Skip to navigation Skip to content

Coding the Adult Disability Assessment Tool (ADAT) 009-05020010

Expand/Collapse all sectionsExpand all



This document explains information on re-use provisions, questionnaires to assess, and coding of the Adult Disability Assessment Tool (ADAT) for Carer Payment (CP) and/or Carer Allowance (CA) claim or review.

On this page:

Re-use provisions

Calculating the ADAT score

Coding the ADAT score

Discretion to approve a person not on the approved THP list

Re-use provisions

Table 1

Carer Payment/Carer Allowance Smart Centre Processing staff.

Expand table

Step

Action

1

Consider if re-use provisions apply

Processing Team: Typically done by specialised processing teams in a service centre or Smart Centre. Unless otherwise stated, staff may complete this step if they are trained.

If customer has lodged a:

  • response to a Medical Review, re-use does not apply. See Table 2
  • claim for CP and/or CA and provided a completed medical report Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over (SA332A) form indicating the care receiver is not expected to live more than 3 months and only one carer is claiming CP, re-use does not apply. See Table 2
  • claim and both a medical report SA332A and carer questionnaire (either within the online claim, or a Carer Payment and/or Carer Allowance Caring for a person 16 years or over (SA406) form, re-use does not apply. See Table 2
  • claim and either a medical report SA332A or a carer questionnaire (either within the online claim, or a SA406), go to Step 2
  • claim for CP and/or CA and has not provided a medical report SA332A or carer questionnaire (either within the online claim, or a SA406), go to Step 2

2

Access the care receiver's record

Processing Team: Typically done by specialised processing teams in a service centre or Smart Centre. Unless otherwise stated, staff may complete this step if they are trained.'S'elect 'Self' from the Care Receiver Summary (CRS) screen and go to the Adult Disability Assessment Tool Summary (ADAS) screen.

The (ADAS) screen lists a summary of existing or previous ADAT assessments.

Re-use provisions may be applied if one of the following is met:

  • the care receiver is aged 16 years or older at time of claim and the carer re-claims for the same care receiver within 26 weeks of CP and/or CA cancellation
  • the care receiver was previously assessed with a terminal illness, with a life expectancy of not substantially longer than 3 months
  • the 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, or
  • the Treating Health Professional (THP) medical report and ADAT assessment scores qualify the carer for the payment being claimed for and the most recently recorded medical report was completed no greater than 24 months (THP sign date) before the date the carer contacts to claim payment

Can an existing ADAT assessment be re-used?

3

Considerations for re-use provisions

Although the re-use provisions may apply, Service Officers must be satisfied that the previous ADAT reflects the care receiver’s current care needs.

If the carer has lodged:

4

Considerations for re-use when care receiver previously qualified for 2 carers

Although the re-use provisions may apply, Service Officers must be satisfied that the previous ADAT:

  • reflects the care receiver’s current care needs, and
  • the THP score will be at least 32.0, and
  • the ADAT score at least 80.0

Consider the following factors:

  • 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 needed
  • if there has been a significant period when no one has received either CP or CA in respect of the care receiver
  • if the care receiver:
    • had overseas trips that appear inconsistent with their condition
    • has been employed since the last ADAT

Does the previous ADAT reflect the care receiver’s current care needs and the THP score will be at least 32.0 and the ADAT score at least 80.0?

5

Carer lodged new medical report without carer questionnaire

Consider the following factors:

  • 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
  • if there has been a significant period when no one has received either CP or CA in respect of the care receiver
  • if the care receiver:
    • had overseas trips which appear inconsistent with their condition
    • has been employed since the last ADAT

Based on these factors, does the previous ADAT reflect the care receiver's current care needs?

  • Yes, If the previous ADAT could:
    • qualify 2 carers for CP (THP score of at least 32 and an ADAT score of at least 80), go to Step 6
    • not qualify 2 carers for CP (THP score of at least 32 and an ADAT score of at least 80), go to Step 7
  • No, a carer questionnaire is required:
    • code the latest medical report SA332A
    • send a Request for Information (RFI) requesting the carer provide a completed SA010
    • update the Progress of Claim DOC to outline why the RFI was sent requesting the SA010
    • place the claim on hold
    • when the carer questionnaire is returned, go to Table 2

6

Re-using a valid ADAT score (previous ADAT could qualify 2 carers for CP - THP score of at least 32 and an ADAT score of at least 80)

Provisionally record the medical report.

