Webinar 3: Aged Care Reforms – Impacts on the Multi-Purpose Service (MPS) program and providers

Cathy Milfull:

Okay. Thanks everyone for joining us for this third MPS reform webinar. My name’s Cathy Milfull and I’m still Acting Assistant Secretary of Thin Markets Branch which is responsible for the MPS Program. So I’ll be hosting the webinar again today. It’s great to be back with you. Also pleased to introduce Simon Christopher who you can see on the screen from our Regulatory Strategy area, and Tanya Clancy from my MPS team. And also our special guest star Margaret Banks from the Australian Commission on Quality and Safety in Health Care. So all joining me on the panel today.

As per the last webinar we’re going to do a formal presentation to start and then we’ll try and leave as much time as we can for a question and answer session at the end. I would like to point out that we have moved to MPS Teams this time so please be a little bit gentle with us. And apologies if there are a few hiccups today or somebody inevitably forgets to turn off their microphone or something of that nature. So unless technology defeats us today though we still want to make this as interactive as possible so just like last time you can certainly submit questions throughout the whole webinar and we’ll try and answer those at the panel session at the end. But just so everyone knows there’s a Q&A panel that you can open on your right and that’s where you put those questions in. So you don’t have to open a separate program anymore which is great.

We’ll try and get to as many questions as we can but don’t worry if we don’t. We’ll publish a list of questions and answers on our new MPS Reforms web page which I have talked about a couple of times before but I’m pleased to say should go live this week. So I’ll get the team to send around a link when that happens. And on that page then will be all our Q&As plus also links to these webinars which are recorded if you want to view them again and also to our slide packs. I did just want to say that we have disabled the chat function this time around but if you do have any problems today with the webinar if you just use that Q&A function we’ll still get the information that’s needed.

So look that’s probably the housekeeping for now so I’ll get my team to bring up the slides and we’ll get started with the formal presentation. But just before we do I just wanted to acknowledge the traditional owners of the lands on which we’re meeting today all across Australia. I would like to pay my respects to Elders past, present and emerging, and I also want to welcome any Aboriginal or Torres Strait Islander peoples here with us today.

[Visual of slide with text saying ‘Multi-Purpose Service (MPS) Webinar 3:’, ‘Aged care reforms:’, ‘impacts on the MPS program & providers’, ’29 July 2024’, ‘Thin Markets Branch’, ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘www.health.gov.au’]

All right. So just to get started this slide outlines what we’re going to cover today. As with previous webinars I’m going to start off myself just giving a few quick updates regarding recent reforms that are relevant to MPS. I’ll then hand over to Tanya who’s going to talk about our direct care trial. Margaret will then talk to the new MPS Module which is being developed to reflect the coming strengthened Aged Care Quality Standards. And lastly before opening up to Q&A Simon will continue the discussion that we’ve been having around expected provider obligations under the new Act and its rules, this time focusing on provider obligations more broadly as opposed to conditions on registration. And as flagged previously just a reminder that the rules for the new Act are still under development so this is preliminary information only and may change.

All right. So this next slide just tells you our future suggested schedule for next webinars. I just wanted to flag that to date we have been focusing very much on topics related to provider obligations and regulations and we’ll certainly return to this rather large topic in September. But as you can see for next month we do want to make a bit of a shift because we’re keen to look more at if you like the MPS client journey under the new Act, so what are the impacts on client pathways requirements. We’ll be talking about eligibility and assessment arrangements for new entrants to MPS but importantly we also want to talk about transitional arrangements for existing individuals who are already for example residents in your MPSs. 

So if there any particular really burning issues or questions you have in that space please feel free to shoot them through to my team in advance so we can make sure that we cover them at the August webinar. And as always the invitation is open for you to suggest additional topics for future webinars.

