Support at Home program questions and answers session – In-home aged care providers

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Support at Home Program’, ‘Questions and answers session for providers’, ‘24 September 2024’, ‘Presenters:’, ‘Nick Morgan, Assistant Secretary, Support at Home Reform Branch’, ‘Lezah Rushton, Assistant Secretary, Assessment and Home Care Transition Branch’, ‘Susan Trainor, Assistant Secretary, Funding Operations and Analysis Branch’, ‘agedcareengagement.health.gov.au’]

[The visuals during this webinar are of each speaker presenting in turn via video]

Nick Morgan:

Hi everyone. Welcome to today’s question and answer session on Support at Home. My name’s Nick Morgan. I look after the Support at Home Reform Branch here in the Department.

I’d like to start by acknowledging the traditional custodians of the lands on which we’re meeting today and by paying my respects to Elders past, present and emerging.

I have Susan Trainor in the office here with me who is the Assistant Secretary for the Funding Operations and Analysis Branch and Lezah Rushton who’s the Assistant Secretary for the Assessment and Home Care Transition Branch here in the Department.

Today’s session is an opportunity for people in the aged care sector to ask questions about the Support at Home Program that’s scheduled to commence from July 2025. The way this is going to run is you ask questions you want answered the most and we’ll try to answer as many as we can over the period. This session is being recorded and will be published. We’ll also be updating our published FAQs for questions that are being asked today including those that we don’t get time to answer.

So let’s kick off. Let’s see what we’ve got in Slido. Okay.

The first question is:

Q:        How does the Department expect operators to continue providing service under Support at Home with significantly reduced revenue? Unit pricing adjustments won’t come close to covering the fee reductions and providers will go under.

So unfortunately I don’t have the unit prices to be able to provide to the sector at the moment. The Independent Health and Aged Care Pricing Authority is currently finalising a set of unit prices that are based on a collection of data that they’re working with service providers on. And I encourage any service providers who are concerned about pricing to reach out to IHACPA to be involved in that work. Absolutely the intention is to build up those prices from existing costs in the sector and we will also be looking at working with Government on what any transition support might need to be when those prices are put into place. So I’m hopeful that those – I know there’s a lot of anxiety by service providers to get their hands on those prices. Hoping to have the first set of pricing advice available in November with the detailed set of pricing including things like any loadings for afterhours or rural and remote and so on to be available in February. Okay.

Q:        Who collects the fees such as client contributions from the clients? Some providers have arrangements to collect income tested fees from clients today. Will this be managed by the Government on an ongoing basis?

So I’ll throw that one to Susan.

Susan Trainor:

So moving forward it is expected that the provider will continue to collect the contribution from a participant where they are asked to make a contribution which is for the independence and everyday living items. What the Government will do though is the means testing assessment and provide advice on what the co-contribution rate is for the particular participant. So you’ll be given information about this person’s co-contribution rate is 5% for example for independence but then collecting that 5% is the responsibility of the provider.

Nick Morgan:

Okay. The next question is about CHSP clients.

Q:        When will they be required to pay the new contribution levels? 1st of the 7th ’25 or 1st of the 7th ’27 or another date?

So no. Not 1st of the 7th ’25. We are not at this stage introducing those fee contribution arrangements across the agency. They are for Support at Home. I think the Government still needs to consider what arrangements would be in place for Commonwealth Home Support Program. No earlier than July 2027 would CHSP come across into Support at Home. Ahead of that date we’ll be starting with the current arrangements in terms of consumer contributions. Whether the Government makes any further decisions prior to July ’27 to make any changes, that’s yet to be decided.

So next question.

Q:        We have clients refusing to pay the income tested care fee. How can we take client contributions from them?

Susan Trainor:

Look this is something that we hear about from time to time around people refusing to pay the income tested care fee. We also hear about providers unilaterally choosing to waive an income tested care fee. This is I think something that we’ll need to work through with providers over the coming months but certainly the expectation is it will be very clear to incoming participants in Support at Home that there is a co-contribution for non-clinical care items and that the expectation is that they will be asked to pay that and that they will be asked to pay that by their provider.

Nick Morgan:

Okay.

It may be worth just on that last question noting that there will be hardship provisions available. On the next one.

Q:        Will the cost of travel between clients be factored into the service fee?

