Australian National Aged Care Classification (AN-ACC) update – November 2022

The Australian National Aged Care Classification (AN-ACC) commenced on 1 October 2022. This webinar provides the aged care sector with the latest information on the AN-ACC funding model, care minutes and 24/7 nursing.

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Presenters

  • Mark Richardson – Assistant Secretary, Residential Care Funding Reform Branch, Department of Health and Aged Care
  • Robert Montefiore-Gardner and Claudia Dukats – Residential Care Funding Reform Branch, Department of Health and Aged Care
  • Angela Tulk – Services Australia
  • Genevieve Donnelly and Joanne Fitzgerald – Independent Health and Aged Care Pricing Authority (IHACPA).

Agenda

This webinar will focus on recent changes to the Australian National Aged Care Classification (AN-ACC) funding model and important information for aged care providers, including:

  • monthly statements
  • payments and claims processes
  • clarification around the palliative care entry process
  • 24/7 nursing requirement, exemption and supplement
  • care minutes and funding sufficiency update.

There will be an opportunity to ask questions during the webinar or pre-submit a question when you register.

This webinar has Auslan interpreters.

Questions and Answers

Presentation slides and video

1:29:56

Mark Richardson:

Hello everyone and welcome to our seventh Residential Aged Care Funding Reform Webinar. Please note that today’s webinar is being recorded and will be available online in around two weeks’ time for those who would like to watch later or not able to attend today.

Firstly I’d like to acknowledge the traditional custodians of the lands on which we meet today. I’m in Canberra on Ngunnawal country and I pay my respects to their Elders past, present and emerging. I would like to extend that acknowledgement and respect to any Aboriginal and/or Torres Strait Islander people joining us today.

My name is Mark Richardson. I am the Assistant Secretary of the Residential Care Funding Reform Branch at the Department of Health and Aged Care. I’m joined today by Joanne Fitzgerald and Genevieve Donnelly from the Independent Health and Aged Care Pricing Authority, Angela Tulk from Services Australia and Directors from the Residential Care Funding Reform Branch Rob Gardner and Claudia Dukats. I’m also pleased to welcome Amber Venner and Maddy Inglis our Auslan interpreters who are joining us for the session.

As mentioned this is the seventh webinar as part of a series of aged care webinars focused on residential aged care funding reform. You can watch recordings of previous webinars and this one when it is available at www.health.gov.au/resources/webinars. You can find information about future events by subscribing to our newsletter at www.health.gov.au/aged-care-newsletter-subscribe. You can also stay connected with the aged care funding reforms by signing up to the Engagement Hub and reading the education material available about AN-ACC including a comprehensive funding guide at www.health.gov.au/initiatives-and-programs/an-acc.

In regards to questions and answers as always we are keen to hear what’s on your mind and you will have an opportunity at the end to ask questions during today’s session. You can submit questions through a Q&A function on Webex. To do this at the bottom right hand side of your screen select Q&A and type your question and submit it to the panel. We have set aside some time at the end of the presentation for your questions and we will attempt to respond to as many as possible at the end of the webinar. All questions and answers including ones that we may not get to will be published on our Residential Aged Care Funding Reform web page when available.

So today is about providing you with some key updates and details since the launch of the AN‑ACC funding model on 1 October this year and upcoming reforms such as the Independent Health and Aged Care Pricing Authority or IHACPA, pricing recommendations and the 24/7 registered nursing requirements. In regards to the 24/7 registered nurse requirements we will take you through some of the key details that you will need to know, the supplement and exemptions, as well as further clarification on the key differences between care minutes and 24/7 registered nursing.

We will provide you with an update on the claims and payment process on the Services Australia Aged Care Provider Portal including monthly statements, and clarification on the palliative care entry process.

Now before I hand over to Joanne and the team I would like to run through an update on progress and what has changed since our last webinar on the 30th of August 2022.

A few key points in terms of an update on the residential aged care funding reform. First on 1 October the AN-ACC funding model was introduced with the first payments under this model being made this month. Second also on 1 October the Transition Fund began and aged care homes that were eligible and approved for funding can expect to see their first payments in early December. Third the second piece of the aged care legislation, the Aged Care Amendment Implementing Care Reform Bill 2022 that provides for registered nurses to be on site and on duty 24 hours a day and seven days a week in aged care homes was introduced on the 27th of July 2022. It has been through the Senate Community Affairs Legislative Committee for inquiry and passed in Parliament on the 27th of October, last month.

I’d like to take a moment to talk about the recent submission of the Quarterly Financial Reports. Thank you to the providers that submitted their Quarterly Financial Reports by the 4th of November, earlier this month. As you may be aware the information you report on the hours delivered by a registered nurse, enrolled nurse and personal care worker will directly inform the staff rating on care minutes which then feeds in to an overall star rating for a service. The Department is currently in the process of conducting reasonableness checks on the data submitted. Some of you may have already been contacted in regards to this check and been provided with information on possible remediation steps. We’d appreciate it if the requests to check your Quarterly Financial Report data are actioned in a timely manner to ensure that the care minutes information is ready for the star ratings process.

Please also be aware that failure to report care minutes to the Department will result in a one star for the staffing sub-category and will subsequently affect your service’s overall star rating.

On a different note and as a last point for the progress update I’d like to share that prior to AN‑ACC going live on 1 October just under 172,000 residents out of approximately 180,000 residents, which is close to 96%, that were in care received an AN-ACC assessment.

It should be noted that at the moment about 8,000 new residents come into care every month so 96% of residents assessed at any given point in time is about right.

I will now hand over to Joanne Fitzgerald who will talk about the Independent Health and Aged Care Pricing Authority’s role in providing advice to Government on residential aged care costings. Thanks Jo.

Joanne Fitzgerald:

[Visual of slide with text saying ‘Section 2’, ‘Providing advice on residential aged care costing and pricing’, ‘Independent Health and Aged Care Pricing Authority’, ‘Joanne Fitzgerald’, ‘A/g Chief Executive Officer’, ‘Genevieve Donnelly’, ‘Executive Director, Aged Care Policy & Communications Branch’, ‘IHACPA’]

Thank you Mark for the opportunity to present today. Good afternoon everyone. I’m Joanne Fitzgerald, Acting CEO of the Independent Health and Aged Care Pricing Authority, or IHACPA, and I’m joined by my colleague Genevieve Donnelly, Executive Director of Aged Care Policy and Communications.

We will use the time today to cover a few items which we hope helps provide further detail on how IHACPA will be contributing to the reform agenda across the aged care sector.

The Independent Hospital Pricing Authority or IHPA was established as an independent Government agency under the Commonwealth National Health Reform Act in 2011. It was set up with remit to support significant reforms to Australian public hospitals. IHPA’s contribution centred on funding reforms through the implementation of activity-based funding of public hospitals nationally. And this saw hospitals funded for the number and complexity of patients they treated, gave transparency to funding and aimed to drive efficiency.

The Authority gives independent and transparent advice in relation to funding for public hospitals by determining the National Efficient Price or NEP for healthcare services provided by public hospitals and the Authority publishes this and other information annually.

In response to recommendations of the Royal Commission into Aged Care Quality and Safety the Federal Budget 21-22 included measures that expanded IHPA’s remit. Under these measures IHPA was to provide advice to inform Commonwealth Government decisions on the costing and pricing of aged care services. This advice will take effect from 1 July 2023.

