Our Russell Kennedy team are finding many of our home care provider clients are facing challenges in understanding the limits of how they can use package funds. The use of package funds has become an increasing focus for the regulators, and providers who allow clients to use their home care funds for uses outside the Aged Care Act face compliance action and the risk of having to refund their clients’ packages, and, in more serious cases, the possibility of fraud charges.
Unfortunately, what is included and what is excluded is not always clear cut. Whilst the legislation outlines a clear list of care and services that are included and excluded, there are numerous services and items which fall into the “grey area”. The resultant uncertainty has unfortunately been compounded by mixed messages from the regulators about what is and isn’t allowed and pressure from care recipients.
Some relief has been provided in the latest version of the Home Care Program Operational Manual (Manual) (released last week) which provides some further examples as to what is permitted and what is not. Here is a summary of some of the new key points:
• The Manual says that cleaning gutters would be an acceptable use of package funds.
• It has been confirmed that preparation and delivery of meals can be included (not the food itself) and it is for the provider to determine how best to charge for this.
• The Manual says that take away food is an excluded item.
• The Guide makes clear that hearing aids and dentures are examples of government funded items that should not be purchased with package funds.
• The Guide clarifies that using package funds to replace gutters and household security alarms would not be allowed.
The following examples have been given for what would constitute an excluded purchase under “general income”:
o Household bills;
o The purchase of a car or petrol;
o Funeral cover;
o Household furniture;
o Solar panels;
o Servicing gas heaters;
o Phone and/or internet plans;
o Entertainment activities such as streaming subscriptions.
The Manual also sets out some parameters for determining whether an item is permitted saying the providers need to assess whether the service or item:
• is linked to the care recipients care needs and goals;
• supports the care recipient’s health and wellbeing in daily living;
• is required to support functional safety in their home;
• is within the scope of their package budget; and
• “would be considered an acceptable use of Government funds.”
Unfortunately, the Manual does not elaborate on this last point. Fundamentally, providers need to be comfortable with the purchase and be prepared to justify it. This is not only about assessing the care recipient’s needs properly, but also having suitable documentation in place.
How can we help?
While the Manual provides some further insight into the current thinking of the regulators, providers need to ensure they and their staff understand the rules and are able to communicate these to clients. Providers also need understand their record keeping obligations.
Russell Kennedy can provide training to providers and their staff on the use of package funds. We have also designed a template policy for HCP expenditure to ensure your care managers feel confident and supported when making decisions surrounding purchases for consumers. The policy outlines the included and excluded items with easy to understand examples and can be easily tailored to your organisation to include specific examples of day to day challenges staff face.
If you require any further information please contact Anita Courtney, Solomon Miller or Johanna Heaven.
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