Webinar 1: Aged Care Reforms – Impacts on the Multi-Purpose Service (MPS) program and providers

George Masri:

Good afternoon everyone. Thanks for joining us for the first webinar about how the aged care reforms will impact the MPS program and its providers. My name is George Masri and I’m the Assistant Secretary of the Thin Markets Branch in the Department of Health and Aged Care which has responsibility for the MPS program. I’m pleased to host today’s session with panel members Cathy Milfull who’s the Director of Rural & Remote Policy and MPS in my Branch, and Simon Christopher, Director of the Harmonisation and Strategy Branch.

We’ll start with the formal presentations shortly but before we commence I just wanted to deal with some issues around the possibility of further questions and answers. So we’ll have a question and answer session following the formal presentations. Also just to provide I guess enough time for those questions and answers, today’s presentation will be reasonable high level, even though the slides provide a bit more detail. But please feel free to request to expand on particular matters of interest during the Q&A session. Questions can be submitted using the Slido throughout the presentation. You’ll also be able to view and prioritise other attendees’ questions. We will try our best to get as many questions as we can, particularly any common questions, but don’t worry if your question doesn’t come up or we don’t get to answer it. We will try and publish written answers to any questions that we are unable to provide today. If you have any concerns during the presentation, for example there’s a problem with sound, please let us know using the chat function rather than Slido.

Today’s webinar is being recorded and the slides presented will also be made available following the session. We’ll now bring up the slide pack and get started. 

[Visual of slide with text saying ‘Multi-Purpose Service (MPS) Webinar 1:’, ‘Aged care reforms: impacts on the MPS program and providers’, ‘8 May 2024’, ‘Thin Markets Branch’, ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘www.health.gov.au’]

But just before we do formally commence, I’d like to acknowledge the traditional owners on the various lands on which we’re meeting today across Australia. I’m here in Canberra. I’d like to pay my respects to the Elders past, present and emerging, and in Canberra that’s the Ngunnawal people, and to welcome and acknowledge any Aboriginal and Torres Strait Islanders that are with us today and also acknowledge I guess that we’re all here to improve access to aged care.

Okay. So the purpose of today’s webinar is really to provide you with information on how we’re addressing the upcoming aged care reforms and how that will impact the MPS program and in turn the providers. As you may be aware the Department is working closely with the states and territories through the MPS Working Group to discuss these reforms, and they’re quite constructive discussions.

But before we move into further policy design and implementation phase for these reforms we want to make sure that we can talk directly to MPS providers, answer your questions, get feedback and support your implementation of these changes. This slide outlines what we intend to cover today. As it is the first of our seminars in a series of webinars it is intended to be an overview and introductory. As I am sure you’ll appreciate there will be also a lot of different levels of knowledge amongst the MPS providers about the reforms so we appreciate your patience as we use today to try to get everyone on the same page about the reform ahead.

Firstly I will provide some context about the current MPS program, the important role that it plays and the important reforms underway in aged care which also impacts on MPS. I’ll try to explain why we need the change, even in a program like MPS which largely receives positive feedback. I want to emphasise also that we’re keen to retain and build the strengths of the existing MPS model which supports innovative, flexible, integrated service delivery so that older people can stay in their own communities and close to family and friends. 

Cathy will then talk about the draft reform schedule for the MPS that we have been developing with the MPS Working Group. This is important as there are a lot of changes going ahead in aged care and as a result we just want to ensure that we’ve planned the approach in managing those changes that are relevant to MPS in a more ordered and appropriate way, and to ensure that MPS providers are actually involved in the journey as we look to improve the aged care outcomes. Cathy will also discuss some of the key reforms that have been planned. We’ll also provide you with a high level overview of how MPS will be impacted by the new Aged Care Act and some of the key structural changes to understand when discussing MPS and the new Act.

Simon will then take you through in a bit more detail really our first deep dive topic for this series of webinars on the provider registration process under the new Aged Care Act. He will explain how the registration arrangements will work and confirm proposed transitional arrangements for existing MPS providers when the new Act commences.

As I mentioned this is the first webinar. It’s just the start of a broader conversation with MPS providers and the state representatives. For future webinars we expect to do a deep dive into further key reforms including topics such as 24/7 registered nurse requirements, obligations on the providers under the new Act. This slide proposes a bit of a draft timetable for future webinars. But we also are really keen to get any suggestions for future topics that you would like to discuss in this series of webinars.

[Visual of slide with text saying ‘The aged care reform context and the MPS’, ‘George Masri, Assistant Secretary, Thin Markets Branch’]

Before we talk about the proposed reforms to MPS I think it’s important to reflect on where we are in terms of the current MPS program, why such reforms are being planned and required. As you can see from this slide the MPS program whilst specialised is already quite significant. There are over 28 providers operating 182 MPS sites across Australia delivering flexible aged care services in rural and remote regions with 3,762 operational places.

