18.104.22.168 CA - care load reviews - CA (child) only
This topic explains care load reviews for CA. This topic covers the following:
- purpose and timing of reviews
- exemption from care load reviews
- form of review
- review of combined scores (1.1.C.200) of 2 children
- multiple care receivers
- qualifying parent/carer reviewed, and
- loss of qualification in review of shared care.
Purpose & timing of reviews
Care load reviews (CA) comprehensively review the care required by the care receiver and provided by the carer to determine whether the carer remains qualified for payment under the DCLA (3.6.12).
A delegate can review CA recipients under the simpler review regime that applies to recognised disabilities (1.1.R.90).
Care load reviews (CA) occur within 12 months of a child reaching each new developmental milestone conducted at:
- 4 years 8 months
- 10 years, and
- 13 years.
Exemption from care load review
If CA was granted less than 12 months before the scheduled review date the carer is exempt from review. There is NO exemption from review, however, if an abridged claim was completed for CA because of a change of care.
Form of review
The review is a request to the recipient and THP (1.1.T.170) to complete a set of questionnaires used by the DCLA to assess whether the carer remains qualified for payment on the basis of meeting care requirements.
Review of combined scores of 2 children
When CA is only payable because of the combined DCLA scores of 2 children (22.214.171.124), care load reviews for each of the children should be conducted at the same time. A parent/carer can have their other child reviewed before their payment is cancelled if CA ceases to be payable after a review of one child because the:
- combined ACL score is no longer +85 or higher, OR
- THP score for either child is no longer above zero.
Multiple care receivers (CA)
Where a carer qualifies for CA (child) for more than one child (i.e. each child qualifies the carer for CA (child) in their own right) they are only reviewed together if the other child/ren is/are within 6 months of the next mandatory milestone review.
Qualifying parent/carer reviewed
Generally, the person who was granted first is the only one reviewed when CA is shared between 2 parent/carers. If both parent/carers were granted at the same time the person who provided the qualifying DCLA questionnaires is reviewed. The review outcome applies to both parent/carers.
When the outcome results in a loss of qualification:
- both parent/carers have the right of appeal, AND
- either may provide new medical information.
Loss of qualification in review of shared care
If a periodic review (1.1.P.190) of shared care CA results in the loss of qualification, both claimants can appeal at the same time and provide new medical information from their respective THPs. The following table shows the treatment of claims under several scenarios.
|If the DCLA scores are …||then …|
|BOTH qualifying||both parents should be re-granted using the lower of the 2 scores.|
|BOTH disqualifying||each parent's claim is reassessed according to their own score.|
one each of:
|the case is referred to the Senior Medical Adviser at Health Services Australia for an independent assessment.|
If only one person appeals, and is successful, the decision to re-grant applies only to that person, and CA is paid at the maximum rate. A new determination to share CA is required if the second carer:
- appeals at a later date, OR
- subsequently reapplies.
Act reference: SSAct section 5(1)-'parent'