The responsibility for sector funding will remain with the system operators, the Commonwealth Government and the Department of Health and Aged Care. The Authority will provide pricing advice to the Commonwealth on residential aged care and respite care for 1 July 2023 and other advice will follow in later years. This advice obviously forms part of much larger reforms across the sector.

So now to our approach to the residential aged care costing and pricing advice.

Activity-based funding systems such as AN-ACC brings together multiple elements in a continuous cycle of work and this begins at the data collection stage. Over time we were able to build bigger and better cost and activity datasets. For example at the moment we have existing datasets available such as the shadow AN-ACC assessments, information from the RUCS study conducted by the University of Wollongong, demographic data, facility information and other datasets such as the Aged Care Financial Reports. The sector has started building Quarterly Financial Report data and generating AN-ACC assessment data following implementation on 1 October 2022. And IHACPA has commenced work towards conducting costing studies that will improve our understanding of the costs of delivering aged care services at the resident level.

As data availability, coverage and quality improves over time we get an increasingly refined understanding of the costs associated with providing aged care services. This in turn helps to refine the classification through greater information on the care and resources required by different groups of residents.

Translating activity cost and classification information into pricing requires policies that articulate how this information will be used to develop pricing advice that is appropriate and supports the desired objectives. For example we may develop pricing adjustments to account for additional costs associated with particular groups of residents or particular facility types. And finally this is all brought together in the provision of pricing advice to support Government decisions.

The cycle is self-reinforcing over time as the implementation of ABF pricing and funding generates more data. This supports more accurate costing in turn supporting refinements to the classification and exploration of appropriate policy options to address changes in the sector, resulting in regular updates to pricing so it can remain aligned to changes in the cost of care over time.

I will now hand over to my colleague Genevieve.

Genevieve Donnelly:

[Visual of slide with text saying ‘Developing a Pricing Framework for Australian Aged Care Services’, ‘Towards an Aged Care Pricing Framework Consultation Paper’, ‘IHACPA’]

Thank you Jo.

In October we completed our public consultation to inform the development of IHACPA’s first pricing framework for Australian residential aged care services. This will be the key policy document supporting IHACPA’s work in developing aged care costing and pricing advice.

In developing the pricing framework we’re aiming to articulate to the sector the policy priorities and objectives IHACPA will aim to support through its advice, the methodology it will use in developing costing and pricing advice, and finally how IHACPA will contribute to the design of the elements of the activity-based funding system.

While the first pricing framework will have a five year vision to shape the direction of IHACPA’s pricing advice development over the medium to long term it will also be subject to annual refinement through annual public consultation. This will help ensure it accurately addresses the changing requirements of the sector over time. Updating and publishing this document on an annual basis supports IHACPA’s commitment to transparency and consultation in delivering its aged care functions.

We have proposed a set of principles which are central to the pricing framework and policy approach. These are broken down into three. Firstly overarching principles that express the policy intent that IHACPA will aim to support. The second, principles that will shape the development of ABF processes. And the third, principles that guide more detailed system design choices. They reflect a long term view of IHACPA’s intent and objectives in developing costing and pricing advice as well as the way it designs data collections and how it will make policy decisions.

The implementation of the costing and pricing cycle will improve our understanding of the costs of providing aged care services and provide the opportunity to examine particular areas more closely in the future.

Public consultation also provides the opportunity for the sector to have input into our future priorities. Currently these include a costing study to support refinement of residential respite pricing in order to better understand the specific costs associated with residential respite care, a review of the one-off adjustments for new residents including on entry to residential aged care, consideration of how Multipurpose Services and National Aboriginal and Torres Strait Islander Flexible Aged Care Program funding could be aligned to AN-ACC funding model, and finally following future reforms development of costing advice for home care.

We hope this provides some insight into the development of costing and pricing advice on residential aged care services. We thank you for your time today and look forward to answering questions later in the webinar.

[Visual of slide with text saying ‘Connect with us’, ‘Subscribe to our mailing list to receive updates on our work developing aged care costing and pricing advice’, ‘Further information’, ‘To learn more about the Independent Health and Aged Care Pricing Authority, get in touch with us via the details below’, ‘(02) 8215 1100’, ‘enquiries.ihacpa@ihacpa.gov.au’, ‘www.ihacpa.gov.au’, ‘Find us online to connect with us’, ‘in Independent Health and Aged Care Pricing Authority’, ‘@IHACPA’]

Mark Richardson:

Thanks Genevieve and Joanne. Angela I think that’s over to you to I guess speak to us about Services Australia Aged Care Provider Portal, your payments and claims and monthly statements.

Angela Tulk:

[Visual of slide with text saying ‘Section 2’, ‘Residential Aged Care funding Reform AN-ACC – Aged Care Payment System changes’, ‘Angela Tulk – Director, Aged Care Transformation Branch’, ‘Australian Government with Crest (logo)’, ‘Services Australia’]

Great. Thanks Mark. Okay. Thank you. So the key topics that I’m going to be covering today is ACFI end dating, our AN-ACC claims process, some system feature changes, the reconciliation of bank statements against the payment statements, some information about NAPS ID and our provider education material.

So as part of the residential aged care funding reform Services Australia launched the new aged care payment system for residential care on the 20th of August 2022. These changes for October included features to support the new Australian National Aged Care Classification, as we all know it as AN-ACC, and some enhancements to the functionality in the aged care payment system.

So from the 1st of November we saw the first AN-ACC claims that were lodged by providers.

The process for claim finalisation in the portal has not changed for AN-ACC. It’s a really important point that we’d like to share with providers today. So Services Australia are taking a really cautious approach of processing these claims to make sure that the calculations are occurring correctly. The result of the October claim checking process means that it may take a little longer for the approval of your claims. We have processed over 60% of claims for October so we’re well into the month and processing of those claims. Our future internal processes will be simplified and it will be enabling a more timely processing of claims in the future.

Some information about ACFI end dating. So it has been end dated in the system. So current claims for October and November are now displaying the AN-ACC classification and every care recipient will have their current ACFI end date as at the 30th of September 2022 and this can be seen on the ACFI summary screen.

I’m just going to show you some screenshots here of the care recipient AN-ACC classification. So as you can see the class for AN-ACC will be listed. It will give a range of other information including the start date.

We will also see the service AN-ACC classification which will show the class for the service.

So these are some important screens if you’re wanting to look at historical data for AN-ACC classifications. It will also show you the ACFI end dating for each care recipient.

So I’m going to talk about some payment statements about what stays the same. So listed here is what you will see that will be the same from the current payment statements for ACFI to moving into AN-ACC. So the general look and feel of the payment statement will be the same. Subsidies and supplements are displayed in separate sections. Payments are itemised for individual care recipients. The care recipient details will still be viewable for all care recipients and payment statement notes are now viewable as well. So ACFI details and their corresponding columns will continue to display if there are adjustments relating to the ACFI payments. The CSV and XML versions of the payment statement are available for download.

So under AN-ACC there are some changes to the way that the payment statement displays. Within subsidies and supplements the total subsidies and supplements paid to the service for the claim month will be displayed. Additional details about the subsidies and supplements will be displayed on the care recipient’s itemised payments. We have a new feature. Subsidies will now be broken down into fixed subsidy, variable subsidy permanent and variable subsidy respite.