It should be recognised that the program is an important working example of delivering integrated health and aged care services. It’s also a program that we think has lots of potential to trial and support more innovative delivery of aged care services moving forward. The MPS program also reflects a significant financial contribution by both the Commonwealth Government and participating states and territories.

The Royal Commission acknowledged the important role that MPS plays. It recognised that MPS provide health and aged care services in areas of rural and remote Australia that could not support a standalone hospital or residential aged care facility. And certainly I would reiterate that at no time when discussing proposed reforms today are we suggesting that the services delivered by particular MPSs are necessarily lacking in some way or problematic. But as you would be aware the Royal Commission made 148 recommendations about how the aged care system should be improved for the future. These recommendations envisage the transition to a new person-centred aged care system where old people can access quality and safe aged care services that they need wherever they are. And providers are encouraged to aim higher than the minimum to deliver quality care. The MPS program must be part of that transition.

The Royal Commission also made specific recommendations around the MPS program, more specifically recommendation 55. These were focused on ensuring the continued expansion and sustainability of the program, equity of access to aged care programs with alignment of eligibility requirements, assessment, client contributions welcomed, as well as the development of a new funding model. But as noted here it was important to recognise that this is not the only Royal Commission recommendation relevant to MPS. The new Aged Care Act is expected to respond to about 50 recommendations of the Royal Commission. Many of these will be relevant to the MPS as well as the other aged care programs.

Since the Royal Commission, the final report of the Aged Care Taskforce has also been published. This Taskforce was established by the Commonwealth and chaired by Minister Wells to review funding arrangements for aged care, develop options for a system that is fair and equitable for all in Australia, and to build on the Royal Commission recommendations. As reflected in this slide, the Taskforce made a number of findings around thin markets. The term thin markets refers to areas where access to services is less than required. Such markets are commonly found in rural and remote areas due to population size and workforce. As a result these recommendations are also relevant to MPS. The Taskforce recommended that block funding be continued for programs such as MPS as mainstream funding arrangements may not work in some of those thin market areas.

A review of a remoteness classification system is also to be undertaken. It was one of the recommendations of the Taskforce. This is relevant to MPS with all the 182 MPS currently located in MM5 to MM7 areas. And the third specific recommendation was older people make fair contribution based on their means. 

The Government response to the Taskforce report is expected to be announced soon but recommendations are consistent with many of the policy initiatives and thinking already underway by the Department.

In terms of context, last but certainly not least we must also recognise that the new Aged Care Act which was recommendation one of the Royal Commission is coming. This new Act is not just a piece of legislation. It will see the introduction of a new person-centred, rights-based aged care system, a system that focuses on individuals and services that they need, not just providers and how they are funded. There are elements of the MPS program that won’t change but other arrangements will need to change and comply with the Act. The new Act also provides a valuable opportunity to further reform the MPS. More broadly it is also an opportunity to simplify complex arrangements for aged care providers that have been developed over time and streamline obligations on providers and ensure that the regulation of the sector is risk proportionate. Whilst change is coming the Department will be engaging directly with MPS providers to ensure that these reforms will work in the context of MPS settings.

I’ll now hand over to Cathy Milfull who will speak about the proposed reforms in a little bit more detail. Thanks Cathy.

Cathy Milfull:

[Visual of slide with text saying ‘What changes are ahead for MPS?’, ‘Cathy Milfull, Director, Thin Markets Branch’]

Thanks George and hi everyone. Now that George has set the scene for us in terms of what needs to change and why we want to take you through what changes to the MPS program are already planned and remain under discussion. But before we even start I just wanted to assure everybody that even where reforms are already planned we want to work with you and our colleagues on the MPS Working Group to make sure these reforms can be implemented as smoothly as possible with adjustments made to mainstream policy settings where this is appropriate if we can. 

We also understand that as they say the devil is in the detail. But to be honest, what we don’t know we don’t know. So we really need your increased involvement in the months ahead. If you have unusual or particularly challenging situations in your MPS or you identify an unintended consequence of an upcoming reform for example, we really want to hear from you. We won’t always have total flexibility to change things but if we work together it will help ensure we can deliver positive outcomes for older people in rural and remote Australia.

So this slide really just gives you a copy of a draft reform schedule for MPS that we had approved in principle in April by what’s called the Senior Officials Group, with some updates we’ve made to reflect progress since then. It shows you the timeframes that are currently being progressed for particular reforms for MPS. Some of these timeframes we have control over. Others will be dependent on other things, for example legislative changes and system changes. As you can see it’s a pretty busy time ahead from now until 2027. As a result it’s particularly important as George mentioned that we really have a planned way forward. We’re also keen to be as transparent as we can around these upcoming changes and our progress towards target dates for particular reforms. 

