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New Funding Model for Residential Aged Care

ACFI Frequently Asked Questions

Frequently asked questions relating to the Aged Care Funding Instrument

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PDF printable version of ACFI FAQ's (PDF 174 KB)

How to use these FAQs
Questions Relating to ACFI Components
ACFI Assessments – General Questions
Diagnoses – General Questions
ACFI 1 - Nutrition
ACFI 2 - Mobility
ACFI 4 - Toileting
ACFI 5 – Continence
ACFI 6 - Cognitive Skills
ACFI 7, 8 and 9 - Behaviours
ACFI 10 – Depression
ACFI 11 - Medication
ACFI 12 - Complex Health Care
ACFI Documentation
Business Rules and Operation
Grandparenting
High Care and Low Care
Extended Hospital Leave (EHL)
Transfers
Ageing In Place and ACAT Approvals
Training
Other Issues
Applications for Classification and Payments Processing

How to use these FAQs

Getting the most out of these FAQs

This set of Frequently Asked Questions has been compiled primarily from questions asked by residential aged care providers. The answers frequently make reference to the ACFI User Guide, the ACFI Assessment Pack or the ACFI Answer Appraisal Pack. It is recommended that these documents are also kept close at hand when reviewing the content of this document.

Organisation of the Questions and Answers

Questions that relate specifically to one of the twelve ACFI Questions are grouped together as are questions relating to the mental and behavioural or medical diagnoses. Other groupings of questions relate to topics such as applications for classification and payment processing, documentation and business rules.

Focus of the ACFI

The basic approach of the ACFI is explained on page 2 of the ACFI User Guide as follows:

The Aged Care Funding Instrument (ACFI) is a resource allocation instrument. It focuses on the main areas that discriminate care needs among residents.

The ACFI focuses on care needs related to day to day, high frequency need for care. These aspects are appropriate for measuring the average cost of care in longer stay environments.

While the ACFI questions provide basic information that is related to fundamental care need areas, it is not a comprehensive assessment package. Comprehensive assessment will consider a broader range of care needs than is necessarily required in a funding instrument.

This approach is fundamental to the operation of the ACFI and needs to be kept in mind when reading this additional material.

Where can I get further information?

For further information you can contact either the Department of Health and Ageing or Medicare Australia depending on the nature of your enquiry.

• For ACFI business rules and funding enquiries contact the Department of Health and Ageing by email on acfi@health.gov.au or by phone on 1800 500 853
• For ACFI Payments Processing and online claiming enquiries contact Medicare Australia on 1800 195 206
  • for ACFI payments matters – select option 1
  • for ACFI online claiming and eBusiness matters - select option 2 Top of page

Questions Relating to ACFI Components

ACFI Assessments – General Questions

Can we use a previously completed assessment for an ACFI appraisal?

Yes – in some cases. If the assessment was completed within the past six months and continues to reflect the care needs of the resident, then it may be used for the purposes of an ACFI appraisal.

Can we accept an assessment that was conducted prior to admission?

Yes – in some cases. There is no requirement that an assessment be completed by the aged care home. This means that an assessment completed by independent person, including the person’s medical practitioner or an ACAT, may be used as evidence. Note, the assessment must have been completed within the past six months and must continue to reflect the care needs of the resident.

Does the PAS-CIS assessment have to be conducted by a Registered Nurse?

No. Approved providers can allocate the responsibility to any staff member they consider to be suitably trained and/or skilled to conduct the assessment.

You should note however, that the circumstances in which an approved provider has discretion not to report allegations or suspicions of reportable assaults are specified in Part 5 of the Accountability Principles 1998. The discretion can be exercised only if, before receipt of the allegation or the start of the suspicion, the care recipient who may have committed the assault had been assessed by an appropriate health professional, such as a geriatrician, other medical practitioner or registered nurse, as suffering from a cognitive or mental impairment.

Does the Cornell assessment have to be conducted by a Registered Nurse?

No. Approved providers can allocate the responsibility to any staff member they consider to be suitably trained and/or skilled to conduct the assessment.

Do we have to use the charts/logs/diaries/records provided in the ACFI pack?

No. However, continence and behaviour charts other than those in the ACFI pack can only be used if they record the same information and use the same codes as the versions in the ACFI Assessment Pack and the recording was undertaken in the past six (6) months and they continue to reflect the care needs of the resident.

If they do not meet this requirement, but do contain sufficient detail then the information can be transcribed into the ACFI Assessment Pack from the provider’s existing records so long as the recording was undertaken in the past six (6) months, continue to reflect the care needs of the resident and provide all the necessary information to complete the specific ACFI record.

If the existing records do not contain sufficient detail, the ACFI records must be completed independently.

Are we required to have a Comprehensive Medical Assessment (CMA) for all residents?

No. A CMA is a voluntary service for residents of aged care homes. It involves a personal attendance by the resident’s GP to undertake a full systems review, including an assessment of the resident’s health and physical and psychological function.

Information gathered during a CMA may be used as evidence to support ACFI questions. For example, diagnoses made or clinical assessments performed in the course of the CMA may be used by the approved provider as evidence of particular care needs.

A CMA should only be performed where the medical practitioner believes it is appropriate and it complies with the Medicare Benefits Schedule guidelines. Please refer to the Medicare Benefits Schedule, Item 712, for any further detail on this matter.

Can we use assessments from the ACCR to assist with an ACFI appraisal?

Yes – in some cases. Assessments that have been conducted as part of completing the ACCR may be used as input for completing an ACFI appraisal, if they were completed within the past six months and continue to reflect the care needs of the resident. Top of page

Diagnoses – General Questions

What is the minimum requirement for a diagnosis to be accepted as evidence?

The minimum requirement for a diagnosis to be accepted as evidence is that the documentation identify the name and profession of the health professional who has confirmed the diagnosis and be dated.

Can we use diagnoses on the ACCR as evidence for an ACFI appraisal?

Yes. The ACCR may be used as a source document for diagnoses for an ACFI appraisal.