The service payment summary. If a service is entitled to an initial one-off entry payment for a care recipient this will be listed in the supplement section as initial entry adjustment payment. Details of one-off entry payments will also be displayed in the care recipient’s itemised payments.

The service payment summary will also have an outstanding balance and advance section which will display the same way as existing payment statements. The special payments will be displayed when they have been paid to the service during the selected months. If there has been no special payments that were paid during the month then the special payments table will not be displayed.

So further details about the special payments can be found on the special payment summary screen within the portal.

The care recipients itemised payments. With AN-ACC classification the care recipient’s details will display under the payment type column. The AN-ACC class will be displayed as variable subsidy, class and the class number. If the care recipient has a change of their classification or adjustments are required there will be multiple variable subsidy payments listed.

The rate effective date for the variable subsidy will be under the care recipient’s entry date or if there has been a change to the care recipient’s AN-ACC classification it will be the date the new classification took effect.

Okay. So on this screen you will see the enteral feeding events and you can see the calculation here against the paid care days. You can see that arrow down the bottom highlighting that.

The care recipient’s itemised payments will also show you what it looks like where there is a combination of AN-ACC with the ACFI retrospective. So an appraisal payment indicator will also be dynamic which will no longer display on AN-ACC payment statements and there is no requirement for reappraisals anymore. So it will display if there are adjustments to ACFI payments on the payment statement.

Okay. So this one is a close up of what shows on slide 10 under the care recipient itemised payment. The care recipient’s AN-ACC classifications and the AN-ACC effective date will now display on the payment statement and this will replace the ACFI details.

We just want you to note there that the effective date will either be the date of entry or the date that the classification took effect if there has been a change in the classification.

So with the supported resident ratio this will be calculated as a monthly average percentage to simplify the reconciliation across the month. For an AN-ACC month the supported resident ratio is displayed in a simplified table on your payment statement.

The supported resident ratio adjustments screen will only display data if there has been an adjustment in that selected month. The format displayed for the adjustment will depend on whether the month being adjusted for was an ACFI or an AN-ACC month. So for example if the claim month was an AN-ACC month but the adjustment was for ACFI the adjustment details would display in the ACFI format.

The screen displays the selected claim month and also the adjusted month in the top right hand corner. The adjustment month dropdown box will provide the option to view other adjustment months if there were multiple months adjusted in the selected claim.

So I’d just like to bring to providers’ attention the Services Australia supported browsers. We have had some enquiries with some technical difficulties around seeing information. So as you need to log on to PRODA please ensure your browsers are a minimum browser version for PRODA. So listed on the screen are the recommended browser versions. Older versions of these browsers will work but they may not display your information correctly as they are not tested and they’re not supported by Services Australia.

So I’d just like to draw your attention to some new infographics that we’ve pulled together. So this one has been created to support the reconciliation of bank statements against the service payment summary. It’s been colour coded to clearly note the connection between the payment statement under the service name and the service payment summary to your bank statement. That’s available on our provider education website.

A further update in relation to the NAPS ID. So following the launch of the aged care payment system services will need to view and use their service ID being their NAPS ID in most circumstances. The services RACS ID will be displayed in some places on our system but you will need to use your NAPS ID in most search fields.

Just drawing your attention to our provider education resources page. This is showing you where you can find the educational resources on our website. Very handy and will have all of the new infographics including those for payment statements.

Thank you and I’ll now hand back to you Mark.

Mark Richardson:

Thanks Angela. That was great. Very useful. Look our next presenter is Rob Gardner. He’s the Director of the Funding Regulation Section and he’s here to talk to us today about the palliative care entry process. So over to you Rob.

Robert Gardner:

[Visual of slide with text saying ‘Section 3’, ‘Palliative care entry process’, ‘Robert Montefiore‑Gardner – Director of Funding Regulation’]

Thanks Mark. Look as Mark said I’m going to take you quickly through the palliative care entry process. There’s a few bits and pieces I want to cover but mainly the entry pathways, take you through some of the forms, who fills it out and when and then just a few examples of palliative care residents and scenarios and how we might go about assessing and funding those scenarios.

So if we have a look at the next slide it’s got three methods of entry into palliative care. And I think it’s just important for people to realise that there is a palliative care class in AN-ACC, class one, that is specifically for people/residents who enter the service to receive palliative care. So they haven’t been in the service before. They’re coming in just to receive palliative care. And that’s a special class for those people. There will be people in palliative care in all of the other AN‑ACC classes, people who’ve been in the service for a while and they might decline either naturally as it said there or they have an episode or event that leads them to needing palliative care. So there’s three different groups of people receiving palliative care in aged care but it’s only the new residents who are eligible for AN-ACC class one.

So if we have a look at the next slide, this is the form.

So you can see there’s a tiny little form on the left there. But the form is completed for residents who enter the service specifically to receive palliative care. So they’re the class one residents. You do not need to fill the form out for anybody other than people who are entering a service to receive palliative care. And the details that are on this form are what is used by the Department to assess whether the person is eligible for AN-ACC class one. So the form outlines the criteria in terms of the Australian Modified Karnofsky Performance Score and the expected life expectancy of the person. If the people do not meet the requirements that are on the form we cannot assess them as eligible for AN-ACC class one. So that is you need to have an AKPS score of 40 or less and a life expectancy of three months or less.

So parts A and B of the form need to be completed by an independent medical practitioner or a nurse practitioner. Parts C and D are completed by the resident and the provider. And then there’s another part on the form for the palliative care phase and this describes an individual and their palliative care needs at a specific point in time, ie when they’re entering. The phases are not sequential and they can change as the individual’s needs change. So the four phases that are indicated are stable, unstable, deteriorating and terminal. The phase is determined by a holistic clinical assessment which incorporates the needs of the person and their family and carers. The phase that’s recorded on the form is one that best describes the person on the day that the assessment is made and there’s more guidance for the palliative care phase on page four of the palliative care status form. And as I said that’s something that’s done by medical professionals. That’s not something that providers need to do.

The form itself is available on the Department of Health and Aged Care website. You can see a link to the form in the presentation and it’s also got contact details if you have any queries or you need assistance in completing it.

So let’s have a look through some of the scenarios where we have people entering for palliative care. So the first scenario is a client who enters, they are palliative but they do not meet the eligibility requirements. For example they might have an AKPS score of 50 or they may have a life expectancy of more than three months. So this person will be considered not eligible for AN‑ACC class one. Obviously they can still enter residential aged care, they can still receive palliative care, but they will have the normal entry process and the normal AN-ACC assessment. And obviously if they then deteriorate over time you can also ask for a re-assessment.

The second question that we get quite frequently is what happens if a person dies before the assessment is completed? So they may go through, they might fill in the details of the form, have the medical assessment done, and then between entry and the Department receiving the forms or before the Department has assessed the forms the person dies. So what happens in this case is that when you as a provider mark the palliative entry box in the aged care entry record on the Services Australia website as palliative that determines the default funding rate for the resident and they will be paid at a rate equivalent to AN-ACC class one. So the person even though they have not been assessed, they will receive funding equivalent to AN-ACC class one for the time that they are in care.

The next question is another question that we hear quite commonly and that’s what happens if an existing resident becomes palliative. And that’s as I said at the beginning just considered a normal part of the residential aged care journey that many residents go through and – sorry. I just got a notification. I should have turned them off. And if a resident becomes palliative after entry the process is that you request a reclassification and then you may receive obviously a different AN-ACC class depending on the needs of the person at the time they’re assessed.

