Terminal illness reviews for Carer Payment (CP) child 009-08060090

When a review is due for the carer of a terminally ill child, details of the activity appear on the Activity List (AL) screen.

The notes line will read CP Child Terminal Illness review for XXX XXX XXXX.

These activities are automatically allocated to Carer Processing teams via the Workload Management Tool (WLM).

Check the carer’s record to see if recent contact has been made to advise of any change in the care receiver's circumstances. For example, the care receiver has entered a hospice or is deceased.

Has a change in circumstances occurred indicating the carer may no longer be qualified for CP?

• Yes, go to Step 5
• No, go to Step 3

The Service Officer must check the carer’s record, as the system cannot identify how many terminal illness reviews a carer has had previously:

• Determine whether a terminal illness review has been performed in the past
• Check historical Child Medical Details (CDMD) screen to see when the Terminal Illness Indicator was last updated and that the indicator is correct (Y or N) for the child medical details. For example, if the indicator was first updated 24 months ago, this is the first review
• Check the intervals between previous CAR/AAP or CDA/AAC activities on the Activity History List (HAL) screen. For example, if this is the third review in approximately 36 months, it is not likely to be the first terminal illness review
• Access the Pension Status History (PNSH) screen – this screen will display the pension status including the CP grant date. All CP (child) claims granted before 1 July 2009 will be under the CDAT – Profoundly Disabled Child rules. See Child Disability Assessment Tool (CDAT) prior to 1 July
• Navigate to the Care Receiver Summary (CRS) screen, select the child care receiver that the review relates to. Check the Child Profound Disability Details (CPDD). If there is a date of event and the indicator has been marked Y in the Advanced Terminal Condition or short life expectancy field, the child has been granted under Profoundly Disabled Child rules (pre 1 July 2009)
• Navigate to the Child Disability Assessment Tool Summary (CDAS) screen. This screen will display all Treating Health Professional Assessments by date. Select 1 THP line at a time to view the Child Medical Details (CDMD). The CDMD screen will provide the date of effect, date the medical report was signed, whether a terminal illness indicator is present and the period of condition

After checking the carer’s record, for reviews generated at:

• 24 and 36 months, go to Step 4
• 48 months and thereafter, go to Step 6

A referral is required to the CSAT social workers using the Social Work Referral guided procedure in Customer First:

• Select CSAT Processing Team - Specialist Assessment > Child Terminal Review

Place the child terminal illness review on hold for 28 days awaiting the CSAT recommendation then CSAT must send the activity to Carer Processing (CD1) for processing.

If there has been a change in the care and/or care receiver's circumstances indicating the carer may no longer be qualified for CP, see Cancellation and suspension of Carer Payment (CP) and/or Carer Allowance (CA).

Finalise the terminal illness review with no further action and create a DOC on the carer’s record stating the reason the terminal illness review is not required.

Procedure ends here.

All carer’s must undergo a medical review if granted CP more than 3 years ago and there is no evidence of a review being completed within the last 12 months.

For the initial reviews at 24 and 36 months, CSAT will provide a recommendation to Carer Processing (CD1) if a review is required for a care receiver with a terminal illness.

Send the carer a manual medical review via the Mail Forms guided procedure, include the following forms:

• SA417 - Review of Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16), and
• SA429 - Carer Allowance Medical Report (for a child under 16 years) if the carer receives Carer Allowance, or
• SA425 - Review of Carer Payment Medical Report (for a child under 16 years) if the carer receives Carer Payment only, or
• SA430 - Review of Carer Payment and Carer Allowance Medical Report (for a child under 16 years) if the carer receives Carer Payment and Carer Allowance

For the initial review at 24 and 36 months, a Q999 letter must be issued in addition to the above stating:

• ‘Based on your recent discussion with a Services Australia Social Worker, the enclosed forms have been issued so that we can continue your assessment for Carer Payment.
  Please return within 28 days to avoid any interruption to your payment. If you are unable to return the forms by the due date or require additional information please contact 132717.
  This information request is under Section 63 of the Social Security (Administration) Act 1999.’