Under the Aged Care Act 1997, ACATs have the authority to transcribe a diagnosis as true and correct information where it has been made by the medical practitioner. This may include transcribing doctor/patient notes etc.

Do all diagnoses have to be less than 12 months old?

No. Only specified diagnoses need to have been made or confirmed in the twelve months prior to the appraisal.

The User Guide (page 14) specifies four Mental and Behavioural diagnoses that must be less than twelve months old including provisional diagnoses or reconfirmations of a diagnosis:

- Code 540 Delirium
- Code 550A Depression, mood and affective disorders
- Code 550B Psychoses e.g. schizophrenia, paranoid states
- Code 560 Neurotic, stress related, anxiety, somatoform disorders e.g. post traumatic stress disorder, phobic and anxiety disorders, nervous tension/stress, obsessive-compulsive disorder.
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These four disorders are the only conditions that require a diagnosis (provisional or reconfirmation of the diagnosis) to have been completed in the past twelve months.

Does each behaviour need an individual diagnosis?

No. An individual diagnosis for each behaviour is not required. Dementia or mental illness can be inclusive for these behaviours.

Can we enter additional Mental and Behavioural Diagnosis codes in the Medical Diagnoses table?

No. You can only enter Mental and Behavioural Diagnoses codes in the Mental and Behavioural Diagnosis section of the ACFI.

The ACFI User Guide, pages 13-14, sets out 10 Codes in the Mental and Behavioural Diagnosis Checklist that can be selected. Multiple diagnosis codes can be selected if a resident has more than one mental and behavioural disorder that has an impact on their current care needs for support and assistance. If there is no disorder of relevance, the first option in the checklist should be ticked (no diagnosis). Codes other than those specified cannot be used.

What are the rules with respect to a Depression Diagnosis?

The rating for ACFI 10 - Depression is limited a maximum of B unless the resident has a diagnosis of depression.

If a diagnosis is not available at the time of the appraisal, indicate on the appraisal pack that you are seeking one. This diagnosis must be sought and received within three (3) months of the appraisal date. The diagnosis must then be kept on file, as well as a copy in the Appraisal Pack and produced on request at validation.

What Medical Diagnoses Code should I use?

The primary purpose of collecting information about medical conditions is to gain an understanding of conditions that are most impacting care needs, and to support planning and research. Therefore, the conditions of most relevance are those that currently impact the care needs of a resident.

The code list used in the ACFI is the same as that used by ACATs to ensure consistency of data. For the ACFI data to be most useful, please try to record diagnosis codes as accurately as possible. If, however, you cannot find a specific code that accurately describes the condition that matches the diagnosis, please select the generalised ‘other’ option in that category.

Note: You should record the diagnosis of MOST relevance to a condition impacting on care needs, e.g. for someone who has had a leg amputation, the diagnosis choices could include diabetes (0402,0403,0404) or other malignant tumours (0211), or other traumatic amputation (leg, ankle, foot, toe) (1605) etc… In this case if the resident did have their leg amputated due to diabetes or a malignant tumour using the corresponding code (0402-0404 or 0211) would enable a better understanding of conditions that impact care needs.

My computer ACFI assessment does not have a complete listing of all the diagnosis codes. What should I do?

If your software version does not have a complete list of the diagnosis codes you will need to contact your software supplier/vendor. Top of page

ACFI 1 - Nutrition

Is hydration (fluids) included in ACFI 1?

No. The indicator selected for care needs with respect to nutrition is eating. There is a strong correlation between a resident’s need for assistance with eating and for assistance with drinking. It is not necessary to assess both to make an accurate funding decision.

Note: A resident’s nutrition and hydration needs must both be met. These remain part of the Accreditation Standards at 2.10.

Can we claim for thickened fluids (as we can for cutting up or vitamising food)?

No. You cannot claim directly for thickened fluids.

You can only claim the specific items in the nutrition checklist as they relate to the assistance that the resident would require to eat a normal meal e.g. that they would need to have the food cut up for them, or they would need to have it vitamised.

ACFI 2 - Mobility

Does Mechanical Lifting Equipment include a transfer belt?

No. A transfer belt is not a mechanical device.

This item may only be checked where the resident requires physical assistance with the use of mechanical lifting equipment for transfers.

Does Mechanical Lifting Equipment include a handi-lift belt?

No. A handi-lift belt is not a mechanical device.

This item may only be checked where the resident requires physical assistance with the use of mechanical lifting equipment for transfers.

ACFI 4 - Toileting

Can we claim for the use of a blue sheet for toileting?

Yes – in some cases. The use of a blue sheet to toilet a resident who is bed/chair bound and is physically unable to sit on the toilet is claimable under ACFI 4 - Toileting.

With an assessed need, the use of a blue sheet could be considered a kind of toilet used for a planned episode of evacuation of the bowel or bladder. This must relate to usual day-to-day care needs.

Can we claim for the use of a Kylie for toileting?

Yes – in some cases. The use of a Kylie to toilet a resident who is bed/chair bound and is physically unable to sit on the toilet is claimable under ACFI 4 - Toileting.

With an assessed need, the use of a Kylie could be considered a kind of toilet used for a planned episode of evacuation of the bowel or bladder. This must relate to usual day-to-day care needs.

Can we claim for the use of a ‘Tena’?

No. A Tena is a continence management device and is not considered under ACFI 4 as a form of toilet. Use of a Tena could be recorded under ACFI 5 - Continence.
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Can we claim for assisting a resident to maintain their colostomy products?

Yes. The emptying of drainage bags can be recorded on the Toileting Checklist under Question 2 Toilet Completion: ‘Supervision: emptying drainage bags, urinals, bedpans or commode bowls’.

You could also claim for the management of ongoing stoma care in ACFI 12 (Item 15).

ACFI 5 – Continence

Can we claim if a resident is not self-managing their own continence device?

No. A claim cannot be made under ACFI 5 - Continence if the resident is continent of urine because of their urinary catheter.