And if we come through to the next question.

And I think I’ve probably forgotten to say something. If you have someone who is terminal, they’ve deteriorated, they’re rapidly deteriorating, you can send a message – I think there’s a link on the screen – to AN-ACC assessors at the Department and request an urgent assessment and we’ll see what we can do for those people.

And then the last question that we get again quite frequently is what happens if residents live longer than three months? Now I think that’s a really good question because obviously we’re asking people to assess that the resident has as life expectancy of three months but we understand that that’s just really an average. So that’s a doctor’s best guess at the time that the assessment is made. Some people will live shorter than that. Some people will live longer. So you’ll continue to receive the palliative care rate of funding for the entire time that that resident is in care. There’s no need to resubmit forms and the funding stays with the resident until they depart the service or the provider or the resident requests a reclassification. Now that might happen if for example the person goes into remission and needs less care. You may wish to request a reclassification but you do not have to.

So obviously if you’ve got more questions you can put them through in the chat but that’s the things that I wanted to take you through today. So I will hand you over to Claudia I think is next.

Claudia Dukats:

[Visual of slide with text saying ‘Section 4’, ‘24/7 registered nursing requirements’, ‘Claudia Dukats – Director of Policy and Care Minutes’]

Thanks Rob. My name is Claudia Dukats and I’m a Director of the AN-ACC Policy and Care Minutes Section in the Residential Care Funding Reform Branch. As Rob said today I’ll be talking about 24/7 registered nursing requirements, the exemption that may apply to eligible providers, the RN supplement, details about reporting and as well go through a few examples of how this policy might play out in reality and cover the less common scenarios. After this I’ll go into some detail on care minutes and a comparison with 24/7 registered nursing requirement, the consultancies that are starting for it and then cover the definitions of workers specifically registered nurses, enrolled nurses and personal care workers under care minutes.

Before I go any further I want to emphasise that both these policies for 24/7 registered nursing and care minutes demonstrates that the Government is fully implementing the Royal Commission recommendation relating to minimum care time standards to address under-staffing in residential aged care. These measures will not only improve resident care but they will also improve the working conditions of the dedicated nurses and carers delivering vital care to older Australians.

So with that in mind let me start with the slide we have up now and explain the 24/7 registered nursing requirement. The Royal Commission into Aged Care Quality and Safety identified that staffing levels are critical to the quality of residential care and recommended at least one registered nurse or RN is on site per residential aged care service at all times. You can see recommendation 86 of the Royal Commission’s final report for more information.

As Mark mentioned at the beginning of the webinar the legislation that enables the implementation of this, the Aged Care Implementing Care Reform Bill 2022 was passed through Parliament on 27 October. So I can confirm that from 1 July 2023 approved services must have an RN on site and on duty 24 hours a day seven days a week. The intended benefits of this requirement are that it will reduce the risk of resident harm that can occur when qualified and experienced care staff are not available in a service to identify and address potential risks as well as give residents better access to care in a service, enabling RNs to manage some issues as first responders, improving resident safety and preventing some unnecessary trips to hospital emergency rooms.

Funding supplement. We will be providing support to eligible providers to help meet this requirement from 1 July 2023. Residential aged care services with 60 residents or less based on occupied beds are eligible for a funding supplement to employ extra RNs to deliver 24/7 RN care. Services with more than 60 residents will not receive the supplement because their existing Australian National Aged Care Classification or AN-ACC funding is sufficient to provide for 24/7 RN care.

Before I talk more about the RN supplement I want to cover off on the 24/7 registered nurse exemption that will apply to eligible providers. The exemption is fairly straightforward and you can see on this slide the two main criteria required are that services must have 30 or less approved beds as well as be located in the Modified Monash Model or MMM 5-7 locations. The other criteria is that residential aged care service will have their compliance status reviewed. The facility must not have outstanding compliance issues otherwise they will not be offered an exemption to the 24/7 nursing requirement. Services that meet all the criteria will be eligible for a one-off 12 month exemption from the 24/7 RN requirement. This exemption is limited to 12 months in line with the underpinning legislation.

For what happens after the 12 months we are starting some consultancy work on this which I’ll talk in detail about later in the presentation.

Services must agree to the exemption and sign a statement that they have suitable care arrangements in place for when they do not have an RN on site, acknowledge that they will not receive a supplement and agree to report monthly on what RN coverage they have. Services can also choose to opt out of the exemption including after they have agreed to it.

This slide provides more detail about the 24/7 registered nurse supplement. The 24/7 registered nurse supplement helps residential aged care services employ extra RNs to always provide an RN on site and on duty. This is a non-means tested supplement and is for residential aged care services with up to 60 residents and is based on occupied beds. This is a non-means tested supplement and is for residential aged care services with up to 60 residents. The supplement tops up the AN-ACC care minutes funding you receive. Services with more than 60 residents do not receive the supplement as their existing care minutes funding is already sufficient for providing 24/7 RN care. This supplement is available to eligible providers from 1 July 2023. The supplement doesn’t apply to flexible care services such as multipurpose services.

The 24/7 RN supplement rate is based on a number of residents in the service with services with fewer residents receiving more funding. The rate is also based on the location of the service under the Modified Monash Model or MMM.

There are two supplement rates. One for services located in metropolitan locations, so MMM 1-4, and the other for services located in rural, remote and very remote locations, MMM 5-7, to account for the additional costs that come with working in these areas. The supplement will cover the cost of up to eight hours overnight registered nurse shift for services located in metropolitan locations, so MMM 1-4, while in rural and remote areas, MMM 5-7, the supplement covers the cost of having a registered nurse on site 24 hours per day not provided by the AN-ACC basic daily subsidy.

The maximum supplement amount is around $27,416.67 (correct price $21,416.67) per month for MMM 1-4 facilities with up to five residents, and around $61,083.33 per month for a MMM 5-7 facility with up to five residents. The maximum supplement payable decreases on a sliding scale as the numbers of residents at the facility increases. As mentioned the supplement cuts off for services with more than 60 residents. For the first two months following the introduction of the 24/7 requirement the supplement funding level a facility receives will be set based on the number of occupied beds at the time the requirement commences. After this time and noting that resident occupancy of a facility is variable the payment will be determined through a three month rolling occupancy average calculated at the beginning of each month on the last three months occupancy.

This approach accounts for occupancy changes while also providing funding certainty for services. If there is an occupancy change within the month it doesn’t impact the supplement funding until the next month when a new three month rolling average is calculated.

The rates. The supplement rate will be adjusted each year on 1 July with consideration to advice from the Independent Hospital and Aged Care Pricing Authority on the cost of delivering RN care. From 2024-25 additional AN-ACC funding will be provided to support services to deliver an additional 15 minutes of care per resident per day. When this happens the RN supplement will reduce and only be available to facilities of 50 residents or less.

Eligibility. The good news. Providers do not need to apply for the supplement. Services Australia automatically pays this supplement to eligible services.

Before I explain the 24/7 nursing reporting requirements I want to talk about why this reporting is important. I know it probably looks like yet another report for residential aged care but we have really worked hard and consulted on this. It’s supposed to be as minimal reporting required as well as meaningful for the Department.