At the top of the diagram in the red section there you can see the reforms that will be implemented via the new Aged Care Act once the relevant Bills are introduced to Parliament, are passed and commenced. I know that you would all like to know exactly when this will be but it will be the Government’s decision as to when the Bill is introduced and what the proposed commencement date is. And then of course the reality is the time required for Parliamentary passage can vary greatly and can depend on a number of factors.

But below the red new Act section you will see reforms that we can progress with or without the new Act. Although where they involve legislative change we’ll certainly take the opportunity to align with the new Act where we can. It is these reforms that I really wanted to focus on today in this part of my presentation. We consider it important that we move forward with these reforms, some of which as you’d be aware were implemented in 2022 or 2023 in mainstream residential care facilities. Not only were these initiatives committed by Government at the election to improve care outcomes for older people, progressing these initiatives now will also ensure that we can stagger these upcoming reforms and hopefully not have them all commence at the same time.

So the next slide here just summarises some of the key, I’m going to say, non-Act related reforms that are being planned for 2024. The top one, a subsidy increase for all providers, has already been implemented. Some of you may also have nominated to participate in the residential experience survey that you can see there which is being trialled for May/June this year. If not I do really encourage you to do so. This important survey has been in place since 2022 in mainstream residential care. It was recommended by the Royal Commission and it gives residents a chance to tell us about the care they access. Is it working, what’s working well and what can be improved. We appreciate that in rural Australia older people may have less choice about the facilities they wish to access if they want to stay near their family and friends but this information we consider still critical to ensure we can improve MPS arrangements for older people in future.

Just probably two last things to mention here. As per a recent email from my team we’re also planning to send out Deeds of Variation to all MPS providers to facilitate the extension of their current agreements up until 30 June 2025. So keep an eye out for those. We’re also going to be opening an allocation round later this year subject to Ministerial approval. And so that will facilitate additional aged care beds being brought online or even new MPS opening. So that’s really the year in a snap. There’s two more reforms there but I’ll talk about those in more detail shortly.

So this slide really focuses on two key non-Act reforms for this year. One is introducing a 24/7 registered nursing and responsibility and the other, what’s often referred to as direct care targets for providers. So these will be the topic of key deep dives in later webinars so don’t be concerned if you feel like you don’t have enough information right now. But I wanted to try and give you a few highlights about this important topic.

So as many of you would be aware these two types of responsibilities were introduced for mainstream residential care providers as of 1 October 2023 and this followed a trial period. These arrangements were not implemented immediately in a legislative sense for MPS and that was because it was considered we needed some more time to work out how these reforms should operate for our specialist aged care program. For MPS to be honest it was also considered a lesser priority as given the integrated health and aged care context it was considered that many providers would already be meeting direct and clinical care targets. But it is important I think that we can assure ourselves of this and that there are equivalent standards of care being provided in MPS and mainstream residential care homes.

So NATSIFAC has already implemented care minute equivalent arrangements and will be progressing 24/7 as well. So now it’s really time for us to work out what’s the best approach to these arrangements for MPS. Similar to mainstream in discussion with jurisdictions and the MPS Working Group we think the best way to do this is by trialling the possible arrangements first. This will ensure we can operationalise these requirements in a way that makes practical sense for providers but also achieves their intended goals.

So in terms of 24/7 requirements we consider that most MPS will already be providing access to at least one registered nurse on site for residents, noting that on site can include the hospital next door or across the road to the aged care wing of your site. So this trial which it has been agreed will commence on 1 July 2024 will be more about testing these assumptions and working with individual providers who cannot meet these requirements or available exemptions. We also really want to test the reporting that’s in place for mainstream residential care homes in GPMS, see if this will work for MPS or whether we need a different approach or can work together to find a better one.

In terms of direct care targets often referred to as care minute requirements we do think that implementation for MPS will be more complicated. As a result the trial for these newer arrangements is expected to have some additional phases with further codesign work to occur this year in consultation with providers on the ground. A pilot will then be undertaken with a limited number of nominated sites prior to a more expansive trial with all providers of the proposed approach for MPS. The reason for this is we need to work with providers to develop the most sensible approach to these arrangements given the absence of AN-ACC assessments in an MPS context and the diversity of our MPS sites. As a result you might see already some of our slides referring to care minutes equivalent. This is because we’ll be using the trial phase to determine what the MPS approach to this reform actually looks like in practice and whether the language care minutes works well in an MPS context. But regardless of terminology the aim is the same. That is we want to ensure aged care residents receive the dedicated care time that they need.

So really as you can see there’s a lot to work through here particularly for care minutes. So really my key message from this slide was just to say to everyone please get involved early in the trials where you can in consultation with your relevant state and territory agency. If you want to influence the outcome and have great ideas for better approaches for MPS you really need to get involved. My team will be kicking off a new reform implementation sub-working group and initial trial and pilot sites will be part of this group. Ideally my team will also get out and meet with staff at these pilot sites before 1 July 2024. But even if you don’t have capacity as an initial trial or pilot site don’t feel you can’t get involved. We are really keen for you to do so.