For example, if a resident has an Supra Pubic Catheter but the bag is routinely emptied by staff, this is not recorded under continence.
However, the emptying of drainage bags can be recorded on the Toileting Checklist under Question 2 Toilet Completion: ‘Supervision: emptying drainage bags, urinals, bedpans or commode bowls’. Ongoing catheter care could be claimed under ACFI 12 (Item 8).

How are the continence records completed for someone who is already on a continence management program?

It is not appropriate to withdraw any care interventions in order to complete the continence record.

If the resident is already on a continence management program then the continence assessment allows you to record ‘scheduled toileting’ as a code in the continence records.

If you are claiming for scheduled toileting (refer to the User Guide for further detail) you must provide documentary evidence of incontinence prior to the implementation of this intervention. Examples of such evidence include the ACCR, or a flowchart completed prior to the scheduled toileting being implemented.

In order to claim funding for ACFI 5 the continence records (urinary record & bowel record) must be completed.

Alternatively, if you have continence records, logs or diaries that have been completed six months prior to the appraisal you may transpose this information across to the ACFI continence records as long as it:

• reflects the resident’s current continence status at the time of the appraisal; and
• contains all the information that is required in the ACFI continence record

Where can we claim for management of constipation?

Aperients for residents can be claimed in ACFI 11 – Medication, and ACFI 12 (Item 7), where the administration of suppositories or enemas for bowel management only requires a frequency of least weekly. The documentary requirements of the ACFI must be met in each of these cases. Top of page

ACFI 6 - Cognitive Skills

Is a PAS-CIS required if the resident already has a diagnosis of dementia?

Yes. A PAS-CIS assessment is required unless it is not appropriate for one of the reasons listed in the Cognitive Skills Assessment Summary found at page 25 of the User Guide (Checklist items 6.2 to 6.6).

The diagnosis should be recorded in the Mental and Behavioural Diagnosis checklist and maintained in the ACFI appraisal pack.

How do I complete a PAS-CIS on a resident with severe cognitive impairment?

It is not appropriate to conduct a PAS-CIS on a resident with a severe cognitive impairment.

In these cases checklist item 6.2 should be selected. If a clinical report is available which provides supporting information, Checklist item 6.7 should also be selected and the clinical report included in the ACFI Appraisal Pack.

It is not necessary to include documentary evidence in the appraisal pack to support the reason given for a PAS not being conducted for a particular resident.

If a PAS was not completed, leave the PAS-CIS score field blank and instead the Cognitive Skills Checklist should be completed using the descriptions in items 1 to 4. See page 26 of the ACFI User Guide for the full details of the checklist.

How do we complete a PAS-CIS for an illiterate resident?

The PAS-CIS is designed to gather information on the major psychogeriatric disorders of residents and the questions are designed to provide results placing residents along a scale of cognitive disorders, including dementia and depression.

To support a B, C or D rating in AFI 6 Cognitive Skills, the PAS-CIS must be completed unless there are specific reasons why its use is inappropriate. If staff identify that a resident cannot use the PAS-CIS due to illiteracy, it is recorded in 6.4 .

It is not necessary to include documentary evidence in the appraisal pack to support the reason given for a PAS not being conducted for a particular resident.

If a PAS was not completed, leave the PAS-CIS score field blank and instead the Cognitive Skills Checklist should be completed using the descriptions in items 1 to 4. See page 26 of the ACFI User Guide for the full details of the checklist.
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What if a resident refuses to answer PAS-CIS questions

The PAS-CIS must be completed to support a B, C or D rating unless there are specific reasons why its use is inappropriate.

If a resident refuses to cooperate with the ACFI appraiser to complete a PAS-CIS, select Item 6.6 in the Cognitive Skills Assessment Summary "Cannot use PAS-CIS due to resident’s refusal to participate". If a clinical report is available which provides supporting information, Checklist item 6.7 should also be selected and the clinical report included in the ACFI Appraisal Pack.

It is not necessary to include documentary evidence in the appraisal pack to support the reason given for a PAS not being conducted for a particular resident.

If a PAS was not completed, leave the PAS-CIS score field blank and instead the Cognitive Skills Checklist should be completed using the descriptions in items 1 to 4. See page 26 of the ACFI User Guide for the full details of the checklist.

ACFI 7, 8 and 9 - Behaviours

Can behaviours be recorded when interventions are in place?

Existing residents with behaviour problems may have interventions in place and these will be designed to address the ongoing behavioural issues. However the frequency of the issues can still be recorded in an ACFI behaviour assessment even if the outcome for the person and staff is better managed because of the developed interventions.

Note: if a behaviour record has been completed for the resident in the last six months, you may transpose that information across to the ACFI behaviour records as long as it:

• reflects the residents current behaviour status at the time of the appraisal,
• contains all the information that is required in the ACFI behaviour records, and
• records behaviour episodes listed on page 44 of the ACFI User Guide.

Can we record behaviours that do not fit into the defined ACFI behaviour codes?

No. You can only use the codes that are defined for each behaviour record.

Can we claim for a resident who refuses to wear mobility aids and/or use their walking frame under ACFI 9 – Physical Behaviour?

No. ACFI 9 does not include behaviours where there is a risk that the person’s poor mobility or balance might lead to injury (see p. 29 ACFI User Guide).

Can we claim for a resident who ‘voids in inappropriate places’ under ACFI 9 – Physical Behaviour?

The behaviour of ‘voiding in inappropriate places’ belongs in ACFI 9 - Physical Behaviour. The appropriate code is under Physical Behaviour (Code P2) – ‘Socially inappropriate behaviour that impacts on other residents’. Note: all behavioural symptoms must disrupt others to the extent of requiring staff assistance.

Can we transcribe from behaviour records in our care system?

Yes – in some cases.

If they contain sufficient detail the information can be transcribed into the ACFI Assessment Pack from the provider’s existing records so long as the recording was undertaken in the past six (6) months, they continue to reflect the care needs of the resident and they provide all the necessary information to complete the specific ACFI record.