The reporting that is completed for 24/7 RN requirement is really crucial to inform us on three key areas. It will inform us about who is meeting the 24/7 requirement, it will provide insightful workforce planning by identifying areas where there are sufficient staff and areas of shortage, the times that are difficult to cover and whether there is a seasonal impact. The data from this reporting will also be able to better inform the exemption policy for the 24/7 RN into the future so we can see where it’s working and where it might need refining. The idea is that all of this information is used to make 24/7 RN requirements fit for purpose and tailored to the conditions of the aged care sector. It really is another way that we get your feedback on what is and isn’t happening out there in aged care homes. So it is important that providers complete the reporting and we will make the most use of it for evaluation and refinement of these policies and programs.

So to bring it back now to how the reporting works the requirement is that you must report monthly on all periods of 30 minutes or more where an RN is not on site and on duty. If you have an RN on duty and on site 24/7 then the reporting for that month is not required. It’s also important to know that the supplement will be paid monthly and a reconciliation will occur after every month. This means that any provider that is not meeting the 24/7 RN requirement during the month or not reporting for that month will have their funding adjusted.

Like Rob had done earlier with palliative care let’s look at a couple of examples for the 24/7 registered nursing policy to see how it will work in practice and what to do when things don’t work. The first example here is what happens if I miss the monthly reporting? In this case if there was a period of 30 minutes or more when an RN was not on site and on duty and you missed the monthly reporting that means your funding for this month would be impacted and would be adjusted at the end of the month. The supplement funding will also be impacted for the next month. It will be withheld until you have completed the monthly report. Also the services will be reported to the Aged Care Quality and Safety Commission.

For the second example if a service had 29 occupied beds one month and was located in MMM 7 location and qualified for the specialised homeless base care tariff would this be accepted for an exemption? The exemption for 24/7 nursing depends on approved beds not occupied beds. The homeless specialisation base care tariff is not a factor for exemption however the MMM 7 would be a factor in the exemption but the approved beds would need to be confirmed before this aged care home could meet the criteria for an exemption.

We have our last example here on the slide which is if a service has 30 approved beds and is located in a MMM 6 location how do I apply for an exemption? The answer here is on the 1st of April 2023 the exemption process will open. The Department will email every eligible service asking for a response either accepting the exemption and providing a signed statement or an email response stating they will not be accepting the exemption at this stage. Responses will be due by the 30th of April 2023.

For further information about 24/7 nursing we also have two web pages available which you can see at the bottom of the slide.

Okay. That’s all on 24/7 RN requirements today and next I’m going to take you through the care minutes.

[Visual of slide with text saying ‘Section 5’, ‘Care minutes updates’, ‘Claudia Dukats – Director of Policy and Care Minutes’]

Here I’ll show a comparison with the 24/7 RN requirement, talk about the consultancies that we are working on for it and then cover the definitions of the workers under care minutes.

Before I talk about the table on the slide that compares care minutes to 24/7 registered nursing I also want to quickly compare care minutes to the AN-ACC funding. You have probably heard care minutes and AN-ACC mentioned together and they are linked but they are different policies and models and separate budget measures from each. Likewise 24/7 registered nursing and care minutes are separate as well but they do have a few things in common. Let me take you through the table we have here. The purpose of 24/7 registered nursing is to provide continuous resident access to high level care from an RN which is similar to the purpose of care minutes, the purpose of which is to increase time of direct care for residents. They also both maintain the shared purpose on meeting minimum staffing levels as recommended from the Royal Commission and to raise the quality of care provided.

The targets introduced for care minutes on 1 October 2022 along with the funding provided through AN-ACC allows time for providers to adjust to the new requirements before they become mandatory on 1 October 2023. There isn’t an introductory period for 24/7 registered nursing which comes into effect on 1 July 2023 so a few months earlier than care minutes.

Both 24/7 nursing and care minutes include RN time as they are regarded as crucial health professionals in residential aged care. The funding mechanism for the 24/7 nursing supplement is a separate payment whereas care minutes is paid via the AN-ACC payments. Reporting 24/7 registered nursing is monthly by exception however care minutes is through the Aged Care Financial Report and the Quarterly Financial Report.

Now for star ratings. Both 24/7 nursing and care minutes will feed in to the star ratings program which is due to start in December next month. Lastly we have exemptions and under the criteria I discussed earlier there is an exemption criteria for 24/7 registered nursing however at the moment care minutes doesn’t have an exemption process. The targets apply to all aged care homes across residential aged care. So you can see there are a few differences but certainly a couple of places where they link together. And each are important policies to implement to meet minimum staff time with aged care residents.

All right. This slide you might have seen previously but we feel it’s an important one to get the message out on. We want to emphasise that you will be supported to meet the new increased requirement with the Government providing $5.4 billion over four years from 1 October 2022 to fund extra direct care time to be delivered by registered nurses, enrolled nurses and personal care workers. Also in the recent October Federal Budget the Government announced an additional $1.9 billion to support providers to meet the increased care minutes requirement that starts from 1 October 2024 moving to the sector average of 215 minutes of direct care time per resident.

The aim of care minutes requirements is not just to increase the average amount of care time for each resident but to raise the quality of care that is being delivered. This is why there is a focus on care being delivered by registered nurses, enrolled nurses and personal care workers. In line with the Royal Commission’s recommendation only the worked hours of these roles will count towards the care minutes targets when they are providing personal care to residents. Care delivered by other staff such as allied health and lifestyle services cannot be counted towards your care minutes. As you can see this slide sets out the duties for direct care staff and I’ll discuss their definitions as well.

For the purposes of care minutes a registered nurse is someone that has completed a three year Bachelor of Nursing through a university to meet the registered nurse standards for practice. They have more responsibilities than an enrolled nurse and their scope of practice can include assessing patients, developing a nursing care plan, administering medicine, providing specialised nursing care. Where a nurse does not have a Bachelors degree but has been licenced by AHPRA as an RN they are considered an RN for the purposes of providing care minutes.

An enrolled nurse is someone that has completed a diploma of nursing through a vocational education provider to meet the enrolled nurse standards for practice. Enrolled nurses work under the direct supervision of a registered nurse and cannot act alone. Typical duties include regularly recording patients’ temperature, pulse, blood pressure, respiration and so on, providing interventions, treatments and therapies from patient care plans, assisting registered nurses and other team members with health education activities, helping patients with their activities of daily life. Where a nurse does not have a diploma but has been licenced by AHPRA as an EN they are considered an EN for the purposes of providing care minutes. ENs cannot provide RN specific care minutes but can perform appropriate nursing tasks that allow RNs more time to provide RN specific care minutes. ENs’ time providing direct care to residents is included in the total care minutes.

Also I’m pleased to let you know that we have recently published our definition of personal care workers. We have had extensive consultation and research on this definition and it will be used to measure the direct care of personal care workers that counts towards care minutes targets. A personal care worker or PCW is an employee classified under the Aged Care Award 2010 or an equivalent Enterprise Agreement as an aged care employee level 2, grade 1 personal care worker up to aged care employee level 7, which is a grade 5 personal care worker, excluding aged care employee level 6, and works under the guidance of a nurse, either an RN or an EN.

