Adult medical reviews for Carer Payment (CP) or Carer Allowance (CA) 009-08050010

When a carer is selected for a medical review, the carer will be sent a notification letter with the following forms:

• Carer Payment and/or Carer Allowance Medical Report for a person 16 years or over (SA332(a))
• Review of care provided - Carer Payment and/or Carer Allowance (caring for a person - 16 years or over) (SA010)

A reminder is registered on the Future Activity List (FAL) screen. If the carer has not returned the review within 28 days and the activity has not been removed from FAL, a reminder letter will be sent to the carer with no forms.

If the carer has not returned the medical review forms after 56 days, Carer Payment (CP) or Carer Allowance (CA) will auto-cancel.

To extend the review (all or part), go to Step 2.

If the care receiver has died since the review forms were issued, go to Step 3.

To reissue forms, go to Step 4.

When all of the review forms have been returned, go to Step 5.

When the carer contacts after cancellation of CP or CA, go to Step 7.

To process a review (Carer Processing Officers only), go to Step 1 of Table 2.

When the carer needs more time to return part or all of the review, it can be extended. For example, a carer may contact to advise they cannot return the Medical Report as they could not get an appointment with the Treating Health Professional before the due date.

If the carer is only returning 1 part of the medical review:

• tell the carer to return the missing form as soon as possible
• ask the carer when they will return the form DOC this date for the Processing Team

To defer the review:

• 'V'iew the activity from the (FAL) screen to view the Future Activity Details (FAY) screen
• extend the action date in the Date field

Note: the medical review activity on the FAL screen may appear on either the carer or care receiver's record.

It is possible to defer both the reminder letter (the 'reminder/request contact stage') and the cancellation stage. It is only possible to defer both for 28 days in total. For example, if the reminder stage is deferred by 15 days, the cancellation stage can only be deferred by 13 days.

See Extending the return date for Carer Payment (CP) and Carer Allowance (CA) medical reviews

If the care receiver has died since the review forms were issued, in Customer First:

• Select the review and code the Complete Review? field with a 'Y'
• Finalise via the Assessment Results (AR) screen
• Run the Daily Driver by keying ‘DD’ in the Next field and pressing [Enter]
• Run the Notification of death to record the care receiver’s death. See Death of an adult or child care receiver and the effect on Carer Payment
• Procedure ends here

Re-issue the forms:

• via the Mail Forms workflow, or
• manually to carer

Ensure the forms have been signed by the carer and the Treating Health Professional (THP):

• date stamp the forms
• check that all parts of the review have been lodged:
• Review of care provided - Carer Payment and/or Carer Allowance - caring for a person 16 years or over (SA010), and
• Carer Payment and/or Carer Allowance Medical Report For a person 16 years or over (SA332(a))

To register the return of a medical 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 cancellation. If not, remove the activity from FAL manually. Note: when the review is removed from the FAL, the date of receipt of the activity will be the date the CDA/AAC activity is moved to Activity List (AL) screen

Navigate to Customer Record to remove the medical review activity manually from the FAL screen:

• go to FAL screen by keying ‘FAL’ in the Next field and press [Enter] or select the ‘Continue’ button
• select the medical review activity and press [Enter]
• key the source code and receipt date
• navigate to the AL screen where this activity will appear as ‘STA’rted and then send this activity to CD1 for action

Note: the activity on the AL screen will only appear in the ISS system (enter SVCDA in Next to display Carer Allowance activities)

• procedure ends here

If the carer contacts as their CP and/or CA has been cancelled MRN for the non-return of the medical review, check if they have returned both parts of the medical review. If the carer has not returned both parts of the medical review.

If the carer has not returned both parts of the medical review:

• Tell them to return the missing form as soon as possible
• Ask the carer when they will return the form and note this in the DOC for the Processing Team
• Procedure ends here

A Fast Note can be sent if:

• both forms have been returned and the review not yet processed, or
• The carer had not returned both parts of the medical review within 13 weeks of cancellation of CP and/or CA, and
• requested a review of the decision within 13 weeks of the cancellation of CP and/or CA and
• has now returned both parts of the medical review and
• the request for review has not been finalised
• the decision may be reassessed

For Carer Payment or Combined CP/CA

• use Fast Note - select Auto text, use Carers > Update > CP Update - Action Required
• Select Confirm
• Complete all fields

For Carer Allowance only:

• Use Fast Note - select Auto text, use Carers > Update > CA Update - Action Required
• Select Confirm
• Complete all fields. Procedure ends here

If the carer has not returned both parts of the medical review within 13 weeks of cancellation of CP and/or CA, and the carer had not requested a review of the cancellation within 13 weeks, the carer will need to reclaim CP and/or CA by using the online claim or via the Assisted Customer Claim (ACC).

