Change of circumstances for Essential Medical Equipment Payment (EMEP) 008-01040040

To view a summary, select Payments & Services > Clean Energy payments > Medical equipment payment explanation summary page.

To access Assessment screens select:

• Payments & Services > Clean Energy payments:
• EMEP screen option, or
• go to the Medical Equipment Task Selector (METS) page

EMEP assessment screens:

• use the Medical Equipment User Selection (MEUS) screen to select the equipment user (or an adult or child equipment user linked to their carer)
• use the Medical Equipment Claim Details (MECD) screen to view previous claim details as well as current claim assessment details (claim date, address type, energy account details, medical equipment EMEP is being claimed for at the current residence)
• use the Medical Equipment User Details (MEUD) page to view details for the person selected from the MEUS screen:
• essential medical equipment being used
• their medical condition if an EMEP was claimed for medically required heating/cooling
• equipment user non-consent reason (if they are not the EMEP customer)
• medical verification details
• use the Medical Equipment Energy Proof (MEEP) page to record details if evidence is provided for an energy account review

To update EMEP details, screens must be accessed within Customer First. In the Next field, key SVMEP.

Adding an equipment user or adding a medical equipment type or medically required heating /cooling can only be done within an MEP NCL activity.

The MECD screen is 'display only' unless processing an MEP NCL activity.

When updating details on the MEUS screen, ensure the equipment user’s name is displayed in the header.

Recording a change of circumstances for a current EMEP customer may automatically cancel EMEP at different levels:

• claimant (no EMEP entitlement)
• claim (EMEP may remain current as a carer or an equipment user for medical equipment and/or medically required heating/cooling used at their current residence)
• equipment user (EMEP may remain current for another equipment user)
• medical equipment (EMEP may remain current for other medical equipment and/or medically required heating/cooling)

EMEP can be manually cancelled via the Benefit Action (BA) screen if necessary.

Note: for most cancellation reasons, customers will be advised automatically. For cancellation reason OTHer, a Free Text (Q999) may need to be issued.

Upon review, EMEP can be restored manually via the Benefit Action (BA) screen for certain cancellation reasons. See Cancellation and rejection codes for EMEP.

If details cannot be updated to pay EMEP, code the EMEP Override page within the restoration activity to pay EMEP.

After a change of address, a new EMEP claim will be required from the customer to receive EMEP for the new residence or address.

There is no need to update EMEP assessment details. EMEP will automatically reassess when the change of address is recorded.

When the change of address is recorded for:

• the EMEP customer who is an equipment user, EMEP will cancel reason MOV (moved from claim address, claimant)
• the EMEP customer who is a carer, EMEP will cancel reason MOV and all links with equipment users will be end dated (Link status will be blank on MEUS page)
• the EMEP equipment user and the EMEP customer is their carer, the equipment user no longer qualifies the customer for EMEP, reason MOE (moved from claim address, equipment user). EMEP will cancel at the customer level unless they are EMEP current for another equipment user

Proof of medical needs

Medical evidence/information for the initial EMEP claim cannot be more than 2 years old. If it is over 2 years old, new medical evidence is required.

The SA449 can be used for new claims to verify that the equipment user:

• requires specified essential medical equipment, or
• has a medical condition that means they cannot regulate their body temperature and medically requires heating/cooling in their home

When there is a change in circumstances, for example a change in residential address:

• the customer loses qualification
• the customer must lodge a new claim
• a new anniversary date is set according to the date of grant of the new claim

Once eligibility for EMEP is established, proof of medical needs is not required again if:

• the customer changes address but the claim is for the same person with the same medical equipment/requirements
• a new carer claims, with no other changes to medical requirements

See  Claiming Essential Medical Equipment Payment (EMEP).

If correcting the second line of a customer's address, EMEP will auto cancel.

If the customer has not moved address:

• in Customer First, create a manual review on the Review Registration (RVR) screen and complete the fields as follows:
• Service Reason: BBY - due to system limitation
• Review Reason: OTH (Other)
• Due Date: next EMEP anniversary date
• Source: INT
• Date of receipt: today's date
• Notes: ‘If the customer has not moved, reassess entitlement to EMEP at next anniversary date.’
• Keyword: EMEPCOA
• Workgroup: leave blank
• Position: leave blank
• Transfer to Region: CRM
• the review will mature on the Due Date coded in the RVR activity. Workload Management will allocate the review for manual action
• when the review falls due, Processing Service Officers must:
• check the MEPSUM screen to review the history of equipment paid for and payment dates to ensure the customer has not already been paid in the last 12 months for the same item(s) of equipment at the same address
• if the claim meets requirements, index and run an MEP/NCL activity

If the customer advises that:

• an item of essential medical equipment has been updated or replaced with the same equipment type at the same address, do not update EMEP details. The current anniversary date still applies. Record details on a DOC
• additional/new essential medical equipment and/or medically required heating cooling is used, they must lodge a new EMEP claim and provide proof of medical needs

