Adult Disability Assessment Tool (ADAT) 009-05020000

The ADAT consists of 2 questionnaires. One is completed by the carer and the other by the Treating Health Professional (THP).

The carer provides information in their online claim, on the Claim for Carer Payment (SA410), the Claim for Carer Payment and Carer Allowance (SA411), or on the Review of care provided Carer Payment and/or Carer Allowance - Caring for a person - 16 years or over (SA010).

The THP completes the Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over (SA332a).

The questions on the medical report are not about specific disabilities. The purpose is to assess the level of disability and its impact on the care receiver to determine the level of care required. Although the form refers to an 'adult' (a person aged 16 years or over), the form may be completed once the care receiver is aged 15 years and nine months.

A functional assessment rating is calculated for each portion of the ADAT - the carer questionnaire and the THP questionnaire. A total ADAT rating is calculated by combining the carer and health professional scores together.

THP scores and total ADAT scores relate to the medical qualifications for CP and CA as follows.

If the THP score is:

• less than 8 or the total score is less than 20, the care receiver does not medically qualify their carer for either CP or CA
• at least 8 and the total score is at least 20, the care receiver will medically qualify their carer for CP if the care receiver has a dependent child who is either under 6 or over 6 and CA is payable for that child
• at least 10 and the total score is at least 25, the care receiver medically qualifies their carer for CP
• at least 12 and the total score is at least 30, the care receiver medically qualifies their carer for CP and CA
• 32 or more and the total score is 80 or more, the care receiver medically qualifies more than 1 carer for CP, but only qualifies one carer for CA

There are other qualifications besides medical qualifications (income and assets, residence), so the achievement of a particular ADAT score as above does not necessarily mean the carer is automatically entitled to CP. to qualify for CP, the carer must meet all other qualification requirements.

If a carer is already in receipt of CA (adult) for a care receiver and a second carer makes a claim under the shared care provision, the care receiver does not have to be tested a second time against the ADAT.

The second carer is not required to provide another medical report for the same care receiver.

However, the online claim and First Contact Service Offer (FCSO) cannot determine if the care receiver is in shared care and a second medical report may be incorrectly issued.

Re-claim provisions allow information previously gathered under the Adult Disability Assessment Determination (ADAD 2018) or terminal condition assessment for CP and/or CA (adult) to be used for a subsequent claim where the carer and care receiver are the same as for the previous assessment. Re-claim provisions are automatically assessed when a carer claims online or First Contact Service Offer (FCSO) is run.

Re-claim provisions may be applied if all of the following are met:

• A carer loses qualification for CP and /or CA
• The carer re-claim one or both of the original payments
• The carer and care receiver/s are those for whom the original CP and /or CA were payable (they are the same carer/care receiver/s)
• Each care receiver meets the age requirements of the original CP and /or CA
• a child care receiver is under 16 years of age
• an adult care receiver is 16 years of age or older

Before 1 July 2018

The re-claim (intention to claim date or claim lodged date) is within or on 26 weeks of the date qualification for CP and /or CA was lost (the date the THP signed the medical report is not an eligibility criteria for reclaim provisions).

From 1 July 2018

The date the re-claim was submitted is within or on 26 weeks of the date qualification for CP and /or CA was lost (the date the THP signed the medical report is not an eligibility criteria for reclaim provisions). Note: Intent to claim provisions were amended on 1 July 2018. See Calculating the start day general rule.

Only the most recent qualifying THP medical report and ADAT carer questionnaire may be used.

An adult care receiver previously assessed with a terminal illness, with a life expectancy of not substantially longer than 3 months, will not be required to provide a new THP medical report and ADAT carer questionnaire.

Where a CP (adult) and/or CA (adult) assessment has previously achieved a qualifying ADAT score of 40 or more and the condition is permanent and non-improving, a new THP report will not be required, irrespective of the THP sign date at the time of reclaim.

Note: re-claim provisions cannot be applied where a carer's benefit has been cancelled as a result of the carer failing to provide a medical report or ADAT carer questionnaire which was required for a medical review.

Carers not eligible for re-claim provisions may be eligible under re-use provisions (see below).

For CP and/or CA claims, information previously gathered under the Adult Disability assessment Determination (ADAD) 2018 or terminal condition assessment for CP and/or CA (adult) may be re-used. Re-use provisions are automatically assessed when a carer claims online or First Contact Service Offer (FCSO) is run.

Re-use may apply for new or previous carers.

Even if reuse provisions apply, Service Officers need to be satisfied that the previous ADAT reflects the current care needs and the carer meets the daily care and constant care requirements. If the Service Officer believes there is a reduction in the care receiver's care needs and is not satisfied that the care receiver would achieve a qualifying THP score and/or overall ADAT score for the respective payment, a new ADAT can be requested.

Clarification of the provision of care should only be sought if there are circumstances indicating the carer is not providing constant or daily care.

In these instances, Service Officers must determine whether a person is qualified for CP and/or CA based on all the relevant material before them, and that all of the qualification criteria has been satisfied. If the carer qualifies under re-use and Service Officers have concerns about the provision of constant or daily care, carers and THPs can be contacted to clarify the care that is required and is provided, however carers are not required to provide care schedules or care plans.

The following factors should be considered:

• When the previous ADAT was conducted
• The medical condition(s) of the care receiver
• The carer score - a low carer score raises concerns as to the level of care required
• Has there been a significant period when no one has received either CP or CA in respect of the care receiver
• Has the care receiver had overseas trips which appear inconsistent with their condition(s)
• Has the care receiver been employed since the last ADAT

Re-use provisions may be applied if the following criteria are met:

• The care receiver is aged 16 years or over at time of re-claim
• The most recent recorded medical report was assessed under ADAD 2018
• The most recent recorded medical report was completed no greater than 24 months THP sign date) before the date the carer contacts to claim payment
• The THP and ADAT scores must qualify the carer for the payment being claimed for under re-use provisions

An adult care receiver who was previously assessed with a terminal illness, with a life expectancy of not substantially longer than 3 months, will not be required to provide a new THP medical report and ADAT carer questionnaire. Eligible care receivers must have a current or non-current link with the prospective carer.

Where a CP and/or CA (adult) assessment has previously achieved a qualifying ADAT score of 40 or more and the condition is permanent and non-improving, a new THP report will not be required, irrespective of the THP sign date at the time of re-use.

A carer may choose to provide a new THP medical report and ADAT carer questionnaire with new information for an adult care receiver instead of re-using previous reports.

If the most recently provided THP medical report and ADAT carer questionnaire do not satisfy all the qualification requirements for re-use, the online claim and FCSO will issue a new THP Medical Report and an ADAT carer questionnaire.

If a medical report or carer questionnaire has been lodged where the re-use provisions apply, see Calculating the Adult Disability Assessment Tool score.

Note: re-use provisions cannot be applied where a carer's benefit has been cancelled as a result of the carer failing to provide a medical report or ADAT carer questionnaire which was required for a medical review.