22.214.171.124 Assessment of CP claim - medical evidence
Medical evidence - adult care receiver aged 16 years & over
Medical evidence (1.1.M.110) about the care receiver (1.1.C.20) is used to determine whether the care receiver's need for constant care will qualify an applicant for CP. The information must be in the form of a professional questionnaire which is completed by the THP and forms part of the ADAT.
Medical evidence - child care receiver aged under 16 years
If a person makes a claim for CP (child), for a care receiver aged under 16 years, a professional questionnaire must be completed by a THP for each child in respect of whom CP is being claimed.
Note: If a person makes a claim for CP (child) for a child with a terminal condition (126.96.36.199), a medical practitioner must certify the child has a terminal condition and the average life expectancy for a child with the same or a similar condition is not substantially longer than 24 months.
Act reference: SSAct section 197E Qualification-child who has a terminal condition
Additional carers (adult & child care receivers)
An additional medical assessment is NOT required in cases where a second carer claims CP in relation to a care receiver who has already qualified a carer for CP. Qualification for the second carer is established on the basis of the care they provide, as detailed in the carer questionnaire they must complete, combined with the medical evidence already available.
For an adult care receiver to qualify more than one carer for CP (adult), they must have been assessed and rated under the ADAT and given a score of at least 80, being a score calculated on the basis of a total professional questionnaire score of at least 32.
For a child care receiver, a THP must certify a specified number of carers required to provide personal care to the care receiver.
Act reference: SSAct section 197B Qualification-child with a severe disability or severe medical condition, section 198 Qualification-disabled adult or disabled adult and dependent child
Policy reference: SS Guide 188.8.131.52 Qualification for CP
Who can provide medical evidence?
Medical evidence would generally be provided by the care receiver's treating doctor but may be provided by any THP from the approved THP list CP (adult) or the approved THP list CP (child) (1.1.T.170).
Example: In a remote area, a medical report from another doctor such as a doctor of the Royal Flying Doctor Service, the Aboriginal Medical Service, or a Community Health Centre would be acceptable.
Note: For CP purposes, if a person makes a claim for a child or an adult with a terminal condition, a medical practitioner must certify that the child or adult has a terminal condition. Claimants should be advised that if there is likely to be an unavoidable delay in obtaining a THP assessment, they should contact Services Australia to arrange an extension of time to submit the HPA (adult) or professional questionnaire (child).
Who pays for the medical assessment?
The cost of medical examinations or reports completed by a THP for the purpose of claiming CP is the responsibility of the claimant. However, the cost of a consultation may be claimed through Medicare if the medical assessment was completed during a consultation in which an examination of the care receiver occurred.