[Visual of slide with text saying ‘Quick updates’, ‘Cathy Milfull, A/g Assistant Secretary, Thin Markets Branch’]

All right. So we’ll move onto just our standard quick updates. This slide shows you an updated version of our MPS reforms schedule that we’ve been using. I’m pleased to say nothing’s really changed this time around in terms of upcoming reform items. We’ve just amended the slide to reflect the actions that have already been completed. So you can see that really our next focus is the expansion round for the MPS Program in September/October this year. And I just wanted to mention for your information that it’s been agreed with the MPS Working Group that this upcoming allocation round will be for residential care places only. If however it’s agreed to be needed we may consider a further round early next year that focus specifically on home care places.

All right. Next up. What’s next with the new Aged Care Act? Look I don’t have a lot of new things to say about the Act today. Just reaffirming that subject to Parliamentary processes we’re still tagging the 1st of July 2025 for a start date. But as you might have seen reported in the media there’s quite a lot of Parliamentary discussions underway at the moment around the Bill and the Government’s response to the Aged Care Taskforce report in particular. So as a result we await confirmation of a date for introduction into Parliament for the Bill. 

But it’s certainly not pens down in any sense and we’re making the most of this time to continue drafting the Rules so that we can share them during Parliamentary passage in priority groups. And we’re working on the transitional and consequential Bills which is now a focus. I just thought today it might just be worth clarifying for those who are not familiar with the terminology too, the transitional Bill is basically used to preserve the position of existing aged care clients and providers under the new Act. This is important as the existing Act and subordinate legislation will cease when the new one commences. So you sometimes hear people talk about grandfathering or grandparenting arrangements but I think this can sometimes be a little bit confusing. While transitional arrangements will certainly be used to preserve equivalent entitlements so people don’t if you like lose out, they do still need to be new provisions agreed to by Government and Parliament as the old provisions will not continue. So we really need to look at all the cohorts and scenarios that impact existing clients and providers.

On the other hand consequentials will cover changes required to other legislation. So there might be for example health legislation, tax legislation, disability support legislation, anything that references the current Aged Care Act we also need to review that and make appropriate amendments where necessary.

All right. Next update was just on the Integrated Assessment Tool or the IAT as it’s commonly known. So I’m sure many of you will be aware this has replaced what was known as the NSAF or the National Aged Care Screening and Assessment Form. So as of 1 July this is now the new tool used to assess the eligibility of older people for Commonwealth subsidised aged care. As the new Act is not in place yet such assessments are not mandatory from an MPS perspective. Nevertheless we would certainly encourage you to still get clients assessed where you can, noting that our previous reporting has shown that the majority of MPS clients have been having ACAT assessments even though it’s not mandatory. If you do this this will help with the transition of existing clients to the new Act.

I can also confirm that there are no changes to the services/programs that can be recommended in the IAT support plan and the support plan completed after the IAT still has the same look and feel. If you’re interested to see what type of questions are used in the new IAT there’s an offline form that’s available on the Department’s website.

So why the IAT? This slide highlights for you some key benefits of the IAT. Look I’m not going to go into too much detail today but just to reiterate that the tool is designed to achieve consistency. It’s designed to ensure proportionate assessments. And also really we want to ensure that older people are only required to tell their story once. Also just important to note that the IAT will become even more important with the new Act because that assessment will be required to support decisions made under the new Aged Care Act and that will include for MPS clients. So that’s why we’ll talk about this in a lot more detail at the August webinar.

Okay. Lastly just a couple more quick updates from me before I hand over to Tanya. Firstly on the 24/7 registered nursing trial. So my team’s been holding a lot of meetings with participating sites and really would thank everybody for all their engagement and feedback so far which I understand has been really positive. We’ll be having our first trial reporting period taking place in August which is pretty exciting and the team will soon get out a reminder email to participating sites with the reporting template for completion. 