If the customer advises that the essential medical equipment and/or medically required heating/cooling is no longer being used, update EMEP details. EMEP will cancel reason VME (no valid medical equipment) if EMEP is only current for that equipment user and equipment. Where the equipment user is:

• an adult:
• select equipment user on MEUS screen
• on the MEUD screen, select medical equipment type
• in the In Use field, key No
• key DOR and Source fields and select Modify button
• finalise activity on the Assessment Results (AR) screen, and
• record details on a DOC
• a child:
• in the claimant's record, go to the METS screen
• navigate to the MEUS screen
• on the MEUD screen, select medical equipment type
• in the In Use field, key No
• Code DOR and Source fields and select Modify button
• finalise activity on the AR screen, and
• record details on a DOC

If details were incorrectly recorded, select the medical equipment type from the MEUD screen and either Modify or Delete the details.

There is no facility to manually record whether or not the concession card requirement is met for EMEP. This is determined by the system when EMEP eligibility is assessed for the initial EMEP claim and on each anniversary date.

There is no need for a customer to advise changes in their concession card entitlement, although they need to meet their notification obligations relating to the concession card.

If the customer advises that they (or the equipment user if not the claimant) no longer contribute to the energy account, check if energy account requirements are still met.

For example, requirements may still be met if the customer no longer holds the energy account but their partner does, or if the customer no longer contributes to paying the account but the equipment user does.

If energy account requirements are no longer met:

• cancel MEP manually via the Benefit Action (BA) screen
• select reason 'LEN' (no liability for energy account)
• finalise activity on the AR screen, and
• record details on a DOC

Energy account details are displayed on the MECD screen for the EMEP claim. These details can only be updated within an MEP NCL activity.

Energy account reviews

Customers do not need to provide evidence that energy account requirements are met unless they are selected for an energy account review.

If a customer claims EMEP as a carer and the equipment user is not a dependent child, the equipment user is required to give their consent for the customer to be paid their EMEP.

The equipment user may later withdraw their consent. They may do this by:

• contacting to withdraw their consent. Invite them to claim EMEP. Update details on the current EMEP customer's record
• select the equipment user on MEUS screen
• on the MEUD screen, select each current medical equipment type(s)/ medically required heating/cooling being used by the equipment user and code/ update the Non consent reason field
• key DOR and Source fields and select Modify button
• finalise activity on the AR screen, and
• record details on a DOC
• lodging an EMEP claim. When the claim is processed (whether or not EMEP is granted) the current customer's EMEP will be automatically reassessed

The current customer's EMEP will cancel reason WDC (consent withdrawn) if they have no other qualifying equipment user.

To receive an EMEP, the customer must be in Australia on the date they claim EMEP and on each anniversary date.

If the customer advises they are going overseas use the Portability script to record details. If the customer advises they are going overseas:

• permanently, EMEP will be cancelled immediately reason NIA (not located in Australia)
• for a temporary absence, EMEP will remain current and eligibility for payment will be determined on the anniversary date

If the customer is not in Australia on the anniversary date, the EMEP will cancel, and a new claim will need to be lodged when they return to Australia.

Has the customer's payment cancelled NIA, but it is not the anniversary date?

• Yes, go to Step 8
• No, go to Step 9

Note: if the customer is overseas and EMEP cancels but not on the anniversary date, this is an incorrect cancellation.

If the EMEP payment is showing as cancelled, and the customer is not overseas on the anniversary date, restore the customer’s payment as follows:

• activate the Department of Home Affairs datalink for the date of return (DOR) on the Carer record
• once link is established, restore the payment via the BA screen
• within the restoration activity, navigate to the Link Summary (LS) screen. Note: the previous link will show it has ended as of the date of cancellation. This requires a new link to be coded the day after the cancellation date
• on the LS screen, next to Add New Link, key Y
• on the Other Customer Links (OCL) screen:
• Link type, key MEP
• From SVC Rsn, key MEP
• To, key MEU
• Start Date, key the day after cancellation date
• record the Source and DOR

When all information is keyed, finalise the restoration, including recording a DOC as per Quality Standards.

If the equipment user is not the EMEP customer, the portability script should only be used if they are a current customer for other payments such as an income support payment.

If they are not a customer and they are going overseas:

• temporarily, record details on a DOC. Procedure ends here
• permanently, update their address. This will automatically reassess the customer's link to the carer's EMEP, which will end the link to the equipment user. EMEP will cancel when there is no other qualifying equipment user. Procedure ends here

If the EMEP customer dies, recording them as deceased will cancel EMEP reason DEA.

If an equipment user dies and they are not the EMEP customer, their death is recorded on their record and this will cause an automatic reassessment of the customer's EMEP. Their EMEP will cancel reason NUE (no eligible equipment users) if the deceased customer was the only qualifying equipment user.

See Confirmation of the death of an adult or child.