If the existing records do not contain sufficient detail, the ACFI records must be completed independently. Top of page

ACFI 10 – Depression

Can we use a different version of the Cornell Scale for Depression (CSD)?

No. The tool in the ACFI Assessment Pack is the tool a service must use for the ACFI.

All instructions for the user are in the one instrument. It guides the user through all modes of data collection (interview and observation) and increases the reliability of the scoring.

Can a service accept a Cornell Scale for Depression (CSD) assessment completed prior to admission?

Yes – in some cases. There is no requirement that an assessment be completed by the aged care home. This means that an assessment completed by an independent person, including the person’s medical practitioner or an ACAT, may be used as evidence. Note, the assessment must have been completed within the past six months and must continue to reflect the care needs of the resident.

Can we claim for ACFI 10 without completing a Cornell Scale for Depression (CSD)?

No. You may only claim based upon the assessed Cornell score. Note that the Cornell Scale for Depression (CSD) was specifically developed to assess signs and symptoms of major depression in residents with dementia but is also suitable for use with other residents.

How do I conduct a Cornell Scale for Depression (CSD) with the resident?

Ratings of some resident interview questions should be based principally on direct observation (i.e. anxiety, sadness, irritability, agitation, retardation). Questions to the resident can provide additional information on these items. The remaining items are scored based on interview behaviour and the resident’s response to direct inquiry.

Who qualifies as an informant for the Cornell Scale for Depression (CSD)?

Informants should know and have frequent contact with the resident. Reliable informants can include care staff for residents in the aged care home or a family member.

The informant interview should be conducted first. The interviewer should ask about any change in symptoms of depression over the prior week. The appraiser should complete each item on the scale.

How do we combine interview and observation results for the Cornell Scale for Depression (CSD)?

It is possible that there will be differences in some items between care staff observations and a resident’s responses to the scale questions. If there are discrepancies in ratings generated from the informant and the resident interviews, the appraiser should re-interview both the informant and the resident. The final ratings represent the appraiser’s clinical impression rather than the response of the informant or the resident. The CSDD take approximately 20 minutes to administer.

How do we claim if a resident is on antidepressants?

If there are remaining symptoms of depression that are impacting on the resident’s life, these can be assessed using the Cornell Scale for Depression under ACFI 10 - Depression.

If the resident needs assistance with their medication, this could be recorded under ACFI 11 – Medication.

Why won’t the webform and/or payments system give me a C rating for ACFI 10?

You probably have not entered the diagnosis of depression under the Mental and Behavioural Diagnoses section of the ACFI.

It is not enough to select option 5 under ACFI 10, indicating that "There is a diagnosis or provisional diagnosis of depression completed or reconfirmed in the past twelve months (diagnosis evidence required as per Mental and Behaviour Diagnosis)."

It is also necessary to select the 550A code under the "Mental and Behaviour Diagnosis" question.

Without the 550A code and a diagnosis in ACFI 10, a resident is limited to an A or B rating.

Can we translate the Cornell Scale for Depression (CSD) into our language so that staff could understand and apply the tool better?

You may translate the Cornell Scale for Depression into another language in order for your staff to use the tool, however the answers must be recorded in English for auditing and record keeping requirements. Top of page

ACFI 11 - Medication

When does a medication chart need to be included in the ACFI appraisal pack?

A copy of the medication chart or record effective at the time of the appraisal, must be included in the ACFI Appraisal Pack if any option other than ‘No Medication’ OR ‘Self Manages Medication’ is selected in the Medication Checklist.

How accurately do we have to measure medication administration time?

The appraiser needs to calculate how many minutes are required for medication assistance over a 24 hour period.

How do we record medication administration time when it varies from day to day?

The time taken to administer the medication for some residents may vary from day to day. In this situation, the appraiser should determine what is a reasonable representation of the person’s usual day to day care need for the administration of medication.

One-off variations in time taken should not be included.

Where there is a pattern of variation in timing, an average over several days or use of the median time taken may be appropriate.

What can be included when calculating the time taken to dispense medication?

The ACFI rating only measures time it takes to assist a resident to take their medication and with medication procedures. It does not include preparation of medications e.g. packaging or crushing. It does not include daily administration of a subcutaneous/intramuscular/ intravenous drug as these are separate checklist items. Time does include administration of prescribed creams, application of patches, etc. as specified in the ACFI User Guide.

How do we time assisting a resident to take medication via a nebuliser?

As per the ACFI User Guide page 34, assistance with medications means "either standby or to provide physical assistance or extensive prompting so that the person completes the ingestion or takes medication by route ordered".

In this situation, the nebuliser is the route ordered for the medication. The time taken does not include preparation of the medication (such as dispensing vial into nebuliser). It only includes the actual time providing assistance with taking the medication.

What do we include in the timing when a resident requires daily application of medicated patches?

ACFI 11 measures the time taken for administration of medication by the route ordered. In this situation, the time taken to apply and remove the patch would be included in this measurement.
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Can we claim for complementary medications?

Yes – in some cases.

If the medication has been ordered by an authorised health professional, is needed on a regular basis and the person requires assistance to complete the ingestion by the route ordered, the approved provider may claim on this question.
The ACFI User Guide p 34 defines medication as follows:

• any substance(s) listed in Schedule 2, 3, 4, 4D, 8 or 9 of the Standard for the Uniform Scheduling of Drugs and Poisons (and its amendments) and/ or
• medication(s) ordered by an authorised health professional or authorised for nurse initiated medication by a Medication Advisory Committee or its equivalent. This excludes food supplements, with or without vitamins, and emollients (e.g. sorbolene cream, aqueous cream, etc).

Authorised health professional means a medical practitioner, dentist, nurse practitioner or other health professional authorised to prescribe by the relevant state/territory legislation.

Does finding a resident count towards the time taken to administer medication?

No. This question only includes the actual time taken to administer the medication. It also excludes the time taken to prepare the medication.

Can we claim administering continuous syringe driver medication under ACFI 11?

No. Syringe drivers are included in ACFI 12 (Item 11) due to the complexity of the procedure which includes preparing and setting up for delivery to the resident.