Just wanted to clarify a few things though about this trial while I have everybody just in response to feedback. Firstly that the trial related documentation is in draft and that’s because it is intended to be improved as the trial continues. But we’ll certainly make sure we share the most up to date trial documentation on our new reform website so it’s easy for you to access and we’ll notify trial sites when there’s been a significant change. Also just wanted to clarify that there are no changes to mainstream 24/7 nursing requirements as a result of this trial. So those arrangements remain in place for now.

And lastly just want to say we are very happy to develop additional support material. So for those trial sites if there are other things that you think would be helpful, for example could improve the consistency of reporting, please just sing out to the team.

All right. So last two updates. Payments. Just quickly on payments, our first quarterly payments for 24-25 went out earlier this month as well as workbooks that explain those payment calculations which have been distributed. And the annual activity report. Just a reminder that we actually have two for the price of one this week. We have a second webinar that is being held on Wednesday that’s specifically on the MPS annual activity report. So we would encourage staff that are specifically involved in that process to dial in and get some advice from my team.

All right. I think that’s it from me so I will now hand over to Tanya who will talk to you about the direct care target trial.

Tanya Clancy:

[Visual of slide with text saying ‘Direct care targets trial’, ‘Tanya Clancy, Assistant Director, Rural & Remote Policy and MPS Section’]

Good afternoon everyone. Thank you Cathy. I’m going to speak to you today about the direct care target trial. So this initiative has been designed to identify an equivalent mechanism to the care minutes requirements for mainstream residential care so that we have assurance of the levels of direct care being provided to residents in MPS. We recognise that given the circumstances MPS are operating in and the absence of AN-ACC classifications for residents that a tailored approach to targets will be required for MPS. We also acknowledge that the environment in which MPS operate may also offer other methods for providing assurance that MPS residents are being provided with sufficient levels of direct care.

We have commenced a phased trial of direct care targets for MPS with a number of sites in South Australia, WA and Victoria and you can see on the map the locations of these sites. Participating sites in these jurisdictions have been nominated through their state and territory representatives on the MPS Working Group. As of the 26th of July we have 47 MPS sites participating with 11 from South Australia, 26 in Queensland, one in Western Australia and eight in Victoria. All MPS in participating jurisdictions would have received additional funding to support direct care target implementation in their first quarterly payment. This is to support improved care outcomes across the board and help everyone prepare for further phases of the trial. While at this stage only some sites are formally participating we are keen for all MPS sites in participating jurisdictions to get involved and support their trial sites as well.

So the implementation timeline. The trial is split into a number of phases. Phase 1 which runs from July to December will be with the nominated Phase 1 trial sites to develop and agree to a direct care target approach to be trialled in Phase 2. Subject to Phase 1 results and further discussion with the MPS Working Group Phase 2 will involve a trial of an agreed direct care target approach or approaches in nominated MPS sites from January ’25 to June ’25. That’s to test workability and the need for any further adjustments. Phase 3 will then involve a trial of an agreed direct care target approach in all MPS sites anticipated to commence 1 July 2025. Phase 4 will involve formal commencement of direct care requirements or equivalent at a date determined in agreement with states and territories. At each phase we intend to confirm the proposed timeline remains appropriate, taking into account issues identified and options for resolution found through previous phases.

So the purpose of the direct care target trial. What we want to do is develop an approach to direct care targets that best suits the circumstances of the MPS program while retaining our shared strong commitment to ensuring appropriate staffing time for residents. During Phase 1 of the trial we will be working collaboratively with MPS providers to undertake planning and design work with a view to determining how direct care targets can or should apply in an integrated health/aged care context including in the absence of AN-ACC assessments. We will also be considering whether there is a need for alternative reporting and assurance mechanisms, and also whether we should use alternative terminology when considering direct care target requirements for MPS. 

Though while we work this out you will see us talking about direct care targets rather than care minutes. We note that even for mainstream residential care this is the language actually used in legislation as well and will be in the new Act with care minutes the more common operational terminology that has been used.

The work undertaken in Phase 1 and the learnings from this work will be used to determine next steps for the Phase 2 trial where a direct care target approach or approaches will be actively trialled in nominated sites.