Activities of a personal care worker that can be reported as care minutes include assisting residents with daily living routines and direct care activities such as self-care or personal care, for example assisting with eating and drinking, monitoring fluid intake, skincare, bathing, washing, dressing, hair care, mouth care, positioning, shaving, bladder and bowel care, mobility and transfers such as getting in and out of bed or to and from the toilet.

Social and emotional support for residents and their families, for example supporting residents to be and feel connected, heard, valued and fulfilled. Regular monitoring and support of residents’ health and wellbeing.

Activities not consistent with personal care work include but are not limited to organising recreational social activities, allied health, including exercise, and hotel services such as catering, cleaning and laundry.

Also social and emotional support is a vital part of residential aged care. Personal care workers can and do support residents’ social and emotional needs as part of their duties and this component of their duties can be included in care minutes. Just like with the need to improve the standard of personal care in residential aged care social and emotional support should enhance, not be at the expense of personal assistance with daily living routines and direct care activities such as bathing and washing, dressing, feeding, getting in and out of bed and getting to and from the toilet and continence management.

Social and emotional support includes activities that support residents to be and feel connected, heard, valued and fulfilled. Examples of the activities that could be counted include but aren’t limited to when a personal care worker spends social time with a resident to have a conversation, assists them personally to undertake personal interests, for example reading or playing a game, assists them personally to participate in a group activity. Running group lifestyle activities that would usually be run by a lifestyle coordinator, for example painting, singing, bingo, excursions, does not count towards care minutes. But a personal care worker personally assisting a resident to take part in these activities does count.

Regarding exemptions the Government is considering situations where it may be appropriate for care minute staffing exemptions, substitution of RNs by other professions to apply consistent with recommendation 86 of the final report. Consultation on the staffing exemptions is ongoing.

For further details on care minutes please see our care minutes and 24/7 nursing requirements guide. The URL is available at the bottom of the screen.

There are five consultations happening in residential aged care at the moment, three of which I’ll provide more detail on today. The five consultancies where we are going out to partner with other organisations to develop and refine policies for residential aged care are one, areas of workforce shortage for RNs. Two, alternative models of care for where an RN is not on site. Three, auditing of 24/7 registered nurse and care minutes reporting. Four, adding the 24/7 RN requirement to the star ratings mechanism. And lastly five, reviewing the ACFR and QFR, that’s Quarterly Financial Report, data collections.

The first one I’ll talk to today is on the areas of workforce constraints or shortages. This consultancy is to scope modelling of an area of workforce constraint for RNs working in aged care. At present we only have anecdotal evidence about areas where RNs are in shortage. This modelling may inform decision making about exemptions from the RN requirement and may also inform targeting of future aged care workforce initiatives.

The second consultancy is looking at if there are alternative options for aged care homes to deliver safe and quality care when an RN is not on site and on duty, particularly due to workforce shortages. This consultancy will also be looking at whether other staff skill mix might be appropriate to meet an exemption and the impact of an aged care home being collocated with a health service. We are looking for evidence-based practical, clinically appropriate options that can be used in different situations. We’re in the early stages of these consultancies but once they have been further progressed they will include targeted consultation on the proposed approaches with key stakeholder groups such as the aged care provider groups and consumer groups, state and territory governments, professional representation bodies and directly with relevant providers and consumers.

The third consultancy we’ll be looking in to is the auditing of 24/7 registered nursing and care minutes reporting. The Department has started monitoring the information that is being submitted by providers to validate the accuracy of information submitted by providers in their 24/7 and care minutes reports. Please note that we are planning to eventually introduce an ongoing program of audits in 2023-24. The audits will be conducted to monitor provider compliance with legislated requirements by cross checking the information submitted in quarterly reports and annual aged care financial reporting statements against other information sources.

While it is expected that most providers will meet the care minutes reporting requirements if non‑compliance is identified the Department may take action to protect the integrity of the Commonwealth’s expenditure and the accuracy of information published through the residential aged care star ratings system. While the design of the auditing program is yet to be finalised it can be expected that the audits may involve a combination of at desk and on site activities. These will check for anomalies in the reports providers have submitted by comparing this data to other information they hold.

For the remaining consultancies on adding 24/7 nursing requirements to star ratings as well as the review of the Quarterly Financial Report and the Aged Care Financial Report data collections, we’ll be providing more information on these as they are developed.

I’ll now hand back to Mark for the Q&A session.

Mark Richardson:

[Visual of slide with text saying ‘Q&A’, ‘Care Minutes and 24/7 Nursing Requirements Guide’, ‘https://www.health.gov.au/initiatives-and-programs/aged-care-247-registered-nurse-requirement’]

Thanks Claudia. Look that was fantastic. That was a real marathon so well done. Look there was a huge amount of information there on both 24/7 and care minutes. As Claudia said we have information up on our website now, a 24/7 and care minutes guide so I’d encourage you all to jump online and take your time to go through that information. Claudia went through a lot of it today but it’s really important that you get your head around that.

But look also thank you to the other presenters, our IHACPA colleagues around AN-ACC pricing, Services Australia around their provider portal and Rob with palliative care.

So look we’ll move on to the questions now. We’ve had a number of questions submitted online and also questions that have been submitted to us before this session or in advance of the session I should say. We’ll do our best to get through them all. I’ll start with the first one that came in I guess before the session today. The question is:

Q:        Has the Fair Work Commission decision to increase the minimum wage by 15% had any impact on the AN-ACC funding?

So look I’ll answer that one. We know the Fair Work Commission has determined that the aged care workers on the award, specifically direct care workers including registered nurses, enrolled nurses and personal care workers, will receive a 15% increase to the minimum wage. However the Fair Work Commission has not finalised the timing of this increase. Once this is settled it is envisaged, although it is dependent on a Government decision, that there will be an AN-ACC price rise to align with the implementation date determined by the Fair Work Commission.

So short answer I guess is that yes there will be an AN-ACC funding increase would be our assumption. It’s just a matter of the timing of that.

Look the second question that we have – Claudia you’re back on – it is:

Q:        Can you please specify which roles and positions are included in the care minutes and which roles are not? Which roles or positions can be considered in the hybrid roles?

Claudia Dukats:

Sure. As mentioned in the presentation only personal/direct care that is delivered from registered nurses, enrolled nurses and personal care workers can be counted towards care minutes. Where a registered nurse, enrolled nurse or personal care worker is employed in a hybrid role, for example providing both personal care and other activities such as rostering, social activities, catering and laundry, only the portion of the worker’s time spent on direct or personal care can count towards care minutes. Other activities that are performed in the context of other roles such as a care manager or a lifestyle worker or a laundry hand are outside the roles of the registered nurse, enrolled nurse and personal care worker. You can find out more information on the types of care staff that can be counted in the care minutes and 24/7 nursing requirements guide that is now available on the Health website.

Mark Richardson:

Fantastic. Thanks Claudia. Look the next question that’s come in is:

Q:        Will care minute targets be considered for enrolled nurses?

So look I’ll answer that one. And to add some context to this one I think what it’s getting at is that we have heard from parts of the sector that they’re looking to no longer employ enrolled nurses and replace them with personal care workers because there’s not a specific target for enrolled nurses.

