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Payment Essentials September 2007
The September 2007 Payment E$$ential$ newsletter designed to keep financial officers within Residential Aged Care Services (RACS) informed of changes to all payment related forms and processes for residential aged care. It has been redesigned and renamed Aged Care Essentials.
You may download this document in PDF format:
Payment Essentials September (PDF 272 KB)
Payment Essentials
Would you like to see an article on a particular topic?
Email the Editor at agedcare-essentials@health.gov.au or send a facsimile to (02) 6289 8595.Past issues can be accessed via our web page at: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-payessdx.htm
Editor
Removal Of The Adjusted Subsidy Reduction Update
From 1 July 2007, the adjusted subsidy reduction was removed from places that have already transferred to the non-government sector. These places are now fully funded (with effect from 1 July 2007).Any places affected by the adjusted subsidy reduction that are transferred to the non-Government sector after 1 July 2007, will have the reduction removed effective from the date of transfer.
What has occurred with payments?
The Medicare payment system has been updated for places that had already transferred to the non-government sector prior to 1 July 2007 and payment of the increased subsidy was made in accordance with the normal subsidy payment cycle.What the payment statements looked like for services no longer affected by the adjusted subsidy reduction?
From July 2007 onwards, the Explanation of Payment for Care Recipients in Approved Residential Aged Care Service, shows:- An increase in the total amount to the full rate in the Rate per Day column.
- ‘Adj Subsidy’ still written in the Payment Type column
- A note on the front page ‘ADVICE’ box of the form informing services that they are now receiving the full rate.
If you have any questions about the increased payment please call the Medicare Australia enquiry number 1800 195 206
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Information Lines
There are now two information lines available to assist aged care service providers.Aged Care Information Line 1800 500 853
The Aged Care Information Line provides information to aged care service providers and the general public about fees, charges, publications, programs and procedures for Australian Government funded residential and community care options.The hours of operation are 8.30am to 5pm Eastern Standard Time Monday to Friday and closed on national public holidays.
Medicare Australia Aged Care Claims 1800 195 206
Medicare Australia has established a single number for Aged Care processing and online claiming enquiries. This provides faster and more streamlined services from Medicare Australia.Aged Care providers can call one number about all claiming and processing enquiries as well as online claiming information and technical enquiries.
The hours of operation are 8.30am to 5pm Eastern Standard Time Monday to Friday and closed on national public holidays.
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Exemptions Removed For Conditional Adjustment Payments (CAP)
An amendment to the Residential Care Subsidy Principles 1997 (the Principles) was recently made to remove two exemptions relating to requirements for eligibility for the Conditional Adjustment Payment. The exemptions that have been removed are those that:- exempt the provider from the requirement to prepare its general purpose financial report in accordance with applicable accounting standards; and
- exempt the provider from the requirement to treat residential aged care as a reportable segment.
The Principles also included a note that states that access to exemptions would be removed from the Principles in 2007 (i.e. with respect to the 2006-07 financial year). To give effect to this, the Principles have now been amended.
This amendment was registered with the Federal Register of Regulatory Instruments on 27 July 2007.
Medicare Australia Update
Online Claiming
Another two software vendors – Management Advantage and Epicor – have been issued with a Notification of Integration (NOI). This brings the number up to four for the number of software vendors who have a fully functional online claiming software product. All software vendors will soon receive the final specifications for Aged Care Funding Instrument (ACFI), which they will also be building into their products well in advance of the 20 March 2007 implementation date.Reminder - Aged Care Single Phone Number
Medicare Australia has consolidated its aged care claims processing and online claiming enquiry numbers into one national number.
The national enquiry number is 1800 195 206**.Please ensure that all your staff who phone Medicare Australia’s aged care state based processing teams are aware of the new number, as redirections have ceased.
Reminder – New Authorised Signatory Process
You will recall in the August edition of Payment Essentials, Medicare Australia advised of its Authorised Signatory Process being replaced with an Annual Approved Provider Statement, effective 1 September 2007.All Approved Providers should have received the new form in a mail out which occurred in early July. If you have not yet submitted your Approved Provider Statement, please do so as soon as possible.
If you didn’t receive a copy of this mail out, and believe you should have, please contact the aged care helpdesk on 1800 195 206** (Option 1) to speak to an aged care payments and processing officer in your state.