So next steps. So if you are a participating site in the direct care target trial you should have received an email with a fact sheet and a link to an online survey for completion by the end of August. If you are a participating site but haven’t yet received this email and link please reach out to the team at MPSreforms@health.gov.au and we can assist you.

Thank you very much. And I will now hand over to Margaret Banks to talk about the revised MPS module.

[Visual of slide with text saying ‘New Quality Standards and the MPS Module’, ‘Margaret Banks, Director, National Standards Program’, ‘Australian Commission on Safety and Quality in Health Care (ACSQHC)’]

Simon Christopher:

You might be on mute Margaret. Sorry.

Margaret Banks:

I apologise. Can I please note that I’m on the lands of the Gadigal people of the Eora nation from the office where I’m speaking today, pay my respects to the custodians, the Aboriginal and Torres Strait Islander custodians of the lands on which we all meet.

So since 2013 the MPS has been required to comply with the National Safety and Quality Health Service Standards and then since 2020 we’ve had in place a Multipurpose Service Aged Care Module. The Module has allowed MPSs to be assessed to two different sets of standards in one assessment process. This has reduced the compliance burden particularly in small services while giving the regulators and the community and funders assurance that the standards are being met.

The actions in the MPS module are ones that are unique to the Aged Care Standards and they cover areas that are really not addressed in the National Safety and Quality Standards. The Commission has been involved in the development of the Aged Care Quality Standards this time around and been responsible for the development of Standard 5 and quite a lot of the input around each of the other Standards. So you’ll see there’s a higher degree of consistency in the way that the Standards are being approached.

With the development of the new Standards, the new Aged Care Quality Standards, a new Module needs to be developed. And so the requirements of the two sets of Standards have been mapped and the aged care specific actions are again being identified and pulled out. The Module will be circulated to MPSs and other key stakeholders in part to identify the resources that you might need to particularly implement a Module. There is though a significant amount of work already underway and the Aged Care Commission as well as the Health Care Commission have developed a swathe of different resources that MPSs will be able to access. Maybe you could move onto the next slide please.

The Commission will provide a mapping document so that if you’re looking for resources that the Aged Care Commission has developed which they are providing by their action number, which will be different to the National Standards and the Module, you’ll be able to track it one to the other and be able to navigate between the two different sets of Standards. In addition the Commission has developed resources that are specific to the National Standards and will be resources developed for the Module.

In terms of assessment for MPSs nothing really substantial will change. You’ll still be assessed in line with the rules and the requirements of the National Safety and Quality Standards. So that’s short notice assessments on a three year accreditation cycle with 24 hours’ notice. You will however be assessed to both the National Standards and the Aged Care Module once the MPS Aged Care Module has been finalised. 

Now I’m happy to take questions. There’s still quite a lot of work to be done in relation to this Module. We’ve done all the preliminary mapping but we now need to restructure it and put it into actions that make sense in relation to the National Standards. At the moment it’s looking like ten instead of six actions but that’s still to be finalised. And certainly we’ll let you know and provide you with draft copies as soon as they’re available.

And so on that note if I could then hand over to Simon Christopher for further discussion on provider obligations and the new Act.

Simon Christopher:

[Visual of slide with text saying ‘Provider obligations under the new Act’, ‘(Part 2 – continued from previous webinar)’, ‘Simon Christopher, Director, Harmonisation and Regulatory Strategy Branch’]

Thanks very much Margaret and good afternoon everyone. It’s good to be talking with you again. Today we’ll go over a quick refresher of provider obligations under the new Act and we’ll highlight a couple of obligations specifically that might be new or varied for MPS providers.

