Age Milestone Mandatory reviews for Carer Payment (CP) (child) and Carer Allowance (CA) (child) 009-08060020

The reviews are auto sent when the care receiver reaches the ages of:

• 4 years and 8 months
• 13 years

The Service Action auto-changes from Not started ('NST') to Started ('STA'):

• a PEN/SVU review activity is generated on the Future Activity List (FAL) screen
• when a review is due, the system auto-sends the forms to the carer with a notification letter
• a DOC is created on the Activity List (AL) screen to advise that carer and care receiver circumstances are under review

The following forms will be auto sent to the carer:

• Review of Carer Payment and Carer Allowance - Care Needs Assessment for a child under 16 years (SA417), and
• Review of Carer Payment and Carer Allowance Medical Report (for a child under 16 years) (SA430)

Check if the carer has received the forms. If customers respond saying they have not been received or are lost, re-issue them.

Do forms need to be re-issued?

• Yes, re-issue the forms:
• via the Mail Forms workflow
• manually to carer
• No, when review forms are returned, go to Step 3

Check that all parts of the review have been lodged.

If the customer has only returned 1 part of the review:

• do not register the documents in the system
• check the form is complete and has been signed by the carer and/or the Treating Health Professional (THP)
• tell the customer of the requirement to return the outstanding form
• ask the carer when they will return the form and note this in a DOC for the Processing Team
• procedure ends here

If both parts of the medical review have been returned by the carer, register the return of the Age Milestone Mandatory review:

• register the documents in the system to prevent the next auto-action (such as reminder, suspension or cancellation)

If the carer is lodging forms at a service centre:

• scan the review forms
• check the review has been removed from the Future Activity List (FAL) screen on either the care receiver's and/or carer's records to prevent possible suspension or cancellation. To remove the medical review activity from the FAL screen:
• navigate to Customer Record
• select the review
• key the source code and receipt date
• navigate to the Activity List (AL) screen where this activity will appear as ‘STA’rted
• procedure ends here

If a carer calls because of receiving a medical review reminder and the medical review is scanned to the carer's record, telephony staff can mature the review from the FAL screen if it has not been removed from the FAL screen already.

Procedure ends here.

For Processing Service staff, go to Step 5.

Reminder at 28 days

If the review forms are not returned within 28 days, a reminder letter will auto-issue.

Place the review activity on hold for 28 days.

Suspension at 56 days

If the review forms are not returned within 56 days of issue, the system will auto-suspend the payments 'FRC' (Fail to Reply to Correspondence).

A suspension letter will be issued to the carer.

If the carer contacts within 13 weeks of the cancellation, conduct a review of the decision to cancel and conduct the review.

If the carer receives CA there are 4 possible actions:

• CA (manual) will be cancelled CAN/MRN
• CA (auto) will be cancelled CAN/CPS
• if there are other CA care receivers, the carer remains current
• if there are no other CA care receivers, the carer is cancelled CAN/NDE

If CP is restored, CA remains cancelled unless it was paid as CA (auto) and there are other CA care receivers.

Action the Service Update

Record and monitor reviews in the Integrated Review System (IRS). The review is to be finalised as a 'CAR' review.

Access the Service Strategy (PQSS) screen and view the recommended Service Actions and Service Details for interacting with the carer. The Service Component can be expanded to view the associated Service Actions, which in turn can be expanded to view the Service Details by placing an 'X' beside the relevant Service Component or Service Action.

If only one part of the review has been returned and 21 days has passed from the date of issue, do not remove the activity from FAL.

Allow the system to automatically issue the reminder letter at 28 days. The system will automatically suspend the record at 56 days, with a Failed to Reply to Correspondence (FRC) suspension letter issued to the customer. If the carer does not respond, payment will cancel after 13 weeks from issue of review and a cancellation letter will be sent automatically.

