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

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Alternative names > for Essential Medical Equipment Payment (EMEP)

Essential Medical Equipment Payment

Forms by code for individuals > SA449 and SA450

Forms

Claim for Essential Medical Equipment Payment (SA440)

Claim for Essential Medical Equipment Payment - Multiple Claim (SA451)

Medical Practitioners - Essential Medical Equipment Payment - Medical confirmation (SA449)

Essential Medical Equipment Payment - Equipment User Declaration (SA450)

Eligibility scenarios

Table 1

Item	Description
1	Respirator and a feeding pump used at home Alice provides care for partner Eric at their home and lodges a claim for EMEP. With the claim, Alice provides confirmation from their Doctor that Eric requires the use of a respirator and a feeding pump. Alice meets other EMEP eligibility criteria and is paid 2 EMEPs when the claim is processed, 1 for each item of essential medical equipment used. Alice does not need to claim again to receive 2 EMEPs each subsequent year for the use of the same 2 items of essential medical equipment at the same residence. Alice is paid every 12 months on the anniversary date of the initial grant date, provided nothing has changed that results in ineligibility.
2	Additional heating/cooling required after a stroke Mary has had a stroke and partner Tom asks about claiming an EMEP for heating/cooling costs at their home. Tom claims EMEP due to providing ongoing care for Mary. Tom provides confirmation from their Doctor that Mary has had a stroke that has resulted in an inability to regulate body temperature. Tom meets other EMEP eligibility criteria and is paid an EMEP when the claim is processed. Tom does not need to claim again to receive an EMEP each year for medically required heating/cooling at their current residence. Tom is paid every 12 months on the anniversary date of the initial grant date, provided nothing has changed that results in ineligibility.
3	Equipment user lives in different residences during the year An elderly parent lives with 2 family members at different residences during the year and uses medically required heating/cooling at each residence. The family member or the elderly parent contributes to paying the energy account at each residence. In this scenario, either the family members or the elderly parent may claim and be eligible for an EMEP at each residence. Up to 2 EMEPs can be paid every 12 months for the same medical equipment or for medically required heating/cooling at 2 different residences. The family members could each be paid an EMEP as a carer of the elderly parent at their home during the 12 month period. Separate claims would be required for each residence, and the elderly parent would need to be at the residence on the date the claim is made The elderly parent could be paid an EMEP at each residence in a 12 month period. They would need to lodge a new claim upon moving to a different residence, as this will cancel EMEP eligibility at the current residence Once EMEP eligibility has been established for the elderly parent for a medical equipment item and/or medically required heating/cooling, that evidence is not required again. EMEP is paid every 12 months on the anniversary date of the initial grant date, provided nothing has changes that results in ineligibility.
4	EMEP anniversary date John claims EMEP on 1 July 2021 due to using a home respirator. John provides proof of medical needs with the claim. John is paid an EMEP on 3 July. An anniversary date is set up so that EMEP will be paid automatically on 1 July 2022 if John is still using a home respirator at the same residence and meets EMEP eligibility requirements on that date. Change of address If John were to move to a different residence, the EMEP would automatically cancel. John would need to lodge a new EMEP claim to receive an EMEP for the use of a home respirator at the new address. If John advises a change of address on 1 October 2021 and lodges a new EMEP claim on the same day, another EMEP could be paid and a new anniversary date would be set up to pay an EMEP on 1 October 2021 (because the anniversary date set up with the previous claim will no longer apply).
5	Equipment user submits a duplicate EMEP on either side of the financial year Fred lodges the first claim for EMEP on 10 June 2020. Services Australia grants the claim for 2 items of medical equipment. The anniversary date is set as 10 June 2021. The 12 month count starts from the grant date of this original claim. While EMEP is current (CUR), the payment will: automatically issue for the 2 items of equipment in 12 months on 10 June 2021 (anniversary date), and continue to automatically pay every 12 months on 10 June until Fred loses qualification. Fred does not need to reclaim each year Fred lodges another claim for EMEP on 3 July 2020, however: there are no change in circumstances, and the claim lists the same 2 items of medical equipment If an EMEP is not payable due to the lodgement of a duplicate EMEP claim, see Processing Essential Medical Equipment Payment (EMEP) claims.

EMEP Bereavement scenarios

Table 2

Item	Description
1	EMEP equipment user has died before 12 month anniversary payment Customer was receiving EMEP on behalf of the equipment user. The equipment user died on 16 April 2022 with the Death notified on the 26 April 2022. EMEP 12 month anniversary date was 1 July 2022. EMEP automatically cancels on 27 April 2022 upon death action of equipment user as no other EMEP is payable to the customer. Cancellation reason NHC - No concession card entitlement. As it would be inappropriate to send an automatic cancellation advice, a manual Q999 is required. EMEP Q999 Bereavement - Cancellation advice to be created from the Letters and Electronic messaging sub-site.
2	EMEP customer died before new claim is finalised Customer submitted an EMEP online claim on 7 March 2022 as the equipment user. Customer did not supply SA449 medical information with claim and request to provide information was issued on 19 March 2022. The customer died on 31 March 2022 and Death was notified on 3 April 2022. Customer did not provide requested medical information before their death. EMEP claim was rejected on 20 April 2022 for reason NMN - No acceptable medical evidence. As it would be inappropriate to send an automatic cancellation advice, a manual Q999 is required. EMEP Q999 Bereavement - Rejection advice to be created from the Letters and Electronic messaging sub-site.
3	EMEP customer change of residential address Customer in receipt of EMEP. Customer notified a change of address on the 14 March 2022, EMEP was cancelled for the reason MOV - Moved from claim address, claimant. EMEP held letter generation was as a result of a change of residential address. EMEP held letter is XCANMEPNQR. EMEP cancellation does NOT relate to a new claim. EMEP cancellation is partly related to a Bereavement event and was held by the system. In this example the held letter would not be deleted from the BLST screen in CF as the bereavement event was the persons partner. Letter will be released. Customer has not re-applied for EMEP and will need the letter to be issued as a reminder to re-apply for EMEP at their new address.

EMEP assessment screens

Table 3: EMEP screens in Process Direct