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8.3 Investigating a claim for attendant care services
Making a claim for attendant care services
Claims for attendant care services must be investigated with reference to whether the services are reasonably required by the client and to ensure that the need for the services are due to the client’s service related injury or disease. Claims must be supported by documentary evidence from the client’s treating doctor, other suitably qualified medical or allied health professional or rehabilitation service provider.
From 29 May 2017, all new attendant care services claims will need to be managed through a specific services plan using R&C ISH processing.
Attendant care services and the National Disability Insurance Scheme (NDIS)
Attendant care services can be provided by both DVA, through a specific service plan, or by the NDIS, through an individual care plan. Where DVA clients are accessing support through the NDIS, they can choose which of these options suits them best. However, an important principle is that the same attendant care service must not be provided by both NDIS and DVA. Therefore, it is important for Rehabilitation Coordinators to advise Occupational Therapists or other allied health professionals undertaking assessments for attendant care services, that they should:
- ask the client whether they are receiving any services or equipment from the NDIS;
- provide details of any services or equipment being provided through the NDIS;
- explain to the client that they cannot receive attendant or personal care services through both the NDIS and DVA; and
- document that they have made the client aware that they cannot receive the same services through both DVA and the NDIS.
Assessment for attendant care services
Where a delegate is not satisfied they have sufficient information upon which to base a decision that a person requires attendant care services, a further assessment should be arranged by an independent and qualified medical professional or rehabilitation service provider with specialist skills, such as a contracted Community Nursing Program Provider or Occupational Therapist with specific expertise (for example in assisting people with brain injury or mental health issues).
For guidelines about referring a client for an activities of daily living assessment, please refer to chapter 8 of the Rehabilitation Procedures Guide.
The amount of compensation payable for attendant care is capped by a statutory limit which is indexed as at 1 July each year, by reference to the Consumer Price Index. Details of the maximum attendant care limits are available in the current payment rates chart in the CLIK Compensation and Support reference library. The MRCA limit is listed on the MRCA Rates and Allowances page. The SRCA limit is listed on the SRCA and Defence Act payments page.
Rehabilitation Coordinators must not approve attendant care services in excess of this statutory limit.
Note: Some persons, who are eligible for attendant care services, may also qualify for household services. In such cases, they may be entitled to payment up to the statutory limit for both attendant care services and for household services. In other words, the statutory limits that apply to both are mutually exclusive.
Payments of a similar nature
Attendant Allowance under the Veterans’ Entitlements Act 1986
Attendant Allowance is paid under the VEA to support veterans with the costs of an attendant to assist with activities of daily living. The allowance is payable to veterans with conditions accepted under the VEA including blindness, amputations and injuries to the cerebro-spinal system.
Delegates must be mindful of the principle that clients should not be receiving, or being paid to access, the same services under different Acts. Therefore, where clients receiving attendant allowance request attendant care services under the MRCA or DRCA, delegates must consider whether attendant care services are reasonably required because of the client’s MRCA/DRCA accepted conditions.
Community nursing services may also be considered where attendant allowance is insufficient to meet the client’s needs due to their VEA conditions.
Carer Payment under the Social Security Act 1991
In cases where a person is receiving a Carer Payment from Centrelink, this does not preclude eligibility for Attendant Care services under the MRCA or SRCA. That is, a person can be receiving a carer payment and attendant care services at the same time. However any person being paid to provide attendant care services under MRCA or SRCA, should advise Centrelink as it may affect their Social Security payments, including carer payment. For example, if the partner or family member of a DVA client is being paid a carer payment by Centrelink and they receive attendant care payments from DVA, they must advise Centrelink that they are receiving attendant care payments. These clients should be aware of their obligations under Social Security Law.
Nursing care needs
Where clients have complex or high care needs, an assessment of their care needs should involve the Community Nursing Program. The Rehabilitation Policy Section works closely with the Community Nursing Program to jointly assess these clients to ensure that the client’s care requirements are met in a coordinated way using best practice principles, and properly accredited care providers. This approach allows tailored approaches delivering high levels of care to be developed where needed. If delegates are aware of clients who require high levels of nursing and/or attendant care services in excess of the statutory limit, due to their accepted conditions, please contact the Rehabilitation Policy section through firstname.lastname@example.org.
Where a client's conditions are such that they are likely to require nursing care, as well as personal care and/or household services, a Clinical Nurse Consultant recommended by DVA's Community Nursing Program may be utilised to conduct a detailed assessment of the person's needs and make recommendations about the type and level of services that they require. In this context, a Clinical Nurse Consultant can be regarded as having the appropriate skills and experience to provide evidence to inform attendant care determinations.
Veterans’ Home Care Program
Personal care services through the Veterans’ Home Care Program (VHC) can be considered to fill any gaps in service provision when:
- the required services cannot be provided using the Safety, Rehabilitation and Compensation Act 1988 (SRCA) and Military Rehabilitation and Compensation Act 2004 (MRCA) provisions, as the need is not related to the client’s accepted conditions; and
- the client holds a DVA Health Card; and
- a VHC assessment confirms that the services can be provided.
Further information about the VHC can be found in section 8.9 of this chapter.
Provision of attendant care services outside Australia
When a person moves overseas and requests assistance with attendant care services, the same decision making principles should be followed. The person should still be asked to provide supporting documentation from their treating doctor, specialist or allied health provider, to enable a decision to be made about the reasonableness of the level of support that the person is seeking. Information about reimbursements for attendant care services payments for clients living overseas can be found in section 8.6 of this Guide.
Approval and review procedures for attendant care services
The process for approving new claims, and reviewing and renewing existing claims for attendant care services are outlined in Section 8 of the Rehabilitation Procedures Library.