EXPLANATORY STATEMENT
Issued by the authority of the Minister for Ageing
Aged Care Act 1997
Determination under Subsection 52-1(1)
Aged Care (Amount of flexible care subsidy – Extended Aged Care at Home – Dementia) Determination 2009 (No. 1)
The Aged Care Act 1997 (the Act) provides for the funding of aged care services. Persons who are approved under the Act to provide flexible aged care services can be eligible to receive flexible care subsidy payments in respect of the care they provide to approved care recipients.
Extended Aged Care at Home - Dementia (EACHD) is a flexible care program in respect of which flexible care subsidy is payable. EACHD provides nursing and personal care services and dementia specific strategies to an aged care recipient in the care recipient’s home where the care recipient would otherwise be eligible for high level residential care.
Subsection 52-1(1) of the Aged Care Act 1997 (the Act) provides that the amount of flexible care subsidy that is payable in respect of a day is the amount determined by the Minister by legislative instrument; or worked out in accordance with a method determined by the Minister by legislative instrument.
This Determination specifies the method for working out the amount of flexible care subsidy payable under section 51-1 of the Act for a day in respect of an EACHD care recipient.
The Determination applies from 1 July 2009 and, from that date, revokes Determination (ACA Ch. 3 No. 20/2008).
Clause 5 sets out the amount of flexible care subsidy payable in respect of a day for a care recipient receiving flexible care in the form of EACHD.
Subclause (a) of the Determination states that the base amount of flexible care subsidy payable for a day in respect of an EACHD care recipient is $130.54.
(b) and (c) of the Determination require an EACHD care recipient to be treated as if he or she were a residential care recipient for the purposes of working out the amount of flexible care subsidy payable for a day in respect of the EACHD care recipient.
(b) and (c) of the Determination provide that if the oxygen supplement payable under section 44-13 and/or the enteral feeding supplement payable under section 44-14 would have been payable in respect of the EACHD care recipient if he or she was receiving residential care, an amount equivalent to each applicable supplement is added to the amount calculated under (a).
(d) provides for an additional daily amount of flexible care subsidy to be paid to an approved provider who provides EACHD to a care recipient in rural and remote location, provided that location has an Accessibility/Remoteness Index of Australia (ARIA) score of 3.52 or more.
Under the ARIA, each suburb and town in Australia is allocated an ARIA score based on its accessibility and remoteness. ARIA scores for all Australian locations are contained in the document entitled Viability Funding — ARIA scores for locations as at 30 July 1999, published by the Commonwealth Department of Health and Ageing. The Department will verify the location of a care recipient by reference to the postcode of the suburb or town in which the care recipient resides.
The more remote the EACHD care recipient’s residential location, the higher the ARIA score for that location and the higher the amount of the additional flexible care subsidy payable to the approved provider in respect of that care recipient. This approach reflects the higher costs involved in operating EACHD care services in rural and remote areas, including the higher costs associated with attracting and retaining staff.
If the ARIA score for an EACHD care recipient’s residential location is less than 3.52 no additional daily amount of flexible care subsidy is payable in respect of the EACHD care recipient. However, where the ARIA score for an EACHD care recipient’s residential location is 3.52 or more, the table in (d) of the Determination sets out the additional daily amount that is payable in respect of that care recipient.
Approved providers who are eligible to receive an additional amount of flexible care subsidy in respect of an EACHD care recipient will receive the additional amount through Medicare Australia’s payment systems.
The amount of flexible care subsidy payable in respect of EACHD is indexed on 1 July each year. As part of this process, the additional amount of flexible care subsidy payable in respect of an EACHD care recipient has also been indexed.
Consultation
As the indexation of the subsidy uses well established formula based on the Consumer Price Index and the Wage Cost Index 9, and is in accordance with policy upon which extensive consultation was undertaken, no specific consultation was undertaken with respect to this instrument.
Information about the increase in the amount of the supplement will be disseminated via print and electronic media to approved providers.
