Program assurance of the Home Care Packages Program

About the HCP Program assurance reviews and activities

The department is responsible for good program governance and integrity. It is responsible for ensuring that funds are spent for approved purposes and in an efficient and effective way.

Increasing numbers of older people in Australia are choosing to remain in their own homes as they age. There is rising demand for home care packages (HCP) to support this choice.

We want to make sure that the maximum amount of funding for HCP supports older people to remain in their own homes for as long as possible.

To achieve this, we conduct assurance reviews and activities that are ongoing and risk-based, focussed on HCP approved providers (providers) to:

• assure value for money for care recipients
• check unfair costs are out of the system
• assure that providers use funds for the purposes approved by the Australian Government
• increase providers' program knowledge to support improvement and delivery of the program requirements
• support prevention of fraud by identifying anomalies and sharp practice
• support better services for our older people.

Risks we focus on 

There are four risks that program assurance reviews/activities focus on:

1. Consumers cannot exercise adequate choice due to HCP Provider processes or a lack of transparency or accuracy in pricing information/agreements. 
2. The HCP Program does achieve value for money for Australian taxpayers and/or HCP care recipients.
3. HCP Program funds are inappropriately or inadvertently used by a HCP Provider or HCP care recipient.
4. HCP Program funds are fraudulently used by a HCP Provider or HCP care recipient.

Activity and review benefits 

Program assurance reviews/activities support the following benefits:

1. Greater value for money for HCP care recipients and taxpayers through enhanced program integrity 
2. Better informed HCP Provider through education and capability uplift, including though the Community of Practice  
3. Improved community confidence in the sector. 
4. Ongoing improvements to the HCP Program benefitting HCP Providers and HCP care recipients. 

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

The review process

Risk-based assurance reviews are in the Annual Assurance Plan.

The department also conducts reviews outside of the planned reviews based on urgency and risk. In addition, we conduct review activities between assurance reviews when needed. Activities are mainly desktop-based.

For assurance reviews, selected providers will receive a legally binding Notice, which will explain:

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

Review Officers work with selected providers throughout the review process. This is through entry and exit meetings as needed to clarify requirements and support providers where needed.

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

A review summary report 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 participants to ask questions. To support the sector to benefit from such reviews, we share findings and learnings through a regular live-chat session. During the session providers can ask us questions about the review or broader program assurance.

A program assurance review compliance team follows up with relevant providers where a review report recommends actions for the provider.

Reviews

We have completed our inaugural review on HCP Indirect and Care Management Charges. We have two reviews in progress that began in September 22 and are due for completion in July 2023. These will include the publishing of a summary report for each review, webinar and a live-chat session on the Community of Practice. Individual provider reports were issued in April 2023.

Review 2 – Unspent funds review

HCP unspent amounts are increasing. This review is assuring, for a risk-based selection of providers, that:

• they self-reported unspent funds accurately to Services Australia (for Improved Payment Arrangement purposes)
• they can return or make available the portion of unspent funds if needed when a person exits the HCP Program or moves to another provider.

Review 3 – Pricing transparency review

Pricing transparency is critical to helping care recipients to make informed choices. This review covered all providers (839) displaying prices on My Aged Care. Taking a two-phased approach, this review is examining providers’ pricing on My Aged Care to check that it is correct, complete and up to date. Phase 1 covered all 839 providers and phase 2 only engaged those providers that required further review.

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, HCP providers can directly engage with the HCP 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 the department 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:

• holding regular live-chat sessions

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

We encourage providers to join the Community of Practice by signing-up at HCP Program Assurance Community of Practice.

Tools for HCP care recipients

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

A fact sheet is available to help care recipients understand how to get the best value for money from their HCP. 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 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.

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