Kerri Lanchester and Chris Edith Qld State Manager, LASA Ltd. Are you on the right path for the Increasing Consumer Choice Home Care Reforms? Kerri Lanchester and Chris Edith Qld State Manager, LASA Ltd.

Aged Care Government subsidised Residential Aged Care Facility Private in home Retirement living, including home care communities Home Care Packages; Hospital in the Home; Transition Care; Compac; Short Term Restorative Care Commonwealth Home Support Programme; HACC (WA); Veterans Home Care Government subsidised Private, truly consumer driven care and services

The New Path where is it going… The Australian Government announced further significant reforms to home care in the 2015-16 Budget Intent of the reforms is to further improve the way that home care services are delivered to older Australians Reforms will be implemented in 2 stages

What were the issues with the current arrangements? The Government identified the current arrangements make it difficult for a consumer to move to another location or provider. The issues included: Lack of portability (the home care package is allocated to a provider, not the consumer) Unspent amounts do not move with the consumer Provider used to have to apply through ACAR to expand services (it’s worth noting in the last ACAR round about 1 in every 20 places sought were allocated/available. Home care places are specific to an aged care planning region

The key changes Stage 1: starting 27 February 2017 NB: Stage 2 is due to commence from July 2018 The most significant changes include (in reverse order): A streamlined process to become an approved provider. Funding for a home care package will follow the consumer A consistent national approach to prioritising access to home care Let’s look at these in more detail

Streamlined process to be an Approved Provider (AP) In September 2016, the Government modified the process to become an approved provider under the Aged Care Act 1997. New providers are encouraged to enter the home care market. They will however: need to demonstrate their suitability as an approved provider meet quality standards

Further changes to the process The Government will be introducing an online smart form to streamline the application process The process to become an approved provider will have less focus on an organisation’s personnel, and more focus on: management systems, including governance & financial management delivery of care, including how you respond to changing care needs

Funding for a home care package will follow the consumer This change provides more choice to the consumer They can select a provider that is suited to them They have more flexibility (portability) if they move to another area to live, as an example It is important to note that the funding does not go to the client but they can direct funding to their provider of choice.

A consistent national approach to prioritising access This will allow a fairer and more flexible way of distributing packages to consumers based on their individual needs and circumstances, Wherever they live! There are two key aspects to this process. the national package inventory and the national queue

The national package inventory The inventory records the status of all home care packages. It has been created by registering all occupied and vacant packages in My Aged Care. The inventory will be added to as the Government releases new home care packages. And as existing packages become vacant.

The national package queue This queue determines the order in which eligible individuals will be assigned a home care package. A consumer’s place in the queue will be based on specific criteria: Their need and circumstances, including a specific priority The period of time since they were approved for care by an ACAT delegate.

Reaching the top of the queue When a consumer reaches the top of the queue they will: be assigned a package at either level 1, level 2, level 3 or level 4. receive a letter confirming they have been assigned a package. which will include a unique referral code And the date by which they must enter into an agreement with a provider which is: 56 days With a possible extension of 28 days.

The path is getting hotter! We’re going to move on to some of the hot topics and things you need to be aware of to keep you on the path! Following these, we’ll move into the Q&A section.

The consumer and consumer discussions The consumer is at the heart of these changes. All consumers who are currently approved for home care have been sent one of 4 letters, depending on where they are in the home care system. LASA has published a table outlining these transitional arrangements

Home care package levels and transitional arrangements Client circumstance Before the 27th Feb. 2017 From the 27th of Feb What does the client need to do Client receiving home care at a level they are satisfied with. A client is already receiving their services at a level 3 and were approved at a broadband of level 3-4.   They will continue to receive their level 3 services but will be added to the national queue for a level 4 package. They do not need to do anything to be added to this queue. If they are happy with the level of services they are receiving at the level 3, they can opt to be removed from the national queue. To do this, they will need to contact My Aged Care. Client currently receiving home care but not at their approved level. A client is receiving services at a level 2 but was originally approved for a level 3 – 4. The client will continue to receive their services at the level 2 but will be added to the national queue for a level 4 package. They do not need to do anything to be added to this queue. If they are happy with the level of services they are receiving at the level 2, they can opt out of the national queue. To do this, they will need to contact My Aged Care.

Home care package levels and transitional arrangements cont. Client circumstance Before the 27th Feb. 2017 From the 27th of Feb What does the client need to do Client has an approval for home care but not receiving home care package services. A client has been approved for a broadband level 1 – 2 but they are currently not receiving any aged care services.   Depending on when this person was approved, they may be automatically added to the national queue for a level 2 package. If they were approved before the 1st July 2016, then they will have received a letter from the Department to ask them to contact the My Aged Care to request to be added to the queue (i.e. they need to ‘opt in’). Clients approved for home care after 1 July 2016 will automatically be added to the national queue. Client has an approval for home care but not receiving home care package services. Client is receiving Commonwealth Home Support Programme (CHSP) as an interim measure. A client was assessed and approved for a Level 1-2 home care package, however, the client is receiving CHSP services as an interim measure. Depending on when this person was approved, they may be automatically added to the national queue for a level 2 package. They will receive a letter from the Department to advise them of whether they need to contact My Aged Care to request to be added to the national queue.

Changing home care providers From 27/2/17 consumers will be able to change their provider if they wish. If they make a change, their unspent amount (less any exit amount) will move with them to the new provider. The consumer has a responsibility *to tell you and their care/service delivery staff of the day they intend to move to another provider, before they change providers. * we’ll look at the Charter of Rights and Responsibilities shortly Once they tell you, you should have a discussion about their needs and mutually agree on a cessation date.

