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

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 enquires 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

Cancel the claim activity as Fred is already current with a valid anniversary date and is claiming for the same 2 items of essential 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.

6

Customer claims EMEP as equipment user and is rejected NMN

George submits a claim for EMEP.

George does not provide confirmation from a Treating Health Professional (THP) he is required to use a nebuliser daily and a request for information is issued. The claim is held for 21 days.

After 21 days, the claim is rejected for reason NMN as George has not provided the required information.

George receives correspondence that his EMEP claim has been rejected and contacts Centrelink within 13 weeks of the rejection notice. A Service Officer explains that George was required to provide confirmation of the condition from the THP. George provides this information within 13 weeks of the decision to reject the claim. George’s original EMEP claim is re-opened for assessment of qualification to EMEP.

Note: EMEP claims may be reassessed where all outstanding requested documents have been provided within 13 weeks of the rejection notice.