EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Ageing
Aged Care Act 1997
Community Care Subsidy Amendment Principles 2005 (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.
The purposes of the Community Care Subsidy Amendment Principles 2005 (No. 1) are to ensure that suitable leave arrangements are available so as to allow existing recipients of community care to receive transition care following an acute hospital episode, and to amend paragraph 12.7(3)(b) of the Principles so that it reflects the original intention of the Act and aligns it with current policy.
Principles made under the Aged Care Act 1997
Subsection 96-1(1) of the Act allows the Minister to make Principles providing for various matters required or permitted by a Part or section of the Act.
Subsection 96-1(2) of the Act provides that any Principles made under subsection 96-1(1) of the Act are disallowable instruments.
The Community Care Subsidy Principles is one of the sets of Principles made under the Act.
Context of the Community Care Subsidy Amendment Principles 2005 (No. 1)
Transition Care
This amendment is, in part, to give effect to the commitment by the Government in the 2004‑05 Budget to provide up to 2,000 new transition care places over three years to help older people make the transition from hospital care, under a new cost-shared model of care with the states and territories.
In this context, transition care refers to a kind of flexible care that is provided to a care recipient at the conclusion of an in-patient hospital episode (after the provision of any necessary acute and subacute care) and in the form of services that are goal-oriented, time-limited and therapy focussed. The services provided will be those necessary to complete the care recipient’s restorative process, optimise the care recipient’s functional capacity and assist the care recipient, family and carer to make appropriate long-term care arrangements. It can be provided in either a residential or community setting, and must be in a non-hospital, more home like environment.
Section 46-4 of the Act allows that a care recipient who is being provided with community care by an approved provider and in accordance with a community care agreement, may request that the approved provider temporarily suspend provision of community care, and that the approved provider must comply with the request. This section also allows that the care recipient will be taken to have been provided with community care, as required by the community care agreement, on each day of any period during which the care recipient is provided with care, other than by the approved provider, of a type and at a level specified in the Community Care Subsidy Principles 1997 (“the Community Care Subsidy Principles”) (see subparagraph 46-2(3)(b)(ii)).
The effect of section 12.7 of the Community Care Subsidy Principles, relating to the suspension of community care services, is to allow existing recipients of community care to take leave from their normal care arrangements.
An unlimited suspension of services is available for a care recipient to attend a hospital for the purpose of receiving hospital treatment, and a total of 56 days is available, per financial year, to receive alternative services like respite or short term residential care (subsection 46-2(3) of the Act and section 12.7 of the Community Care Subsidy Principles). Of this, 28 days can be taken in a particular financial year to receive alternative services, and the remaining 28 days can be taken for any reason. During these periods, approved providers remain eligible to receive the community care subsidy.
Experience with a number of Innovative Care Rehabilitation Service (ICRS) pilots, which were funded under the Innovative Care provisions of the Flexible Care Subsidy Principles 1997, has suggested that the average length of time required for transition care will be in the order of eight weeks. In consultation with State and Territory officials, it has been agreed that the initial maximum period for Transition Care should be 12 weeks, with the possibility of an extension of up to 6 weeks where the care recipient has been assessed as needing further transition care.
Because hospital leave requires that the care recipient attends a hospital for hospital treatment, this unlimited form of leave is not available for Transition Care.
While existing care recipients in community care could utilise the other currently available leave arrangements for the purpose of receiving Transition Care, the amounts of leave would be insufficient (56 days for suspension of community care services). This arrangement would also mean that the care recipient would be using a leave entitlement intended for other purposes (such as respite care and holiday time spent with the recipient’s family). In addition, the approved provider would cease to receive funding for holding the place open for the recipient after 56 days, because community care was no longer taken to have been provided after this time.
As allowed under subparagraph 46-2(3)(b)(ii) of the Act, this amendment specifies, in the Community Care Subsidy Principles, that a community care recipient is taken to have been provided with community care while receiving transition care, and specifies that this would be for a day for which flexible care subsidy is payable. This, in effect, limits the maximum period for suspension of community care services to 84 days for any particular episode of transition care, with a possible extension of up to a maximum total period of 126 days (see new section 15.34 of the Flexible Care Subsidy Principles 1997).
Five day rule
A further purpose of these Amending Principles is to amend paragraph 12.7(3)(b) of the Principles so that it reflects the original policy intention .
The conditions for leave from a Community Aged Care Package (CACP) are found under
s 46-2 of the Act. Provisions for continued payment of subsidy to approved providers were originally established under Determination No. 1993-94, Aged or Disabled Persons Care Act 1954, Entitlements Relating to Suspension of Community Aged Care Services (the Determination) as amended by Minister Carmen Lawrence in 1994.
