Hospitalisation reviews for Carer Payment (CP) and Carer Allowance (CA) for a child under 16 years 009-08040030

For:

• 12 weekly reviews, go to Step 2
• Manual Follow-up (MFU) to check review forms returned, go to Step 5
• 24 month reviews, go to Step 7
• MFU at 5 weeks after forms issued and suspension of payment, go to Step 9
• Subsequent 12 monthly reviews from 36 months on, see Step 1 in Table 2
• to re-issue the forms, see Step 4 in Table 2
• check and register the returned review forms, see Step 7 in Table 2

If the details of the Absences Summary (ABSN) screen are updated and the care receiver returns to care, any future Hospitalisation (H12) reviews are auto-cancelled.

If the period in hospital for a child is extended, the Service Officer should check to determine if the extension means the absence is over 12 weeks. If there is a change and the absence is now over 12 weeks then a H12 review should be set up for 12 weeks from the start of the absence or the start date of eligibility.

If hospitalisation absences recorded on the ABSN screen are non-consecutive but exceed 12 weeks there is no requirement for a review.

If there are less than 14 days per fortnight recorded then this is not a continuous absence.

If the start date of the previous occurrence is 1 day after the previous end date then this is a continuous absence, for example, if the start date for hospitalisation is 1 March 2010 to 31 March 2010. A new hospitalisation absence is then recorded from 1 April 2010 to 24 May 2010.

If the care receiver is in hospital on 1 July 2009, the 12 week count for the hospitalisation provision will only commence from 1 July 2009.

If the carer receiving Carer Allowance (CA) is also receiving Carer Payment (CP) for the same care receiver/s then only 1 review will be set up and CA will control the review.

The carer of a hospitalised child will be reviewed every 12 weeks (84 days) of continuous hospitalisation. Carers on CP and/or CA will be reviewed.

For the 12 weekly review the pre-populated form Review of Carer Payment and Carer Allowance while your child is in hospital (SA396) will be sent to the carer.

Reviews after 12 weeks are to occur even if the 12 continuous weeks spans a calendar year.

Note: the 12 week review will be carried out a total of 7 times if the customer remains in hospital for over 21 months.

CP

In the PEN system, the Future Activity List (FAL) screen will be coded automatically with the following codes:

• Review Reason Code: H12 Child 12 week hospital
• Keywords: 12WEEK HOSPITAL

CA

In the CDA system, the FAL screen will be coded automatically with the following:

• Review Reason Code: H12 - Child 12 week review set up
• Keywords: 12WEEK HOSPITAL

Service Officer to complete the following checks:

• the customer is also a CA carer receiver for the same period
• the care receiver Customer Reference Number (CRN) is current for the carer
• CA is current at the time the review matures

The SA396 is auto-sent to the customer at 12 weeks.

The system will set up an MFU for 3 weeks.

If the review form has not been returned by end of the initial week 15, or subsequent 3 week period for return of form, an MFU will be generated and show on the Activity List (AL) screen.

If there is no end date on the record or the date of the absence extends for a further 9 weeks from the system date, create a further 12 weekly hospitalisation review on the customer's record so that the second or subsequent 12 weekly review can take place.

Check if the review form has been returned.

Has the SA396 been returned by the end of week 3?

• Yes, see Step 5 in Table 2
• No, go to Step 6

If the review form has not been returned by the end of week 15, or for subsequent reviews at end of 3 weeks, issue another review form manually or reprint a copy from the History Summary (HS) screen.

Hold the MFU until the end of week 17, or for subsequent reviews 5 weeks after the 12 week review date.

If the review form has not been lodged by the end of week 17, or for subsequent reviews 5 weeks after the 12 week review date, payment of CP (child) is to be auto-suspended and the MFU completed.

If payment remains suspended at the end of week 30, it will auto-cancel.

Has the customer been in hospital for 24 months?

• Yes, go to Step 7
• No:
• go to Step 3 for another 12 weekly review, or
• if no review is required, procedure ends here

The system will automatically set up the review.

The carer has been in continuous receipt of payment (inclusive of periods of suspension) for CP (child) and /or CA (Child) for a care receiver who has been continuously hospitalised for 24 months.

The carer and care receiver are to undergo a full care load and medical review.

Check if the care receiver has been hospitalised continuously.