For reviews at 48 months and thereafter, a Q999 letter must be issued in addition to the above forms stating:

• ‘The enclosed forms have been issued so that we can continue your assessment for Carer Payment.
  Please return within 28 days to avoid any interruption to your payment. If you are unable to return the forms by the due date or require additional information please contact 132717.
  This information request is under Section 63 of the Social Security (Administration) Act 1999.’

Place the terminal illness review on hold for 28 days on the Activity List (AL) screen in Customer Record.

If, after 28 days:

• neither of the parts of the medical review have been returned, code the Carer Payment Review (CPRV) screen only to finalise the review
• both parts of the medical review have not been returned:
• code the information received, and
• allow an automatic cancellation of CP (and Carer Allowance (CA) to occur. See Cancellation and suspension of Carer Payment (CP) and/or Carer Allowance (CA)
• both parts of the medical review have been returned, the review must be processed using the DCLAD (2010). If the child care receiver no longer has a terminal illness as stated by the Treating Health Professional (THP):
• update the terminal illness indicator displayed on the Child Medical Details (CDMD) screen, and
• change the indicator to ‘N’

The Service Officer must check the Child Profound Disability Details (CPDD) screen, if information exists on this screen this must also be updated by coding the review date of effect in the Event Date field and Change the Advanced terminal condition and short life expectancy to ‘N’ if the child meets savings provisions, update the remaining fields.

Finalise the review by completing the CPRV screen. Payment will be assessed based on the DCLAD (2020) and the carer informed of the outcome.

A DOC must be created on the carer’s record detailing the outcome of the terminal illness medical review.

A referral to a CSAT social worker is made by a Service Officer following a file assessment investigation of the carer and care receiver’s circumstances. The CSAT referral should only be for CP that has been granted for a care receiver with a terminal illness after 24 months and subsequently at 36 months post grant.

If the referral does not meet this criteria, close the referral without action and create a CSAT Assessment Finalised Fast Note detailing the reason a CSAT recommendation is not required.

Ensure the CSAT Assessment Finalised Fast Note created includes the keywords ‘ACTCAR’ and ‘URGENT’. Transfer the activities to office code CD1.

See the Resources page for how to SWIS a Child Terminal Review and/or the DOC template to include the Fast Note to return to CD1.

After examining the carer’s record, contact the carer by phone to determine whether the care receiver's condition or circumstances have changed.

Due to the sensitive nature of the contact, only a social worker from the CSAT can progress a discussion with a carer about the child care receiver's medical condition. The social worker will make a recommendation from the contact as to whether a terminal illness medical review will proceed. This review is to confirm if the customer still qualifies under the criteria.

If the carer cannot be contacted by phone after 2 phone attempts, a letter (Q164) is to be sent to the carer requesting contact within 21 days of the date the letter was issued. If the carer does not make contact within 21 days, go to Step 6 otherwise go to Step 3.

Has there been a change in the care receiver's medical condition or circumstances indicating a medical review if required?

• Yes, (medical condition), go to Step 4
• No, go to Step 5

If there has been a change in the care receiver's illness or circumstances indicating a medical review is required, a report in the Social Work Information System (SWIS) must be completed. This report must include the date of contact and all other relevant information including the recommendation for a medical review.

Create a CSAT Assessment Finalised Fast Note detailing the change in the child's medical condition or circumstances and/or the reason for the review.

Ensure the CSAT Assessment Finalised Fast Note created includes the keywords ‘ACTCAR’ and ‘URGENT’. Transfer the activities to office code CD1.

See the Resources page for a SWIS and/or DOC template.

Procedure ends here.

If there has been no change in the care receiver’s illness or circumstances indicating no medical review is required, a report in the Social Work Information System (SWIS) must be completed. This report must include the date of contact and all other relevant information including the recommendation for no medical review.

Create a CSAT Assessment Finalised Fast Note detailing the child's medical condition or circumstances and/or the reason no review is required.

Ensure the CSAT Assessment Finalised Fast Note created includes the keywords ‘ACTCAR’ and ‘URGENT’. Transfer the activities to office code CD1.

See the Resources page for a SWIS and/or DOC template.

Procedure ends here.

Create a CSAT Assessment Finalised Fast Note detailing the reason a CSAT recommendation is not required or unable to be made.