The short answer is yes. IHACPA is looking at all of the costs that providers incur today in delivering services including all of the travel, admin and other costs associated with the delivery of services to inform the pricing advice that they are developing at the moment. In addition I’d note that in addition to service prices there will be the thin market grants available to those providers who are operating in rural and remote areas. They’ll be able to apply for those grants. And one of the obvious reasons why those grants might be needed is where people are travelling long distances to deliver services adding to the cost.

Q:        How will providers register to become a restorative care or end of life provider?

So the new registration arrangements involve the registration categories and there will be a deeming process to deem providers into those registration categories. There’s not a registration category to be an end of life provider and technically there’s not a registration category for a restorative care provider. What there is is a requirement to have someone who is qualified to effectively be a restorative care partner who is someone who’s got clinical qualifications who is able to coordinate a restorative care program or an individual. That’s in the registration category four. And all home care package providers will be deemed across to have registration into service category four because that’s where care management also sits which will need to have sort of clinical oversight over the care management.

So the other thing that we will be publishing – we’ve got some work underway now – is some clinical guidance on the short term restorative pathway. So it’s effectively providers are able to offer a short term restorative care partner. They will be registered into the registration category and able to deliver the services in line with the manual.

Q:        Will providers need to arrange and pay for assistive technology and home modifications and then claim from Support at Home or is the expectation that the clients will have a separate Government department to liaise with to arrange?

It’s the former not the latter. So the assistive technology and home modifications will have a funding tier associated with it that sits on the client’s budget. And a provider will source the equipment or home modifications and invoice against that funding tier. Now having said that we are working with states and territories on access to their loans scheme. So we’ve got the trial running in New South Wales at the moment to provide Home Care Package clients with access to equipment loans. Under that arrangement we expect that the prescriber, whoever the prescriber is, whether they work for your organisation or are external, would be engaging with the state loans program such as EnableNSW and EnableNSW would be facilitating the delivery and provision of the equipment and ongoing maintenance and so on for that loan equipment. So that will look a little different for the loans. And I expect that will only really be in New South Wales from July ’25 but we’re working with all states and territories to try and bring their schemes on over time.

Q:        In a recent inbox article on the impacts to providers they put the actual implications for providers as a whopping 38.5% decrease in care management cost recovery. Please provide context on how the Government is considering providers’ impact and coming up with changes to care management and package management.

So service providers today can charge a care management fee up to 20%. I think the average is somewhere in the order of 16/17%. What we understand is that some of that funding is contributing towards scheduling and rostering costs that will be factored into the ongoing prices. And I know it’s frustrating again for people that I’m not able to demonstrate that through the actual prices that are being set. It’s not a reduction in the client budget if you like to be 10% care management. It’s still 90% care which is being delivered by service providers. That 10% care management funding when we’ve looked at it equates to lower package levels – I said this the other day – but around about an hour a month, and at highest package levels somewhere around six hours a month. 

But in addition to the 10% care management there will also be a loading provided that doesn’t come from clients’ budgets in respect of different client groups including First Nations people, anyone who’s been referred by the care finder, anyone who’s homeless or at risk of homelessness or anyone who’s eligible for the Veterans supplement. And those loadings will also go into the care management pool for the service provider. The loadings I think are going to be calculated as an hour a month times the care management price. So I don’t have a dollar value for you but that would be in addition. And then that pool can be used across all your clients. You have flexibility about how that pool’s used. So we know it’s lumpy. Some people need more care management at certain times, some people less. You have that flexibility around how you spend that fund. I think that same inbox article talked about that’s how it is today. That’s not any great change. But I just want to be clear for people that we’re not tying that 10% to individuals. There is flexibility across that pool to spend that funding on care management.

Sorry. There was another part to that question I did want to touch on which is how are we testing the impacts I suppose. And one of the things that we are looking at is from a provider perspective we did a survey, we got 300 providers giving us detail on exactly what level of services they deliver across all of the different service types. We’re taking that data and we’re looking at once we get prices running through the volume of services that providers are delivering to see what the impact is on the revenue that’s reported through the Quarterly Financial Reporting, and that will inform our advice to Government about what that sort of transition support might need to look like.

I think this might be for Lezah.

Q:        When will the Support at Home Handbook be released and what will it contain? We believe it was noted that it would be this week. Could you confirm?

