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• Income tested fees been replaced by means tested care fees;

• 4 different daily care fees been replaced by one standard daily care fee.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 ADJUSTMENTADJUSTMENT PERIOD: 10/2014 TOTAL AMOUNT: 89348.96, MONTHLY AMOUNT: 89348.96 …………. ITSR IN AUG & SEP 14 CLAIMS SHOULD NOT HAVE OCCURRED (MEANS TESTING ERROR)

PROVIDER NOTES

RESPITE CARE RECIPIENT DETAILS

Care Recipient Surname

First NameCare

Recipient ID

Entry DepartureBRC Type

SR ACATReappraisal Date

Appraisal 

Expiry 

Date

WC/TP%

Room Type

RC/Leave Days

TC Days Left

ALLAN22/12/2014

H 21

LAUREL31/10/2014

H 1

ALLAN01/12/2014

12/12/2014 H 52

HEATHER08/12/2014

15/12/2014 L 56

GEORGE29/12/2014

31/12/2014 H 61

RONALD13/10/2014

14/12/2014 L 1

IVAN12/12/2014

24/12/2014 L 51

SILVA04/12/2014

H 35

PHILLIPA09/12/2014

L 40

ANGELINA17/10/2014

H 8

PERMANENT CARE RECIPIENT DETAILS

Care Recipient Surname

First Name Care Recipient

ID Entry Departure

BRC Type

SR ACAT Reappraisal

Date

Appraisal Expiry

Date WC/TP%

Room Type

RC/ Leave Days

TC Days Left

MARILYN 22/07/2014 R 21/01/2015 52 MARIA 19/09/2014 10/12/2014 STD L R 18/03/2015 DOUGLAS 14/11/2014 STD L R 14/11/2015 52 DAVID 29/02/2012 STD S R 28/02/2013 52 BERYL 18/12/2006 STD A R 18/12/2009 52 DELMA 06/08/2012 STD S R 06/02/2014 52 ELAINE 25/11/2009 STD R 25/11/2010 52 WARWICK 16/08/2007 NON R 02/12/2010 52 JOSEPH 25/06/2007 STD C R 23/09/2012 52 CHARLES 01/07/2010 STD S R 11/02/2012 52 DONALD 16/01/2007 NON R 18/07/2014 52 SADIE 02/04/2012 STD R 02/04/2013 52 MARIA 21/08/2007 STD C R 27/10/2011 52 BERNARD 01/02/2012 STD S R 01/02/2013 52 EILEEN 30/12/2011 STD R 30/06/2013 52 EVA 16/09/2014 12/12/2014 STD L R 12/12/2014 AVICE 09/10/2013 STD SH R 09/04/2015 52 AUDERY 25/01/2007 NON B R 19/07/2014 52 GEORGE 18/06/2009 PRO S R 23/09/2012 52

PERMANENT CARE RECIPIENT PAYMENTS

CARE RECIPIENT Payment

Type Effective

Date

Appraisal Payment Indicator

LEAVE DAYS Paid Care Days

Non Clm Days

RATE Per Day

TOTAL Amount

Due

Paid Days Unpaid

ID Surname, First Name

Social Leave

Hosp Leave

TC Leave

Social Leave

TC Leave

MARGARET Adjusted Subsidy: MLN 30/01/2015 31 85.75 2658.25

Payroll Tax Supp 01/12/2014 31 9.19 284.89 2943.14

MARIA Adjusted Subsidy: HHH 18/03/2015 9 208.68 1878.12 Means Tested Accommodation Supplement 01/12/2014 9 34.56 311.04 Payroll Tax Supp 01/12/2014 9 9.19 82.71

Adjustments for Claim Period November 2014 Means Tested Accommodation Supplement 30 34.56 1036.80 Adjustments for Claim Period October 2014 Means Tested Accommodation Supplement 31 34.56 1071.36 Adjustments for Claim Period September 2014 Means Tested Accommodation Supplement 1 34.20 34.20

Means Tested Accommodation Supplement 11 34.56 380.16 4794.39

DOUGLAS Adjusted Subsidy: HHM 14/11/2015 31 188.40 5840.40 Means Tested Accommodation Supplement 14/11/2014 31 34.56 1071.36 Payroll Tax Supp 01/12/2014 31 9.19 284.89

Day % Achieved for Service % Achieved post 2008 Reforms Day % Achieved for Service % Achieved post 2008 Reforms

01 48.36 (59/122) 49.12 (56/114) 16 48.76 (59/121) 49.55 (56/113)

02 48.36 (59/122) 49.12 (56/114) 17 48.76 (59/121) 49.55 (56/113)

03 48.36 (59/122) 49.12 (56/114) 18 48.76 (59/121) 49.55 (56/113)

04 48.36 (59/122) 49.12 (56/114) 19 48.76 (59/121) 49.55 (56/113)

05 48.36 (59/122) 49.12 (56/114) 20 48.36 (59/122) 49.12 (56/114)

06 48.36 (59/122) 49.12 (56/114) 21 48.36 (59/122) 49.12 (56/114)

07 48.36 (59/122) 49.12 (56/114) 22 48.36 (59/122) 49.12 (56/114)

08 48.36 (59/122) 49.12 (56/114) 23 48.76 (59/121) 49.55 (56/113)

09 48.36 (59/122) 49.12 (56/114) 24 48.76 (59/121) 49.55 (56/113)

10 48.36 (59/122) 49.12 (56/114) 25 48.76 (59/121) 49.55 (56/113)

11 48.36 (59/122) 49.12 (56/114) 26 48.76 (59/121) 49.55 (56/113)

12 48.36 (59/122) 49.12 (56/114) 27 48.76 (59/121) 49.55 (56/113)

13 48.76 (59/121) 49.55 (56/113) 28 48.76 (59/121) 49.55 (56/113)

14 48.76 (59/121) 49.55 (56/113) 29 48.76 (59/121) 49.55 (56/113)

15 48.76 (59/121) 49.55 (56/113) 30 48.76 (59/121) 49.55 (56/113)

31 48.76 (59/121) 49.55 (56/113)

Accommodation Supplement 45026.26

SUPPORTED RESIDENT RATIOS SUMMARY

Respite Care Allocation 2920

Respite Care Usage 167

Respite Care Year To Date 1257

Incentive Payment

Period Start 01/02/2014

Period End 31/01/2015

Residential Respite Incentive Allocation 2920

Residential Respite Incentive Usage 1458

Residential Respite % Achieved 49.93

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

Full Late Adj Sub Red. Ext. Hosp Red.

20/09/2014 Respite Low 44.21 3High 123.97 164Suppl. Low 36.33 28.31 3Suppl. High 50.93 42.91 164

01/07/2014 Permanent S2 143.90 31ADL High 107.52 2276

Medium 77.61 1354 31Low 35.65 31

BEH High 35.20 2308 31Medium 16.88 1012Low 8.14 310No Pymt 0.00 31

CHC High 65.96 2084 31Medium 45.68 1272Low 16.04 244No Pymt 0.00 61

Total Days 3890