Can we claim for ‘as needed’ (PRN) medications?

Yes – in some cases.

As per the ACFI User Guide (p.34), ACFI 11 Medication relates to the needs of the person for assistance in taking medications administered on a regular basis. Infrequent or irregular administration of medication(s) is not covered in this question.

A PRN medication could only be included if it meets the requirement of being administered on a regular basis.
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Are ‘over the counter medications’ (OTCs) included in ACFI 11?

Yes – in some cases.

If the medication has been ordered by an authorised health professional, is needed on a regular basis and the person requires assistance to complete the ingestion by the route ordered, the approved provider may claim on this question.

Whether or not the medication may be purchased over the counter is not relevant to the claim.

The ACFI User Guide p 34 defines medication as follows:

• any substance(s) listed in Schedule 2, 3, 4, 4D, 8 or 9 of the Standard for the Uniform Scheduling of Drugs and Poisons (and its amendments) and/ or
• medication(s) ordered by an authorised health professional or authorised for nurse initiated medication by a Medication Advisory Committee or its equivalent. This excludes food supplements, with or without vitamins, and emollients (e.g. sorbolene cream, aqueous cream, etc).

Authorised health professional means a medical practitioner, dentist, nurse practitioner or other health professional authorised to prescribe by the relevant state/territory legislation.

Is there any specific claim for S8 Medication under ACFI

No. The ACFI rating measures time taken to assist with ingestion or administration of daily medications ordered by an authorised health professional. Whether the medication is S8 or another listed substance is not relevant so long as it is included in the Medication definition.

The ACFI User Guide p 34 defines medication as follows:

• any substance(s) listed in Schedule 2, 3, 4, 4D, 8 or 9 of the Standard for the Uniform Scheduling of Drugs and Poisons (and its amendments) and/ or
• medication(s) ordered by an authorised health professional or authorised for nurse initiated medication by a Medication Advisory Committee or its equivalent. This excludes food supplements, with or without vitamins, and emollients (e.g. sorbolene cream, aqueous cream, etc).

Authorised health professional means a medical practitioner, dentist, nurse practitioner or other health professional authorised to prescribe by the relevant state/territory legislation.

Can we claim for assisting with medication via a PEG?

Yes. Note, however, that this does not include preparation time and the medication provided must be administered on a regular basis.

The time taken to administer this medication via a PEG would vary depending if it was administered by a bolus or non bolus delivery. Top of page

ACFI 12 - Complex Health Care

What are the requirements for directives?

ACFI 12 does not specify the format in which the directives are captured. The details of the procedure, and the name and profession of the person directing the procedure, must be clearly identified.

What records of complex health care procedures do we have to keep?

Where the requirements of a complex health care item include ‘on request: record’, this refers the usual record of treatment for that item. A review officer may request to see these as part of a Classification Review.

Can we claim for eye toilets under ACFI 12?

No. Eye toilets cannot be claimed under any ACFI questions.

Can we claim if pain management is not undertaken by an allied health professional or registered nurse?

This could be claimed if it meets the requirements of Item 3 - Pain Management.

Can we claim for pain management undertaken by an Aromatherapist?

This could be claimed under Item 3 - Pain Management as long as it meets the specified requirements.

With respect to item to items 4a and 4b, it depends on the therapist’s status as an ‘allied health professional’ in the relevant jurisdiction. Again, the other requirements of these items must be met i.e. a directive and an assessment.

The definition of an allied health professional for the purposes of providing a directive in ACFI 12 can be found in the ACFI User Guide (p36). Aromatherapists are not included in this definition.
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Can we assess for pain within the first 7 days?

Yes – in some cases.

The business rules for the ACFI require that a resident’s appraisal not commence in the first 7 days after the person enters care. This allows the person to settle into their new environment before a funding level is assessed.

This should not in any way restrict assessing for care planning and delivery. If the resident’s quality of life would be compromised if an assessment of a care need was not conducted (eg, a pain assessment) then the approved provider should conduct the relevant assessment immediately and commence appropriate care for that assessed need.

This assessment may be used to complete the ACFI so long as it continues to reflect the resident’s ongoing care needs during the ACFI appraisal period.

What type of equipment can be used in complex pain management?

A claim can be made in either 4a or 4b for complex pain management and practice if it involves therapeutic massage and/or pain management involving technical equipment specifically designed for pain management - see page 37 of the ACFI User Guide.

The Department of Health and Ageing does not maintain a list of included equipment as this may change without notice.

Can we claim for the management of skin integrity of residents with dementia?

No. While some residents with end stage dementia residents often sit down in one position for prolonged periods of time this does not fit the definition of complex skin integrity management in complex health care. This item relates only to residents who are confined to bed and/or chair or cannot self ambulate.

What is the definition of ‘cannot self ambulate’ in ACFI 12 item 5?

A resident cannot self ambulate if they require extensive assistance with transfers and locomotion.

Does special feeding of residents with dysphagia have to be done by an RN?

Yes. In order to claim for ACFI, this must be undertaken by a registered nurse.
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Can we claim for a resident who is self catheterising?

No.

Can we claim for recurrent Urinary Tract Infections (UTIs) under Item 9 - Management of Chronic Infectious Diseases?

No.

For the management of chronic UTIs there may be a claim in ACFI 5 – Continence, or ACFI 12 (Item 8) - Complex Health Care, or ACFI 11 - Medication if a long term antibiotic has been prescribed.

What is considered to be a Chronic Wound?

While there is no exact ruling of when a wound becomes chronic, a chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do. Chronic wounds seem to be detained in one or more phrases of wound healing. For example; chronic wounds often remain in the inflammatory stage too long. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds this balance is lost and degradation plays too large a role.

Chronic wounds mostly affect people over the age of 60.

The vast majority of chronic wounds can be classified into three categories: venous ulcers, diabetic, and pressure ulcers.

Can we claim for leg protectors under skin integrity?

Yes – in some cases.

