Maximising income through legislative compliance in residential aged care - essential processes and staffing implications

2 primary sources of funding in residential aged care: Medicare entitlements – subsidy (ACFI) and supplements (around 70%) Resident fees and payments (around 30%)

Under both the old and new arrangements a significant proportion of these funds are determined at the time of admission: Most user charging Some supplements, in particular the means tested accommodation supplement

The July 2015 new arrangements introduced significant changes to user charging in residential aged care: Accommodation bonds and accommodation charges replaced by accommodation payments and accommodation contributions; Income tested fees been replaced by means tested care fees; 4 different daily care fees been replaced by one standard daily care fee.

In broad funding terms user charging changes have been focused on residents who would have been high care under the old arrangements: Replacement of accommodation charge by accommodation payments (financial benefit for approved providers); New means tested care fee (MTCF) and accommodation contribution arrangements (financial benefit for Commonwealth). Not as a significant impact upon residents who would have been low care – unless one considers potential impact of the greater financial emphasis under the new arrangements that can be placed on admission of higher ACFI levels (reflection of Government policy). Team approach, roles and coordination.

Maximising income for approved providers through structural processes that deliver consistent income results targeted through strategic planning; ie approved provider sets the pricing structure within the ranges determined by the Commonwealth through the Aged Care Act 1997 and Fees and Payments Principles 2014 (No. 2). The new arrangements have, for residents paying an accommodation payment, abolished the structural requirement underpinning the principle a resident can only be charged what they can afford to pay.

A resident on the full aged care pension with total assets equal to greater than the Home Exemption Cap amount (currently $157,051.20) can be charged an accommodation payment as high as the wealthiest resident. Temptation to apply flat maximum accommodation payment policy without adequate consideration of potential consequences; (ie don’t admit for less than a room’s maximum accommodation payment): Debt potential - the “pyramid” possibility Mandates of aged care providers Public image and marketing Impact upon admissions staff

Major impact upon staff involved in the admissions process and ongoing resident fees (accounts), with significant structural changes to what residents are to be informed of and what can and cannot be charged (at time of admission and throughout a resident’s occupancy). Admission and resident fees staff require detailed knowledge of user charging system under old and new arrangements – to charge the correct fees and payments for each resident and ensure entitled supplements are received. Implications re staff: Resourcing, quantitative and qualitative training Retention

An admissions process that maximises regulatory compliance is beneficial to all: Maximises staff competence and hence confidence Minimises error regulatory compliance means meeting accreditation requirements and less complaints (or successful complaints) transparency and accurate fees for residents Marketing - a reputation for fairness and professionalism. Is simply good, smart business.

Admissions process that meets regulatory requirements underpinned by: provision of required information in the relevant format; and standard templates for all documents requiring residents’ and approved providers’ signatures. Human element remains a key factor hence appropriately trained staff essential.

Admissions process also includes Medicare requirements: Medicare Claim Form Medicare Statements

Medicare is a relatively complex system - do you understand how to interpret the Medicare Statement? Provides information on broader funding streams and trends to specific details on each resident’s payments. Can you tell whether there are errors, where your organisation is not receiving funds it should be receiving? Again, staff require detailed specialist knowledge to ensure minimising income loss – this is where one identifies all is as it should thereby minimising “lost” income.

ADJUSTMENTS FOR MONTH ENDING OCTOBER 2014 ADH - AD HOC ADJUSTMENT ADJUSTMENT PERIOD: 10/2014 TOTAL AMOUNT: , MONTHLY AMOUNT: …………. ITSR IN AUG & SEP 14 CLAIMS SHOULD NOT HAVE OCCURRED (MEANS TESTING ERROR) PROVIDER NOTES RESPITE CARE RECIPIENT DETAILS Care Recipient Surname First Name Care Recipient ID EntryDeparture BRC Type SRACAT Reappr aisal Date Apprais al Expiry Date WC/TP % Room Type RC/ Leave Days TC Days Left ALLAN22/12/2014H21 LAUREL31/10/2014H1 ALLAN01/12/201412/12/2014H52 HEATHER08/12/201415/12/2014L56 GEORGE29/12/201431/12/2014H61 RONALD13/10/201414/12/2014L1 IVAN12/12/201424/12/2014L51 SILVA04/12/2014H35 PHILLIPA09/12/2014L40 ANGELINA17/10/2014H8

PERMANENT CARE RECIPIENT DETAILS

PERMANENT CARE RECIPIENT PAYMENTS

SUPPORTED RESIDENT RATIOS SUMMARY

Respite Care Allocation2920 Respite Care Usage167 Respite Care Year To Date1257 Incentive Payment Period Start01/02/2014 Period End31/01/2015 Residential Respite Incentive Allocation2920 Residential Respite Incentive Usage1458 Residential Respite % Achieved49.93 RESPITE CARE SUMMARY

PAYMENT SUMMARY

DAILY SUBSIDY LEVELS Date of Effect Assessment Type Assessment Level Amt Per Day Certified Amt Per Day Non-Certified Bed Days Current FullLateAdj Sub Red.Ext. Hosp Red. 20/09/2014RespiteLow High Suppl. Low Suppl. High /07/2014PermanentS ADLHigh Medium Low BEHHigh Medium Low No Pymt CHCHigh Medium Low No Pymt Total Days3890