Lezah Rushton:

So in terms of the handbook and what it will contain, so the intent of the handbook as a kind of first publication, it does target detail for providers. We will do a separate handbook that’s a little more nuanced for clients so that will come later. The handbook basically goes through each of the components of the new program, unpacks that in a level of detail. It does contain detail around the service list, how those services are aligned to the three classifications as well, and then the various rates. It also has quite a comprehensive section on the grandparenting arrangements and the funding around grandparenting as well. We are still on track to release that this week. It’s just going through final checks and balances through the publishing process but the intent absolutely is to get that out as soon as possible and still targeting this week.

Nick Morgan:

Okay. I think we’ve got one that maybe we’ve – it’s obviously a concern because it’s kind of I think repeating a question.

Q:        If a client refuses to pay their co-contributions how are we expected to manage this? Can we stop providing service or does security of tenure apply?

I’m going to look to Susan in the first instance.

Susan Trainor:

And look I think the answer to that question is that’s something that we will as part of developing final policy and rules around the system be keen to speak with providers around settings in that. I think that the vast majority of participants we would expect will be willing to pay the co‑contribution and there are certainly arrangements you can put in place like direct debit to make that easier for them. But we will need to give some consideration to what happens in these circumstances. There will as Nick mentioned earlier of course be hardship provisions for people where it’s genuinely a matter that they cannot afford to make their prescribed co-contribution. But if they are simply refusing we’ll need to give some thought to what happens in that situation.

Nick Morgan:

Okay. This is another one for Susan.

Q:        Will current Home Care Package clients need to pay the new percentage of services like 17% towards cleaning and gardening or only new Home Care Package clients? Thank you.

Susan Trainor:

That’s a great question. So the Government when announcing the reforms announced a thing called the no worse off principle. The no worse off principle effectively means that those who were receiving a home care package as of the date of announcement, which was the 12th of September, those who on the 12th of September were on the national priority system or those who had been approved for a package will be grandparented under arrangements that are at least where they will contribute no more than they currently do under the home care system. For people who don’t pay an income tested care fee under their Home Care Package, they will continue to pay no fees in Support at Home for however long they remain in the program. If they are one of the 14% of people who are assessed as required to pay an income tested care fee they will move to transitional rates. So it will move to a system where they are paying a contribution rate based on their pension status and whether they hold a Commonwealth seniors health card. But they will be discounted rates compared to the independence and everyday living co-contribution rates for a new entrant to Support at Home. Those discounted rates I am expecting will be in the handbook when it is published and they will ensure they’ve been carefully set at a rate that means that no participant in the home care system right now will pay more under Support at Home than they would in their income tested care fee.

Nick Morgan:

Thanks Susan. Okay.

Q:        With all of the information that can’t be supplied like pricing is it truly realistic for a change of this size to be implemented on July 1st?

So we are tracking towards July 1st. We’ve been talking about July 2025 for a long time. I obviously for a long time haven’t been able to give you prices and I’m still slightly shy of being able to do that. But a lot more of the details are being provided now and the handbook will put those together. We will be through Lezah’s team – in fact I shouldn’t have jumped in. I should have thrown this straight to Lezah. But through Lezah’s team doing a lot of work with software vendors, providers and others and working hard on the communication and getting information out as quickly as we can to get to that date. That’s a decision of Government. Lezah sorry I should have thrown that to you. Do you want to jump in there?

Lezah Rushton:

Yeah. Sure. And there is another question that keeps popping up around when will providers be able to learn more about claiming requirements from Services Australia which again links into that question about when will systems information be available. So as you know with the announcement on the 12th we got final policy sort of parameters. We have been working for many, many months on specifying the design and development around the IT systems to support this. So just putting the final touches on that to reflect final policy arrangements. We do have a Tech Talk scheduled for 9th of October where we will go into some more of the detail around the digital stream of work that will support Support at Home so please do come along to that as well. Payment interfaces will be existing interfaces with Services Australia obviously enhanced to support the new program. We are targeting to get material out to providers and software vendors as soon as possible. Likely to be towards the end of October, early November.

Nick Morgan:

Thanks Lezah. Next question.

Q:        Can you please advise how the decision to cap domestic assistance at 52 hours a year was reached? Has consideration been given to the multiple services this may cover? Housekeeping, laundry, unaccompanied shopping, etcetera.