Overview
The Aged Care (Amount of Flexible Care Subsidy – Extended Aged Care at Home – Dementia) Determination 2009 (No. 1) was enacted to provide a method for determining the amount of flexible care subsidy payable under the Aged Care Act 1997 for recipients of the Extended Aged Care at Home - Dementia (EACHD) program. This legislation was introduced by the Minister for Ageing and aims to ensure that care providers receive appropriate subsidy payments for the services they provide, reflecting the higher costs associated with delivering care in rural and remote areas. The determination specifies a base amount of $130.54 per day for EACHD recipients, with additional supplements for oxygen and enteral feeding where applicable, and an additional daily amount for providers in areas with an Accessibility/Remoteness Index of Australia (ARIA) score of 3.52 or higher, to account for higher operational costs in remote locations. This approach ensures that the subsidy adequately reflects the circumstances and needs of both the care recipients and the providers.
Scope and Application
The Aged Care Act 1997 provides for the funding of aged care services, with the Aged Care (Amount of Flexible Care Subsidy – Extended Aged Care at Home – Dementia) Determination 2009 setting the method for calculating the flexible care subsidy payable under the Act for a day in respect of an Extended Aged Care at Home - Dementia (EACHD) care recipient. The Determination applies to approved providers of flexible aged care services, who are eligible to receive flexible care subsidy payments for the care they provide to approved care recipients. The Determination applies nationally, with the amount of flexible care subsidy indexed on 1 July each year, including the additional amount payable for EACHD care recipients in rural and remote locations with an Accessibility/Remoteness Index of Australia (ARIA) score of 3.52 or more. The Determination does not specify any exclusions, exemptions, or thresholds, nor does it extend or restrict application through subordinate instruments.
Key Provisions
The Aged Care (Amount of flexible care subsidy – Extended Aged Care at Home – Dementia) Determination 2009 (No. 1) specifies the method for calculating the amount of flexible care subsidy payable under section 51-1 of the Aged Care Act 1997 for a day in respect of a care recipient receiving Extended Aged Care at Home - Dementia (EACHD) services. The Determination applies from 1 July 2009 and replaces the previous Determination (ACA Ch. 3 No. 20/2008). Clause 5 of the Determination states that the base amount of flexible care subsidy payable for a day for an EACHD care recipient is $130.54 (subclause (a)). For the purposes of calculating this amount, an EACHD care recipient is treated as if they were a residential care recipient, and if applicable, amounts equivalent to the oxygen supplement and/or enteral feeding supplement payable under sections 44-13 and 44-14 are added to the base amount (subclauses (b) and (c)). Furthermore, an additional daily amount of flexible care subsidy is payable to an approved provider who provides EACHD to a care recipient in a rural or remote location with an Accessibility/Remoteness Index of Australia (ARIA) score of 3.52 or more (subclause (d)). The amount of the additional subsidy is determined by the ARIA score, with higher scores reflecting higher costs associated with operating EACHD care services in more remote areas.
The Determination imposes several obligations on approved providers and care recipients. Approved providers must ensure that they are eligible to receive the flexible care subsidy and must submit accurate information about the care provided to Medicare Australia. Care recipients must meet the eligibility criteria for the EACHD program and must reside in a location with an ARIA score of 3.52 or more to be eligible for the additional daily amount of flexible care subsidy. Approved providers must also ensure that they are aware of the indexation of the subsidy, which occurs on 1 July each year, and that they update their records accordingly. The Department of Health and Ageing will verify the location of a care recipient by reference to the postcode of the suburb or town in which the care recipient resides.
There are no specific offences, penalties, or civil/criminal consequences outlined in the Determination for breach of its provisions. However, failure to comply with the requirements of the Aged Care Act 1997 and the Aged Care Principles 1997 may result in a range of penalties, including fines and imprisonment. Approved providers who are found to have provided misleading or false information to Medicare Australia may also be subject to financial penalties and may be excluded from the aged care system. It is important for approved providers and care recipients to ensure that they are aware of their obligations under the Determination and the Aged Care Act 1997 to avoid any potential consequences.