I know everyone’s going to ask about money so just wanted to confirm that if your state and territory has agreed to participate in the trial phase additional care minutes related funding is expected to be available to MPS sites. The aim of that is to help you get ready, engage with my team and participate in these trials and then move towards complying with any new requirements. At this stage there is no additional funding available for trialling 24/7 arrangements but that’s because our assumption is that most MPSs are expected to already be meeting these nursing requirements. But the whole point of the trial is to really test that assumption and it will help us build an evidence base on any further costs that are involved for consideration by Government.

All right.

[Visual of slide with text saying ‘MPS and the new Aged Care Act’, ‘Cathy Milfull, Director, Thin Markets Branch’]

So moving on. I’m just going to move on to give you a quick high level overview of MPS and the new Act. Some of the slides are quite detailed but I wanted you to have these for reference material. And noting that we’ve got Slido on the side there I’m hoping that if you have a look at these slides and I don’t cover something it might inform your questions to us and George, myself and Simon can expand later in the Q&A session.

So here on the first slide you can just see basically a high level overview of the areas in which the new Act will impact MPS. You may have seen a similar slide for the Act overall in the Exposure Draft consultations but we’ve tried to do this one for you just to really focus on MPS specifically. It highlights the key areas of change under the new Act. That includes areas that were covered in the Exposure Draft that you’ve hopefully had a look at. So system entry, services and regulation. And then also changes to funding and structure which will be evident in the final Bill for the new Act.

So just moving on a bit we just wanted to have a talk briefly about system entry and service related changes. There will be a future deep dive at a future webinar on this one but today I just wanted to go through a few points to make sure everyone is on the same page and inform your questions. So just some key points I guess in this space. Under the new Act a delegate will need to make a decision to approve certain services for an older person before they can access funded aged care services under the Act. And that includes through an MPS. So it’s different to current arrangements. A delegate’s decision will need to follow an independent assessment of the person’s needs by a needs assessor. It is also important to recognise that under the new Act only people who meet certain eligibility requirements will be able to be assessed by an assessor. So that includes certain age related criteria.

But don’t be concerned. These arrangements will be grandfathered with those already in an MPS able to still keep on accessing the care that they’re receiving. We’re also working on alternative entry arrangements for the Bill and this will facilitate individuals commencing care in an MPS ahead of application and assessment processes where that assessment would be delayed. The individual will still need to be assessed but the idea here is it could be done retrospectively so that it won’t impact care being delivered where needed. As MPS providers you’ll also be able to deliver services on a service list that the person has been approved to access. In some cases this will be a group of services like permanent residential care. In other cases it will be specific types of services as in the case for home support. So it’s quite different to the current world. There is no concept of flexible care in the new Act. Rather MPS will just be funded differently to deliver the same services to older people in their care with adjustments to regulatory arrangements where appropriate and agreed.

So if you have a look on the next slide here this just shows you that service list, I guess an example of the service list that I was talking about. The service list is still being finalised and it’s going to change quite a bit over time. But we will certainly discuss this more with jurisdictions as drafting progresses.

So lastly just on system entry and services, I wanted to give you I guess some assurance with this slide that while there are a lot of changes coming a lot of things will stay the same. But some things are just being relabelled with different terminology. So don’t let that kind of put you off. For example your MPS sites or services will be called a residential care home in the new world and Simon will take you through this in a bit more detail later.

Similarly while older people approved for aged care services will be given a classification and a priority rating for residential care for example this will still not impact how services are delivered to them if they choose to enter an MPS for their services.

Okay. So just to give you a bit of a visual. I’m not going to go through this in detail. We will have a more detailed deep dive into this later. But this slide just gives you an idea of that I guess front entry process to an MPS and this slide really focuses on new clients. It does though reflect the proposed grandfathering and alternative entry arrangements that I’ve already mentioned.

The next slide though shows you just in a bit more detail those transitional arrangements particularly in the green box down to the right. And we will be really wanting to go through this in quite a bit of detail with you at a subsequent webinar because we’ll need your assistance as providers to put these arrangements in place to ensure a smooth transition for existing MPS clients.

Okay. So that’s really it in terms of system entry and the new Act for now. But before I hand over to Simon I just wanted to flag that the new Act does include a new regulatory model. There has been lots of public consultation about these changes over the last two years in particular. You may have seen Simon at some other webinars. But we do appreciate that sometimes it can be difficult to understand what the proposed new arrangements mean for MPS providers. So really we want to use these webinars moving forward to provide some more nuanced explanations for MPS providers and discuss any potential issues or concerns that you have. The regulatory model is obviously a very big topic so we’ve decided to divide that into three. So today’s topic is registration. This was included in the Exposure Draft and is reasonably settled from a legislative perspective. So keen for you guys to listen to Simon, get a shared understanding of where we’ve landed, and if you can raise any red line issues with us as soon as possible that would be greatly appreciated. 