If the THP score has reduced, re-use provisions can apply if all of the following are met:

  • the latest THP score is 32 or more
  • the THP stated condition is PNI
  • the total ADAT score is likely to be 80 or higher

If all the above are met, re-use can apply. Otherwise:

  • submit an enquiry to the Carer Helpdesk to check if a new carer questionnaire is required. Make sure to include the provisionally coded ADAT score and the previous ADAT score in the request
  • update the Progress of Claim DOC to advise the case is referred the Carer Helpdesk. Include the provisionally coded ADAT score and previous ADAT score
  • delete the provisional information
  • wait for advice from the Carer Helpdesk if a new carer questionnaire is required

If Carer helpdesk advises a new carer questionnaire is not required, re-use applies:

  • update the Progress of Claim DOC to advise the Carer Helpdesk response; a new carer questionnaire is not required, and re-use applies
  • as the latest medical report SA332A is not being used it should not be coded. Coding ADAT procedure ends here

See:

A new carer questionnaire is required, re-use does not apply:

  • send a Request for Information (RFI) requesting the carer provide a completed SA010
  • annotate the Progress of Claim DOC to outline the Carer Helpdesk response and why the RFI was sent requesting the SA010
  • place the claim on hold
  • when the forms are returned go to Table 2

If the THP score has not reduced, reuse can apply:

  • cancel the activity that contains the provisional THP information. As the latest medical report is not being used, it must not be coded
  • update the Progress of Claim DOC to advise that re-use applies and the new SA332A was not used/coded. Coding ADAT procedure ends here

See:

7

Reusing a valid ADAT score

Re-use provisions can apply if all of the following are met:

  • the latest THP score is 12 or more
  • the THP stated condition is PNI
  • a second carer is unlikely to claim
  • the total ADAT score is likely to be over 40

If all the above are met, reuse can apply.

Cancel the activity that contains the provisional THP information. As the latest medical report is not being used, it must not be coded.

Update the Progress of Claim DOC to advise that re-use applies and the new SA332A form was not used/coded. Procedure ends here.

See:

If reuse provisions are not met:

  • submit an enquiry to the Carer Helpdesk to see if a new carer questionnaire is required. Include the provisionally coded ADAT score and the previous ADAT score in the request
  • update the Progress of Claim DOC stating the case has been referred to the Carer Helpdesk. Include the provisionally coded ADAT score and previous ADAT score
  • delete the provisional THP information
  • wait for advice from the Carer Helpdesk if a new carer questionnaire is required

If the Carer Helpdesk advises a new carer questionnaire is not required, re-use applies:

  • update the Progress of Claim DOC to advise the Carer Helpdesk response (that a new carer questionnaire is not required, and re-use applies)
  • as the latest medical report SA332A is not being used it should not be coded. Coding ADAT procedure ends here

See:

If a new carer questionnaire is required:

  • send a Request for Information (RFI) to the carer to provide a completed Review of care provided - Carer Payment and/or Carer Allowance - Caring for a person 16 years or over SA010
  • annotate the Progress of Claim DOC to outline the Carer Helpdesk response and why the RFI was sent requesting the SA010
  • place the claim on hold
  • when the forms are returned, go to Table 2

8

Carer provided completed questionnaire without medical report (SA332A)

Provisionally record the carer questionnaire.

