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

If a customer notifies more than one CoC, changes may be recorded in the same activity. This is so the system can, (where appropriate):

• cancel for the correct reason, and
• send the correct letter

See the Resources page for EMEP screens in Process Direct.

To view a summary of EMEP payments, key MEPSUM in the Super Key.

Is EMEP current?

• Yes, go to Step 4
• No, go to Step 2

EMEP can be restored for certain cancellation reasons. See Cancellation and rejection codes for Essential Medical Equipment Payment (EMEP) to determine if EMEP can be restored.

• If EMEP can be restored and the Service Officer is suitably skilled to restore EMEP, go to Step 3
• If the Service Officer is not suitably skilled and EMEP can be restored create an open work item:
• Use Fast Note - select Auto Text, use EMEP > EMEP restoration > EMEP restoration request
• Select Confirm
• Edit Auto Text: include relevant details
• Select Continue
• Procedure ends here
• If correcting address details for customer and/or equipment user, see Table 2 > Step 1
• If allocated a review activity work item:
• Check the MEPSUM screen to review the history of equipment paid for and payment dates to make sure 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, create a Social Online Application (SOA) shell, using the anniversary date as the Date of Receipt
• Process the claim, go to Processing Essential Medical Equipment Payment (EMEP) claims, procedure ends here

For all other circumstances, where EMEP is not current, advise customer of:

• the cancellation
• their review and appeal options
• new claim requirements

Procedure ends here.

Only suitably skilled EMEP Service Officers can restore payment.

EMEP can be restored for certain cancellation reasons. See Cancellation and rejection codes for Essential Medical Equipment Payment (EMEP).

Make any other CoC before restoring EMEP.

To restore EMEP, in Process Direct go to the Benefit Action (BA) screen:

• Select MEP - Medical Equipment Payment in the Benefit Type Code
• Key RES - Restore
• Select Date of Effect, key date of the original claim
• Select Save
• Update:
• Receipt Date
• Channel
• Service Reason - if the system does not select a default Service Reason, select MEP
• Select Save
• Select Assess and address any errors under Message Log on the (SWE) screen
• Select Assess to go to the Entitlement (ELD) screen. If the customer is entitled to arrears, check the correct amount is being paid. If required
• Select Finish to finalise the activity
• DOC the restoration

If EMEP does not restore, coding is required on the Medical Equipment Payment Override (MEOV) screen. Refer to Service Support Officer (SSO) to update the MEOV screen.

Is another CoC required?

• Yes, go to Step 4
• No, procedure ends here

A customer and/or equipment user may contact to advise of a CoC.

If the contact relates to:

• adding an equipment user, medical equipment type or medically required heating/cooling, see Claiming Essential Medical Equipment Payment (EMEP)
• changing address details, go to Step 5
• updating medical equipment or medically required heating/cooling, go to Step 6
• updating contribution to energy account, go to Step 8
• withdrawing equipment user consent, go to Step 9
• equipment user going overseas, go to Step 11
• customer going overseas, go to Step 10
• cancellation reason NIA, go to Step 12
• advising death of a customer or equipment user, go to Step 13
• equipment user temporarily enters a hospital/prison/care facility, go to Step 14

A change of address will cancel EMEP and a new claim will then be required to receive EMEP for the new residence or address.

This includes correcting a customer and/or equipment user’s current address (such as street name spelling). To correct a customer and/or equipment user’s address, see Table 2 > Step 1.

Where equipment user leaves care, a change of address of the equipment user is required.

When the change of address is recorded for an EMEP:

• customer who is an equipment user:
• EMEP will cancel reason MOV (moved from claim address, claimant)
• customer who is a carer:
• EMEP will cancel reason MOV
• all links with equipment users will be end dated
• Link status will be blank on MEUD screen
• equipment user and the EMEP customer is the carer:
• EMEP will cancel for the equipment user
• cancellation reason MOE (moved from claim address, equipment user)
• EMEP will also cancel at the customer level unless they receive EMEP for themselves or another equipment user

See Updating address details for more information.

See Table 2 > Step 2.

