IPA have now been in effect for six months. We are happy to report that as at 28 February 2022, 95.2% of services have lodged a claim under the new invoicing rules (September 2021 claim onwards) and 85.4% of services have lodged a December 2021 or January 2022 claim.
Services Australia has approved 87.8% of claims within 2 business days and 96.3% of claims within 5 business days.
The Department of Health and Services Australia understand that some providers are still experiencing issues with their claims. Below are the common queries we are receiving and how providers can resolve them.
Contacts and guidance
If you have any queries about the claiming process, your claims or payments, please call Services Australia’s aged care claims and payments enquiry line on 1800 195 206 (from 8.30am to 5pm AEDT, Monday to Friday).
For queries that are not time-sensitive, Services Australia’s aged care payments team can also be contacted by email at email@example.com. Note that queries submitted via email are addressed on a first in / first served basis, and response times may be impacted by the volume of queries from others submitted through this channel. Please do not send unessential emails such as “Thanks” following resolution of an enquiry.
For further guidance visit the IPA website or view the recently updated IPA Q&A Fact Sheet which includes guidance on managing debts and large purchases. If you have general IPA enquiries, you can email firstname.lastname@example.org.
70 days to claim for departed care recipients
Home care providers have up to 70 days from a care recipient’s departure to adjust care events, finalise outstanding invoice amounts and submit these adjustments as part of their monthly claim. In some situations, a provider may not have a full 70 days to claim due to a departure occurring in the middle of a claim month. Providers should ensure that their business processes support departures being processed within 70 days to meet legislated requirements.
If you have a claim that includes departed care recipients, and you do not finalise the claim within the 70-day period, you will not be paid the invoice amount for any affected care recipients as part of your monthly claim.
Services Australia will only consider manually processing a claim outside of the 70 days in exceptional circumstances. Each instance will need to be considered on a case-by-case basis by emailing Services Australia with the claim details (if the issue is time-sensitive, please call the Services Australia’s aged care claims and payments enquiry line after sending the email).
Unable to finalise a claim
Departed care recipients
In some circumstances providers may not have been able to finalise a claim that includes departed care recipients with outstanding invoice amounts after the 70-day period. System changes have been implemented to address this issue; however, if you are finalising a claim that includes a care recipient with a departure date before 9 February 2022, you will need to call Services Australia to resolve this issue promptly.
Unspent funds reporting
Providers will not be able to submit their December 2021 claim (and all subsequent claims) if they have not reported unspent funds for every care recipient in at least one monthly claim between September and December 2021.
Reporting unspent funds for departed care recipients
This issue only affects care recipients who are not opted in.
Providers should not adjust the unspent funds amount for a departed care recipient in the departure month where the invoice amount is higher than the maximum contribution amount for that month. This leads to errors in unspent funds calculations and the amount transferred to the receiving provider.
Services Australia’s systems will automatically reconcile the last invoice amount with the reported unspent funds amount for departed care recipients. If you have adjusted the unspent funds amount for a departed care recipient, please contact Services Australia for a resolution.
Opt-in cut off has now passed
The deadline to decide whether to opt in for each care recipient who has been in their care since before 1 September 2021 has now passed (28 February 2022). If you have not opted in for a care recipient, you must report the Commonwealth portion of provider-held unspent funds each month for those care recipients. All providers must include the total provider-held unspent funds in the care recipients’ monthly statement.
Income tested care fee (ITCF)
IPA has not changed the way the income tested care fee (ITCF) is calculated or collected.
The only exception to this is where a provider had made a business decision, prior to 1 September 2021, that they would not collect the ITCF.
Providers are permitted to continue to not collect (or ‘waive’) the ITCF where:
- they can demonstrate that they had not collected fees from that care recipient on an ongoing basis (not just ad-hoc) for some months prior to 1 September 2021; AND
- they hold unspent funds and have not opted-in for this care recipient so have access to unspent funds.
In all other circumstances, including where the provider is not holding any unspent funds for the care recipient, the provider must collect the ITCF.
Providers can view a care recipient’s assessed ITCF via the home care payment statement available within the Aged Care Provider Portal.
If a care recipient refuses to pay their assessed ITCF, this could be grounds for the provider to withdrawal services, following appropriate processes. For more information, please see the IPA Q&A Fact Sheet.
If an ITCF is refunded to a provider due to a quarterly review, the fees must be returned to the care recipient. If the care recipient has already left care and their balance has been settled, then the ITCF must be refunded to the care recipient or their estate.
If an ITCF is increased due to a quarterly review, the provider must ask the care recipient to pay the increased fee. If the care recipient has already left care and their balance has been settled the ITCF should be claimed from the care recipient or their estate.
If the provider does not collect the ITCF from care recipients, the provider could be out of pocket for package expenses and will be liable to pay these expenses out of retained earnings.
Better practice monthly statement
The department has now released the Better Practice Home Care Package (HCP) Monthly Statement template.
Introduction of a legislative requirement to show where a care recipient’s unspent funds are being held is currently being considered, noting that the Royal Commission into Aged Care Quality and Safety recommended that this requirement takes effect by 1 July 2022. Advice will be provided soon on the scope and timing of the change, to provide sufficient time for providers and software vendors to update systems.
The department encourages all home care providers to use the template to:
- improve the quality of HCP statements
- support providers to align their monthly statement with Improved Payment Arrangements changes
- make it easier for care recipients to understand their statement
- support care recipients make informed choices with their HCP funds.
The Provider Guide Better Practice Home Care Package Statement will help you use the template.
Senior Australians receiving home care can follow the Consumer Guidance Understanding your Home Care Package statement to help understand their monthly statements.