If the carer contacts:

• within 13 weeks of the cancellation and both parts of the review have been returned, conduct a review of the decision to cancel
• after 13 weeks of cancellation, the carer must make a new claim for CA

To process the review and determine ongoing medical entitlement:

• 'S'elect the CAR/SVU activity from the AL or FAL screen. Use field help ('?') for coding assistance
• update the CPRV or CDRV screen within the same activity as updates to any screens that are pre-selected from the following list. Use date of determination as date of event. Some of the following screens will be pre-selected, depending on the details coded on the CPRV and CDRV screen:
• Care and Institution Details (CRCI) screen. This screen is only presented if 'Y' is coded on the Go to Care Details field.
• Care Details (CDCR) screen. This screen is only presented if 'Y' is coded on the Go to Care Details field
• Child Medical Details (CDMD) screen
• Treating Health Professional Assessment (CDTT) screen
• Care Load - Behaviour (CLBHA)
• Care Load - Behaviour (CLBHB)
• Care Load - Everyday Tasks (CLET)
• Care Load - Special Care Needs (CLSCA)
• Care Load - Special Care Needs (CLSCB)

Update (where required) the carer and care receiver circumstances including:

• contact details
• temporary absence (for example, hospitalisation, respite). If the carer indicates that there has been an absence these details must be coded on the Absences Detail (ABSN) screen. See:
• Coding a one-off absence for Carer Allowance (CA)/Carer Payment (CP) when the care receiver is absent
• Coding a regular absence for Carer Allowance (CA)/Carer Payment (CP) when the care receiver is absent
• Temporary cessation of care (respite) and hospitalisation
• change in a child's condition or amount of care provided
• paid or voluntary work, study or training for CP customers only. Update the details on the Carer Payment Activity Summary (CPAS) screen to record the absence. See Carer Payment (CP) - Carer undertakes paid employment, self employment, voluntary work, education or training activities for assistance

The outcome of the review could be that the CP could continue at the same rate, be increased, be decreased or be cancelled.

An auto-advice will be sent to the carer notifying them of the review result.

If payment is to:

• cancel, go to Step 9
• continue, go to Step 10

If the reason for cancellation is cessation of care, the date of event for the cancellation is the date that care ceased.

If the Treating Health Professional score is sufficient for payment to continue, but the carer score is too low (or vice versa), contact the carer to discuss the outcome before finalising the review activity. When the review is finalised, an advice of cancellation letter will be sent to the customer.

Explain qualification requirements and, if the payment is still to be cancelled, also explain review and appeal rights. See Advising verbally of an unfavourable decision.

The date of effect for cancellation for not attaining a qualifying score is the date of determination of the review under s118(13) SSAA.

Record the details on a DOC and finalise the activity via the Assessment Results (AR) screen.

Note: if CP and/or CA has been previously cancelled (for example, CAN/MRN) and further information is provided for a review of the cancellation, however the carer remains ineligible for CP and/or CA due to another reason (such as failed ADAT), the carer must be contacted, a manual letter (Q999) issued and the carer's record updated with a DOC. See the Resources page in Adult medical reviews for Carer Payment (CP) and Carer Allowance (CA) for Q999 text. In this situation, the original date of cancellation (CAN/MRN) remains the original date of decision.

Update status of Service Actions and Service Component to indicate if relevant Service Details have been competed, or no action taken.

In Customer First

• In Next: key PQSS to go to the Service Strategy screen
• Key an ‘X’ in the CAR Child Care Receiver Age Milestone (430) field to expand the components
• Key an ‘I’ in the Process Forms (397) field and update STS field to ‘COM’
• Key the DOR field with the date activity is being completed
• Note: Warning – W001PQ – Service Action status change will trigger a service update will display at top of screen
• In Next: key AR and select Enter/Continue and finalise the activity
• Navigate back to PQSS screen and expand the CAR Child Care Receiver Age Milestone (430) field
• Place an ‘I’ in the Follow Up (164) field and update STS field to either
• Completed (COM), or
• No Action Taken (NAT)
• Warning – W001PQ – Service Action status change will trigger a service update will display at top of screen
• In Next: key AR and select Enter/Continue and finalise the activity

Note:

• The Service Component will remain 'STA' until all Service Actions have been finalised (either 'COM' or 'NAT')
• when the Service Component is completed it cannot be restarted

Correctly attribute a Service Profiling debt to the associated Integrated Review System (IRS) Service Update.

Document the outcome of the review.