Ensure the CSAT Assessment Finalised Fast Note created includes the keywords ‘ACTCAR’ and ‘URGENT’. Transfer the activities to office CD1.

See the Resources page for a SWIS and/or DOC template.

The CSAT recommendation must be taken into consideration when the Service Officer determines the next steps for the terminal illness review.

The CSAT recommendation will be documented on the carer’s record with 1 of the following outcomes:

• Medical review required, go to Step 2
• Medical review not required, go to Step 3
• Review circumstances as carer may no longer be eligible for CP, go to Step 4
• CSAT recommendation not required, go to Step 5
• Unable to make contact with the carer, go to Step 6

If the Service Officer agrees with the CSAT recommendation that a medical review is required at 24 months after the grant of CP, send the carer a manual medical review via the Mail Forms guided procedure, include the following forms:

• SA417 - Review of Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16), and
• SA429 - Carer Allowance Medical Report (for a child under 16 years) if the carer receives Carer Allowance, or
• SA425 - Review of Carer Payment Medical Report (for a child under 16 years) if the carer receives Carer Payment only, or
• SA430 - Review of Carer Payment and Carer Allowance Medical Report (for a child under 16 years) if the carer receives Carer Payment and Carer Allowance

Place the terminal illness review on hold for 28 days on the Activity List (AL) screen in Customer Record.

If, after 28 days:

• neither of the parts of the medical review have been returned, code the Carer Payment Review (CPRV) screen only to finalise the review
• both parts of the medical review have not been returned:
• code the information received, and
• allow an automatic cancellation of CP (and Carer Allowance (CA)) to occur
• both parts of the medical review have been returned, the review must be processed using the DCLAD (2020). If the child care receiver no longer has a terminal illness as stated by the Treating Health Professional (THP):
• update the terminal illness indicator displayed on the Child Medical Details (CDMD) screen, and
• change the indicator to ‘N’

The Service Officer must check the Child Profound Disability Details (CPDD) screen, where information exists on this screen this must also be updated by coding the review date of effect in the Event Date field and Change the Advanced terminal condition and short life expectancy field to ‘N’. If the child meets savings provisions, update the remaining fields.

Finalise the review by completing the CPRV screen. Payment will be assessed based on the DCLAD (2020) and carer informed of outcome.

Create a DOC on the carer’s record detailing the outcome of the terminal illness medical review.

Procedure ends here.

If the Service Officer agrees with the CSAT recommendation that a medical review is not required at 24 months after the grant of CP, create a ‘DOC’ outlining why the determination was made not to proceed with a review. The review activity must be finalised from the Activity List (AL) screen.

Procedure ends here.

The CSAT social worker may recommend the carer is no longer eligible for CP due to a change in the carer or care receiver's circumstances. For example, the care receiver is deceased or care receiver has entered permanent care. If the Service Officer agrees qualification for CP and/or Carer Allowance (CA) has been lost see Cancellation and suspension of Carer Payment (CP) and/or Carer Allowance (CA).

Contact must be made with the carer to advise of the cancellation.

Procedure ends here.

A doc may be received from the CSAT social worker advising this is not an appropriate terminal illness review for the CSAT social worker to contact. This may occur when:

• a terminal illness review has been previously completed at 24 months after the grant of CP
• it has not been 24 months since the carer commenced CP

If a terminal illness review has previously been completed at 24 months, all carer’s must undergo a full medical review if granted CP (child) under terminal illness provisions more than 3 years ago and there is no evidence of a review within the last 12 months.

If CSAT social worker notifies medical condition meets the list of recognised disabilities, the terminal indicator can be removed from the CDAT screen. If a medical review is required, send the carer a manual medical review via the Mail Forms guided procedure, include the following forms:

• SA394 - Carer Payment and/or Carer Allowance - Care Needs Assessment (for a child under 16), and
• SA426 - Carer Allowance Medical Report (for a child under 16 years) if the carer receives both Carer Payment and Carer Allowance, or
• SA428 - Carer Payment Medical Report (for a child under 16 years) of the carer receives Carer Payment only

When the review forms are returned, see Medical reviews for child care receivers.

Procedure ends here.

In the event the CSAT social worker has been unable to make contact with the carer, this will be documented. Suspend CP until the carer makes contact.