What has changed so far?
Capping to Care and Package Management Fees
As of January 1st, the first changes for the year were the capping of Care and Package management fees, abolishment of exit charges and integrated pricing of third-party services (given this has already occurred it will be lightly touched on).
Care management fees have been capped at 20% of the package level whilst package management fees are now capped at 15% of the package level. Package management fees cannot be charged in monthly periods where there is no service, other than the first month of commencement, although providers are still able to charge a care management fee during these months.
The Department of Health and Ageing (DoHA) have given reminders that they will be monitoring providers throughout this transition period to ensure fees are not pushed up to the cap limits and there is no shifting of fees without reasonable grounds. Third party services charges also need to be all inclusive and transparent for the care recipient.
Care recipients will need to agree to any price increases; however, providers can reduce or eliminate costs by simply notifying the care recipient rather than the need for mutual agreement.
What to expect from July, 2024 proposed changes
Introduction
The current in-home aged care programs consist of the Commonwealth Home Support Programme (CHSP), Home Care Packages (HCP) and Short-term Restorative Care (STRC). Based from the Royal commission into aged cares recommendations the intent for change is to create one program with one assessment process that will:
enable older Australians to better understand and navigate the system
maintain clinical oversight and support with practical assistance where needed
ensure providers are funded to meet the full cost of care, while achieving value for money
be flexible for changes to the needs of older Australians
promote innovation and future investment for in-home aged care
Changes to assessment tool and process
A key recommendation has been to simplify the current in-home aged care system by introducing one program with one assessment process. The intent is for the verified assessment tool to be better aligned to older Australians care needs whilst matching their service recommendations. This will also need the flexibility to cater for changes to older Australians care needs over time.
Trials have been completed using an integrated assessment tool (IAT) during 2022, this is in the process of being further tested as a prototype assessment tool (PAT) from April to June 2023.
This new assessment tool will cover:
difficulties with activities of daily living
cognitive issues
psycho-social issues
medical conditions
frailty
home environment
Upon completion of assessment the older Australian and the assessor will jointly develop their initial support plan and upon agreement could include services that are either support at home, transition care or residential care.
Indicative model for a new program
The proposed Support at home can be further divided into Short Term Support for Independence and ongoing supports at home.
These services are not necessarily offered together but dependent on the assessed needs of the older Australian as seen below.
Short Term Support for Independence (if needed)
AND/OR
Ongoing supports at home (as required)
Short Term Support for Independence
This program has been designed to cater for older Australians who have been assessed as having short term needs or would benefit from:
Goods, equipment and assistive technology – with the DoHA looking to introduce grant funding similar to CHSP, which may also include a loan and a refurbishment scheme with additional consideration for national procurement arrangements to reduce costs
Home modifications
Short term allied health
Specialised support services for episodic support (e.g., dementia, vision and continence advisory support)
Ongoing supports at home
The ongoing support at homes program is proposed as activity-based funding (paid in arrears) with supplementary grants for a subset of providers.
The initial assessment process will determine a quarterly budget amount that is distributed with set services within an initial support plan determined between the assessor and older Australian.
Pricing
Under the proposed model older Australians will have the ability to adjust services listed in the initial support plan as their care needs change over time. There may be constraints on this such as limitations on the total amount of the budget which can be allocated to domestic assistance or home maintenance to prevent forgoing of clinical support which has been identified as beneficial to the older Australian.
The department will be working with the Independent Health and Pricing Authority to develop prices for each type of service, this will incorporate administration, travel and other costs. This will be further complemented with grants to help service providers with their fixed costs and also supplement services where there is a shortage of providers in regional and remote areas.
The quarterly budget would reset every three months with any unspent funds being forfeited for that period.
Flexibility
For additional flexibility and to cater for episodic changes to the older Australians care needs, it is proposed that there will be an additional funding pool calculated at 25% of the total cost of the client’s package. There has been feedback from providers that this should come with clear guidelines to minimise confusion and perception of unfairness between older Australians accessing these funds.
A system for client contributions will exist but are still being investigated given these are different across the current funded programs.
Feedback provided by the sector is that the current payment system does not need a complete overhaul as it has the ability to be enhanced to support monthly or more frequent payments with automatic data capture.
What else is being proposed?
The other items which will be covered in our next article include:
Older Australians gaining the ability to access multiple providers for different services
Care partners, their proposed changes of role and considerations on how to navigate when an older Australian has multiple providers
The encouragement of innovation and investment, which has referenced similar proposals to the residential sector (notably Clinical star ratings).
As always, we are here to assist, should you have any questions, please contact us at admin@assisthealthcare.com.au and be sure to subscribe to remain up to date throughout the year. Feel free to jump on our home page to see our core service offerings!
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