As of 27 February 2017, funding for a home care package follows the care recipient.
Care recipients can choose the provider who best meets their goals and needs, and change providers if they wish.
If they change providers, any unspent amounts (less the exit amount) in their package follows them to the new home care provider.
You need to know
Increasing Choice in Home Care reform
There is a consistent national approach for how home care packages are assigned to eligible care recipients through My Aged Care.
Aged Care Assessment Teams (ACATs) approve care recipients for home care at a specific package level – 1, 2, 3 or 4.
The process for becoming an approved provider will be streamlined including:
- approved providers of residential care and flexible care can apply to provide home care through a specific application process
- approved provider status will no longer lapse after 2 years
- approved providers no longer need to apply for home care places through an Aged Care Approvals Round (ACAR) - they can adjust the services they offer to meet demand across different service areas and home care package levels
What’s not changing under the reform
- Existing care recipients receive services at their current home care package level
- Fee and income testing arrangements remain unchanged
- Claims and payments are made through the existing Aged Care Payment System
- Home care subsidy and supplements are paid to you and not directly to care recipients
- Packages are delivered on a consumer directed care basis
- You need to meet relevant quality and accreditation standards
- The total number of home care packages across the country is still capped
- You need to send us an Aged Care Entry Record (ACER) within 28 days of a client starting their home care package – it’s important to send us the ACER early to reduce the chance of a client having their home care package withdrawn
Changes to claiming
There are no changes to how you submit claims and receive payment for home care services provided. You can still use the existing online or paper channel to submit your claim.
Your existing care recipients (as at 26 February 2017) are automatically assigned packages. This is visible to you and the care recipient, and ensures payment continues without any action from you or your care recipients.
Read more about claiming for home care services on the Department of Health website.
Care level transfer
From 27 February 2017, you no longer need to submit a change in the level of care for a care recipient when claiming. The information is sent to us electronically after the ACAT assessment. The Department of Health (Health) sends any later level of care changes through the My Aged Care system.
The existing process applies for care recipients who change care levels before 27 February.
The paper and electronic claim forms have been updated so you can record the Commonwealth portion of the unspent home care amount to be returned. You can record a dollar and cents amount or zero.
Other changes to the claim form include the removal of reporting individual care recipient care levels, and carer status.
Helpful claiming information
You don’t need the referral code to claim payments. The referral code is only used to assign a package to a care recipient so providers can get the appropriate funding.
The aged care payment system recognises the existing provider and service IDs, and the existing care recipient ID that is currently used for claiming purposes.
Organisation with a number of discrete service IDs
There’s no change to how you claim for your services. Care recipients with an approved package at each service are aligned to the service IDs that are used now.
When you enter into a Home Care Agreement with a new care recipient, you need to align them with an existing service ID within your organisation.
Withdrawn home care packages
You won’t be eligible for payment if a care recipient’s home care package is withdrawn.
We are sent a message from Health to tell us the package has been withdrawn.
You’ll be paid any retrospective payments or adjustments for eligible events which occurred while the care recipient was still assigned a package and in your care.
Care recipients without an assigned home care package
You can only claim for care recipients with an assigned home care package. You can discuss Home Care agreements with care recipients before they have their package assigned.
Under the new arrangements care recipients have 56 days - with the option for a 28 day extension - from being assigned a home care package to enter into a Home Care Agreement with their preferred provider.
Residential care providers
Existing residential care providers who become approved home care providers after 27 February 2017 need to use a separate claiming process for home care.
If you’re registered for Online Claiming, you don’t need to register for Aged Care Online Services. You can log on using the same user ID and password. You need to select either the ‘Home Care’ or the ‘Residential Care and ACAT’ system.
Revised Viability Supplement scoring matrix
The new Viability Supplement scoring matrix was introduced on 1 January 2017. There are no changes to your claiming process. You just need to tell us your care recipients’ location details when they enter care or change location.
Read more about the Aged Care Viability Supplement for care providers.
Contact the aged care enquiry line if you have any issues with your claim.
The payment statement shows the returned Commonwealth unspent home care amount.
The recovered amount is listed as ‘CW Unspent Amount’. It’s visible:
- in the body of the payment statement as a Payment Type adjustment for the reported care recipient and period, and
- on the summary page as a total amount
If there are no unspent amounts for the claim period, the CW Unspent Amount is blank.
You can access your payment statement using Aged Care Online Services.
You’ll receive a monthly advance payment. There are no changes to the calculation and payment of claims for existing and new home care providers from 27 February 2017.
Information from Health is used to calculate the advance for new home care providers from 27 February 2017.
Reporting changes to events
There are no changes to how you report events. There are no new leave or departure types.
You don’t need to tell us of any changes to a care recipient’s level of care as the information is provided from Health through My Aged Care. If the care recipient changes care level before 27 February 2017, the old process applies.
You need to tell us within 31 days if a care recipient ceases care. You need to tell us the care recipient’s name, their cessation day, and the reason for their departure through the Aged Care Payment System.
If a care recipient leaves home care or passes away, you have 70 days to report the Commonwealth portion of the care recipient's unspent home care amount (including if the amount is zero). Read more about unspent home care amounts on the Health website.
If a care recipient decides to change providers, their unspent home care package funds (less any exit amount) moves with them to their new provider.
You need to discuss the care recipient’s needs and mutually agree on a departure day. You need to provide care up until the departure day.
Under the Charter of Care Recipients’ Rights and Responsibilities - Home Care, care recipients have a responsibility to tell providers and their staff of the day they intend to stop receiving home care services, before they change providers. Care recipients have the right (under the Charter) to choose their provider, and to change providers if they wish.
It’s important you agree on a departure date with your care recipient. This defines the period you can claim home care subsidy for. It also lets you reconcile the care recipient’s home care package funds accurately and calculate any unspent amounts you may need to transfer to their new provider.
Read more about changing home care providers on the Health website.
Unspent home care amount
The unspent home care amount is the total amount of home care subsidy (including any supplements) and home care fees paid (for the period of care) to an approved provider for a care recipient, that have not been spent or committed for the care recipient’s care.
The unspent home care amount is calculated for the period between:
- 1 July 2015, or the date on which the care recipient started receiving home care with your organisation – whichever is later, and
- the date on which your organisation ceased providing home care to the care recipient – the departure (or cessation) day
Read more about managing unspent home care amounts on the Health website.
If a care recipient leaves home care or passes away, you have 70 days to tell us the Commonwealth portion of the unspent home care amount (including nil amounts) through the usual claims process. The Commonwealth portion is recovered in future home care subsidy payments, or through a debt notice.
Calculating the unspent home care amount
You can find step by step instructions on how to calculate unspent home care amounts in the amended User Rights Principles 2014 available from the Federal Register of Legislation.
Examples for calculating unspent home care amounts are also available on the Health website.
Any home care fees paid in advance aren’t included in the calculation of the unspent home care amount and must be separately refunded by the provider. Also, home care subsidy isn’t paid for the care recipient's departure day.
Factsheets and other resources are available for home care providers and care recipients on Health’s website.