** Call charges apply from mobile and pay phones only
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News Flash
On Wednesday 15 August 2007, Medicare Australia received its first online Residential Claim. It was sent through from Assisi Centre Aged Care using Management Advantage software and support.Congratulations to both for sending the first successful online claim to Medicare Australia.
Interim Accommodation Supplement
As advised in the August edition of Payment Essentials, the payment of the Interim Accommodation Supplement (IAS) for high care residents (excluding residents in extra service places) will commence in October 2007.The payments will be made in instalments rather than as part of each monthly claim. The three instalments will be automatically processed as part of a service’s claim for the September 2007, December 2007 and March 2008 payment periods. The amount of each instalment equal to $3.50, times by the number of care days provided to eligible high care residents:
- from 1 July 2007 to 30 September 2007 (inclusive), for the first instalment to be paid in October;
- from 1 October 2007 to 31 December 2007 (inclusive), for the second instalment to be paid in January 2008; and
- from 1 January 2008 to 19 March 2008 (inclusive) for the third instalment to be paid in April 2008.
If you have any queries about the amounts you receive, contact Medicare Australia Aged Care Payments on 1800 195 206** (option 1).
**call charges apply from mobile pay phones only
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Respite Care Rates – Low Rate per day
An incorrect rate of $34.80 has been used for the calculation of low level respite care subsidy since 1 July 2007 for care recipients in Qld, SA, WA, Tas and NT.The correct rate should have been $34.90.
The correct rate will apply from 1 August 2007. Adjustments to correct any impacted July payments are expected to be made by the end of October.
This will only affect care recipients in receipt of low level respite care for the July 2007 claim period in those states. Respite Care payments to providers in ACT, NSW and Vic are not impacted.
Medicare Australia regrets any inconvenience that this may have caused. If you have any queries about this matter, contact Medicare Australia Aged Care Payments on 1800 195 206 (Option 1).
Extra Service Status For Residential Aged Care Homes
Invitation To Apply
The Secretary of the Department of Health and Ageing invites approved providers of residential aged care to apply for Extra Service status in 2008.Closing Date | Applications will be accepted between: |
| Friday 29 February 2008 | 15 February 2008 and 29 February 2008 |
All applications will be assessed against the criteria set out in the Aged Care Act 1997 and the Extra Service Principles 1997. Note that in some regions, applications maybe assessed competitively.
All applicants must complete the approved application form. The application form and guidelines are available on the Department’s internet site at:
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-ess-essprov.htm
It will be to an applicant’s advantage to send in sufficient text and material evidence to support the claims made in the application. If the documentation cannot be downloaded from the internet, please contact the Aged Care Information Line on 1800 500 853 to obtain a copy. The Information Line is open from 8.30am to 5pm Eastern Standard time (Monday to Friday).
The Minister for Ageing has determined under section 32-7 of the Aged Care Act 1997 that the maximum proportion of residential care places allocated in each State and Territory that may be Extra Service places is 15 per cent.
Two signed application forms with one set of clearly labelled attachments are to be sent to:
Postal Address
Extra Service ApplicationsResidential Program Management Branch
Department of Health and Ageing
MDP 75
GPO Box 9848
CANBERRA ACT 2601
Street Address
Extra Service ApplicationsResidential Program Management Branch
Department of Health and Ageing
MDP 75
Ground Floor Reception
Alexander Building
Furzer Street
WODEN ACT 2606
Please submit the Benchmark List section of the application form for approval of Extra Service status in electronic format as well as in hard copy to facilitate the publication of successful Extra Service packages on the Departmental website.
When sending the Benchmark List, the List should be marked with the name of the facility and its location. Commercial-in-confidence information which appears elsewhere in the application form should not be sent to the Department in electronic format. Electronic copies of the Benchmark List are to be sent to the following e-mail address: ESS Applications and Inquiries@health.gov.au
Should providers approved for Extra Service status, who were not approved under the Extra Service Benchmarks, wish to have their list of approved Extra Services published on the website, they can also submit their information to the above e-mail address.
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Police Check Declaration Reminder
Due By 30 September 2007
Approved providers of aged care services will soon receive the Police Check Declaration 2007. The Declaration is a ‘one-off’ requirement of the Accountability Principles 1998 and relates to compliance with police check requirements between 1 March 2007 and 1 September 2007.The Declaration will require approved providers to affirm that they have met their obligations and responsibilities with respect to police records checks (i.e. national criminal history record check) for all relevant staff and volunteers. The Declaration applies to residential aged care services, community care services and flexible services directly subsidised by the Australian Government under the Aged Care Act 1997.