Next month we’ll then move onto provider obligations. This is a larger topic. It was covered in the Exposure Draft but a lot of the details of the obligations are in the rules or the subordinate legislation that is still to come. So we want to try and give you as much I guess forward information about that as possible so we can have a fulsome discussion. And at a later webinar we can also discuss regulatory actions under the Act. We can also get relevant regulatory bodies along to talk to you if that would be helpful.

But that’s it from me for now as I’m sure you’re pretty sick of my voice. So I’m going to hand over to Simon to talk provider registration. So thanks Simon and thanks everybody for listening.

Simon Christopher:

[Visual of slide with text saying ‘Registration as a provider under the new Act’, ‘Simon Christopher, Director, Harmonisation and Regulatory Strategy Branch’]

Thanks Cathy. Good afternoon everyone. Thanks for your time today. Cathy I’m sure my voice would more likely put people to sleep. So hopefully my content isn’t too dry for people. But today I’m looking to provide you an overview of the process by which we’ll what we call deem existing providers across to the new regulatory model on commencement of the new Act. The new regulatory model seeks to embed person-centred, rights-based care as we rebuild trust and confidence in the aged care system.

I’ll also talk you through specifically as Cathy mentioned we’re focusing on the registration process for new providers and what we call the renewal process for those existing providers that existing providers will need to undergo at regular intervals. I’ll also flag a couple of areas that we’re seeking your input on.

A key change under the new Aged Care Act is the introduction of a single universal provider registration model. The registration model will require all providers to be registered by the Aged Care Quality and Safety Commission to deliver funded aged care services irrespective of the program type or funding stream that they deliver services under. Providers must register into one or more of the six provider registration categories based on the service types that they intend to deliver. The provider registration category will determine which obligations and conditions a provider must comply with. Whilst the transitional arrangements are still being finalised it’s worth noting that under the new Act only registered providers can deliver funded aged care services.

To ensure continuity of care for older people all existing providers will be automatically deemed on the commencement of the new Act and considered as registered into the registration category or categories that reflect their service provision. And this may also be in line with their expectations of their current Funding Agreements. The Department will undertake this and this will include MPS services.

Existing providers will be deemed to be registered for a specified period. This initial registration end date will be set by the Commission based on a number of factors such as the length of time since the last audit, a provider’s risk profile, and also sequencing the flow of all providers into a cadence of renewal applications allowing for workforce capacity management for the Commission as they seek to assess and consider these applications.

Government providers will need to opt in to the deeming process, effectively agreeing to be deemed and deliver services under the new Act. We’re continuing to work through the level of agreement required to operationalise this opt in requirement. All MPS providers are expected to be registered in category six, the residential care category, so that they can continue to deliver permanent residential care and residential respite. Some MPS providers will also be registered into additional categories which you can see on the slide to reflect the types of home and community services they deliver. We will be validating your data with you and we’ll reach out to some providers if further clarification or information is required to facilitate the deeming process. This could include confirmation of services delivered or your organisational details. We’ll work collaboratively with the Thin Markets team and the MPS Working Group on this validation process as we progress this work.

As part of the deeming process we’ll set up your information into the Government Provider Management System or GPMS that some of you might be familiar with. GPMS makes it easier for providers to access and report information to Government. The deeming and transition process is intended to prevent any negative impacts on the delivery of care to older people and ensure providers are ready for these changes. On commencement of the new Aged Care Act all providers deemed to be registered will automatically start to be regulated under the new regulatory model.

A new provider who enters into an MPS agreement with the Commonwealth will also need to apply and be registered with the Commission in category six, residential care, and any other relevant categories they wish to deliver services in. The Commission must also approve at least one residential care home if there’s not already an approved residential care home that’s being attached as part of that application where the provider will deliver services under category six.

I mentioned earlier that all existing providers who are deemed on commencement of the new Act will also need to go through a renewal application and assessment prior to the end of their registration period. As mentioned you’ll be advised of that date on commencement of the new Act as part of that deeming process. Prior to the expiry of your registration period the Commission will invite you to commence the registration renewal process. The Commission will advise you of the timeframe for commencing a registration renewal application and the timeframe in which you need to complete and submit the application form.

Registration processes are expected to be streamlined for Government providers. As I mentioned providers will need to apply using approved forms. They will also need to pay a fee if specified for that service type. They will need to specify certain information including the category or categories that they are applying to register in, the service types they intend to deliver, that they intend to deliver services through the MPS program so that we know they are part of a specialist aged care program, each residential care home that they are seeking approval for and any additional information required by the rules for each home, for example the address, person in charge, bed numbers, proof of ownership or permission to use a particulate site and certificate of occupancy. And each responsible person of the entity for the Government provider, nominated contact person.