ACFI 12 (Item 12) includes ‘protective bandaging’. Leg protectors could be claimed if the requirements of this item are met.

Is there a time limit for a palliative care programs

No.

There is no time limit specified for this complex health care item.

A Palliative care program is one involving end of life care where ongoing care will involve very intensive clinical nursing and/ or complex pain management. Top of page

ACFI Documentation

Where can we get a hard copy of the ACFI User Guide?

This document is available in PDF format from the Department of Health and Ageing’s website at: www.health.gov.au/acfi .

Where can we get a hard copy of the ACFI Assessment Pack?

This document is available in PDF format from the Department of Health and Ageing’s website at: www.health.gov.au/acfi .

Where can we get a hard copy of the ACFI Answer Appraisal Pack?

This document is available in PDF format from the Department of Health and Ageing’s website at: www.health.gov.au/acfi .

Where can we get a hard copy of the ACFI Application for Classification form?

The ACFI Application for Classification form is available in 'fillable' PDF format from the Medicare Australia’s website in the aged care forms section at: www.medicareaustralia.gov.au/provider/aged-care/.

Alternatively providers can register for Online Claiming and submit ACFI Application for Classifications via Medicare Australia’s web form facility.

Is it possible to get an editable copy of the ACFI Reference Documentation?

No. In order to maintain their integrity all ACFI Reference Documentation is only available in PDF format from the Department of Health and Ageing’s website at: www.health.gov.au/acfi .
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Are service providers able to put their own organisation’s logo on the ACFI Reference Documentation?

Modifications are restricted to essential operational requirements only e.g. inclusion of identification information. This may include identification of the resident and the service provider, in some cases represented as a logo.

Do ACFI records need to be kept when a resident departs care?

Yes. Under the Aged Care Act 1997 (subsection 88-2), an approved provider must retain the care records (including ACFI information) for any care recipient who ceases receiving permanent care for the period ending 3 years after the 30 June of the year in which provision of the care ceased.

What identification is required for online assessment records?

If an assessment form is completed online and stored electronically then there must be system processes in place to ensure that the person who ‘signed’ the form is identifiable when a classification review occurs.

For the purposes of ACFI, an electronic signature is accepted in the same manner as a hand written signature. The only requirement would be that the log of electronic signatures must be available at the time of a review of classification so that the review officer may confirm the identity of the signatory.

An audit log must also be kept as part of the data recording system to record who entered the data and at what time.

What happens to an ACFI appraisal pack when a resident transfers?

A copy of the ACFI Appraisal Pack should be provided to the new aged care home.

The original completed ACFI Assessment Pack for the resident would be retained and filed by the original aged care home.

What if the Aged Care Client Record is unavailable or very old

The ACCR is a nominated source document for an ACFI appraisal and should be included wherever possible. It is seen as an important component of the ACFI Appraisal Pack as it can also help to complete the overall picture of a person’s care needs.

However, if an ACCR is not available for someone who has lived in residential care for many years, it is not necessary to obtain one for the purposes of completing the ACFI appraisal. Providers should not contact Medicare Australia or ACATs for copies of the ACCR to support the ACFI appraisal.

Business Rules and Operation

General Business Rules

Do ACFI classifications expire?

ACFI classifications will not generally expire. However, they will expire in the following circumstances:

• six months after a resident enters care directly from an in-patient hospital episode;
• six months after a ‘major change’ in care needs;
• upon return from extended hospital leave (of 30 days or more);
• six months after a return from extended hospital leave; and
• upon departure from care.

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When is an approved provider able to re-appraise a resident?

A voluntary reappraisal of residents’ care needs may be completed in the following circumstances:

• at any time 12 months or more after the existing classification took effect;
• when the resident has a ‘major change’ in care needs;
• at any time where the resident is classified at the lowest applicable classification level (ie, no or minimal assessed care needs in all three ACFI care domains or is classified as RCS8); and
• within 2 months after a resident transfers from an aged care service.

Will approved providers be penalised if they submit a late reappraisal?

If a reappraisal is received within 3 months of the end of a reappraisal period the approved provider will receive the ACFI rate from the date of receipt and a late application reduced rate ($25 less than ACFI rate but not less than $0) from the date the resident entered care until the day prior to date of receipt.

If a reappraisal is received more than 3 months after the end of a reappraisal period the approved provider will receive the ACFI rate from the date of receipt and nil subsidy prior to that date.

What do we do if a resident is in care for less than 7 days?

Under the ACFI business rules, appraisals cannot be conducted in the first seven days after a resident enters care. If a care recipient leaves a residential care service before the end of seven days from the day the person began receiving care, an ACFI appraisal may be made for the period for which care was provided. The Application for Classification may be submitted to Medicare Australia within 28 days of the day on which the approved provider began providing care to the person based on the evidence available on the resident’s care needs gathered during the period of time the resident was in care. The ACFI Appraisal becomes the default classification for that resident.
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What do we do if a resident leaves care before the appraisal is completed?

If a care recipient leaves a residential care service before the ACFI appraisal is completed, an ACFI appraisal may still be made for the period for which care was provided. The Application for Classification may be submitted to Medicare Australia based on the evidence available on the resident’s care needs gathered during the period of time the resident was in care. The ACFI Appraisal becomes the default classification for that resident.

What do we do if a resident is admitted to hospital before the appraisal is completed?

If a care recipient is admitted to hospital before the ACFI appraisal, or reappraisal, is completed, an Application for Classification may be submitted to Medicare Australia based on the available evidence of the resident’s care needs.

The aged care service should however wait until they are certain that the resident is not going to return from hospital in time to complete the appraisal, before submitting an Application for Classification based on an incomplete appraisal.

Note: assessments completed within the past six months that continue to reflect the care needs of the resident may be used for the purposes of an ACFI appraisal.

What is an ACFI capped rate?

Generally, the ACFI subsidy payable for a resident is the sum of the amounts payable for each of the three ACFI domains (ie ADL, BEH and CHC). This is called the ACFI Rate. Until 30 June 2011 however, the amount of subsidy payable cannot exceed a capped amount (the maximum rate). Where the sum of the three domains does exceed the capped amount, the maximum rate will be payable as below.