So the first point is that domestic assistance as a whole is not capped at 52 hours a year. The Government has said cleaning. Now I had a meeting with a smaller group of service providers this morning where this was raised and we’re still going to need to work through I think how we implement that 52 hour cap. One option is that domestic assistance invoices go through without having to break it down into what was cleaning and what wasn’t with a confirmation that the 52 hour cap has not been breached for any individual. The sort of feedback I got today from a handful of providers and the consumer lobby was that’s probably not that helpful to us. We’d rather have a separate item called cleaning versus the rest of domestic assistance to be able to keep track of that. So we’ve got a bit more work to do there based on that feedback in terms of how it’s implemented. But just to be clear it’s not all of domestic assistance. It was simply cleaning which brings its own issue in terms of how you separate that out. All right.

Q:        Will all Home Care Package clients be under the new rules of Support at Home capped hours and carry over of unspent funds etcetera?

So two different points there. Will all Home Care Package clients be under the new rules of Support at Home? Yes. So that’s the rules around you have a quarterly budget and you can only save up to $1,000 or 10% of that budget between quarters. So you’ll have the same Home Care Package budget amount divided into four quarterly budgets with the saving provisions and so on. There will be contributions. You’ll have grandfathered contributions that may be set at zero or may be set at a discounted rate or maybe the new rates depending on whether you’ve come into Home Care Packages or the MPS before the 12th of September or after. So the new Support at Home model will apply.

Has that question just disappeared? I can’t remember. There was a second part to it.

Susan Trainor:

Carry over of unspent funds.

Nick Morgan:

The carry over of unspent funds. However all Home Care Package recipients who do have unspent funds balances will carry those unspent funds over into Support at Home and they will be able to draw on those unspent funds once they’ve used their Support at Home budget. Hopefully that answers both sides of the question.

Q:        What will care management look like for consumers who don’t receive clinical services? Will care management have to be RNs? What will the industry do with the thousands of non-clinical case managers that have been trained up over recent years?

So the answer to that one is care managers will not have to be RNs. I said this the other day but we recognise there’s generally a kind of team-based model to care management. We don’t want to break that model. We are talking to IHACPA about developing both a clinical rate and potentially a non-clinical rate rather than just some average that either overpays some people and underpays others. So there’s some work going on in terms of the sort of prices. But when we’ve consulted on care management the guidance we’ve received from service providers is that probably the preferred qualifications for non-clinical care managers may be – I think it was a Cert IV was proposed but they were only as preferred qualifications. It wasn’t a mandatory qualification. So not looking to unseat those non-clinical case managers.

Q:        When will providers be able to learn about the claiming requirements from Services Australia?

This time I will throw to Lezah.

Lezah Rushton:

Okay. So as I said earlier we will go into this in a lot more detail in the Tech Talk in October. Essentially providers will submit invoices through existing channels with Services Australia. Those invoices or claims for payment will need to be itemised by client and by service. So a much more granular level of information will need to be provided to Services Australia to facilitate that payment. Invoices can be submitted to Services Australia up to daily or they can be batched depending on what sort of works best for providers. So we’ll provide I guess detail on how you’ll need to adapt your systems to work with that. Final invoices for a quarter we’re anticipating we’ll give 60 days to finalise each quarter so that we can manage unspent budgets, sort of carry over of funds and the like. Our current KPIs with Services Australia envisage payment within seven days but that is kind of a maximum so the idea is that they pay those invoices as a priority to keep that fund sort of going through. So the technical detail around how those payment systems are going to work are being finalised to be provided very shortly.

Nick Morgan:

Okay. Thanks Lezah. The next question.

Q:        How can providers prepare their budget for 25-26 when we don’t even know the pricing details? There won’t be enough time to analyse and prepare a budget where providers will be able to make a marginal break even.

So I understand the concern. As I’ve indicated I think November will be when I’m able to provide guidance on prices through the advice of IHACPA that’s coming through to Government with more details in February. I do certainly recognise the short timeframe that that gives providers in terms of planning. It’s the timeframe that we have at the moment. As I said earlier we did do that survey with providers to collect information about the services they deliver so that we can also be providing Government with advice on what sort of transitional support might need to be available against the prices that we get from IHACPA. So that is also further information that we’ll need to make available at around the same time that we’re letting people know what the prices are.