New and renewing providers will need to meet a number of requirements. These are expected to include the existence of a valid ABN, they are suitable as a provider and they have suitable responsible persons. The Commission will need to consider a provider’s compliance with the law and history of any banning orders or any NDIS sanctions that may be in place. They need to ensure that the provider has an understanding of the services they intend to deliver which will need to align to the proposed registration categories, and that they have the commitment, capability and capacity to deliver these services.

The Department’s continuing to refine renewal of registration in the draft legislation to ensure it’s proportionate and streamlined and recognises existing information held by the Commission. We’re really keen to make sure that the Commission doesn’t need to do tick a box exercises, if it knows and holds some of this information already, that that’s as streamlined and proportionate as possible. This remains subject to final drafting and ultimately a decision of Government in relation to the new Act.

Unlike other providers MPS providers will not need to be audited by the Commission against the Aged Care Quality Standards as part of registration and renewal processes. As you’d be familiar the Australian Commission on Safety and Quality in Healthcare using the National Safety and Quality Health Service Standards and the MPS Aged Care Module will continue to assess MPS providers which will inform a new or renewal registration decision application. The MPS Aged Care Module is being updated to reflect the Strengthened Aged Care Quality Standards.

There are a couple of definitions being given further consideration following community feedback on the Exposure Draft of the new Aged Care Act. The first one I wanted to flag with you is the responsible person. The current definition is on the slide.

We consider that it may not be appropriate for (a) any person who is responsible for executive decisions of the registered provider, and (b) any person who has authority or responsibility for or a significant influence over planning, directing or controlling the activities of a registered provider to apply to Government providers, for example because these provisions could inadvertently capture Ministers or Departmental officials who are not involved in the day to day running of an MPS. So we’re really keen to hear your feedback on this definition and any particular views for your situations which will help us kind of work that through.

The second definition I wanted to raise with you is the residential care home. MPS sites will need to meet the definition of a residential care home. This definition included in the current Exposure Draft for the new Act remains under discussion and is expected to need some adjustment to fully cater for all MPS models. Of particulate note we’re seeking to progress amendments to the text to cover different MPS models, for example closer to something along the following lines. A place where aged care services are delivered that is within or collocated with a hospital or other health service and is covered by an agreement with the Commonwealth to deliver aged care services as part of an integrated service agreement. Your further feedback on this is very welcome. Our email address is on the slide I believe should you wish to provide us any further feedback directly. And with that I’ll hand back to George.

George Masri:

[Visual of slide with text saying ‘Questions?’]

Great. Thanks Simon and thanks Cathy. It’s also pleasing to note that we’ve got a few questions on the Slido so we’ll commence the panel discussion with some of the questions that you’ve sent through and that we may not necessarily have answered in our presentation. So we’re reviewing the questions. So I might just go to some of the ones, not necessarily in order, but we’ll go through them and I might start off I guess with both articulating the question and then maybe just a brief response and then open up to other panel members to add to it.

So for example:

Q:        Will there be an additional 24/7 registered nurse funding for MPSs similar to the increased funding received for residential aged care facilities?

Look at this stage we’re not in a position to really articulate any increased funding and it’s not going to be something that we’ll be looking at at the moment in the trial period. But as Cathy mentioned we want to use the trial period to build on evidence to ensure that we’ve got clarity about the additional costs involved and the need for funding. So that’s something that I think will be a key aspect of the trials for the 24/7.

Happy for any of my other colleagues to elaborate.

Cathy Milfull:

Thanks George. I think that’s right. And apologies everyone. It is a bit confusing because we’ve got the two trials coming potentially, one for 24/7 which has no additional funding associated with it yet, but care minutes which will as long as your state and territory agrees to participate. So happy to explain any of that in more detail as it becomes clear who’s nominated to participate etcetera.

George Masri:

Thanks Cathy. And that’s a good segue to the other question.

Q:        How does someone apply to be on the trial?

So we’re really encouraging providers to participate. This is a good way to influence I guess how we implement some of these reforms. So we recommend that you contact your state or territory agency to discuss being involved but we can also provide contact details so that you can contact us directly through our MPS mailbox.

Q:        Will the My Aged Care portal be updated to allow MPS outlets to accept referrals for permanent aged care?

So that’s a good question. We’re aware that this has been an issue and we have raised it with our colleagues, not least our IT colleagues. That’s something also maybe it would be great to sort of discuss further with providers who’ve got ideas about how we could actually improve that functionality. But that’s going to be an important part of just ensuring that people who want to access aged care can get the most accurate information. But again I don’t know if Cathy you want to add anything further to that? 

Cathy Milfull:

No. I don’t think so George. But yeah obviously there’s a lot of work going on in the background with IT improvements for changes that are associated with the new Act. So I guess I’ll put a general callout to MPS providers if there are things that you feel in the current environment that kind of are letting us down please let us know because now’s the time to get some of those issues reflected in the IT wish list if you like. They’ve got a lot to do by the time the new Act commences so it will need to be prioritised. But the more we’re aware hopefully we can add in additional benefits as we go.

