Overview of Consumer Directed Care CDC Home Care Exit Amounts

October 20, 2016

The Australian Government is improving the way home care services are delivered to older Australians. From 27 February 2017, funding for a home care package will follow the consumer, allowing them to choose the approved home care provider that can best meet their goals and needs. Consumers will be able to change providers if they wish, and funding for their package will follow them.

What is an exit amount?

An exit amount is a fee/charge that a provider can deduct from a client’s unspent home care package funds if the client leaves their care (either because the client decides to change to another home care provider, or the client leaves home care). The exit amount is intended to allow providers to recover administrative costs associated with determining and making payment of unspent home care amounts. An exit amount can only be deducted from 27 February 2017 onwards. It is not mandatory to charge an exit amount.

There are transitional arrangements for exit amounts in the lead up to 27 February 2017 that allow for the inclusion of an exit amount in a consumer’s Home Care Agreement (refer Fact Sheet on Exit Amounts – Transition Provisions).

What changes are occurring?

If a client ceases home care with your organisation before 27 February 2017, you can retain unspent home care package funds (other than home care fees paid in advance).

If a client ceases home care with your organisation on or after 27 February 2017, unspent home care package funds, less any exit amount, will need to be:

  • transferred to the client’s new home care provider; or

  • if the consumer has left home care (for example if they entered permanent residential aged care or died), returned to the Commonwealth and the consumer (or their estate).

Requirements for providers

1. Your maximum exit amount must be provided for publication on My Aged Care

If you wish to include an exit amount in your Home Care Agreement you must:

  • provide the department with your organisation’s maximum exit amount for publication on My Aged Care

  • keep copies of all exit amount notifications to the department as this will help manage enquiries from clients.

From 27 February 2017, the published exit amount will be the maximum exit amount you can include in any of your client's Home Care Agreements; you can however negotiate lesser amounts for individual clients.

Maximum exit amounts will be published on My Aged Care from 27 February 2017 to ensure consumers are aware of the maximum fee they may be asked to agree to when they are choosing a home care provider.

From 27 February 2017, you will be able to update your organisation’s published exit amount to a lower or higher amount, by providing the department with a new maximum exit amount for publication. Once provided to the department, you can start disclosing the new maximum exit amount in (new or varied) Home Care Agreements.

2. Any exit amount must be disclosed in the Home Care Agreement

If you wish to apply an exit amount, the amount must be included in the client’s Home Care Agreement and agreed to by the client. This ensures that clients are aware of the maximum exit amount that may be deducted from their unspent home care amount if they change providers or leave home care.

Deducting an exit amount

There is no maximum cap or theshold on the exit amount set by the department. However, the exit amount you may deduct from a client’s unspent home care amount cannot be more than:

  • your published exit amount (at the time the Home Care Agreement was entered into); and

  • the exit amount included in the client’s Home Care Agreement; and

  • the unspent home care amount remaining in the client’s package. This ensures that the exit amount cannot result in a debt for the client.

Example

Anton has been allocated a level 2 package and has found a suitable provider through the My Aged Care service finder. The provider has a published maximum exit amount of $500. The provider offers Anton a Home Care Agreement which includes a negotiated exit amount of $250.

Later, Anton leaves home care and enters residential aged care. Anton’s provider calculates that the unspent home care amount is $150 (before the exit amount is applied). The exit amount to be deducted by Anton’s provider cannot be more than the provider’s published exit amount of $500, the $250 exit amount in Anton’s Home Care Agreement or his unspent home care amount of $150.

Therefore, the maximum exit amount that can be deducted is $150.

The table below provides further examples of the maximum exit amount that can be deducted for other scenarios.

                                                                                         Client A - Anton          Client B - Sarah        Client C - Mark

Published exit amount                                                                    $500                            $500                          $500

Negotiated exit amount in a client’s Home Care Agreement    $250                            $250                          $250

Unspent home care amount available                                          $150                            $500                              $0

Maximum exit amount that can be deducted                             $150                            $250                               $0

 

Read more at https://agedcare.health.gov.au/programs/home-care/overview-of-exit-amounts

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