Q:        Now there is no package management fees do we add a margin to purchases such as continence aids, wound dressings and even home modifications or are we expected to do this for free?

Look I think that’s a good point. There will be categories for the purchase of continence aids and in some cases the consumables and home mods and so on and the intention is for those to be billed at cost. So it’s not a price set in our system as to what you charge for those. In terms of what we mean by cost and the definition of that and whether that can have a margin in it, that’s a good point and that’s something we’ll have to provide further clarification around I think.

Q:        Are providers still expected to manage subcontractors like they do now? Are we still expected to process all the invoices and submit claims the same way? This is an extremely time consuming process.

Short answer is yes. From July 2025 when Support at Home commences we’re commencing with the single service provider model that we have in Home Care Packages with subcontractors working to the single provider. The intention’s always been for Support at Home when CHSP joins the program – and that’s no earlier than July 2027 – that we move to a model where all of those single service providers in CHSP can also operate and a participant can go to individual service providers rather than everyone having to be subcontracted back through a single service provider. So that’s some way off and there are still a number of issues that we need to resolve to make that model work. But from 2025 a single provider subcontracting other providers to deliver services. And certainly from a pricing perspective that’s something that’s been raised consistently as a concern, is what if the prices you set are not sufficient to cover the cost of the subcontractors we need to use. That’s something that we’ve explicitly put on IHACPA, the pricing authority’s radar to consider explicitly in their advice to Government around prices.

Q:        If the provider uses third parties to perform clinical care will the care provider organise this with the clinical provider charged by the clinical provider and then request for payment from Services Australia within the rate card?

It’s a similar question to the one above but just references that the providers are clinical. The answer is still yes. And again the price for subcontracting, we need to ensure that it’s sufficient to cover those costs. The only point that I’d make here is that in order to subcontract clinical services you as the service provider still need to be registered into that clinical category. So for nursing you would need to be registered into registration category five to be able to deliver nursing, whether or not you are delivering it yourself or you are subcontracting those nursing services, and that requires clinical oversight.

Q:        Regarding the $15,000 limit on assistive technology and home modifications funding will there be any provision for the Support at Home Program to partially fund high cost modifications that exceed this amount?

So yes. The $15,000 is not a cap on what your home modification might cost. It’s a cap on what the program would pay towards that modification. So people may well spend more than that on a modification. So yes is the answer to that one.

Q:        Every new client needs more than one hour case management for the initial assessment, care planning, goal setting, etcetera, service and support connections. Will there be a higher percentage considered for new admissions? This needs to align with the strengthened Quality Standards. 

At this stage the care management rates are calculated at as I say 10% plus any loadings that apply to the client. That goes into a pool for a service provider and if across that pool the service provider has a handful of new clients or a number of new clients that come through who maybe require more support early and then less support the next month or whatever it might be there is the flexibility to do that from the pool. It’s not tied to the individual client, that 10% as I’ve said before. But no there’s not an additional loading for a new client on top of that 10%.

I think the way that that pool will be reset is at the start of each quarter. For any new clients who come on there will be an upgrading of the pool for the new clients who’ve joined. If any clients leave during that period there won’t be a reduction in the care management funding that sits with the provider.

Q:        The $15,000 cap will effectively rule out level access bathroom modifications. There appears to no longer be an option to accumulate funds for more complex modifications. What are the Department’s recommendations for those people who need bathroom modifications but can’t self-fund them?

So the cap has been set at $15,000. I mean I think Steve you would have a better sense than me as to what $15,000 can or can’t buy in the market. But I think that is a significant contribution towards a modification such as installing a flat shower in a bathroom. It may not cover the full cost and the remainder would as I said earlier be something that a person could contribute to. In our codesign sessions a while ago now on the assistive technology and home modification scheme there were people offering other sort of suggestions for drawing down on the value of your house to meet other additional costs of renovations if people wanted to do that for example. But the cap has been set at $15,000.

Susan Trainor:

I think we just lost a question that we hadn’t actually answered there which was about the referral pathway for Commonwealth Home Support Program participants between now and 1 July 2027 and how we would – I think it’s come back now.

Nick Morgan:

Okay. Referral pathway.