If the carer score has not reduced:

  • cancel the activity that contains the provisional carer questionnaire. As the latest carer questionnaire is not being used, it must not be coded
  • update the Progress of Claim DOC to advise that re-use applies, and the new Carer Questionnaire was not used/coded. Coding ADAT procedure ends here

See:

If the carer score has reduced:

  • and the previous THP combined with the new Care score result in an ADAT of 40 or higher, and there are no concerns with the level of care provided by the carer, Re-use can apply:
    • update the Progress of Claim DOC to advise that a new carer questionnaire is not required, and re-use applies
    • as the carer questionnaire is not being used it should not be coded. Coding ADAT procedure ends here
  • and the total ADAT would be less than 40, staff should check when the previous ADAT was coded:
    • If the previous ADAT is within the last 12 months of the new claim being lodged, even if the new combined score is below 40, the ADAT is deemed to be still current. Re-use can apply. Procedure ends here
    • If the previous ADAT was more than 12 month prior the new claim being lodged, submit an enquiry to the Level 2 Policy Helpdesk, with the Carer’s CRN or claim ID, to check if a new medical report SA332A form is needed. Include the provisionally coded ADAT score and the previous ADAT score in the request
  • update the Progress of Claim DOC to advise the case has been referred to the Carer Helpdesk. Include the provisionally coded ADAT score and previous ADAT score
  • delete the provisional ADAT information
  • wait for advice from the Carer Helpdesk as to whether a new medical report is required

If the Carer Helpdesk advises a new medical report is not required, re-use applies.

  • update the Progress of Claim DOC to advise the Carer Helpdesk response (that a new carer questionnaire is not required, and re-use applies)
  • as the latest medical report SA332A is not being used it should not be coded. Coding ADAT procedure ends here

See:

If the Carer helpdesk advises a new medical report is required:

  • send a Request for Information (RFI) requesting the carer provide a completed SA332A form
  • annotate the Progress of Claim DOC to outline the Carer Helpdesk response and why the RFI was sent requesting the SA332A
  • place the claim on hold
  • when the forms are returned, go to Table 2

Calculating the ADAT score

Table 2

Carer Payment/Carer Allowance Smart Centre Processing staff.

Expand table

Step

Action

1

Approved Treating Health Professional

Has the Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over (SA332A) form been completed by an Approved Treating Health Professional?

  • Yes, go to Step 2
  • No, a replacement medical report will need to be requested:
    • make genuine attempts to contact the carer by phone to advise that a new report is required and the reasons. Record the verbal request in the Progress of Claim Note and/or DOC
    • if a verbal request for the medical report is not possible or practical to get, send a Q888 letter to the customer requesting the new medical report. See Resources for approved text for a Q888 letter to be issued to the customer. Procedure ends here

2

Does the care receiver have a terminal illness?

On the SA322A form at Question 7, has the THP indicated the care receiver has a terminal illness and is not expected to live more than 3 months?

3

Check day to day care need questions on form provided by carer

The location of the 'Day to day care needs' questions will vary depending on the form (for example, on the SA010, see Questions 5-7).

Examine the 'Day to day care need' questions. Has the carer given more than one response to any question?

4

Accept answer resulting in highest ADAT score

Accept the most beneficial answer to the carer and disregard the other responses.

Note: where no answer has been provided, contact the carer to find out why. Give the carer the opportunity to respond to unanswered questions in their questionnaire.

5

Adult Disability Management (ADMG) screen

This is the first screen in the ADAT screen flow where information provided by the carer is recorded.

The Adult Disability Behaviour (ADBH) screen is the second screen, also for information provided by the carer.

The next 3 screens are for entry of information provided by the THP:

  • Adult Medical Details (ADMD)
  • Adult Disability Personal Activities (ADPA), and
  • Adult Disability Cognitive Functions (ADCF) screens

When correcting a THP score, there should be 2 separate ADAT lines for the same date of effect. The system will then read the line coded later.

6

Entering information on ADMG screen

Information provided by the carer on their claim or review form (SA010) must be keyed on the ADMG screen before completion of the Adult Disability Behaviour (ADBH) screens.

The ADMG screen contains the following:

  • Initial DOR is protected and displays the date of receipt of the first activity used to enter details of this ADAT assessment, defaulted from ADMD screen
  • Effect Date is protected and is the date from which the medical information takes effect for the assessment, defaults from ADMD screen
  • Date signed is used to record the date the carer signed the assessment, or if it was not dated, the date of receipt, or the date of effect
  • questions are mandatory fields to input the responses received from the carer on their claim or review form (SA010). Use field help ('?') for valid values
  • Source, DOR and Action in the footer. The Action field is optional and will accept 'I'nsert or 'C'orrect on this screen
  • press [Enter] to view the DMG screen with the recorded information
  • press [Enter] to view the ADBH screen

7

ADBH screen

This is the second screen for recording information provided by the carer.