George Masri:

Thanks Cathy. 

Q:        Would the assessment come from ACAT?

So that’s a good question. I guess certainly one of the recommendations coming out of the Royal Commission and other reviews was for that assessment of people who are accessing the MPSs. So the assessments will be done by the proposed new single assessment workforce. What we can do is invite the policy area that’s responsible for assessments to come along to one of these webinars to explain the assessment arrangements in more detail if that’s an area of interest. So I think that’s worth really exploring how that will be applied in the context of MPS.

Q:        What remoteness classification is currently used by aged care and the MPS program?

So it’s the Modified Monash Model. There’s various versions and in fact there’s a review being undertaken as we speak. The final report of that review is due in July this year. But in the context of MPSs it’s the 2017 version of the Modified Monash Model. I guess that sort of reflects what Cathy mentioned earlier was the MPSs sort of sit within small, rural and remote locations, so the MM5, 6 and 7. But also I guess why I think the remoteness classification is important more generally as it applies across the board to other aged care programs, it’s connected to funding, for example in mainstream residential aged care with the AN-ACC funding. It also could look at exemptions, for example the 24/7 nursing, the implementation of that, and some exemptions are possible for the small, rural and remote locations. So there is the application of the MMM classification when we actually recently put out an aged care infrastructure or capital assistance grants round and we were really looking to target many of the rural and remote locations. So there was a focus on using the Modified Monash Model to actually prioritise some of the funding that will go into capital assistance programs.

So I think as the Taskforce, the Aged Care Taskforce recommended, it is appropriate I think to sort of review the application for remoteness classification across the board including MPSs. Again Cathy I don’t know if you want to add anything further?

Cathy Milfull:

I don’t think so George.

George Masri:

Q:        So who is leading the residential experience surveys?

Again the Department has engaged HealthConsult to conduct the trials to look at residents’ experience. That’s across the board but also included in the MPSs. That might be something that we could also provide more detail and a link to the relevant details of that trial if people are interested in participating.

Cathy Milfull:

Team online perhaps you could put those links in the chat for everyone. That might be useful.

George Masri:

Q:        What and how much will the trial funding be as this may influence the decision to participate in the trial or pilot?

So as Cathy mentioned we don’t have any funding available for the 24/7. There will be – subject to certain arrangements we will look at funding for the care minutes trials. They’ll be calculated per place per site and take into account the classification, the Modified Monash Model classification location.

Cathy Milfull:

Yeah. Thanks George. And so the states and territories have I guess some high level information about the amount of funding we have on offer annually moving forward for care minutes. So have a chat with your state and territory but it will really depend as George said on the number of places, residential care places you have, and extent of the remoteness really of your MPS.

George Masri:

Thanks Cathy.

Q:        Will the retrospective approval process for entry be managed in a similar way to emergency respite?

And as I understand it be similar to emergency entry arrangements in the current Act but it will be expanded and will cover MPSs more broadly where this is a delay in the assessment. But again if Cathy or Simon want to add further to that.

Cathy Milfull:

Yeah George. And thanks everyone for the question. I think we’ll try and do some more consultation I think on the alternative entry arrangements once they’re locked down just so people can highlight any unintended consequences. But George and I have been advocating strongly to make sure there’s enough flexibility in the MPS context. We are aware that in some cases you’ll just need to commence delivery of care. So as I mentioned it’s really about how we can retrospectively make sure those people are assessed. And there’s just some outstanding questions I guess how that works in MPS given block funding arrangements. So we’ll confirm that and get back to you all.

George Masri:

Thanks Cathy. There’s another one on 24/7 care.

Q:        As it stands particularly with the on site requirements that were stated is very ambiguous. Will there be any further narrowing of this such as stating that the RN is employed for the sole purpose of the aged care home or will this continue to be interpreted by the MPS providers?

So that’s a good question. There are a range of nuances but I’ll hand over again to Cathy to elaborate further.

Cathy Milfull:

Thanks George. And thanks for the question. I think we’ve had a lot of discussion with our MPS Working Group about what on site means and we did do a bit of a paper on this for the states and territories. But certainly for those who want to participate in the trial our plan was to do a more I guess simple and easy to read policy document that explains what we mean by on site. But I guess just to reassure everyone there is no intention to sort of say that that RN has to be employed for the sole purpose of sitting next to an aged care bed and being available for that specific purpose. They just need to be on site and we need to have someone there 24/7. So they could be in that acute part of the hospital. As long as their if you like employment allows them to cross health and aged care then that would be fine.

George Masri:

Thanks Cathy. Got a question also about:

Q:        When will the provider registration requirements and the associated grandfathering arrangements commence?

Again I’ll hand over to Simon and Cathy.