These provisions enabled a care recipient to take a holiday, to enter hospital or to temporarily receive alternative care without losing access to the package on their return. A care recipient’s request not to receive services for more than 5 consecutive days constituted suspension of services.
These provisions also allowed for service providers to continue to receive subsidy in a number of circumstances where care had been suspended. These included, where the care recipients suspended service to enter hospital, where the care recipient suspended services to receive alternative care services such as respite care for a period of up to 28 days, and for an additional 28 days for any reason. Periods of leave less than five consecutive days were not recorded as a suspension of services by the provider and they would therefore receive subsidy for these days.
Conditions for Suspension of Community Care Services are set out in s 46-2 of the Aged Care Act 1997. Section 46-2 (4) of the Act provides that the Community Care Subsidy Principles may specify a maximum number of days for which a care recipient may be taken to have been provided with community care under that subsection during a particular year. These provisions are found in s 12.7 of the Principles and entitle care recipients to unlimited hospital leave, 28 days of alternative care such as respite care and 28 days for any other reason, during which time, the approved provider remains eligible for the community care subsidy.
Paragraph 12.7(3)(b) of the Principles also provides that after 5 consecutive days of leave the approved provider is no longer eligible for a subsidy for the care recipient. The formulation of the provision in that way would produce an unintended and undesired result. The amendment is intended to better reflect the original policy intention. It provides, in effect, in the new subsection 12.7(4), that there is a 5 day period of suspension from community care available for any reason that may be added to any other kinds of suspension from community care under subsection 46-2(3).
Consultation
Transition care
The parameters of transition care, as reflected in this instrument, have been developed through a consultation process with State and Territory Government representatives. All States and Territories were included in a Transition Care Task Group, along with appropriate clinical representatives. The maximum periods for the payment of flexible care subsidy for transition care was agreed with State and Territory officials.
Five day rule
Conditions for Suspension of Community Care Services as set out in s 46-2 of the Act do not require that there should be a maximum number of consecutive days that will be permitted, as is set out in s12.7 (3)(b) of the Principles. This subsection does not reflect the intention of the original provisions or current practice in the industry so there is no legal impediment to removing the 5 consecutive day limitation. For this reason there ought to be no objections to the proposals by the relevant organisations within the aged care industry. The amendment will align it with the original policy intent and so redress this anomaly.
Regulation impact statement
The Office of Regulation Review (ORR) assessed the proposed amendments and determined that the preparation of Regulation Impact Statements was not required (ORR ID numbers 7225 and 6264 for transition care and the five day rule respectively).
ATTACHMENT
NOTES ON CLAUSES
Clause 1 provides that the Amending Principles are to be cited as the Community Care Subsidy Amendment Principles 2005 (No. 1).
Clause 2 provides that the Principles commence on the day that they are registered.
Clause 3 amends the Community Care Subsidy Principles 1997 as set out in the Schedule.
Schedule 1: Amendments
Item 1 amends the heading of section 12.3 to the plural form “Definitions”.
Item 2 amends section 12.3 to include the definition for transition care as set out under section 15.28 of the Flexible Care Subsidy Principles (as inserted by the Flexible Care Amendment Principles 2005 (No. 1).
Item 3 amends subsection 12.7(1) to allow community care recipients to take leave from their normal care arrangements so that they can receive transition care. This is provided in the form of a suspension of community care services.
New paragraph 12.7(1)(a) maintains the original intent of the former subsection 12.7(1), and provides for suspension of services where a care recipient is provided with alternative care services at least at an equivalent level to community care. It now includes new wording to exclude transition care from this provision.
New paragraph 12.7(1)(b) inserts the provision for transition care. This paragraph allows that, under subparagraph 46-2(3)(b)(ii) of the Act, transition care, provided by an approved provider to whom flexible care is payable in respect of a care recipient and a day, is a type of care for which a community care recipient will be taken to have been provided with community care (that is, for which a suspension of services will apply).
New subsections 12.7(2) and 12.7(3) maintain the intent of the former subsections 12.7(2) and 12.7(3), which provided a 28 day suspension of community care for alternative forms of care (other than services provided by the approved provider of the community care) of a type, and at a level, specified in the Community Care Subsidy Principles, and a further 28 day suspension of services for other purposes. New wording has been included to exclude transition care from these provisions.
Also under Item 3, the revised wording for the former subsection 12.7(3)(b), concerning the five day rule, has been inserted as subsection 12.7(4). The wording is amended to reflect the original wording in the Determination. The amended subsection allows that, in addition to any period for which a care recipient will be taken to have been provided with community care under 46-2(3) of the Act, the care recipient can also request a suspension of services for any period of less than 5 consecutive days. This must be at the care recipient’s request. During such periods, the care recipient will be taken to have been provided with community care as required by the community care agreement.