When accessed after updating the ADMG screen, the Initial DOR, Effect Date and Date Signed fields will be protected and updated. Otherwise, the ADBH screen will display the most recent occurrence, or blank if there are no existing occurrences.

Complete the following fields:

Cognitive Function Questions

Question fields are used to input the responses received on the carer claim or SA010 review form. Code one of the following in the Response field:

  • 'A' - Always
  • 'B' - Usually
  • 'C' - Sometimes
  • 'D' - Never

Behaviour Questions

Question fields are used to input the responses received on the carer claim or SA010 review form. Code one of the following in the Response field:

  • 'A' - Never
  • 'B' - Sometimes
  • 'C' - Often
  • Source and DOR fields in the footer will default from the previous screen
  • press [Enter] to view the screen with the recorded information

Press [Enter] to view the Adult Medical Details (ADMD) screen.

 


Coding the ADAT score

Table 3

Carer Payment/Carer Allowance Smart Centre Processing staff.

Expand table

Step

Action

1

Check THP questionnaire reflects the person's medical condition/disability

Note: if the THP is a close relative (parent, child, sibling or grandparent) of the carer or care receiver, consideration if the medical report will be accepted as an accurate reflection of the care receiver’s care needs.

Is the Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over (SA332A) THP questionnaire an accurate reflection of the person's medical condition/disability?

  • Yes, go to Step 2
  • No, and it has been established there are inconsistencies with the completed questionnaire, and it is not an accurate reflection of the person to whom it relates. The Service Officer must contact the THP to discuss the information provided and seek clarification about the care needs of the person. If there are concerns about the information being provided by the THP, the Service Officer must consider the following factors before contacting the THP:
    • Is there sufficient information to determine whether the person is eligible for payment?
    • Does the THP assessment appear to accurately reflect the care receiver's medical condition/disability? For example, THP indicates care required more than 12 months and also certifies in the tick a box section that the condition is less than 6 months?
    • Are there are inconsistencies between the information given by the THP and the carer? For example, the doctor states high care needs for one area when the carer says low care required or vice versa, not forgetting there is no validation for adult care receivers
      When contacting the THP, they may provide information either verbally or in writing
      Clearly document any conversations and interactions with the THP within the Progress of Claim DOC
  • If the clarified responses cannot be updated, an additional request must be made of the customer to provide another Medical Report. The replacement medical report must be completed by another THP
  • If still not satisfied the report is accurate, an additional request must be made to customer requested the return of replacement medical report. See Resources for approved text
  • Arrange for Team Leader, Local Peer Support (LPS) or SSO to issue a Q888 letter requesting return of replacement medical report. See Resources for approved text

Note: if it is suspected the information contained within the SA332A form may be fraudulent, report via Report suspected fraud and corruption.

2

Before coding ADMD screen, examine the SA332A form

Note: due to a system fault, if 2 medical reports are coded and only one carer questionnaire coded, the system reads the first rather than the most recent medical report. As this may lead to an incorrect assessment, remove the first medical report. Include this action in a DOC.

If no answer has been provided, contact the THP to find out why. Give the THP the opportunity to respond to unanswered questions in the questionnaire. If any questions for questions 10, 11 or 12 have not been completed, before contacting the THP check if the ADAT produces a qualifying score. If so, do not contact the THP and document this on the carer's record. This qualifying score can be used for the claim.

Has the health professional marked more than one answer to any part of Questions 10, 11 or 12?

  • Yes, accept only the answer which results in the highest ADAT score (for example, the most beneficial) and disregard the other responses. Go to Step 3
  • No, go to Step 3

3

Coding ADMD screen

The Adult Medical Details (ADMD) screen is the first screen where information from the SA332(a) is keyed.