Simon Christopher:

Thanks George. I might kick it off Cathy because I think the grandfathering piece might be more around clients rather than providers. So thanks for the question. The regulatory model and the provider registration process within it is due to commence with the new Act. And as Cathy mentioned earlier that’s still a decision of Government when that will occur, and based on how quickly it gets through the house and through Parliament. But in relation to the second part of your question around the data validation we’re still working through some of that at the moment and we’ll be working with Cathy and team to engage with the Working Group but we anticipate it will be – and I’m going to say this broadly so apologise. But we’ll be sequencing it from when we start to understand the new Act will come into commencement, as that starts to progress through, it’s introduced etcetera. So we’ll be allowing a really good period of time prior to that to validate the information with you so that we can work through any particular issues and make sure that that deemed information is accurate. I’ll throw to you Cathy.

Cathy Milfull:

Thanks Simon. And I think obviously we’re going to have grandfathering arrangements sort of in two areas. Yourselves as the providers, and I think that will be a reasonably simple exercise that we will start early with you all. There’s also the grandfathering of MPS clients and I think that’s actually going to be a more complex task. So that’s why I’m really keen to focus on that at a further webinar because really as some of you would be aware we don’t currently collect MPS client data in the Department so we will need to be working with providers to work out who are these people that are currently in MPS and what are the services that they’re receiving.

George Masri:

Thanks Cathy and Simon. Acknowledging just about three minutes to go. 

Q:        Is there an update on the assessment tool to be used that will determine care minutes and requirements?

I guess that’s all part of the pilot but Cathy if you want to elaborate?

Cathy Milfull:

Yeah. So thanks George. I think we’ve got two more questions around care minutes about the tool and also nursing hour ratios, things like that. So I think both of those really is why we’re having the trial and pilot phases. We understand that MPS is a bit different. There’s the integrated health component. So we want to understand what other arrangements you already have in place for your nursing staff and whether there’s existing reporting we can use and whether there’s perhaps innovative ways that we can make sure that direct care targets are met. As I mentioned it’s really about that outcome for the client and that’s what we’re after.

George Masri:

Great. So I’m just going through further questions. 

Q:        Additional MPS allocations for 2024. Will there be any impediment to the service applying for allocation where they are located in a community that also has a separate residential aged care facility operating in a community?

That’s I guess part of the criteria for determining allocation but Cathy?

Cathy Milfull:

I think there’s no if you like complete blocker, if that’s the question. So we removed that from policy I think – correct me if I’m wrong team – about a year ago following the recommendation of the Royal Commission. But it is of course something that we would take into account. So if you’re looking to open a new MPS and there is a separate RACF there are some questions around need and community need and competition but there’s no absolute blocker anymore that it can’t be done.

George Masri:

The issue of MPS sites being critical in regional areas for younger people with disability as home care providers are limited or no existence in some of those remote areas. It’s certainly a topic that is very much part of negotiations and discussions with the states and territories. The new Aged Care Act will make it clear I guess the younger people who have access to aged care. There will be some grandfathering provisions but again Simon or Cathy may want to elaborate on that.

Cathy Milfull:

I mean I don’t think I have anything specific on that one guys. I mean I think a lot of people in their submissions to the Exposure Draft obviously raised concerns about some of the new eligibility provisions. But as George mentioned really there are discussions underway between the states and territories and the Commonwealth to work out what are those alternative arrangements going to be. But I think realistically we do understand the pressures in this space in regional areas but we also are conscious of the recommendations of the Royal Commission that aged care is not really ideally the place for younger people. So we want to make sure they’re getting services that best suit their needs. 

George Masri:

Thanks Cathy. And I think the last one.

Q:        For in-home services such as domestic assistance, allied health or community nursing, how will reporting work?

They’re the services that the MPS provide. Sorry Simon.

Simon Christopher:

No. That’s all right. I was just going to say George I think part of what we are doing as we go through, and Cathy’s kind of highlighted the obligations is the next piece of work, I think that’s probably a good question that we can pick up as part of the reporting expectations across categories of registration. So we might put a pin in that if we can and definitely pick it up as a further deep dive when we get into other parts of the reg model. Because I think we’ll have greater clarity for you around that to be honest.

George Masri:

Thanks Simon.

Cathy Milfull:

And George I think we’ve got a few more questions coming in around 24/7 but I note given the time I suggest we park them for now and everybody – as I said we really want the 24/7 trial itself to be a topic at the next webinar so we’ll certainly look at your questions. But if you’ve got other things in that space you particularly want us to address please feel free to ping us at the mailbox.

George Masri:

That’s great. Look on that note I wanted to thank everyone for taking the time out today and to also provide some really useful questions and comments. We hope you found today’s session useful. We look forward to continuing to engage with you around these MPS reforms. As Cathy mentioned we weren’t able to cover off all the questions but what we’ll do is come back to you with some responses to that and also doing a bit of a deep dive in future webinars. And really look forward to hopefully you joining us in a month’s time and continue the conversation.

So thanks again. Have a great afternoon. Bye for now.

Cathy Milfull:

Thanks everyone.

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