Q:        Secondly will assessors have the choice to refer to Support at Home or CHSP and what would the criteria for referral be from one to the other?

So the new integrated assessment tool uses a range of different assessment instruments which people are scored on. So can you get upstairs on your own, with help, with no help, which scores effectively zero, one, two I think. Something like that. Or one, two, three. Those scores across all of the different assessment instruments are combined in a way that assigns you to a classification under Support at Home and an assessor can override that recommendation from the IAT and put you in a different classification, a higher classification, or they might talk to you about a short term restorative episode in the first instance and then a reassessment after that for example. 

For CHSP the same tool will for people’s whose scores are effectively below a threshold say these people are assigned to CHSP. It aligns from our assessment trial to the people who were being referred into CHSP, broadly aligns with them. There will be maybe a few more people who are assigned to Support at Home I think than currently. But they will be assigned to CHSP and from there it’s no different to today. They will be allocated codes for the different services they’ve been approved for or referrals to service providers just as they would in CHSP today.

I think that answers the whole question in reverse. Okay.

Q:        Will inclusions and exclusions for Home Care Package clients remain the same?

Well no. We’re going to have the service list which I’m hoping – I keep saying it will be hopefully published this week but it’s imminent. We’ll publish a service list and that service list will have some inclusions and exclusions specified. I think some of the more contentious inclusions and exclusions at the moment are around items like the purchase of goods and the assistive technology and home modification scheme will have a separate item list with its own inclusions and exclusions on it, and I’m also hoping to publish that shortly. It just needs a little bit more time to get ticked off at our end. But within the next few weeks we should have both up and published for people I hope so that it’s transparent to everyone what the inclusions and exclusions in Support at Home are.

Q:        What will happen to Home Care Package clients with CHSP top ups?

So the provisions that exist today to enable someone to access CHSP services while in receipt of a Home Care Package are being replicated for Support at Home. So for example if you’ve allocated your budget and you still need respite you can access CHSP respite. Or if you’ve had a social support group that you’ve been a participant in you won’t be booted out of that group once you sort of move into Support at Home. You’ll be able to continue accessing that via the CHSP provider. And so those provisions are going to be replicated. Notwithstanding there may be people in CHSP who shouldn’t be accessing services in CHSP today who are Home Care Package clients under the rules of the program but effectively the arrangements today will be the same in Support at Home.

Q:        Will the now worse off philosophy apply to providers?

Well I mean I can’t understand the point of the question. It’s a bit of a dig I guess at you’re saying ‘Well you’re saying no worse off for consumers. What about providers?’ I’ve said it a couple of times now but we are looking at running those pricing scenarios through the data that we collected from 300 service providers about the services they deliver to compare to existing revenue and to advise Government around what we think transition arrangements need to be for the program so that we have continuity of care and that the delivery of services remains affordable. So that is something that we are very conscious of and will be working on but we the same as you need to do the sums off the back of the prices once we see those prices and provide that advice to Government.

Q:        Will providers be required to coordinate all services for a client as we do now for the Home Care Package clients? Previously it was reported that clients would engage with different providers to deliver services, eg mowing.

So I touched on this before but when the Government decided to defer the inclusion of the Commonwealth Home Support Program, CHSP to no earlier than July 2027 we moved away from that model of people having multiple different service providers and said from July 2025 we would retain the current Home Care Package model of a single provider coordinating services for the Support at Home clients who are basically the same level of complexity as Home Care Package clients while CHSP remains separate, looking after people with lower needs. From July 2027 or no earlier than July ’27 the intention remains to open up the market to now enable people to have multiple different service providers. But as I just said a second ago there remains issues that we have to kind of work through to make that work well. And I’ve talked about them in the past. Things like making sure someone doesn’t overbook services with multiple providers and then the last one in discovers there’s no budget left against the client. We need to solve for that before we introduce that model. And similarly if a care partner or care manager is working with a person who has multiple different providers how those information flows work so that the care partner can support them in their care. Those two things are still to be resolved for the post 2027 version of Support at Home.

Q:        What will the process be for people assessed/approved/allocated between 12 September and 30 June?