Look the short answer is no we’re not at this point looking at a separate care minutes target for enrolled nurses. However as we’ve advised previously the worked hours of enrolled nurses contribute to the care minute targets. And I think some important points here. First of all the Royal Commission identified that staffing levels including the right mix of RNs, ENs and PCWs, is vital to the quality of care that older Australians receive. Therefore ENs are an important part of the aged care workforce in the residential aged care sector as they free up RNs to work at the top of their scope of practice providing more complex, clinical care for residents in care. They are also vital for when an RN is not on site, for example when workforce shortages make it impossible to have an RN on site all day.

Look the other key point is that the funding of $5.4 billion for care minutes from the 1st of October this year includes funding for enrolled nurses. So that funding allocated by Government went down to the proportion of RNs, ENs and PCWs in the sector. So it clearly includes funding to maintain those existing proportions of workers, in other words to maintain the number of enrolled nurses that you currently have employed.

But look lastly I think an important point is that residential aged care services are required to ensure that the workforce is sufficient and is skilled and qualified to provide safe, respectful and quality aged care that is consistent with the needs of their residents as required by the Aged Care Quality Standard number 7. So the right nursing skill mix within the service including having appropriately skilled and qualified ENs will be monitored by the Aged Care Quality and Safety Commission and we will be providing them I guess that information through the Quarterly Financial Report that the sector submits to us. So providers that have an insufficient number of ENs in their workforce are potentially at risk of not meeting this quality standard.

Look I’ll jump to some other questions now that came in once again before this session. And it’s for you Angela from a Services Australia perspective. The first one is:

Q:        When is my October claim going to be approved?

Angela Tulk:

Thanks Mark. As I said in the presentation Services Australia have been taking a really cautious approach to the claims processing. We’re continuing to do our quality checking to make sure that the AN-ACC classifications are accurate. I’ve just actually got some new statistics through while we’ve been in the webinar and we’ve actually processed now 68% of claims for the month of October. So we’re well on our way to getting those completed in the next week or so. We do appreciate all of the providers’ patience but I think it’s really important to note that accuracy is also fairly important.

Mark Richardson:

Fantastic. Thanks Angela. And look I think another important question that’s come through is:

Q:        When will the payment statement PDF be available?

Angela Tulk:

Yes. So our payment statement PDF is due to be released on the 3rd of December. So still a couple of weeks away but I am advised that it is on track for release.

Mark Richardson:

Okay. Thanks Angela. Look some of the ones that have come in just recently online. The question is:

Q:        Can you please advise when what you were discussing applies or does not to NATISFAC funded residential aged care services?

So just really quickly I’ll answer that one. What you heard today in terms of what applies – that’s probably the easiest way of answering the question – what applies to NATISFAC was the care minutes target. That’s 200 and 215. There’s been no Government decision yet in relation to 24/7 and obviously NATSIFAC isn’t funded through AN-ACC so things like palliative care and so forth didn’t relate. I think Jo and Genevieve mentioned as part of their IHACPA presentation that they were looking at how NATSIFAC and MPS could potentially be incorporated into AN-ACC. But at the moment 200 minutes and 215 is what applies to NATSIFAC.

The next question Claudia, or I might have the first go at this. But 24/7 RN exemptions.

Q:        How was the exemption level of less than 30 beds worked out? This is unrealistic as homes with 30 to 45 beds also need an exemption as they are in areas where there are no RNs available and no extra supplement will change this. Please comment if this has involved consultation with the industry to know what is happening on the ground. Will this be amended to reflect reality?

So look there’s probably a number of aspects to this question. I’ll have the first go at it and Claudia if you want to add anything more than happy for you to do so. That is the Government decision at this point in time. So it’s 30 beds or less in MMM 5 to MMM 7 areas. I think an important point is that at the moment we estimate it would impact about 191 facilities or 7% of facilities across the country. So Government was looking at I guess targeting small facilities in obviously regional and very remote parts of Australia where it thought the most difficulty would be had in terms of where the workforce shortages are chronic in terms of obtaining an RN.

There’s a real balance there. At the end of the day Government obviously made a commitment to deliver 24/7 and trying to get that balance right in terms of small facilities the decision was made that 30 beds was that right balance and also meeting I guess the commitment around delivering 24/7 registered nurse care.

I think it’s also important to say as a second point that the Commission, the Aged Care Quality and Safety Commission, has said that it will take a risk-based and proportional response to facilities when not meeting 24/7. So it will become one of those criteria that it looks at in a suite of things. So it doesn’t necessarily mean that compliance action would be taken. It needs to be looked at in terms of its totality I think is the key message there. The other thing that the Commission has identified is that it would take a very different view of facilities that have made a genuine effort to recruit and where there’s evidence that could be found for that to recruit registered nurses for 24/7. Facilities that obviously haven’t made those genuine efforts they would look at differently.

So Claudia I don’t know if you have anything to add to that?

No? Okay. Cool.

The next one I think is for you Rob.

Q:        Can a nurse practitioner employed by the provider complete the palliative care form?

Robert Gardner:

Thanks Mark. The answer to that is no. They have to be independent of the facility. So they can – if they come and visit residents in the facility, that is fine, but if they’re employed at the facility then no they cannot.

Mark Richardson:

Yep. Fantastic. Thanks Rob. And look sticking on the palliative care line of questioning. My system just jumped. The question is:

Q:        Is there a process for palliative client and going into respite rather than permanent?

Robert Gardner:

So there’s no specific process for respite residents who are palliative. Now obviously if the provider feels that they are able to deliver the care the resident needs as a respite resident and they have an approval for respite care then they’re entitled to go into respite care as a resident and they can do that.

Mark Richardson:

Fantastic Thanks Rob. And look Claudia we might jump back to some of those pre-submitted questions. So I think there’s another one here that’s important in terms of clarifying for the sector. So it’s around care minutes definition. The question is:

Q:        Can you please clarify RN classification for care minutes? Of course in Victoria ENs are known and registered as RN division two.

Claudia Dukats:

Sure. An RN is someone who has completed a Bachelor of Nursing through a university to meet the RN standards for practice as described in the presentation. An EN is someone who’s completed a Diploma of Nursing through a vocational education provider to meet the EN standards of practice. ENs work under the direct supervision of an RN and cannot act alone. The Royal Commission recommendation was that division one nurses, that is registered nurses, are included in the registered nurse minutes for care minute purposes and division two, that is enrolled nurses, are included in the 200 care minutes, so the non-RN time.

So while enrolled nurses are called or registered as RN division two nurses in Victoria they are not the same as registered nurses who are registered as an RN division one.

Mark Richardson:

Great. Thanks Claudia.

We might jump back to some of the online questions. And Claudia I think this one is for you as well. Care minutes and 24/7 is always a favourite topic.

Q:        What happens when a facility has staff outside of these definitions that provide paid care and assistance with daily living and emotional support to residents? How do the costs associated with the provision of this care be covered and accounted for and fit into this narrow classification?

I’m happy to have a go at that if you want Claudia. Look the definitions that Claudia’s outlined, that we have outlined previously are consistent with the Royal Commission. So there are some in the sector that describe that as being narrow. The whole purpose of the Royal Commission was to try to increase the amount of care that was being provided to residents. It was found that residents weren’t receiving an adequate amount of care in relation to daily living and as a result we have the 200 minutes recommendation. So we’d expect to see an increase in the number of staff employed in the sector given that additional funding has been provided to deliver 200 minutes. Trying to change definitions to include other professions that might be doing parts or crossover in terms of personal care worker and enrolled nurses wouldn’t be consistent with what was trying to be achieved.