Approved providers will need to submit the Declaration by 30 September 2007
Approved providers with more than one aged care service must complete a separate declaration for each service.
New Entrants to Residential Aged Care Fees and Charges Flow Chart – (permanent entry*)
*different arrangements apply for respite entry residents who:- cannot be asked to pay an accommodation payment or income-tested fees
- can be asked to pay a basic daily care fee up to the ‘pensioner’ rate (currently $30.77 a day), regardless of whether they are pensioners or not
Basic Daily Care Fee
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Income-Tested Fee
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New Entrants to Residential Aged Care Fees and Charges Flow Chart – (permanent entry*)
*different arrangements apply for respite entry residents who:- cannot be asked to pay an accommodation payment or income-tested fees
- can be asked to pay a basic daily care fee up to the ‘pensioner’ rate (currently $30.77 a day), regardless of whether they are pensioners or not
Accommodation Payment
NOTE: Accommodation payments cannot be charged while the aged care home is not certified.
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Assessment For Accommodation Charge
NOTE: The Accommodation charge applies for a maximum of 5 years for residents who first entered permanent care before 1 July 2004.
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Frequently Asked Questions
Q: If I am on an overseas pension, am I a concessional resident?
Answer:
No, to be considered a pensioner for residential aged care fee purposes, a resident must be in receipt of an Australian Government means-tested pension. An overseas pension does not meet this criterion. An overseas pension is considered as private income for fee purposes in residential aged care therefore the resident would be a self-funded retiree.Concessional status is not dependent on pensioner status alone; there are other criteria that apply. In addition to receiving an income support payment (an Australian Government means-tested pension), the resident must:
- have assets less than a minimum amount, currently $33,000 at the time of entry to residential aged care; and
- not have owned a home in the past two years or more.
- their partner of dependent child; or
- a carer who has lived in the home continuously for the past two years and that carer is eligible for an income support payment at the time the person enters the aged care home; or
- a close relation who has lived in the home continuously for the past five years and that close relation is eligible for an income support payment at the time the person enters the aged care home.
Q: Who should residents and/or their families call to discuss issues around their income-tested fees?
Answer:
Residents and their registered nominees are advised to call the Aged Care Information Line on 1800 500 853. It should be noted that the Department of Health and Ageing officers, for resident privacy reasons, can only discuss detailed fee issues with a registered nominee, however, the Aged Care Information Line officers may be able to assist by advising family members the rules related to income testing.It should be noted that service providers should call the Medicare Australia national inquiry number on 1800 195 206.
Income-Tested Fees - Quarterly Review Dates
The next quarterly review of income-tested fees run is scheduled for 15 September 2007, with 20 September 2007 as the date of effect. It is expected that the Department will begin issuing review letters during the week commencing 17 September 2007.Quarterly review letters are issued following the ‘run date’ for those residents who have a change to their:
- income-tested fee from the effective date;
- Class C (hardship) fee reduction from the effective date; or
- income-tested fee or Class C fee reduction for any past periods and therefore the residents are due a refund.
- the maximum income-tested fee for a day as previously advised to provider and resident; and
- the current maximum income-tested fee for that day as at the time the review is conducted.
However, as the refund is the resident’s entitlement, it should be passed to the resident, or their estate, as quickly as possible.
Fee advice letters should reach aged care homes and residents within about 14 days of the run date.
The variations to the income-tested fee are itemised on the next available payment claim following the quarterly review eg for the September quarterly review, the adjustments should be made on the September payment statement.
The following quarterly review will be run on 24 November2007, with an effective date for fee changes of 1 January 2008.
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Accommodation Bond Refund Interest Rates And Timeframes
It is important for approved provider to ensure that they apply the correct interest rates to refunds of accommodation bonds. Providers can check the Department’s internet site at the start of each quarter, January, April, July and October for any changes to the Base Interest Rate or Maximum Permissible Interest Rate for the refund of accommodation bonds.Information on the interest rates applicable to each quarter will also be sent to approved providers.
The latest rates for the Base Interest Rate (BIR) and Maximum Permissible Interest Rate (MPR) are located at: http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-finance-refundrates.htm
or
Home > For Health Professionals > Aged care > Residential Care > Financial Information > Accommodation Bond Refund Interest Rates
In situations in which either the BIR or MPIR changes while interest is accruing on an accommodation bond refund, the rate to be used in calculating interest will be that which applied at the time that BIR or MPIR first became payable.