So there’s two parts to that question and maybe Susan and I can do a tag team on this. There’s what’s the package that you get that you take into Support at Home and then there’s what are the consumer contributions you pay on that budget? And the answer to those two questions is different. So in terms of the package or the budget that you take into Support at Home anyone who is on a Home Care Package or on the queue or on the waitlist as at the 30th of June ’25, they will take that package level into Support at Home. If you’re on the waitlist when that package becomes available that will be the budget level that you have under Support at Home.

But in terms of your participant contributions that’s where that 12 September date comes into play.

Susan Trainor:

And so what really matters for that 12 September date is whether or not a person has been approved. So if they have undergone an assessment and been approved and regardless of whether they have a package, are still on the national priority system, or if they have been approved and have not actually got themselves on the formal waiting list through the national priority system, they would be under the transitional Support at Home rates. It’s the person who has yet to be assessed and approved that we’re really interested in I think in this question. And a person who is not approved on 12th of September will move to the new Support at Home contribution rates with the 5% to 50% for independence and 17.5% to 80% for everyday living. And that applies regardless of where they are in the queue by 30 June. So even if they are not yet assessed, they get assessed, approved and given a Home Care Package before 30 June, they will still move to the non-transitional rates from the 1st of July 2025.

Nick Morgan:

Okay.

Q:        You mentioned last week that care management is pooled for all of the provider’s clients. Can you elaborate on that please?

So all clients’ budgets – at the start of each quarter there will be a care management amount that will equate to 10% of clients’ budgets, so the amount that you can bill against a client’s budget is their budget minus 10% effectively and that 10% is held for care management. So when invoicing you might have a care management kind of cost centre or a code that you’re billing against and all your care management services will be delivered at a care management price, or as I said earlier there may be two care management prices, a clinical and non-clinical price. And there will be no consumer contributions or anything on care management. It sits in the clinical category. And you will invoice Services Australia for the hours of care management that you have delivered against that single cost code for care management which is a pool of 10% of all of your clients’ budgets available to use for care management, plus as I said the loadings for those other categories of clients will all be sitting in that pool and if there are people on your books who require very little care management you may deliver not many hours to those people. People who need more, you may deliver more hours to those people. Or as Janine said earlier if you’ve got a number of new clients with whom you needed to do some additional work around care planning you may be billing more in respect of those clients than others. 

So care management is lumpy. When needs change it can be quite intensive and then it can drop off to be a lot less at certain periods. On that basis we opted to pool the care management funding rather than have it sort of individualised in individuals’ budgets.

Q:        Will the new Support at Home Program continue to subsidise meals, for example 30% paid by the participants and 70% paid by the Home Care Package? 

I think the answer is yes, that meals are still on the service list, but the actual percentages there, that’s going to be at the everyday - - -

Susan Trainor:

That means that for some people, a full rate pensioner, that would mean their personal co‑contribution would be at the 17.5% rate but that varies based on the means of the person. So for part pensioners and Commonwealth seniors health card holders they’d be on a sliding scale for the contribution there, right through to a self-funded retiree who’s not eligible for the Commonwealth seniors health card who would be paying 80% of the cost of those meals.

Nick Morgan:

All right.

Q:        Will CHSP providers be able to deliver Support at Home services once deeming has taken place from 1 July ’25? If not it will be an expensive application process.

So the answer to this one will depend on the registration process, once you’re deemed into your registration categories. And effectively every Support at Home provider needs to be registered into category four. So if today you are delivering personal care, nursing services and so on under the CHSP, you will be deemed into those categories. So technically then you would be able to start offering Support at Home services as a new Support at Home provider provided you can offer sort of care management support. For CHSP providers who are delivering – let’s say a meals provider or a transport provider who is not deemed into the registration category four which has some clinical governance for care management then you would not be able to deliver Support at Home services. I think that is the answer.

In terms of the secondary question about any fees to register as a Support at Home provider, I’m sorry. I don’t have the answer today but that’s one we can look to – unless anyone else does – look to add to the FAQs.

Q:        Our organisation promotes choice of providers and do not have a workforce only case management. Should we pack up and get out now? 