If the customer and/or equipment user advises:

• an item of 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
• an item of medical equipment has been recorded incorrectly, and the correct equipment was verified by their medical practitioner in their initial claim:
• update EMEP equipment details, go to Step 7
• of additional/new medical equipment and/or medically required heating cooling, they must lodge a new EMEP claim and provide proof of medical needs, procedure ends here
• medical equipment and/or medically required heating/cooling is no longer being used, update EMEP equipment details, go to Step 7

If details were incorrectly recorded:

• Select MEUD
• Select the medical equipment type
• Update or Delete the details

EMEP will cancel for the updated medical equipment and/or medically required heating/cooling.

See Table 2 > Step 2.

If updates are required, Service Officer must:

• Go to Process Direct
• Key MEUD - Medical Equipment User Details in the Super Key
• Select action Edit
• Select Event date
• Select Equipment Type
• Select Equipment used: Yes/No
• Select relevant Certificate code list:
• OME - Other medical evidence
• RAP - DVA rehabilitation appliances program
• SAT - State and terr schemes, rebates and concessions
• TDR - SA449 treating doctor’s report
• Certificate accepted: Yes/No
• Select Save

See Table 2 > Step 2.

Energy account details can be viewed through the Medical Equipment Claim Details (MECD) screen.

In Process Direct key MECD in the Super Key.

Note: details can only be recorded within a MEP NCL activity.

Energy account reviews

Customers selected for an energy account review need to provide evidence, outside these reviews evidence is not required.

If the customer and/or equipment user advises they no longer contribute to the energy account, check if energy account requirements are still met.

If energy account requirements are no longer met cancel EMEP manually key Benefit Action (BA) screen in the Super Key:

• Select Add new
• Key benefit Type code: MEP
• Enter Benefit Action: CAN
• Select Reason - LEN - No liability for energy account
• Enter Effect Date as the date of cancellation
• Enter Receipt Date
• Select Save

See Table 2 > Step 2.

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 EMEP.

Non consent reason details can be viewed and updated in Process Direct:

• Key MEUD - Medical Equipment User Details in the Super Key
• Select Medical Equipment
• Select Edit
• Select Equipment Type
• Select Equipment used: Yes/No
• Select relevant Certificate code list
• OME - Other medical evidence
• RAP - DVA rehabilitation appliances program
• SAT - State and terr schemes, rebates and concessions
• TDR - SA449 treating doctor’s report
• Select Certificate accepted: Yes/No
• Select Save
• Select Assess

The equipment user may withdraw their consent by Lodging an EMEP claim:

• When the claim is processed:
• consent will be withdrawn
• the current customer's EMEP will be automatically reassessed
• Go to the AR screen to check outcome
• Once the activity is assessing correctly, select Finalise

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

If the equipment user wishes to claim in their own right, invite them to claim EMEP. See Claiming Essential Medical Equipment Payment (EMEP).

Procedure ends here.

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

If the customer is not in Australia on the 12 monthly anniversary date, EMEP will cancel and a new claim will need to be lodged on return to Australia.

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

For permanent departures EMEP will cancel immediately NIA - not located in Australia.

For temporary absence EMEP will remain current and eligibility for the annual payment will be determined on the 12 monthly anniversary date.

Has the customer's EMEP cancelled NIA, and it is not the anniversary date?

• Yes, go to Step 11
• No, see Table 2 > Step 2

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 a social security pension, social security benefit or ABSTUDY Living Allowance.

EMEP will cancel automatically when an immigration data match for an equipment user advises they have left Australia.

If they are not receiving a social security pension, social security benefit or ABSTUDY Living Allowance and going overseas:

• Temporarily:
• Record details on a DOC on the equipment users record
• Procedure ends here
• Permanently within 14 days, update address for equipment user, this will:
• automatically reassess the link to the carer's EMEP
• end the link to the equipment user
• cancel EMEP when no other qualifying equipment user is linked
• record details on a DOC on the equipment user’s record
• Procedure ends here
• Permanently outside 14 days, advise the equipment user to:
• update portability through online services within 14 days of travel, or
• where they don’t have online services, contact to advise
• record details on a DOC on the equipment user’s record
• Procedure ends here

If the customer is overseas and EMEP cancels but not on the EMEP anniversary date, this is an incorrect cancellation and restoration of EMEP is required.