Providers should also ensure that new accommodation bond agreements reflect the changes to the timeframes for refunding accommodation bonds which commenced on 31 May 2006. These timeframes, which are set out in section 57-21 of the Aged Care Act 1997, apply to all accommodation bonds that become due for refund after 31 May 2006 and apply irrespective of contractual arrangements.
Further information on interest rates and timeframes for refunding accommodation bonds is available from the User’s Guide to Approved Provider Holding Accommodation Bonds, available on the Department’s internet site at: http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-prudential-guidelines.htm
or
Home > For Health Professionals > Aged care > Residential Care > Financial Information > User’s Guide to the regulation of approved providers holding accommodation bonds
When Is An Acat Reassessment Required?
There have been regular queries from service providers regarding the need for ACAT reassessment of new or existing residents of residential aged care facilities. The following sets out the circumstances where an reassessment is, and is not, required.Reassessment IS required if:
- approval has lapsed – if the person has not become a care recipient in the twelve month period from the date of approval by the ACAT Delegate.
- approval has expired- if the approval is time limited to a specific period of care and that period ends.
- approval has lapsed – if there is a break in approved care of more than one day (excluding approved leave).
- approval has been revoked – the Secretary to the Department of Health and Ageing is satisfied that the person has ceased to be eligible to receive a type of aged care for which they were approved.
- the person enters an aged care facility with a low level care approval and their initial RCS appraisal is high and the provider wishes to claim high care subsidy.
- a resident approved to receive low level care, has aged in place and is receiving high level care, but is moving to another facility as a high care resident.
- a resident is approved for low level ‘dementia specific’ care, but this care is not available and the resident is deemed to require high level care. ‘Dementia specific’ is an ACAT recommendation for the most appropriate form of care; it is a not a care type. The approval is valid for low level residential care whether the facility offers dementia specific care or not.
- where a resident’s condition has improved and they wish to leave residential care and access community care services for which they are not approved.
- a reassessment is requested in an appeal against an assessment decision.
- there is more than four weeks between approval and entry to the Transition Care Program.
Reassessment is NOT required if:
- the resident’s first RCS appraisal is low but a subsequent RCS appraisal is high and the resident remains in the same facility, they are ageing in place.
- the person is approved for high residential care and enters the facility as low level care.
- the resident is approved for high level residential care, has been accessing low level care but now requires high level care within the same or another facility and approval has not lapsed.
- the resident is moving facilities and is continuing to access the same or lesser level of care and there is no more than one day break in care (excluding approved leave).
- the person has a current ACAT approval on entry, has occupied an unfunded bed, and is moving to an Australian Government funded bed for the same level and type of care for which they were approved.
- the person is approved for ‘Dementia specific’ low level care and will access low level care that is not necessarily dementia specific.
Assessment for Residential Respite Care
- respite approval is valid for 12 months from the date of approval by the ACAT delegate. A person is approved for 63 subsidised days respite per financial year. Therefore if the approval period encompasses two financial years the person would be eligible to receive up to 126 subsidised days respite during the 12 month period.
- ACATs can approve extensions of 21 days at a time if the person’s approval for residential respite care is still valid. There is no limit to the amount of extensions a person may receive. Service providers should apply for an extension prior to expiry.
- reassessment is required if the person has not accessed any respite care in the 12 month period from the date of approval by the ACAT Delegate or if the approval is time limited to a specific period of care and that period ends.
- any movement from a low level to high level of care requires reassessment.
Aged Care Funding Instrument (ACFI)
Training
The first stage of the national ACFI training program, being delivered via the TAFE network, will run through September and October 2007. A 12 hour training course will be provided free of charge to one ‘management’ representative from each residential aged care service.In November this year, registrations will be invited for the ‘appraiser’ training to be conducted in February and March 2008. This will provide training for between two and four staff from each residential aged care facility. The number of training places will depend on the number of approved beds in the facility.