Fields on the ADMD screen:

  • Initial DOR is a display only field showing the date of receipt of the first activity used to enter details of the (ADAT) assessment. The date is defaulted from the Initial DOR field on the ADMG screen if the carer assessment details have been keyed. If assessment details have not been entered, this field will be empty until the ADMD is redisplayed after updating
  • THP ID displays a single number allocated to the THP assessment once the ADMD is updated. It is display only
  • Health Professional Name is mandatory, used to record the name of the THP who completed the assessment. See Question 16 on the SA332A form
  • Qualifications is mandatory, used to enter a 3-digit code for the qualifications of the THP who completed the assessment. See Question 16 on the SA332A form. When the updated ADMD screen is redisplayed, the code will be expanded. Use field help ('?') for valid values:
    • ACA Aged Care Assessor
    • AHW Aboriginal Health Worker
    • GEN Medical Practitioner
    • OCT Occupational Therapist
    • PHY Physiotherapist
    • RGN Registered Nurse
    • SPL Specialist
  • Contact Phone is mandatory for recording the phone number of the THP who completed the assessment. See Question 16 on the SA332A form. The first part of the field is for the 2-digit area code. For mobile phone numbers, leave the area code blank
  • 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. See Question 16 on the SA332A form. If the THP assessment was signed more than 3 months before the claim was lodged and the Service Officer:
    • determines it is an accurate reflection of the adult care receiver'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 adult care receiver'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 adult care receiver'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
    • if the THP did not sign the medical report but it has an office stamp for the THP, the report can be accepted unless there are any concerns about the validity of the report. If there are concerns, checking the Australian Health Practitioner Regulation Agency (AHPRA) home page might address these concerns
    • if the THP did not sign the medical report and there is no office stamp for the THP, the report cannot be accepted
    • Period of Condition will record the expected length of care from the THP. Use field help ('?') for valid values:
    • TMI - Terminal Illness not expected to live longer than 3 months' TM3 ' - Terminal Illness expected to live longer than 3 months
    • PIM - Permanent Condition that is improving
    • PNI - Permanent Condition that is not improving
    • TL6 - Temporary condition that will last less than 6 months
    • TG6 - Temporary condition that will last more than 6 months but less than 12 months
    • T12 - Temporary condition that will last 12 months or longer
    • RL6 - Review value, temporary less than 6 months
    • RG6 - Review value, greater than 6 months and less than 12 months

4

ADMD screen coding continued

Effect date is mandatory to record the date from which the medical information will take effect for the assessment. See Question 3 on the SA332A form. For a:

  • new claim, the date will be the claim was submitted. Note: intent to claim provisions were amended on 1 July 2018 and apply only to carers in vulnerable circumstances. See Intent to claim for vulnerable customers
  • review, the effect date will be the date of determination. Where a SA332A is obtained to reconsider or review a decision, a second entry must be coded with the same effect date as the original decision. Two lines with the same date of effect will be displayed, and the system will read the later entry

Medical Condition is mandatory.

  • See Question 1 on the SA332A form. Key the 3-digit code for the medical condition of the care receiver. Staff should attempt to record all listed conditions onto the system. Note: a maximum of 4 conditions can be recorded on this screen. When the updated ADMD screen is redisplayed, the code will be expanded. Use field help ('?') for valid values

Class is display only, shows the international classification code for the medical condition.

  • The field is blank until a medical condition is entered. When the screen is redisplayed, the class code is displayed

Source and DOR fields in the footer will default from previous screen:

  • press [Enter]. The ADMD screen will redisplay. If the recorded condition could be a recognised disability, a warning will be presented. It is safe to ignore this warning as recognised disabilities are not relevant in the assessment of adult care receivers
  • Add Another THP response? is shown on the redisplayed ADMD screen. It is used to add further THP assessments to the same adult disability assessment if required:
    • if further assessments are coded, the latest assessment will always be used in determining the health professional score. If 'Y' is keyed in this field, a new ADMD screen will be presented with the same date in the Initial DOR field as the ADMD screen being updated. The number in the THP ID field will be incremented if a new ADMD screen is updated
    • if there are no further THP assessments, leave blank
    • if the information is recorded as a 'correction', the system will continue to read the original information, and the historical information will be lost
  • press [Enter] to view the Adult Disability Personal Activities (ADPA) screen

5

The ADPA screen

This is the second screen for recording the THP's assessment in the ADAT screen flow.

