There are 3 service groups that are delivered in home or community settings:
- home support, including the restorative care and end-of-life pathways
- assistive technology
- home modifications.
Person-centred subsidies apply to all 3 of these service groups. Provider-based subsidies only apply to services in the home support service group.
The general process to work out the eligible person-centred subsidy amount is similar for all 3 home or community service groups.
[Chapter 4 – Part 2 – Division 1, Division 2, Division 3]
Calculating the eligible person-centred subsidy
The full method to work out the eligible person-centred subsidy for each service group and classification type is explained in the Act. A summary of the method is provided below, following these general steps:
- Find the service price.
- Subtract any reductions from the service price.
- Add any secondary person-centred supplements, if applicable.
- Calculate the final eligible subsidy amount.
Final eligible subsidy amount
Work out the price of the service delivered. The way to work out the price depends on the service and how it was delivered:
- If the subsidy basis is unit price, this amount is based on the number of units delivered multiplied by the unit price – for example the unit price for a meal multiplied by the number of meals delivered.
- If the subsidy basis is efficient price, this amount is based on the number of hours a service was provided – for example, the price per hour for personal care multiplied by the hours of care delivered.
- If the subsidy basis is actual cost, this is the actual cost of the service – for example, the cost of buying an item, such as vitamins.
Subtract reductions
Subtract any reductions from the price. A reduction is an amount that can reduce how much subsidy the government pays. There are 2 types of reductions in the Act:
- A compensation payment reduction may apply if someone is entitled to or has received compensation for something related to the cost of their aged care services. For example, if someone gets compensation for an insurance claim that covers the same service they’re accessing under the Act.
- An individual contribution reduction is based on the amount the older person is paying towards their aged care services (their individual contribution) which is decided through means testing.
Subtracting reductions from the price gives the provisional subsidy amount.
Add secondary person-centred supplements
The last step is adding any secondary person-centred supplements that the older person is entitled to.
Final eligible subsidy amount
The provider is eligible for the amount of person-centred subsidy worked out using this method. How much subsidy the provider actually receives depends on the older person’s available funding balance. This is worked out when the provider makes a claim for a subsidy.
Person-centred supplements
Person-centred supplements are extra amounts that an older person may be entitled to which impact on the amount the government will pay for delivery of services to the older person. Most supplements are created in the Rules, which includes the amount and how they apply. This is so the government can use them to respond quickly to a community need in the aged care system.
There are 2 types of person-centred supplements. The main difference between them is one type is used in the calculation of the amount of subsidy a provider is eligible for, and the other type is used to determine an older person’s funding balance. This affects whether the supplement amount can be reduced by means testing or not.
Primary person-centred supplements
Primary supplements provide additional funding for specific, immediate care needs like oxygen or enteral feeding. They are aimed at providing additional assistance to directly support an older person with that specific issue.
Primary person-centred supplements are added to an older person’s available funding balance, which is used when a provider makes a subsidy claim. This means they aren’t included to work out the eligible subsidy amount and can be reduced based on what an older person can afford to pay.
Secondary person-centred supplements
Secondary supplements refer to other types of supplements that help with broader financial needs or service provider viability.
When working out the eligible person-centred subsidy amount, secondary person-centred supplements are added as the last step. This means they are never reduced by means testing.
Under the Act, the secondary person-centred supplements include the fee reduction supplement. This supplement applies to people who meet certain conditions, such as financial hardship. This is explained in the Rules.
Examples of supplements
If there was a global pandemic that impacted aged care, the Minister for Aged Care and Seniors could add a primary person-centred supplement to the Rules. This supplement would provide extra funding to respond to the impact of the global pandemic but could be reduced by means testing so that some people may get less funding if they can afford to pay more for services.
If a group of people needed extra support due to a specific, shared form of hardship, the minister could add a secondary person-centred supplement to the Rules. This group of people might then be eligible for a supplement which is not reduced by means testing.