If the customer requests an explanation or applies for a formal review of the decision, see Request for an explanation or application for a formal review (CLK).

If the customer requests an explanation or applies for a formal review of the decision, see Request for an explanation or application for a formal review (CLK).

If CP and/or CA has been cancelled (CAN/MRN)

• If the customer has returned both parts of the medical review within 13 weeks of cancellation of CP and/or CA, the decision may be reassessed and
• the new ADAT information has been recorded and
• if the carer is eligible
• CP and/or CA can be restored via ‘Benefit Action’ from date of cancellation.
• See Step 4 in the Restoring Carer Payment (CP) table and/or Step 1 in the Restore CA table
• a refresh may be required for the care receiver adult before restoration of Carer Payment (CP).
• If the customer has not returned both parts of the medical review within 13 weeks of cancellation of CP and/or CA, and
• had requested a review of the decision within 13 weeks and
• has now returned both parts of the medical review and
• the request for review has not been finalised

The decision may be reassessed, and

• once the new ADAT information has been recorded and
• if the carer is eligible
• CP and/or CA can be restored via ‘Benefit Action’ from date of cancellation
• See Step 4 in the Restoring Carer Payment (CP) table and/or Step 1 in the Restore CA table
• a refresh may be required for the care receiver adult before restoration of Carer Payment (CP).

If the customer has requested a review of the decision within 13 weeks but has not returned both parts of the medical review, proceed with the review. See Request for an explanation or application for a formal review (CLK).

If the decision is not favourable proceed with the request for review.

If CP and/or CA has been cancelled (CAN/MRN), and:

• further information is provided, and
• the carer remains ineligible for CP or CA due to another reason (for example, Failed ADAT), the carer must be contacted:
• issue a manual letter, using Q999 text
• the original date of cancellation remains the original date of decision
• the reason for the cancellation (CAN/MRN) remains unchanged
• DOC the carer's record

If the carer has not returned both parts of the medical review within 13 weeks of cancellation of CP and/or CA, and the carer had not requested a review of the cancellation within 13 weeks, the carer will need to reclaim CP and/or CA by using the online claim or via the Assisted Customer Claim (ACC).

Use Customer First to process reviews.

Access the carer's Care Receiver Summary (CRS) screen.

Select the care receiver.

If the care receiver is provided:

• constant care and attention by the CP carer in the home of the care receiver, go to Step 5. Note: this requirement does not apply to CP (XWP))
• daily care and attention by the:
• CA carer in the home of the carer or care receiver, go to Step 5
• CP/CA carer who is no longer providing constant care, contact the Level 2 Policy Help Desk as this could be a complex constant care scenario

Otherwise, go to Step 3.

Possible reasons for an absence from care include:

• care receiver in respite care
• care receiver is in hospital
• carer or care receiver is absent overseas
• care is absent
• care receiver undertaken education, training or treatment

Is the reason care is not being provided due to 1 of the above circumstances?

• Yes, code any absences. Code absences that have not been recorded, as part of the CAR/AAP or CDA/AAC activity. Go to Step 5
• No, the carer is not qualified for CP and/or CA. Cancel the payment as part of the CAR/AAP or CDA/AAC activity. Go to Step 4

To process the review and cancel CP and/or CA due to the permanent absence of the care receiver or cessation of care by the carer:

Carer Payment (this section does not apply to CP (XWP))

• 'S'elect the CAR/AAP activity from the AL or FAL screen to go to the Carer Payment Review (CPRV) screen
• finalise review activity by coding the Complete Review? field with a 'Y' and then finalise via the Assessment Results (AR) screen
• go to the care receiver's record
• go to the Care Receiver Summary (CRS) screen
• 'S'elect 'Self' and press [Enter]. The Care Receiver Task Selector (CETS) screen will display
• 'S'elect the Care and Institution Details (CRCI) screen
• the date of event for cancellation is the day after care ceased
• in the carer's record, complete a DOC with the review outcome and decision details
• the carer will receive an auto-advice informing them of the review result

Carer Allowance

• 'S'elect the CDA/AAC activity from the AL or FAL screen to go to the Carer Allowance Review (CDRV) screen
• action the review in the care receiver's record and the date of effect for cancellation is the day after care ceased
• 'S'elect the Go To Care Details field by keying 'Y' to go to the Care Details (CDCR) screen
• code the CDCR screen, ensure the Care days field is keyed as '0'. [Enter] to return to the CDRV screen
• code the Complete Review? field with a 'Y'
• complete the Source, DOR and Action fields. Press [Enter] to go to the Assessment Results (AR) screen
• the AR screen will show the CA is to be cancelled
• in the carer's record, complete a DOC with the review outcome and the decision details

An auto-advice will be sent to the carer notifying them of the review result. Contact the carer by phone to advise the outcome of the review. Explain qualification requirements and review and appeal rights.