For example, a resident classified as High in all three care domains (ADL, BEH and CHC) would currently have a total ACFI rate of $171.43. However, as this exceeds the maximum rate, the amount will be capped at $138.11 per day.

The maximum rate will increase over four years and will be calculated as follows:

• 20 March 2008 to 30 June 2009 - $10 more than RCS1 rate
• 1 July 2009 to 30 June 2010 - $20 more than RCS1 rate (as indexed)
• 1 July 2010 to 30 June 2011 - $30 more than RCS1 rate (as indexed)

The ACFI rate will not be capped from 1 July 2011 onwards. Top of page

Grandparenting

Will we receive a lower subsidy for a resident under the ACFI than we did for that resident under the RCS?

No. Once an ACFI appraisal has been completed for an existing resident, the rate of subsidy will be either the new ACFI rate or the person’s existing RCS rate. If the ACFI appraisal results in an increase in the daily subsidy of $15 or more, the ACFI based subsidy is payable. If the ACFI appraisal results in a rate that does not increase the daily subsidy by $15 or more, the RCS rate of subsidy continues to be paid.

This ‘RCS saved rate’ for existing residents will continue to be ‘grand-parented’ until either the person’s care needs increase to the extent that an ACFI rate becomes payable or the resident departs care.

When will grand-parenting cease?

Subsidies will continue to be paid at the existing rate (plus indexation) for a resident on an ‘RCS-saved rate’ until either their care needs increase to the extent that an ACFI rate becomes payable or the resident is discharged from the aged care home.

High Care and Low Care

What is the definition of High Care and Low Care under the ACFI?

The ACFI administration guide states that a resident will be classified at a high level of residential care if they are in any one of the following categories:

• 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.

If a resident is categorised at any of the care levels above, they are considered to require a high level of residential care, except for the special ‘interim low’ definition below. If a resident is categorised at any other care levels they require a low level of residential care.
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‘Interim Low’ – Special Low Care Category

If the resident has an ACAT approval that is limited to Low Care, and their initial ACFI classification fits within the definition of High Care, and they have not aged in place, they are classified as ‘interim low’ (low care) and are funded at a default rate of $44.98 per day.

Extended Hospital Leave (EHL)

What is extended hospital leave (EHL)?

When a resident is absent from a residential care service for a period of thirty days or more for the purposes of receiving hospital care, this is called 'Extended Hospital Leave'.

This may include a period of hospital care followed by another from of leave e.g. for transition care.

For full details, see the definition in Schedule 1 Dictionary of the Aged Care Act 1997.

What happens to a resident’s classification while they are on extended hospital leave (EHL)?

While a resident is on EHL their current classification continues. This classification expires on the day on which the leave ends.

An appraisal must be completed and submitted in the period ending two (2) months after the date the resident leaves hospital. The new classification takes effect from the day the person returns to care.

What subsidy is paid when a resident it on extended hospital leave (EHL)?

When a resident is on extended hospital leave, the subsidy rate is reduced by 50% from the 30th day of EHL until the leave ends.

Does a resident who has returned from extended hospital leave (EHL) need to be reappraised?

Yes. A resident needs to be reappraised within 2 months of returning from EHL.

This new classification takes effect from the date of their return to care. This classification then expires six months after the person returned to care and a reappraisal must be submitted during the period one month before or one month after this expiry date.

Transfers

Does a resident’s ACFI classification expire when they transfer?

No – in most cases. An ACFI classification does not expire where a resident leaves the care of one aged care service and enters the care of another service within 28 days.

Do we have to appraise an ACFI classified resident that has transferred from another service?

No – you do not have to if the resident is entering your service within 28 days of leaving the previous service. You may however choose conduct a reappraisal if you believe the current classification does not reflect their current care needs.

The same timeframes apply to this appraisal as for a new resident.

Do we have to notify anyone we are accepting the existing ACFI classification for a transferred resident?

No. The classification and subsidy will automatically default to the existing rate when you submit the Resident Entry Record.

Does an RCS classification expire when a resident transfers?

Yes. It is necessary to conduct a new ACFI appraisal when a resident that still has an RCS classification transfers to another aged care service.

Note: this is distinct from a resident that has an ACFI classification but is receiving a subsidy based on an RCS saved rate.

How do we complete an ACFI appraisal if a resident transfers shortly after entry?

Normally assessments cannot be commenced within seven days of entry and the appraisal cannot be submitted within twenty-eight days of entry into care.

Where the resident transfers to the care of a second service within the first 7 days of entering care of the first service, the Classification Principles (9.16) allow the first service a shorter period to undertake an ACFI Appraisal but still to lodge the ACFI Application for Classification within 28 days of the resident entering care. The second service can submit a reappraisal within 2 months of the day that the resident enters their care or accept the default classification but is prohibited from sharing any information on the resident (transfer of information can only be from the first to the second service). Top of page

Ageing In Place and ACAT Approvals

Has Ageing-in-Place changed with the introduction of the ACFI?

No. A resident whose initial approval for permanent residential aged care is limited to low care will continue to be able to ‘age in place’ to a high care classification without the need for an ACAT reassessment. The introduction of the ACFI does not change this basic policy. However, there are some small exceptions outlined below.

When can a resident age in place under the ACFI?

Under the ACFI an ‘aging in place’ event defines when the full ACFI high care subsidy may be paid if the resident’s ACAT approval is limited to low care. A resident may ‘age in place’ in one of the following three ways:

1. a reappraisal is conducted that results in a HIGH CARE classification (e.g. on expiry of an existing classification, or a voluntary reappraisal following a transfer, or following a major change in care needs);
2. an ACAT approval for care is provided which is not limited to low care; or
3. a Departmental Review Officer confirms the resident’s ACFI classification during a classification review.

Is a current ACAT Approval required when transferring?

No – in most cases.

