The Bill provides for a new Support at Home program (Support at Home) which will replace and amalgamate the Home Care Packages Program (HCP) and Short-Term Restorative Care Programme (STRC). The Commonwealth Home Support Programme (CHSP) will also transition into Support at Home no earlier than 1 July 2027 (it will be a ‘specialist aged care program’ under the Bill), to ensure providers have adequate time to update business systems, adapt to new payment arrangements and transition existing clients, limiting disruption to client experience.
Access
Current HCP and STRC recipients will automatically transition into Support at Home. Individuals accessing Support at Home for the first time will be assessed through a new Single Assessment System. Where an individual is eligible, information from their assessment will inform what services they need and allow the assessor to develop an individual support plan, which they can share with their Support at Home provider. Following assessment, an individual will receive a notice of decision containing a summary of the individual’s aged care needs and goals, an ongoing quarterly budget based on their assessment qualification and any approval for short-term supports (i.e. assistive technology). This is similar to the care plan individuals receive under the existing HCP program.
Once funding becomes available, individuals will be assigned a budget and can begin accessing services. The Department of Health and Aged Care (Department) expects wait times for funding to reduce to less than 3 months by July 2027. If wait times exceed expectations, individuals will be assigned an interim allocation of 60% of their classification budget while awaiting their full funding allocation.
Classifications
A new classification framework will specify the different funding levels available to individuals based on their assessment. The new framework expands the current four HCP levels to eight funding classifications and two short-term care pathways (Restorative Care Pathway and the End-of-Life Pathway). The Department has indicated that they will confirm the final budget amounts before the commencement of Support at Home and the funding amounts for each classification will continue to be periodically reviewed to reflect indexation.
Support at Home will establish a new prioritisation system to replace the National Priority System for HCP, meaning access to services will be prioritised using information collected during the assessment process. In line with HCP, if an individual’s needs increase in the future, they will need to apply for reassessment. If the System Governor approves the reassessment, the individual may then be reclassified and receive and increased budget. Individuals will be able to carry over unspent funds of up to $1,000 or 10% of the quarterly budget (whichever is greater).
Service Providers
In line with obligations of current HCP providers, each individual will have a single Support at Home service provider responsible for ensuring they receive services that meet their needs within their quarterly budget and arranging and sourcing required assistive technology and/or home modifications. Current HCP providers will be deemed into Support at Home and will be able to continue delivering services to existing care recipients. Individuals can engage third parties to deliver services if their provider agrees to support the arrangement, however, the provider will remain ultimately responsible for the quality and safety of the service the individual receives and for meeting regulatory requirements. Individuals will still be able to self-manage their care and services in-line with current arrangements.
Capped Prices
The Government will set prices caps informed by advice from the Independent Health and Aged Care Pricing Authority (IHACPA) for each service type (contained in the Service List) and providers cannot charge unit prices exceeding the caps. As the price caps will include the full cost of service delivery including administration costs, providers will not be able to charge separate administration fees. Additionally, providers may deliver services that are not included on the Service List. However, these services will not be subsidised by the Government.
Individual contributions
Individuals will only pay contributions on the services they have received and will be calculated on a rate per hour, or unit of service, at a set percentage of the price for each service type. The Government will pay the remainder of the price or cost as a subsidy to the provider. The amount an individual contributes will be based on the type of service received and the individual’s age-pension status, means and Commonwealth Seniors Health Care status. In comparison, the current HCP fee arrangements are not impacted by the level of services used. Once an individual contributes $130,000 across Support at Home and the non-clinical care component of their contribution to residential care, they will not be required to pay any further contributions under a lifetime cap.
Provider Payment Arrangements
Payments made to providers by Services Australia will be for the price or cost of the service or item, less any participant contribution payable. Providers will have up to 60 days to finalise claims to the Government for ongoing services delivered in that quarter. Once the claim is finalised, the Government subsidy amount and the participant contribution amount will be debited from the participant’s budget. Providers operating in thin markets may apply for a two-year supplementary grant to support their financial viability.
Self-management arrangements
Self-management arrangements will be agreed between individuals and their provider. Providers will still be required to undertake administrative functions such as claiming and worker screening checks and can apply a capped loading to cover these costs where the individual chooses their own worker.
Assistive Technology and Home Modifications Scheme (AT-HM Scheme)
Providers will be responsible for arranging and sourcing any assistive technology/home modifications that may be required. There will be three main funding tiers for each assistive technology and home modifications. Each funding tier will have a 12-month period in which the individual must use the allocated funding and funding will not accrue over time, with the exception of the high funding tier, which may be extended for an additional twelve months to complete complex modifications. Individuals will have co-contribution requirements and must meet all additional costs above the funding tier limit. The Department has indicated the AT-HM list is being finalised and will be made available in the coming
months.
AT-HM funding will be on a payment in arrears basis and allocation will be separate from an individual’s quarterly budget.
Further development trials
A pooled funding trial will be established to test the option of budget pooling for participants living in group settings, such as retirement villages. The Department will run an expression of interest process to identify suitable provider participants.
Care Management
All individuals will have access to care management activities (such as care planning and service coordination) that are delivered through a care partner. Individuals receiving ongoing services will have 10% of their quarterly budget set aside for care management, with the Government providing an additional supplement for individuals with diverse needs. Care management funding for all participants will be pooled with their provider in a care management fund, allowing providers to adjust care management support as an individual’s needs change over time. Providers will claim and be paid for care management services after they have been delivered at unit prices in line with, or below, the price caps set by Government. There will be no limit on the unspent care management funds providers can hold between quarters, however, there will be an annual check to ensure providers are not accruing more than one quarter’s worth of unspent funds between financial years.
Short-term support
The Restorative Care Pathway will replace the STRC Programme providing 5,000 places per quarter (compared to 2,269 under STRC). An individual will be eligible for up to 12 weeks (compared to 8 weeks under STRC) of care which can be extended up to 16 weeks in certain circumstances (e.g. for regional services). As with the STRC Programme, individuals cannot access the Restorative Care Pathway more than twice within a 12-month period, but not in consecutive quarters. Additionally, individuals will receive approximately $6,000 funding for the 12-week episode, which may be increased if determined by a restorative care partner supporting the individual.
In line with the recommendations of the Royal Commission, the End-of-Life Pathway will support individuals who have been diagnosed with less than three months to live and who wish to remain at home. This pathway will be the highest funding classification per day with a total of $25,000 available over three-months. This may be extended to 16 weeks to provide additional flexibility. Individuals can only access the End-of-Life pathway once and should they live longer than expected, will then transition onto the relevant Support at Home classification.
Resources
The Department of Health and Aged Care has released the Support at Home Handbook which outlines the core components of the program.
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