CP (XWP) will auto-cancel if the carer's only or last payment level CA is suspended or cancelled or changes to CA HCC only.

Procedure ends here.

To process the review and determine ongoing medical entitlement:

• 'S'elect the CAR/AAP or CDA/AAC activity from the AL or FAL screen. Use field help ('?') for coding assistance
• ensure the CPRV or CDRV screen is updated within the same activity as updates to any screens that are pre-selected from the following list. Some of the following screens will be pre-selected, depending on the details coded on the CPRV or CDRV screen:
• Care and Institution Details (CRCI) screen. This screen is only presented if 'Y' is keyed in the Go to Care Details field
• Care Details (CDCR) screen. This screen is only presented if 'Y' is keyed in the Go to Care Details field
• Care Receiver Benefit Action (CJBA) screen
• Adult Medical Details (ADMD) screen

Note: recording a change in the period of condition on the ADMD screen as part of a medical review should not cancel a carer's payment. If the period of condition is coded as 'Review value temporary less than 6 months' (RL6) or 'Review value, greater than 6 months and less than 12 months' (RG6) and the carer and care receiver meet all other CA qualifications, CA will continue.

• Adult Disability Management (ADMG) screen
• Adult Disability Behaviour (ADBH) screen
• Adult Disability Personal Activities (ADPA) screen
• Adult Disability Cognitive Functions (ADCF) screen

The review result will be presented on the AR screen.

Can payment be continued as a result of the review?

• Yes,
• Date of Effect for continuation of payments is the Date of Receipt of the review
• Record details on a DOC and finalise the activity
• Go to Step 8
• Yes, but CP and/or CA has been cancelled MRN
• If the carer has returned both parts of the medical review within 13 weeks of cancellation of CP and/or CA, or
• requested a review of decision within 13 weeks of cancellation of CP and/or CA, but returned both parts of the review after 13 weeks of cancellation and the request for review of decision has not been finalised CP and/or CA can be restored from the date of cancellation. See Step 4 in the Restoring Carer Payment (CP) table and/or Step 1 in the Restore CA table. Once payment/s are restored, go to Step 8
  Note: a refresh may be required for the care receiver adult before restoration of Carer Payment (CP)
• No, go to Step 7

If CP and/or CA is cancelled CAN/MRN, and

• the carer had requested a review of decision within 13 weeks of cancellation of CP and/or CA, proceed with the request for review of decision. Procedure ends here
• the carer had not requested a review of decision within 13 weeks of cancellation of CP and/or CA, the carer must be contacted:
• issue a manual letter using Q999 text
• the original date of cancellation remains the original date of decision
• the reason for the cancellation (CAN/MRN) remains unchanged
• DOC the carer's record

If CP and/or CA is cancelled due to the ADAT score

• contact the carer to discuss the outcome before finalising the review activity
• Explain qualification requirements and if the THP score is sufficient, but the carer score too low (or vice versa), consider if either have been understated when speaking with the carer
• if the payment is still to be cancelled, also explain review and appeal rights.
• If the carer was also receiving CP (XWP) this will auto-cancel if the carer's only or last payment level CA is suspended or cancelled. Qualification for CP (XWP) is permanently lost if there is a break in payment level CA entitlement.
• Where a qualifying score was not achieved, the date of effect (DOE) of cancellation is the date of determination
  Note: the DOE field on the ADMD screen will need to be updated to the date of determination
• Finalise the activity via the Assessment Results (AR) screen and record the details on a DOC

When a carer receiving CP only completes a medical review, and if all of the following conditions are met, a Claim for Carer Allowance following Carer Payment Review (SA341) will be auto-sent with an invitation to claim Carer Allowance:

• the customer is in receipt of CP (adult) for the care receiver but is not in receipt of CA (adult) for the same care receiver
• no other carer is paid CA (adult) for the care receiver
• the carer is not being paid CP only for a bereavement period
• the care receiver has not permanently entered an institution
• the carer is the sole carer of the care receiver
• the thresholds for each of the following is met, and at least 1 must have changed from below to above the threshold
• total ADAT score from less than 30 to 30 or more
• THP score from less than 12 to 12 or more
• Period of Condition from 'TL6' or 'TG6' to 'T12', 'TMI', 'TM3', 'PIM' or 'PNI'
• for the date of commencement of a Carer Allowance claim following lodgement of a SA341, see Coding a claim for Carer Allowance (CA) where the care receiver is 16 or over