For new THP assessments, first update the medical details on the ADMD screen. To add a new THP assessment to an existing ADAT assessment, first complete the Add Another THP Response? field.

Fields on this screen:

  • Initial DOR is protected, shows the date of receipt of the first activity used to enter details of this ADAT assessment, defaulted from ADMD screen
  • Effect Date is protected, shows the date from which the medical information takes effect for the assessment, defaults from ADMD screen
  • Date Signed is protected, shows the date on which the SA332A form was signed, defaults from ADMD screen
  • Health Professional Name displays the name of the THP who completed the assessment, defaults from ADMD screen
  • THP ID is protected, shows the system generated number allocated to the THP's assessment, defaults from ADMD screen
  • Questions are used to input the responses received from the THP on the SA332A form. All questions are mandatory
  • Source and DOR in the footer will default from previous screen
  • press [Enter] to view the ADPA screen
  • press [Enter] to view the Adult Disability Cognitive Functions (ADCF) screen

6

Adult Disability Cognitive Functions (ADCF) screen

This is the third screen for recording THP responses.

It shows a series of 13 questions relating to Questions 11 and 12 of the SA332A form. On completion, press [Enter] to redisplay the screen with the calculated score and expanded text for each response.

Fields on this screen:

  • Initial DOR is protected, shows the date of receipt of the first activity used to key details of this ADAT assessment, defaults from ADMD screen
  • Effect Date is protected, shows the date from which the medical information takes effect for the assessment, defaults from ADMD screen
  • Date Signed is protected, shows the date on which the SA332A was signed, defaults from ADMD screen
  • Health Professional Name field displays the name of the THP who completed the assessment, defaults from ADMD screen
  • THP ID is protected, shows the system generated number allocated to the THP assessment, defaults from ADMD screen
  • Questions are used to input the responses received from the health professional on the SA332A at Questions 11 and 12. Use field help ('?') for valid values
  • Source and DOR in the footer will default from the previous screen
  • press [Enter] to view the ADCF screen
  • press [Enter] to view the Adult Disability Assessment Tool Summary (ADAS) screen

Note: Question 11 on the SA332A consists of 3 sub-questions 11.1, 11.2 and 11.3.

If the THP has indicated:

  • Y at question 11.1, all correct answers at 11.2, and N at question 11.3, this cannot be recorded on the ADCF screen. An error message will appear: E23DL - at least 1 B2 response must be N if cognitively impaired. In this scenario the response to question 11.1 must be changed to a 'N', this has no implications on the overall scoring regime for the ADAT
  • N at question 11.1 and selected Y to one or more incorrect answers at 11.2, the THP must be contacted by phone to clarify the inconsistent responses
  • Y at question 11.1, provided answers at 11.2 and also indicated they were not able to administer the Abbreviated Mental Test at 11.3, this cannot be recorded on the ADCF screen. An error message will appear 'E233DL - cannot enter responses to B2 if unable to administer test'. In this scenario the responses to question 11.2 must be disregarded and the response to 11.3 must be used
  • no answers at 11.1, but answered questions at 11.2 or they were unable to administer the Abbreviated Mental Test at 11.3, accept that the response at 11.1 would be Y

If the ADAT produces a qualifying score and there are unanswered questions that have no bearing on the carer's qualification for CP or CA, do not contact the carer or THP, and document this on the carer's record.

7

ADAS screen

This screen displays totals relating to the new ADAT assessment (and any previous ones). Note the relevant components, which are the:

  • health professional score, and
  • total score

As the ADAT is used in the assessment of both CP and CA, and because for CP there is the concept of a 'lower ADAT score adult' and a 'higher ADAT score adult', the significance of the actual scores will be explained in the new claim procedure for the particular claim.