To implement the ACFI a number of legislative amendments were made. Of particular relevance to the this question is an amendment made to the Approval of Care Recipients Principles 1997 which took effect on 20 March 2008.

This amendment (see subsection 5.14(2)) allows the approval for residential care to continue for a period of up to 28 days (not counting any days on which the resident is on approved leave) when a resident transfers from one facility to another, or returns to the same facility.

During the transition period, the effect that this amendment will have on a resident’s ACAT approval in relation to transfers between aged care facilities may differ, depending on whether the resident is classified under the Resident Classification Scale (RCS) or ACFI.

The table below contains detailed information about when an ACAT reassessment and approval for high level residential care may be required for residents that transfer (within 28 days) to a high care place in another facility.

ACAT APPROVAL	ACFI classification	RCS classification	Has resident aged in place at time of transfer?	Is a reassessment required?
Low level	N/A	High (RCS 1-4)	Yes	Yes. If the receiving facility wants to claim a high care ACFI subsidy from the date of entry.1 Alternatively, the provider can wait for the resident to age in place. and/or Yes. If the resident wishes to pay an accommodation charge to the new home rather than rolling over an existing bond.
Low level	High	N/A	No	Yes. If the receiving facility wants to claim a high care ACFI subsidy from the date of entry.2 Alternatively, the provider can wait for the resident to age in place. and/or Yes. If the resident wishes to pay an accommodation charge to the new home rather than rolling over an existing bond.
Low level	High	N/A	Yes	No. Under the ACFI rules if the resident moves within 28 days their ACFI classification will also transfer with them.3 Yes. ACAT reassessment to high required if the resident wishes to pay an accommodation charge to the new home rather than rolling over an existing bond.
High level	High	N/A		Not required.
High level	Low	N/A		Not required.

Notes:
1. For a resident’s first ACFI appraisal where the ACAT approval is limited to low care, but whose ACFI classification rates them as a high care, the resident will be classified as ‘interim low’ and the rate of subsidy payable is $44.14 per day, this will be paid until they 'age in place'.
2. Under ACFI rules if the resident moves within 28 days their ACFI classification will also transfer with them. The new facility can either accept this classification (in which case Note 1 will apply) or reappraise them within 2 months of entry. If they choose to reappraise them this is equivalent to 'ageing in place' and in these circumstances an ACAT reassessment would not be required for the facility to receive the full high care ACFI subsidy.
3. In this circumstance an ACAT reassessment would not be required for the facility to receive the full high care ACFI subsidy as they have already 'aged in place'.

When does a change in ACAT approval take effect?

An ACAT approval for care takes effect from the date that the approval is given. Any change in care subsidy as a result of the approval is from this date forward only. Top of page

Training

Can Registered Training Organisations (RTOs) deliver ACFI training?

Yes. RTOs are able to deliver ACFI training and may use the Commonwealth owned training material, which is available on the departmental website at www.health.gov.au/acfi .
The conditions of use are that the copyright of the Commonwealth is acknowledged, and that no endorsement by the Commonwealth of the training delivered by the organisation is stated or implied.

Can the training CD be copied?

Yes. The CDs provided at the ACFI training course may be copied on condition that: they are not modified; the copyright of the Commonwealth is acknowledged, and that no endorsement by the Commonwealth of any training delivered using the discs is stated or implied.

Additional copies of the discs may be purchased from TAFE New South Wales Western Institute at a cost of $25 each. You may contact TAFE by email at acfi@tafensw.edu.au or by telephone on 1300 553 718.

Other Issues

How does the ACFI fund therapy services and support for families?

The ACFI distributes care subsidies to residential aged care providers based on an assessment of care needs. The research conducted along with the development of the ACFI showed that it is not necessary to measure every indicator to accurately set a level of subsidy.

The change in the method of allocating funding has not changed any of the obligations of providers to meet the therapy and other needs of their residents.
Accreditation Standards under the Aged Care Act 1997(the Act) require approved providers to ensure that residents are assisted to achieve maximum independence and that optimum levels of mobility and dexterity are achieved for all residents. The Accreditation Standards also require that residents are referred to appropriate health specialists in accordance with the resident’s needs and preferences.

Approved providers must meet the Specified Care and Services provisions under the Act which require that low care residents who are assessed as needing therapy or other allied health services are assisted in obtaining these services. High care residents assessed as needing such services must be provided with these services by the approved provider at no cost to the resident.

Are Multi-purpose services (MPS) covered by the ACFI?

No. Multi-purpose Services are not funded under the ACFI but rather using a funding agreement negotiated with the relevant State or Territory Government.

Applications for Classification and Payments Processing

Can partial reappraisals be submitted?

No. A complete application for classification must be submitted.

Can I enter Mental and Behavioural Diagnosis Codes in the Medical Diagnosis?

The only place that codes in the 500-599 range can be accepted is in the Mental and Behaviour Diagnosis.

Why am I not receiving the HIGH rate of behaviour subsidy for a resident that scored enough points in the behaviour questions?

The HIGH rate of behaviour subsidy is only paid for residents that have at least one diagnosis in the mental and behavioural category.

The only place that codes in the 500-599 range can be accepted is in the Mental and Behaviour Diagnosis.

In the first instance you should check that you entered the 500-599 codes in the Mental and Behaviour Diagnosis question and not the Medical Diagnosis question.

If they have been entered in the Medical Diagnosis question and not the Mental and Behaviour Diagnosis you will not receive the higher payments under the Behaviour domain.

Can you explain why my ACFI 6 – Cognitive Skills Checklist is being rejected?

A common reason that ratings are being rejected is that appraisers indicating they have not done a PAS-CIS and are therefore using the Cognitive Skills Checklist to determine the level of impairment. Some, however, are then also entering a PAS-CIS score for this level in the Cognitive Skills Assessment Summary (option 6.8).

If you have not undertaken a PAS-CIS you must not enter a PAS-CIS score.

You only need to ensure that the correct options have been selected (ie 6.1 - 6.7), and that the selected checklist item description best matches the residents impairment level.
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