Program assurance of the Home Care Packages Program

About the program assurance reviews and activities

We are responsible for good program governance and integrity. This includes ensuring funds are spent efficiently, effectively and for approved purposes.

Older people in Australia are increasingly choosing to remain in their own homes. There is rising demand for Home Care Packages to support this choice.

We want to ensure the maximum amount of funding is available for Home Care Packages to support older people to remain in their own homes as long as possible.

To achieve this, we conduct assurance reviews and activities that are ongoing and risk-based to:

• assure value for money for care recipients
• check unfair costs are out of the system
• assure providers use funds for approved purposes only
• increase providers' program knowledge to support improvement and delivery of the program requirements
• prevent fraud by identifying deliberate non-compliance
• support better services for our older people.

Risks we focus on

Program assurance reviews/activities focus on these risks:

• Care recipients cannot exercise adequate choice due to provider processes or a lack of transparency or accuracy in pricing information/agreements.
• The program does not achieve value for money for Australian taxpayers and/or care recipients.
• Program funds are inappropriately or inadvertently used by a provider or care recipient.
• Program funds are fraudulently used by a provider or care recipient.

Activity and review benefits

Benefits include:

• greater value for money for care recipients and taxpayers through enhanced program integrity
• better informed providers through education and capability uplift, including though the Community of Practice 
• improved community confidence in the sector
• ongoing improvements to the program benefitting providers and care recipients.

The Home Care Packages Program Assurance Framework and the Assurance Plan support these activities.

The review process

Risk-based assurance reviews and activities are guided by the Assurance Plan.

We also conduct reviews and activities outside of the planned reviews based on urgency and risk. Activities are mainly desktop-based.

For assurance reviews, selected providers (that are corporations) will receive a legally binding notice, which will explain:

• the scope of the review
• what the provider needs to do
• what documents to provide.

Review officers work with selected providers throughout the review process. This could be through entry and exit meetings, and ongoing communication as needed to clarify requirements and support providers.

At the end of the review process, providers usually receive individual review reports. These include any recommended actions and areas for improvement identified during the review.

A program assurance review compliance team will follow up with relevant providers if they do not complete the recommended actions in their review report within the given timeframe.

A summary report of review findings is also usually published at the end of the review. We then conduct a webinar to present key learnings and outcomes from the review and to allow webinar participants to ask questions. To support the sector to benefit from such reviews, we share findings and learnings through the online Community of Practice.

Reviews

We have completed a number of reviews of the Home Care Packages Program and issued the below summary reports:

• Review 1 – Indirect and Care Management Charges
• Review 2 – Unspent Funds (Commonwealth Portion)
• Review 3 – Pricing Transparency on My Aged Care
• Review 4 – Excluded items.

We held webinars for reviews 1 to 4 to discuss the findings of the reviews. You can find recordings of these webinars, along with the slides, transcripts and answers to questions on our webinar page.

Current reviews

Pricing transparency

Accurate, clear and up to date Home Care Packages pricing information on My Aged Care helps older people to exercise choice and control over the care they receive. It also helps them to understand providers’ fees and charges.

The first pricing transparency review in 2023 significantly improved the quality of providers’ pricing information available to care recipients through My Aged Care.

In July 2024, we commenced a second review of providers’ pricing information on My Aged Care.

Payment validation

This review will assess whether the amount claimed by providers under the Home Care Packages Program in May 2024 was for care and services that were actually delivered to selected care recipients at an agreed price.

The review will answer:

• Are providers charging for goods or services which have not been delivered?
• Do providers have evidence to support the price charged, including the agreed price and actual price paid for goods and services?
• Are providers claiming the ‘correct’ total amount to Services Australia for each care recipient (consistent with the care recipient’s May 2024 monthly statement)?
• What payment controls (checks and balances) has the provider implemented to reduce the risk of making incorrect or fraudulent claims?

Provider engagement – Community of Practice

We have created an online Community of Practice to support all providers (not just those subject to a program assurance review or activity). The Community of Practice offers a safe space for providers to talk with us and each other on program assurance reviews and related matters.

As a registered member of the Community of Practice, providers can directly engage with the program assurance review team.

They can also:

• understand review findings
• uplift their program knowledge
• improve care for older people in Australia.

They can also hear from us about lessons learnt from program assurance reviews and gain information about completing the requirements for reviews. Providers can also give feedback on reviews.

The Community of Practice also offers providers the opportunity to leverage this platform to:

• develop and discuss new ideas
• share resources
• build a sense of community with other providers.

Examples of Community of Practice activities include:

• responding to questions from providers on program assurance matters
• sharing posts on topics of interest
• seeking feedback from users on whether the Community of Practice site is easy to use and navigate through.

We encourage providers to join the Community of Practice.

Tools for care recipients

We have prepared some tools to help care recipients compare provider charges. These are available on the My Aged Care website.

Our fact sheet with more information can help care recipients understand how to get the best value for money from their package. It also provides instructions on how to use My Aged Care to compare providers.

Based on the findings of each review, we consider how to best support care recipients and program improvements.

Key legislation

The Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Act 2021 came into effect on 1 July 2021. This allows us to compel providers to participate in program assurance reviews when invited and supports the publishing of review findings. See Part 6.8 of the Act.

Key resources

After the release of the report, we hosted a webinar to share the key learnings and outcomes from the review.

After the release of the report, we hosted a webinar to share the key learnings and outcomes from the review.

After the release of the report, we hosted a webinar to share the key learnings and outcomes from the review.

After the release of the report, we hosted a webinar to share the key learnings and outcomes from the review.

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