ACFI Information Packs
To coincide with the manager training, the Department of Health and Ageing is preparing information packs to be distributed to all facilities. These packs will contain copies of written information about the ACFI as well as a DVD for use as an information resource for staff.Aged Care Online Claiming
The implementation of the ACFI on 20 March 2008, will also see the introduction of access to ‘Online Claiming’ for any facility with an internet connection. This will enable facilities to submit their ACFI Applications for Classification via the internet. A training environment, so that staff can get used to the operation of the web site, will be available later in 2007. Full details on how to access this site will be distributed when it is available.The ACFI Web site
The ACFI web site (www.health.gov.au/ACFI) has had a minor makeover. Information available from this site includes:- The ACFI User Guide
- The ACFI Assesments
- The Answer Appraisal Pack
- Information about the ACFI Business Rules – including some illustrative scenarios
- ACFI Scores and Funding Categories
- Indicative Pricing for ACFI Classifications (indexed on 1 July 2007).
Description | Old Rates (to 30 June 2007) | New Rates (from 1 July 2007) |
Maximum Basic Daily Care Fee#: |  | |
| - all respite residents (pensioners and non-pensioners) | up to $30.77 | up to $30.77 |
| - other residents who receive a full or part means-tested Australian pension ##- | up to $30.77 | up to $30.77 |
| - other non-pensioner residents ### | up to $38.35 | up to $38.35 |
| Residents who were receiving care in a hostel on 30 September 1997 and whoare NOT currently at a home that was a nursing home before 1 October 1997. | | |
| - residents receiving full or part means-tested Australian pension## | up to $29.97 | up to $29.97 |
| - non-pensioners### | up to $37.55 | up to $37.55 |
| Residents who are currently receiving care in the same ‘hostel’ where they were living on 30 Septmeber 1997 and who are paying ‘grandparented’ variable fees | | (see The Residential Care Manual section 7.3.3) |
Maximum Daily Income Tested Fee: | | |
| - residents receiving a full means-tested Australian pension | N/A | N/A |
| - residents receiving a part means-tested Australian pension | up to $23.70 | up to $23.70 |
| | |
| $37,835 | $37,939 |
| $74,942 | $75,046 |
| - non-pensioner residents | | |
| up to $53.96 | up to $53.96 |
| $81,894 | $81,998 |
| $163,060 | $163,164 |
Pensioner allowable limit for accommodation bonds: | | |
| The non-pensioner rate of basic daily care fee (above) may apply for pensionerresidents whose accommodation bond is over this amount | $132,000 | $132,000 |
| Minimum assets a person must be left with when calculating the maximum Accommodation Bond | $33,000 | $33,000 |
Maximum Accommodation Charge for new entrants to your home* | | |
1July 2007 - 30 June 2008 | | |
| - for concessional residents and charge exempt residents | N/A | N/A |
| - for residents who first entered residential aged care from 1/7/2004 | | |
| $9.80 | $10.04 |
| calculated amount** | calculated amount** |
| $17.13 | $17.55 |
| calculated amount** | calculated amount** |
| - for residents who first entered residential aged care before 1/7/2004**** | | |
| $7.49 | $7.67 |
| calculated amount** | calculated amount** |
| $14.95 | $15.31 |
| calculated amount** | calculated amount** |
| Asset cutoff level | | |
| - for concessional *** resident status | $33,000 | $33,000 |
| - for assisted *** resident status | $52,500 | $52,500 |
Maximum permissible interest rate | | |
| - Accommodation Bond | From 1 April 2007 to 30 June 2007 10.37% | From 1 July 2007 to 30 September 2007 10.37% |
| - Accommodation Charge | From 20 March 2007 7.% | From 1 July 2007 7% |
| Pensioner Supplement (per day) | From 1 July 2006 to 30 June 2007 $6.32 | From 1 July 2007 to 30 June 2008 $6.45 |
| Age pension per fortnight (maximum basic rate) | $506.80 | $506.80 |
| Age pension per fortnight (maximum basic rate + GST supplement) | $525.10 | $525.10 |
## ‘Pensioner’ maximum rate also applies to blind pensioners & non-pensioner residents who have a dependent child
### ‘Non-pensioner’ maximum rate also may apply for pensioners who agree to pay a bond above the ‘pensioner allowable limit’
* Rate remains unchanged for resident’s stay in the one home, regardless of annual indexation of the max. rate for new entrants
** Margin of assets over $33,000 divided by 1,825 (See section 8.3.3.4 of The Residential Care Manual).
*** See The Residential Care Manual for additional criteria for concessional (6.3.5.1.2) and assisted (6.3.5.1.4) status.
**** Accommodation charge limited to a maximum period of five years and is fixed at date of entry.
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