Tricia I think I’d advise you wait for the prices to see the extent to which you can afford the services that you are subcontracting on behalf of your participants under those prices. And as I said earlier we’ve been talking to IHACPA and encourage any organisation out there including yourselves to engage with IHACPA in particular around that subcontracting point and whether there’s a sort of loading that can be applied where any organisation is subcontracting care workers. I think it’s a pretty high percentage of care workers today are effectively subcontracted by service providers. I can’t recall the figure but it’s a large minority of services are subcontracted and we need to make sure that the system works for those service types. We can’t just have a big chunk of service providers dropping services because they see a price that’s not viable in the marketplace. And so that’s something that we’ll be really closely focusing on as those prices are available and as we’re sort running those through that market analysis work that I’ve mentioned a couple of times.

Q:        Will self-managed clients have access to the 10% that will be set aside for care management to providers?

Look the answer to that is – well I’m not quite sure the way you’ve framed that question exactly what you’re asking. So I won’t say yes or no. I’ll just say all clients will pay 10% of their budget to their provider for care management regardless of whether they are undertaking self-management or not. That means that when things go wrong – and we’ve talked about care management being lumpy and things might be smooth sailing, you don’t need much care management, but when things go wrong there is care management available to you whether you’re self-managing or not. Someone who can check in with you, make sure your care plan’s working for you, help you with navigating the system and all the rest of it. So I understand for clients who are self-managing there may be some opposition to that but that’s where the policy has landed.

Q:        When a Home Care Package client is grandfathered into Support at Home will there be any guarantee that contributions will not impact them? Also if a Home Care Package client is reassessed and moved to Support at Home will there be an expectation that contributions are enabled at that point in time?

That’s one for Susan.

Susan Trainor:

So I think this relates to the no worse off principle again. And the simple answer is that yes there is a guarantee through that no worse off principle that no one will be paying more under Support at Home than they are under their Home Care Package. So that means if a person’s paying no income tested care fee now they will pay no co-contributions under Support at Home for however long they remain in the program. And the transitional rates for existing home care package recipients under Support at Home mean that they will pay the same or less under Support at Home than they would in their Home Care Package. And that is true regardless of when they are reassessed or move through classifications. That’s not a review point or something that would cause them to move to the newer fee arrangements. They’ll stay under either the zero contribution or the transitional arrangements for however long they stay in Support at Home.

Nick Morgan:

Q:        During the webinar on Thursday it was stated that domestic and gardening maintenance would have capped hours. What happens to those that are currently receiving home care and they wish this to be grandfathered?

Look as it stands – I don’t know that we’ve explicitly gone into that. But as it stands Support at Home arrangements would apply and while the dollar amounts will be grandfathered, the aggregate contributions will be grandfathered, the new rules will apply which means those caps on – and again it’s not domestic assistance. It’s only the cleaning component of domestic assistance and gardening services will have capped hours for everybody including existing home care clients who may be using more than that today.

Q:        When will unit prices be released?

As I’ve said I’m hoping to be able to provide that to you as soon as I can in November once we’ve received guidance from the pricing authority and the Government has considered those prices. With further details including any loadings like for rural and remote, after hours, some of the individual service prices – I think there’s a multitude of allied health services within the allied health service type that will be broken down into individual prices – those more detailed prices will be available in February from IHACPA. In November we are looking at sort of the one line sort of pricing being available.

Q:        Will any communication go out to current Home Care Package recipients from the Department? We’re already seeing unease with our consumers around the news in the media.

Lezah?

Lezah Rushton:

I might take this one Nick and then noting we are just a little over time so we probably have to wind up maybe after this one. Nick just loves talking about this stuff. So absolutely there is a plan to send out letters to current HCP clients. So we’re in the process of finalising that communication. It’s part of a broader communications package so it’s about what’s the right time to kind of send that out. But I guess once the handbook goes out we will do a broader update across the website material as well with a lot more of that detail. But part of our comms package absolutely is to write directly to current home care participants.

Nick Morgan:

All right. Sorry. I didn’t realise we were at time. Time flies.

Lezah Rushton:

Yeah. I’ve got to wind you up.

Nick Morgan:

Yeah. Okay. Look thanks everybody. We’re going to leave it there. There’s a lot more questions in here. We’ll run through those and look out for FAQs that seek to update a lot of those questions. I can see a couple. We’ve sort of answered them. I can see have sort of been at least partially answered already. So hopefully you can glean from some of the other answers to some of the other questions a bit of a response. But we will look to update those FAQs.

Thanks for calling in. Thanks for your questions. We appreciate it. Bye for now.

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