IPA Update | Carrying Forward Funds – Department Clarification

Carrying Forward Funds to Future Claim Periods – Department Clarification

We contacted the Department to seek clarification on how the new IPA situation applies to carried forward expenditure from one claim period to another. The scenarios presented are not exclusive and the principle would therefore apply to the concept of carried forward overspend situations. Please find the Department’s response below.

SCENARIOS:

Scenario 1.

A Consumer receives more services in a month due to special circumstances such as the need for additional physio services. The Provider supports the Consumer’s need and arranges the services. The cost of those services, along with other services in that month results in the Provider exceeding the revenue received from the Consumer plus the Government for that month. Is this allowable as a carried forward loss that can be claimed in a subsequent month when the services are less than the revenue received?

Scenario 2.

An allied health professional has determined that in the interests of mobility support, a consumer needs to have a walking aid, such as a walking frame or a mobile wheelchair. The Consumer does not have sufficient unspent funds to cover the cost of this purchase but due to the urgency of the need, the Provider is prepared to pre-fund the cost and recover the funds from the Consumer over subsequent months when surplus funds are accumulated due to less services being delivered or the Consumer being absent or on hospital leave for example.

Can the Provider carry forward such overspent funds and claim the funds at a later stage if surplus funds are accumulated in the programme? If this is not allowed, it would discourage Providers from supporting the immediate needs of consumers if there are insufficient surplus unspent funds to cover the cost in the relevant claiming period. Clearly if no such surplus unspent funds subsequently became available, the Provider would be at risk of being out of pocket. There would be no circumstance where the Provider would be able to draw down more funds than the programme had allocated for the use of the Consumer over their time in the programme.

DEPARTMENT RESPONSE:

Please find the response from the Home Care Policy Section, Department of Health below.

Thank you for you enquiry regarding carrying funds over months. Please note the following responses have been pulled from the Q&A Fact Sheet available on the Health website.

Scenario 1.

Improved Payment Arrangements will not change the ability of providers to charge fees to cover additional care and services over and above those the care recipient could otherwise afford under their package.

If a care recipient needs or wishes to purchase care and services over and above the budget of their available package budget, they need to consider:

• reviewing their care plan to identify alternatives and priorities or
• purchasing additional care and services from their own funds to increase the value of their package.

As per existing arrangements, fee changes must be included in the Home Care Agreement and providers must discuss and agree on these fees with the care recipient before they start services.

Any agreed additional care and service fees must be subtracted from the price reported to Services Australia.

An Aged Care Assessment Team (ACAT) assessment may also be required if the care recipient’s care needs have increased significantly. Some care recipients may already have suitable approvals. If they do need a new ACAT assessment, the provider can assist to arrange this, with the care recipient’s permission.

Providers should claim the full cost of services delivered in the month. Providers will be paid the lesser of: The shortfall amount or the maximum contribution amount (definitions above). The outstanding amount can be covered by any unspent funds held by the provider for the care recipient or else the costs must be covered by the provider. The outstanding amount cannot be added to a claim in a future month, except in the case of errors.

Alternatively, the provider and care recipient can agree to postpone the purchase until the care recipient has accrued sufficient funds in their home care account or agree to cover the cost through additional fees.

Scenario 2.

As per existing arrangements, any large purchases must be:

• related to the care recipient’s care needs
• agreed within the care recipient’s care plan
• within the available budget for the package level, with any fees mutually agreed with the care recipient through the Home Care Agreement before purchase.

Providers can access unspent funds to pay for large purchases. Where the cost exceeds available funds for care recipient, providers and their care recipients can:

• postpone the purchase until there are sufficient funds to cover the costs
• enter leasing arrangements where appropriate.

Providers must not split the cost over multiple claim months.

There are certain circumstances where a HCP care recipient can access Commonwealth Home Support Programme (CHSP) services over and above the services provided through the home care package budget. See the Commonwealth Home Support Programme Manual for more information. This may be subject to the available capacity of CHSP providers and their available funding, given CHSP clients will be the priority. Consumer contributions may apply.

The information from the Department above highlights the need for careful planning under the new IPA. Our eHCP and e-REC applications are being modified to meet the IPA requirements by the first reporting period, but if you need support please contact us.