In Process Direct activate the Department of Home Affairs datalink for the date of return (DOR) on the Carer record.

Once link is established, restore the payment through the BA screen

• Select Add
• Benefit Type Code, select MEP - Medical Equipment Payment
• Benefit Action, key RES - Restore
• Date of Effect, key date of the original claim
• Select Save
• Update:
• Receipt Date
• Channel
• Service Reason - if the system does not select a default Service Reason, select MEP
• Select Save
• Select Assess and address any errors under Message Log on the (SWE) screen
• Select Assess to go to the Entitlement (ELD) screen. If the customer is entitled to arrears, check the correct amount is being paid
• Select Finish to finalise the activity
• Record details in a DOC

Procedure ends here.

If the equipment user dies and they are not the EMEP customer:

• Record the death action on their (equipment user’s) record
• An automatic reassessment occurs for the EMEP customer
• If the deceased was the only qualifying equipment user:
• EMEP will cancel NUE - no eligible equipment users

If the EMEP customer dies and they are the equipment user:

• Record the death action
• EMEP will cancel DEA - Death/Executor information

If the EMEP customer dies and they are not the equipment user:

• Record the death action
• EMEP will cancel DEA - Death/Executor information
• If the person notifying of the EMEP customer’s death is the equipment user, advise them they may still qualify for EMEP and to lodge a new claim

See Table 2 > Step 2.

If the equipment user temporarily enters a hospital/prison/care facility:

• Select MEMQ - Medical Equipment User Qualification
• Key start date
• Select applicable Eligible indicator: No
• Select Ineligibility reason. For example, if they are in hospital or in prison
• Select Save
• Update:
• Receipt Date
• Channel
• Service Reason - MEP
• Select Save
• Select Assess and address any errors under Message Log on the (SWE) screen
• Select Assess to go to the Entitlement (ELD) screen
• Select Finish to finalise the activity
• Record details on a DOC

Procedure ends here.

If correcting a customer's address, EMEP will auto cancel.

If EMEP has been cancelled and the customer has not moved address, create a manual review on the Review Registration (RVR) screen in Process Direct. Update 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

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

To finalise the transaction:

• Select Assess
• Clear any warnings or errors showing on the SWE screen.
• Check ELD reflects the correct circumstances
• Select Finish
• If a checklist of scans shows, mark as complete using the tick boxes to close scans off the customer’s record

Has EMEP cancelled Not in Australia (NIA)?

• Yes, go to Step 3
• No, go to Step 4

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

In Process Direct activate the Department of Home Affairs datalink for the date of return on the Carer record.

Once link is established, restore the payment through the BA screen:

• Select Add
• Select MEP - Medical Equipment Payment in the Benefit Type Code
• Select RES - Restore
• Select Date of Effect, key date of the original claim
• Select Save
• Update:
• Receipt Date
• Channel
• Service Reason - if the system does not select a default Service Reason, select MEP
• Select Save
• Select Assess and address any errors under Message Log on the (SWE) screen
• Select Assess to go to the Entitlement (ELD) screen. If the customer is entitled to arrears, check the correct amount is being paid
• Select Finish to finalise the activity

Go to Step 4

Record details of the reassessment on a DOC.

An automatic letter is issued advising the result of the change of circumstance.

For cancellation reason OTH, a manual letter (Q999) is required. Note: OTH should only be used as a final option where no other cancellation, suspension or change in circumstance coding is appropriate.

Where required, advise the customer or equipment user to make a new claim, see Claiming Essential Medical Equipment Payment (EMEP).

Has EMEP cancelled due to death of an equipment user, carer or customer?

• Yes, in Customer First:
• Create an EMEP Bereavement - Cancellation advice and issue to executor/estate, see Letters and electronic messaging sub site
• Record details of Q999 issued in DOC
• Procedure ends here
• Note: XCANMEPNQR advice will be deleted from the BLST screen by EMEP Program team
• No, procedure ends here