First a quick reminder of what’s different in terms of provider obligations under the new Act. Revised provider obligations will be in place when the new Act commences. These will be presented as either conditions on registration which include compliance with the Quality Standards, specific obligations or new duties placed on providers. They will reflect obligations that already apply via Part 4 of the current Act, related principles and standards, as well as MPS agreements. They will be collocated and easier to understand and navigate. Obligations will apply to MPS providers where they are not specifically excluded from application in the rules. There will be some new obligations but most are similar or varied and streamlined where possible. Just move to the next slide if we can please.

Registration conditions are described in Chapter 3, Part 4, Division 2 of the Bill for the new Act. For some obligations significant additional details will be provided in the rules including the details of requirements to be met and the kinds of providers that must comply with them. Provider obligations as opposed to conditions often relate to matters that are relevant to the Department’s function as the aged care system governor as well as the Commission’s functions as the regulator. As I mentioned previously when we last met key parts of the new rules are expected to be released for public consultation after the Bill for the new Act has been introduced to Parliament. This will support Parliamentary discussions on the Bill including committee investigations. We welcome your further feedback and suggestions as the rules continue to be drafted and are released for consultation. We would be particularly interested to hear if there’s anything problematic in an MPS context.

Like last time these next two slides are designed to show you what is likely to be the same or different in terms of specific obligations on MPS providers. On this first slide you’ll see the obligations relating to reporting and notifications. In both cases it’s anticipated that there may be some additional or varied requirements for MPS providers however we will work through this in more detail with the MPS Working Group and yourselves as drafting of the rules continues. This will be important to ensure we can minimise any unnecessary duplicative regulation and that these obligations are clear, noting that both of these obligations are civil penalty provisions where non-compliance exists. 

The type of reporting required from MPS providers is likely to remain the same however this is a good time to make sure everyone is clear on their obligations and to consider anything that could be done differently or more effectively. As a result we would encourage you to share any concerns about existing arrangements with the MPS team. It is also important to understand that there is expected to be a clear obligation to ensure information reported is accurate. Clearly this is already implied but the new legislation will be clearer on this matter.

Notification is arguably a type of reporting as well however here we are talking about ad hoc requirements to notify the Aged Care Commission for example where certain events occur. They contrast to the regular cyclical reporting requirements as flagged.

New notifications expected to be required under the Act include when there have been significant changes in the scale of service delivery, the service types delivered or changes to associated providers. These are to ensure that information for clients around services delivered by providers are able to be kept up to date and to inform the regulator or the Department as the system steward of changes in the aged care market that could impact the quality or availability of services. The Act includes that notification must firstly be given within the earlier of 14 days after either the event has occurred or the provider becomes aware of the change in circumstances and are to be provided in an approved form.

Further information in relation to notifications or change of circumstances or events of a kind which will be prescribed by the rules. So we will certainly share more detail on this as it becomes available. Just jump to the next slide thank you.

So this slide outlines obligations where no significant changes are expected. This includes obligations to responsible persons and the Code of Conduct. So that brings me to the end of my presentation so back to you Cathy and look forward to some questions in a moment.

Cathy Milfull:

Thanks Simon and thanks everyone. So I would like to open the Q&A session. Although at this point I think we’ve only got two questions so would encourage providers out there to get in any other questions that you have while I look at the first two, which I think both really relate to those new IAT arrangements. So the first question was:

Q:        Will all existing current MPS residents require reassessment on the IAT by July 2025 even if they are already assessed under the NSAF?

So look we’ll talk more about that next webinar but basically I think my answer would be where at all possible we want to avoid reassessments. We don’t want existing clients have to go through reassessments as a matter of course for the new Act where possible, noting that often they may regularly require reassessment at some point anyway. But we will have some legal and constitutional requirements that need to be met so we’ll talk to you about those in August. I would say though to get these arrangements working we are likely to need to know which clients are currently accessing services from your MPS and what are the services they’re currently accessing. And we may also need to confirm certain information with you about their aged care needs. So we’ll go through that in more detail next time but we’re hoping to be able to if you like group existing clients into cohorts to be able to confirm certain information with you about those and then hopefully we can avoid reassessment in most cases.