And maybe to take that a little bit further I think the question specifically referenced emotional support. You could have an allied health professional, a physio providing services to a resident and talking to them while they’re doing that, providing emotional support, having a conversation with them about their day and how they’re going. That doesn’t mean the allied health profession or the physio can count that time. This is about personal care workers. It’s about enrolled nurses and registered nurses. So look I don’t think it’s a narrow definition. I think it’s a definition consistent with the intent of the Royal Commission in ensuring that we’re improving care standards for people in residential aged care facilities.

Claudia do you want to add anything?

Claudia Dukats:

I guess the only thing I would add is probably as a first step when you’re trying to think through the process think are they employed under that award that personal care workers are. Because that’s probably the first criteria, and then look at the type of work that’s being done.

Mark Richardson:

Yep. Great. Thanks Claudia. Look the next question online again. It’s just jumped. Hang on.

There we go.

Q:        Does a supplement apply for a new developing village until they reach 60 residents where start up costs are considerable?

So this is 24/7 Claudia.

Yeah? Are you comfortable?

Claudia Dukats:

Yeah. Sorry. I would have to take that one on notice.

Mark Richardson:

Well I think it’s a rolling three month average isn’t it?

Claudia Dukats:

It is.

Mark Richardson:

Yeah. So while you’re under 60 beds the answer would be yes. Once that rolling three month average puts you over 60 beds then you would no longer be eligible for the supplement. Are you comfortable with that Claudia?

Claudia Dukats:

Yep.

Mark Richardson:

Okay. Okay. Back in the palliative care space. So Rob.

Q:        We have heard numerous examples of existing residents declining too quickly into palliative care for the assessors to make it to the home, therefore a significant gap is created between the level of care provided and the funding. What is the solution to escalate decline to palliative care so that assessors can prioritise this or can these residents be added to class one process so they can go to class 13?

I think you may have addressed this Rob in your presentation but if you could answer that please?

Robert Gardner:

Sure. Thanks. Thanks Mark. So I think that as I said in the presentation the class one is only for new residents who are entering the facility. We have heard from the sector that people do decline quickly and sometimes assessors are not getting out there in time. So what we’ve done is we’ve got an email address that people can contact if they’ve got someone who has declined very quickly and they need an urgent assessment. So that is an anaccassessments@health.gov.au. So you can send an email to that and we’ll do our best to get someone out there quickly.

Mark Richardson:

Great. Fantastic. Thanks Rob. Look we’ll keep on the palliative. It just jumped on me again.

We’ll stick on the palliative care line of questioning if I can find where I was up to again.

Which I can’t so we’ll go to the – sorry Rob?

Robert Gardner:

I was going to say I did see one that I can answer now if you’d like.

Mark Richardson:

It was around the ACATs.

Robert Gardner:

Yes. That’s right. So I’ve got that one in front of me so I can answer that now if you like. So the question is:

Q:        If someone meets the criteria of the palliative care status form do they also need an ACAT [1:24:42]?

And the answer to that is yes. So AN-ACC class one is a funding mechanism for someone who has to be eligible for residential aged care in order that they be paid subsidy. So whether it’s permanent care or respite care, if you’re palliative you still need to have the ACAT approval [1:25:10] and then you’ll get the palliative care status form filled in and then do your residential aged care entry as normal.

Mark Richardson:

Fantastic. Thanks Rob. We’ll jump back to 24/7. So Claudia a question for you.

Q:        So this reporting is only providers that receive the supplement?

So that’s the 24/7 monthly report.

Claudia Dukats:

No. That’s not correct. All services will be required. It’s in the legislation that they report monthly on the amount – by exception – of the 24/7 RN coverage.

Mark Richardson:

Great. Thanks Claudia. And look we might jump back to some of the pre-submitted questions now that we had on Services Australia and your provider portal Angela. There was a question here.

Q:        Medicare currently does not fix any issues where providers lost money in the September payment statement. Is there a process to follow ensuring that errors are being corrected and money refunded in a timely manner to providers?

Angela Tulk:

Okay. So the actual payment processes under ACFI will continue under AN-ACC. So the process itself is the same. So providers will continue to lodge their claims in the same fashion, they’ll be paid an advance on a monthly calendar basis as normal, and this will be done and calculated in the period for two months before the actual claim month. And just to note that it’s pro-rata for the number of calendar days in that month. So if there is any adjustments that need to be made once the claim has been received that will actually happen in the month that the advance was paid.

I’d just like to say though however if you believe that you have been paid incorrectly the best thing to do is to call the Services Australia provider line so they can look at your individual circumstances and we can investigate that further.

Mark Richardson:

Great. Thanks Angela. Look we’re going to have to put a stop to the questions there unfortunately. I know we’ve had a lot that have come through. We will endeavour to answer those and put them up online as soon as we can. But look just to go through some key things. We’re only six weeks in to AN-ACC and also the care minute targets and we’re really I guess – we’re comfortable and excited about the engagement that we’re getting from the sector on all of this so thank you for that.

But look I think it’s important to just go through some next steps and what you can expect. So the first one would be that during February 2023 we’ll be publishing the QFR reporting information that you have provided us. In April 2023 we will be opening the process for accepting the 24/7 registered nursing requirement exemption by emailing eligible aged care services.

In the May 2023-24 Budget we can expect an AN-ACC price adjustment for 1 July 2023 informed by recommendations from the Independent Health and Aged Care Pricing Authority. And finally in July 2023 the 24/7 registered nurse requirement will become mandatory for all aged care facilities.

So look lastly before we finish I just want to remind you about how you can stay connected. First of all you can watch our previous webinars, subscribe to our newsletter and alerts, sign up to engage with us through the engagement hub and find a wealth of information on our website by visiting the URLs that you can see on this slide.

[Visual of slide with text saying ‘Connect’, ‘Watch:’, ‘https://www.health.gov.au/resources/webinars’, ‘Subscribe:’, ‘http://www.health.gov.au/aged-care-newsletter-subscribe’, ‘Engage’, ‘AN-ACC: https://www.health.gov.au/initiatives-and-programs/an-acc’, ‘Care minutes: https://www.health.gov.au/initiatives-and-programs/an-acc/providers/care-minutes’, ‘24/4 registered nursing: https://www.health.gov.au/initiatives-and-programs/aged-care-247-registered-nurse-requirement’, ‘Star Ratings webinar’, ‘https://agedcareengagement.health.gov.au/engagement/webinar:-star-ratings-information-for-residential-aged-care-providers/’, ‘health.gov.au/aged-care-reforms’]

You can also register for the star ratings webinar that is on tomorrow at 1:00pm Eastern Daylight Savings Time to find out more information on the purpose, development and design of star ratings. So please use the website address on the screen now to register.

And lastly we would like to know what you thought of today’s webinar so please use the QR code on the screen to provide feedback to our team. Was it the information you were seeking? Did you find it helpful? What can we do to improve? So you can open up your camera app on your mobile, scan the code and follow the link to the survey. Please let us know what you think.

So look once again thank you for your time today. Thank you to all the presenters who did a fantastic job. And I hope you all have a merry Christmas and a happy New Year. Thank you.

[Closing visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Thank you’, ‘If you have any questions after the webinar, please email them to acfr@health.gov.au’, ‘health.gov.au/aged-care-reforms’]

[End of Transcript]

 

 

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