However, if the:

  • THP score is less than 8, the care receiver will not qualify the carer for either CP or CA
  • total score is less than 20, the care receiver will not qualify the carer for either CP or CA
  • THP score is 12 or greater, and the total score is 30 or greater, the care may qualify the carer for both CP and CA

8

Final steps

Press [Enter]:

  • swap to the carer's record by keying:
    • the Customer Reference Number (CRN) into the CRN field, or
    • 'FL' in the Nxt field
  • continue with the new claim or review procedure

If the ADAT score is not qualifying, reject the claim. Contact the Level 2 Policy Help Desk if the carer:

  • has already provided an SA332A from a person not on the approved THP list, or
  • indicates that someone not on the list would be more familiar with the care receiver’s medical condition or care needs. See Table 4

For more information, if this is a:


Discretion to approve a person not on the approved THP list

Table 4

Carer Payment/Carer Allowance Smart Centre Processing staff.

Expand table

Step

Action

1

When discretion may be used

In every case, the initial ADAT decision must first be finalised based on a Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over (SA332A) form from a THP from the approved THP list.

Has the carer lodged a recognised THP medical report from a THP on the approved THP list?

  • Yes, use the approved THP’s report for the ADAT assessment. Go to Step 3
  • No, if the lodged medical report is from a non-approved person:
    • tell the carer to lodge an SA332A that is completed by an approved THP
    • use the approved THP report for the ADAT assessment
    • once the approved THP report for the ADAT assessment is received, go to Step 2

2

ADAT assessment outcome using approved THP’s report

Does the report from the approved THP result in a qualifying score?

3

Non-qualifying score using approved THP’s report

Contact the carer as part of the normal unfavourable decision process. See Advising verbally of an unfavourable decision (CLK).

Does the carer indicate they cannot provide a second THP report from a THP on the approved THP list, but they have already provided or could provide a report from a person not on the approved THP list?

  • Yes, tell the carer that policy advice is needed and get more information from the carer, including:
    • Non approved person’s qualifications
    • Period of time which they been involved with the care receiver
    • Non approved person’s relationship to the care receiver
    • The reasons why an approved THP could not complete the SA332A form
    • Include a DOC on the record about the discussion about the medical report and request advice from the Level 2 Policy Help Desk. Note: do not request a report from a non-approved THP at this point. Go to Step 4
  • No, request a second report from a person on the approved THP list if the carer wants to appeal the assessment. See Reassessment of claims following rejection in Claiming Carer Payment (CP) and/or Carer Allowance (CA). Procedure ends here

4

Lodge a policy query with the Level 2 Policy Help Desk

Provide the help desk with the information the customer provided.

Note: Service Officers are expected to hold the record in the Hold to User (HTU) model, for continuity of service and consistency. See Work Optimiser for staff.

Does the Level 2 Policy Help Desk support inviting or using a medical report from a non-approved person?

5

Helpdesk supports inviting or using a report from a non-approved person

Has the carer already provided a report from a non-approved person?

  • Yes, use the report for the new ADAT assessment and fully document the reason discretion was used. If the new ADAT results in a non-qualifying score, see Advising verbally of an unfavourable decision (CLK). Procedure ends here
  • No:
    • contact the carer to request a SA332A medical report form from a non-approved person. Note: it is important to clearly tell the carer verbally that permission to provide the non-approved person’s report does not guarantee the reassessment will be successful
    • hold the record in the Hold to User (HTU) model, for continuity of service and consistency. See Work Optimiser for staff

When this is provided, go to Step 6.

6

Lodge a second policy query with the Level 2 Policy Help Desk

Provide the Level 2 Policy Help Desk with the:

  • ADAT score using the non-approved person’s report
  • non approved person’s qualifications
  • period of time which they been involved with the care receiver
  • non approved person’s relationship to the care receiver the reasons why another approved THP could not complete the SA332A form

Does the helpdesk support using the SA332A completed by a person who is not on the approved list?

  • Yes, finalise the reassessment. Fully document the reason the person was approved
  • No, create an ODR DOC on the customer’s record. Make sure the carer is aware of their appeal rights

For more details, see Reassessment of claims following rejection in Claiming Carer Payment (CP) and/or Carer Allowance (CA) and First contact about a decision and the internal review process.