I think we also had a similar question.

Q:        Will the IAT be compulsory for all new MPS residents following launch of the Aged Care Act or will there be a lead time before it is compulsory?

So essentially at this stage the intention is that when the new Aged Care Act commences anyone who is seeking subsidised aged care after that time, they would need to apply under the new provisions in the Act. They’ll have to have their eligibility assessed and go through an assessment process which yes will be based on the IAT. So yes in that sense it will be compulsory. At this time there’s no sort of transitional period post commencement of the Act but we can certainly discuss that further next week. Next month sorry. I’m getting excited.

Other questions.

Margaret I might throw one to you if that’s all right. We’ve got:

Q:        Will the Aged Care Module cover services delivered in the community as well as bed based, so I’m assuming residential aged care? 

Margaret Banks:

Absolutely. We expect that the National Standards if they’re applied to a facility and the Module will cover all of those services.

Cathy Milfull:

Thanks Margaret. Simon. And I don’t know if you can answer this off the top of your head, but we’ve been asked for some clarity on any financial penalty for not notifying of material changes within the timeframe.

Simon Christopher:

Thanks Cathy. So the current draft of the Bill has penalty units applied at 30 units. Obviously that’s all still subject to Parliamentary processes and again that’s subject to the Aged Care Quality and Safety Commission taking action for a breach of that provision. But I think the main point to focus in on there is really the importance of those updates of information are flagged in such a way as there’s a penalty provision applied to that notification process. And we think that that helps change behaviour across the entire provider cohort to ensure that we’ve got the most accurate and up to date information.

Cathy Milfull:

Thanks Simon. And I think as Simon’s talked to the group before, obviously the aim of the new model is to have a suite of regulatory powers available to deal with particular scenarios. So it’s not a situation where people are jumping straight to massive financial penalties because someone hasn’t completed a report obviously. I’m sure I’m not speaking for the Aged Care Commission here but they’d be looking at the provider’s conduct as a whole and also past conduct, is there a repeated pattern of issue here. So they’re the sorts of things that we will need to take into account.

Other questions?

Q:        Will there be an invite sent out for the webinar on the 31st?

Tanya I might throw that to you. I’m sure we’ll get invites out as soon as we can. There might just be a placeholder at the moment I suspect.

Tanya Clancy:

Yeah. I’ll look into that as soon as the webinar finishes.

Cathy Milfull:

Excellent. Anything new coming in?

Q:        Could you please share a link to the Exposure Draft for the Aged Care Act?

Yes we can certainly do that. Either post in the chat or I’ll get the team to send it out for you. But no problems there.

All right. Have I missed any questions team, panel members?

Margaret Banks:

No. Can’t see any extras. No.

Cathy Milfull:

Okay. And thanks Kate. You’ve posted the link to the Exposure Draft. That’s great. All right. Well if there’s no other questions we might leave it there and make it short and sweet today. Sorry Simon. 

Simon Christopher:

Yeah. Thanks Cathy. I was just going to just pick up on the Exposure Draft. The copy that’s in there is probably the consultation Exposure Draft. So I would just flag that some of the additional detail in the next iteration of the Bill will become available once that’s introduced to Parliament. So we can circulate that at that point. I just wanted to clarify that what we’ve got is what’s been publicly available to date. So once we cross that threshold we’ll be more than happy to make sure that’s circulated to the group.

Cathy Milfull:

Thanks Simon and good point. All right. Well I’m not seeing any other questions come in. So look that might be short and sweet today. But as I said next time we’ll have a more focused conversation on MPS clients under the new Act. If you have any things you particularly want us to address let us know. Otherwise I wanted to say a big thank you to Simon who’s come along to a number of our webinars now, and also Margaret for joining us. Much appreciated. And Tanya and my whole team for all their brilliant organisation as usual. So thanks everyone. Great to catch up with you and looking forward to talking with you further next month. Okay. Bye.

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