Payment (CP) claims for care receivers aged under 16

Note: * denotes system generated version of that form

Continue coding CDTT screen:

• Issue Care Needs/Carer Assessment? allows the user to control the automatic issue of the pre-populated form Carer Payment and Care Allowance - Care Needs Assessment for a child under 16 years (SA408*/SA394). Key 'Y' to issue a CNA form, or leave as N to stop the issue. The field appears on CDTT if the THP assessment score is greater than zero.
  Note: if this field is not displayed, issue an SA408*/SA394 manually, see Step 10
• Care Needs/Carer Assessment Issued is protected to display the date of issue of the carer assessment form It will not display if the Issue Care Needs/Carer Assessment? field does not appear. In an activity that is:
• provisional, this field initially sets to 'blank' but if the Issue Care Needs/Carer Assessment? field is changed to Y, the field will display the current system date
• completed or a redisplay of an incomplete activity, this field displays the previous date keyed
• Source and Date of Receipt (DOR) in the footer will default information from the previous screen
• press [Enter] to view the CDTT screen with the calculated total THP score
• press [Enter]. If validation is required, the CLVL screen will display if the CNA has been coded for either CP or CA and validation of the answers is required for a new claim activity

If the CLVL error SR004 displays on SWE, a process called validation will be required.

Is validation required?

• Yes,
• See Care Load Validation (CLVL) screen
• Go to Step 7
• No, go to Step 7

Issue the Carer Payment and Care Allowance - Care Needs Assessment for a child under 16 years (SA408*/SA394).

The  Issue Care Needs/Carer Assessment?  field (defaults to  N  when the score is '0 or less' in the Carer Allowance New Claim process) and the  Date Issued  field will display.

To issue an SA408*/SA394, change the  N  to 'Y' and the date issued will display. If the carer requires a duplicate of the system issued form, print from the History Summary (HS) screen.

When reassessing a CA HCC-only customer, issue the SA408*/SA394  manually as the  Issue Care Needs/Carer Assessment?  field is  not  displayed.

If processing the score is not complete, return to Calculating the total DCLAD (2020) score.