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New Funding Model for Residential Aged Care

Business Rules

Details of the new proposed business rules for the ACFI.

ACFI Instrument ACFI Administration - Quick Guide to Proposed Rules (from 20 March 2008)

When must I complete an ACFI ?

A Resident New to Residential Aged Care

• within 2 months but not within the first 7 days after admission—cannot submit within 28 days

A Resident Transferred from Another Facility

• if 28 days or more since leaving previous home,then as for a new resident

When a Classification Expires

• in the period one month before or one month after the expiry of an existing classification - whether RCS or ACFI

Requested by the Secretary

• Within the period specified in a notice issued by the Department requiring a resident be reappraised

When can I choose to complete an ACFI ?

You can choose to complete an ACFI Re-Appraisal in the following circumstances:

• if there has been a "major change" in the resident"s care needs
• if the resident has transferred from another facility within 28 days and the existing classification does not reflect their current care needs
• any time where you are receiving no subsidy for the resident (unfunded resident)
• any time from 12 months after the current ACFI classification took effect.

When do classifications expire ?

The classification of a resident expires under the following circumstances:

• six months after admission directly from hospital
• the day prior to their return from extended hospital leave ( of 30 days or more )
• six months after their return from extended hospital leave
• on departure from the facility, except if transferring to another facility within 28 days
• six months after a re-classification on the grounds of a "major change" in their care needs

"Major Change" Re-Appraisal

Under the ACFI, a major change is defined as any increase of two levels. This increase could occur as a change of two levels within one domain, or as a one-step increase in two or more domains - as long as there are two increases.
Exception: Where the resident is categorised as High on Activities of Daily Living (ADLs) and Medium on Complex Health Care, a reappraisal may be submitted at any time to reclassify the resident to High in Health Care.

This is permitted even if there is no change in the Behaviour levels.
Note: Classifications under the major change provision expire after 6 months

Documentation Requirements

The documentation and evidentiary requirements will be contained in the ACFI User Guide and Chapter 5 of the Residential Care Manual

Low and High Care

Aged Care Assessment Teams/Services will continue to approve clients for residential care, including limiting the approval for some residents to low care.

The subsequent ACFI appraisal by the home will result in an ACFI classification which will be considered a high or low level of care. The conditions for high care are:

• a score of High in the ADL Domain; or
• a score of High in the CHC Domain; or
• a score of High in the Behaviour Domain together with a score above Nil in at least one of the ADL or CHC domains; or
• a score of Medium or High in at least two of the three domains.

Where the ACAT approval is for low care, the rate of subsidy paid cannot exceed a specified amount.

This will apply until either:

• a new ACAT assessment has been completed;
• a Review Officer classifies the resident at an ACFI level equivalent to a high level of care following a review; or
• the resident “ages in place” (i.e. a valid reappraisal or a major change in classification is accepted).

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Payments Pending Classification

As per current arrangements, if the ACAT approval is limited to low care, no subsidy will be paid until the ACFI Appraisal is received.

Otherwise, the facility will be paid a fixed amount (to be specified) until the ACFI Appraisal is received.

Respite Care

Respite care subsidies will be paid at fixed rates for respite high or respite low.

Late Applications

Where an application for classification is received after the due date:

• the classification takes effect from the date it is received
• the full/new subsidy rate is payable from the date of receipt of the application
• a reduced daily rate will be payable between the admission/expiry date and the date of receipt

The reduced fee amounts may be changed from time to time as determined by the Minister but will initially be a $25 reduction in the daily rate (but not less than $0).

Where an application for classification is lodged more than 3 months after the appraisal period (i.e. 5 months after admission, or 4 months after expiry):

• the resident will be deemed to be classified at the lowest classification level for the period from the date of entry/expiry to the day prior to the date the application is received
• the classification takes effect from the date the application is received
• no subsidy is payable for the period between the date of admission/expiry and the day prior to the date the application is received.

Other Supplements & CAP

Arrangements relating to other supplements (e.g. oxygen, enteral feeding, payroll tax) will remain unchanged.

The Conditional Adjustment Payment (CAP) will continue to be paid as a percentage of Basic Subsidy. Basic Subsidy comprises the total amounts paid under the ACFI for ADLs, Behaviour, and Complex Health Care.

Transition Arrangements

Special Time Periods

Where a resident enters residential aged care in the period from 20 March 2008 up to and including 19 April 2008, the application for classification may be lodged up to 3 months from the date of entry.

Where the RCS classification of an existing resident is due to expire in the period from 20 March 2008 up to and including 19 April 2008, the application for classification may be lodged up to 2 months after the expiry date.

Note: Where the classification for an existing resident, who has been assessed under the RCS rules in the Classification Principles, expires prior to 20 March 2008, an RCS reappraisal is required as per existing rules.

"Grand-parenting" Arrangements

If a resident"s RCS classification has expired, but the ACFI appraisal would result in a rate of subsidy that is less than $15 above the existing RCS rate, the subsidy for that resident will continue to be paid at the existing RCS rate. This is referred to as the "RCS Saved Rate"

When does the subsidy for a resident move from the RCS to being ACFI funded ?

• When their RCS Classification expires; AND the subsidy resulting from the initial ACFI appraisal is $15 or more above the existing RCS rate. This same rule would also apply to subsequent ACFI Reappraisals.
• When there is a "major change" in their care needs. For the purposes of changing from RCS funding to ACFI funding, the requirement is that the ACFI subsidy is $30 or more above the existing RCS rate.

ACFI Validation / Review Program

A different approach to classification validation will apply under the ACFI. Most validations will be conducted along the following lines.

The validator will conduct a "desk audit" on site at the aged care home. This will check the completeness and accuracy of the ACFI appraisal packs for a sample of residents.

As a second step in the desk audit the validator will check the level of congruence between the checklists and supporting documentation enclosed in the ACFI Appraisal Pack (e.g. the ACCR, the medication chart and diagnoses). Validators will usually ask to meet and observe the resident.

Where there is incongruence, the validators may seek further information through interviewing staff, assess the resident"s impairment using simple task assessments or undertake a re-assessment using ACFI assessments such as thePsychogeriatric Assessment Scales (PAS) to confirm that the classification is correct.
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