Issue the following:

• Request for Information (RFI) letter
• include relevant forms as listed on the Resources page

Set up a review for 3 weeks from the date the 24 month review matures to check that the forms are returned

If the review forms have not been returned by end of the 3 week period for return of form, an MFU will be generated. Check if the review forms have been returned.

Have the forms been returned by the end of week 3 after the 24 months review?

• Yes, see Step 7 in Table 2
• No, the review form has not been returned by the end of week 3:
• reissue the request for information and review forms again manually. Reprint review forms from Online forms or reprint a copy from the HS screen
• hold the MFU until the end of week 5

MFU at week 5 after review forms were sent and suspension of payment

Have the forms been returned by week 5 MFU?

• Yes, see Step 7 in Table 2
• No, suspend the customer's CP and/or CA using reason code 'FRC' (failure to reply to correspondence)

Note: if CP is suspended the Service Officer must clearly document reasons for the suspension on the customer’s record and include their logon ID and contact details.

Procedure ends here until the carer contacts or forms are returned.

The carer has been in continuous receipt of payment (inclusive of periods of suspension) for Carer Payment (child) and /or Carer Allowance (Child) for a care receiver who has been continuously hospitalised for each additional 12 months after the initial 24 months (the child has now been continuously hospitalised for 36 months).

The carer and care receiver will be required to undergo a full care load and medical review.

Note: repeat this step every 12 months from 36 months on if the care receiver remains hospitalised continuously for this period of time.

Check if the care receiver has been hospitalised continuously.

Issue the following:

• Request for Information (RFI) letter
• forms listed on the Resources page

Set up an MFU for 21 days for the return of the forms.

If the review forms have not been returned by the end of the 3 week period for return of form, an MFU will be generated. Check if the review forms have been returned.

Have the forms been returned by the end of week 3 after the 12 monthly review?

• Yes, go to Step 8.
• No, the review form has not been returned by the end of week 3:
• reissue the request for information and review forms again manually. Print review forms using Online forms or reprint a copy from the HS screen
• hold the MFU until the end of week 5

MFU at week 5 after review forms were sent and suspension of payment

Have the forms been returned by week 5 MFU?

• Yes, go to Step 7
• No, suspend the customer's CP and/or CA using reason code 'FRC' (failure to reply to correspondence)

Note: if CP is suspended the Service Officer must clearly document reasons for the suspension on the customer’s record and include their logon ID and contact details.

Procedure ends here until the carer contacts or forms are returned.

If the customer has not received the forms, or has lost them, it may be necessary to re-issue them. The forms should be accompanied by a Request for Information (RFI) letter outlining:

• details as to the information or action required
• timeframe for response (noting that this must be reasonable)
• consequences of non-compliance, and
• the relevant legislative reference under which the request has been made.

Re-issue the forms to the customer:

• use the Mail Forms workflow, or
• manually via the HS screen

See Viewing or reissuing a letter or electronic message.

If the customer is lodging forms at the service centre:

• check the correct forms have been lodged
• check each form is completed and signed
• date stamp each form

Register the returned review on the system to prevent the next auto-action (for example, reminder, suspension, cancellation).

To register the return of the Hospitalisation review:

• scan the review forms
• check that the review has been removed from the FAL screen on both the care receiver's and carer's records to prevent possible suspension/cancellation. If not, do it manually. The record in which the review is created is determined by the type of medical review. The reviews will show as:
• Carer Payment - in the PEN system, Review Reason Code: H12 Child 12 weekly hospital, Keywords: HOSPITAL
• Carer Allowance - in system CDA, Review Reason Code: H12, Keywords: 12WEEK HSP#### *REVIEW - '####' is a count of the number of 12 weekly reviews a customer has had

For Service Centre staff, procedure ends here.

DOCument the return of the SA396 including details about whether:

• the care receiver is still in hospital
• the carer is continuing to provide care
• the care receiver has returned to the carer's care and from what date

If the care receiver is still in hospital and requires care, record a further 14 weeks of hospitalisation on the ABSN screen.

For the 24 month and subsequent 12 monthly reviews, calculate the total Disability Care Load Assessment Determination (DCLAD) (2010) score.

If the customer does not return the review forms by the end of week 5 after the review matures, cancel the CP and/or CA.

An automatic advice will be sent to the customer notifying them of the review result.

Make at least 2 genuine attempts to contact the customer to advise of the unfavourable decision. The customer may wish to provide a further medical report from another health professional.

If the outcome is cancellation, explain the decision and advise the customer of their review and appeal rights.