Changing home care providers cont. The start day for the new provider must be on or after the cessation day for the existing provider. When a consumer is changing providers and there is no gap in care: The start day for the new provider should be the same as the cessation day the existing provider. This will ensure there is no gap in payment of the home care subsidy. It is important to note where there is no gap in care, the existing provider will not be paid a subsidy for the cessation day and the new provider will be paid a subsidy for the start day. If there are overlapping claims, the new provider won’t be paid – providers need to talk to each other!

Current providers My Aged Care will also alert you when a consumer is seeking to change providers. When they initiate a transfer to a new home care provider, a message will notify you of their name and the date the referral was accepted. Then you need to issue a notice to the consumer of any unspent amounts. You will need to keep written notices of unspent amounts, records of payments of unspent amounts and notice of exit amounts provided to the Department.

New/ receiving providers As a new or receiving provider you will have arranged to have access to the provider portal in My Aged Care and you may receive a referral. You will be able to view some consumer information in order to decide if you are able to cater to their needs. Note: you will only be able to view the consumer’s full details once a referral has been accepted. You will also have access to the comprehensive assessment – the National Screening and Assessment form (NSAF). Then you are required to lodge an Aged Care Entry Record (ACER) within 28 days of a consumer commencing home care. And you will be required to deliver care and services under a CDC framework.

New providers and financial reporting To ensure you receive your subsidies, you will need to: provide your bank details to DHS and register with DHS for online claiming. If you choose to do manual claiming, you will be required to: complete an approved provider statement (every 3 years) and provide a financial report via a template (this does not need to be audited).

Consumers transferring between levels after 27/02/17 It is important to note that services will no longer be able to submit a change in the level of care for a consumer from 27/2/17. Instead the information will be sent to DHS following an Aged Care Assessment Team (ACAT) assessment And any upgrade of a consumer’s level of care will be sent to DHS by the Department through the NSAF.

Consumers and Consumer Directed Care (CDC) Some things aren’t changing - all providers must continue to deliver home care packages on a CDC basis. This means they will continue to require: A home care agreement (this must be offered to the consumer). The consumer’s rights and responsibilities – the Charter (this needs to be explained and a copy needs to be provided) An individual budget and a monthly statement (including the balance of unspent amounts)

The Home Care Agreement (HCA) prior to 27/02/17 For consumers with HCA prior to 27/2/17 providers need to consider: The inclusion of an exit amount Information about changing providers It is important that any variation includes evidence of mutual consent. Note: you may not need to prepare a new HCA but could consider a letter of variation (signed by both parties) However, this may be a good opportunity to review your HCA.

The Home Care Agreement (HCA) after 27/02/17 cont. Once a consumer starts with a provider, they have 56 days to enter into a HCA with the provider of their choice (with an option of a 28 day extension. If you want to include an exit amount in your HCA then you will need to advise the Department of the maximum amount (whole $ figure). This will need to be published on My Aged Care before it can be included in a HCA.

The Charter of Rights and Responsibilities The Charter of Rights and Responsibilities has been revised and will come into effect on 27/2/17. There are 2 revisions relating to ICHCH: Responsibilities (under Communication): (c) before the care recipient changes approved providers, to tell the approved provider and their staff of the day the care recipient intends to cease to receive home care services from the approved provider. Rights (under Consumer Directed Care - choice and flexibility): (f) to choose the approved provider that is to provide home care to him or her, and to have flexibility to change that approved provider if he or she wishes.

Unspent home care amount (portability) As part of the introduction of portability, a consumer has flexibility to change their approved provider. In this scenario, and if they leave home care completely, any amounts that have not been spent must be reconciled after paying any outstanding invoices - And an exit amount (if you are having one) and reimbursed to the client or the Government on a proportionate basis if exiting or transferred to a new provider. There are 3 different portions to be aware of: Commonwealth portion (home care subsidy and supplements) Consumer portion (home care fees; basic daily fees and any income tested fee and The transfer portion

Exit amounts The Government recognises there are administrative costs associated with reconciling an individual’s package. It is important to note that is not mandatory to have an exit amount. If you do want to charge an exit amount, you will need to complete the Notification of Home Care Maximum Exit Amount form by 24/2/17. If you decide not to charge an exit amount, you will still need to enter an amount of $0.00 on the Service Finder.

Exit amounts – key points The inclusion of an exit amount in a home care agreement must be mutually agreed between you and the consumer. Your service’s maximum exit amount must be sent to the Department for publication on My Aged Care by 24/2/17. You can’t charge an exit amount if there are no unspent amounts (i.e., it can’t result in a debt for the consumer) The exit amount can’t be > than the consumer’s unspent home care amount. It can be entered into an agreement before 27/2 but can’t be deducted until after 27/2

The Service Finder From 27/2 the My Aged Care system will be updated to enable you to promote the services you offer and support informed decision making by consumers. This will also assist consumers (and assessors) to research and compare providers by narrowing their search criteria. The department has issued a provider template with updated data fields for the Home Care Service Finder on My Aged Care. You will need to update your own profile the only mandatory requirement is to populate the maximum exit amount field.

The Service Finder cont. The information will be captured in the home care package service finder at the organisation, outlet and service item levels. This can include: Cultural, religious and language specialisations Specialised services, including mental health, vision and/or hearing And your tailored service description. Note: This can be configured into the My Aged Care portal from 27/2

Questions and Answer time We’ll now be moving into the Q&A session. Please note, any additional questions received will be addressed in further updates.

Try going down a new path but keep track of where you want to go… And finally remember you can take the lead and decide where you want to go on this journey. And then you can consider all the different paths you can go down! Thank you and we hope you found this informative.

End of Webinar Final details: Following this webinar it will be available to view on demand, please contact kerri.lanchester@qld.lasa.asn.au for further information. If you have any other questions, please contact kerri.lanchester@qld.lasa.asn.au