ACAI Guideline Review & Medicare Review Claudia Giugni May 4, 2010

1. ISO 9001 Lic QEC22546 SAI Global ACAI Guideline Review & Medicare Review Claudia Giugni May 4, 2010

4. Overview • Aged Care Access Initiative Program Guidelines • Medicare Changes

5. Aged Care Access InitiativeProgram Guidelines • ACAI Program Guidelines (GP and Allied Health components) • 2010/2011 Guidelines are not yet available and we have not had any direct guidance about their content at this point • Victoria recently stated that shortly feedback from divisions will be requested to inform the 2010 / 2011 Guidelines – opportunity!!

6. Aged Care Access InitiativeProgram GuidelinesGP Component • Noted change for GP Incentive payments (announced April 2010) • GP Incentive component • an increase in the payment to GPs who provide at least 60 attendances to residents in RACFs from $1,000 to $1,500 a year • an increase in the payment to GPs who provide at least 140 attendances to residents of RACFs from $1,500 to $3,500 a year

7. Comprehensive Medical Assessment • CMA replaced by new time based health assessment items – 701, 703, 705, 707 • The use of these new items will not count towards the qualifying service levels for ACAI • Time based health assessments – target group = permanent residents of RACFs (can be provided annually) • RNs can assist with the health assessment process in accordance with accepted medical practice and under the supervision of a medical practitioner • Time taken with these assessments includes the time of a nurse • Previous Department proformas can be used with the new items

8. Allied Health Component • Revisiting the 09/10 Guidelines • Key Principles • Operation and eligible services • Funding allocations and allowable use of funding • Aged Care Legislation • Performance Indicators

9. Key Principles • • Allied health services funded should be identified through a needs assessment. • • It is not necessary to undertake a new needs assessment every year. The annual program plans for 2009-10 and 2010-11 can be based on the needs assessment undertaken in 2008, taking into account experience in providing allied health services during the previous year and any changes in local circumstances. • • Allied health services provided on an individual or group basis are eligible. • • This program applies to residents of Commonwealth funded residential aged care facilities and Multipurpose Services. • • Allied health services funded under Medicare or through other Government sources cannot be paid for under the Aged Care Access Initiative (ACAI). ACAI funding cannot be used to cover the payment ‘gaps’ or co-payments for services funded under Medicare or services where a private health insurance rebate is claimed. • • State Based Organisations will manage and deliver the program in conjunction with Divisions of General Practice.

10. Operation & Eligible Services • Allied Health service provision where this is not funded by other funding sources • Applies to Commonwealth-funded RACFs and MPSs • Individual allied health services may also include participation in case conferencing and care planning • Remuneration for Allied Health staff – varies across Australia and is not mandated through ACAI. Guidance can be obtained from relevant professional associations • Eligible services – pg 7 and 8 of guidelines

11. Aboriginal Health Workers Aboriginal Mental Health Workers Audiologists Chiropodists Chiropractors Counsellors Diabetes Educators Dietitians/nutritionists Dental/Oral Hygienists* Diversional Therapists Exercise Physiologists Occupational Therapists Orthoptists Orthotists/Prosthetists Osteopaths Physiotherapists Podiatrists Psychologists Radiographers Registered Nurses, with specialist roles Social Workers Speech Pathologists For the purpose of the ACAI , an allied health service may include services provided by: *In jurisdictions where the services of a dental/oral hygienist can only be provided following on the provision of a review and care plan by a dentist, use of ACAI allied health service funds for the dental service will be considered by the Department on a case by case basis. NB: Other allied health Registered Nurse in Specialist Role

12. Education / Training • Provision of generalised group training by allied health staff for staff of RACFs should not usually be provided. However, it is acceptable for allied health professionals to provide specific instruction in the needs of a particular resident to the aged care facility staff who may need to assist the resident with the provision of that service on a day to day basis. (Pg 8, Guidelines) • Consider asking the AHP to incorporate this time into their fee plan

13. Funding allocation and allowable use of funding • Funding allocated for 09-10 based on number of high and low care beds operational in NSW + program indexation. We have not been advised of allocation for 10-11 • Allowable use of funding • Program Administration costs – maximum of 25% total funds (including SBOs and Divisions) • Allied health professional costs

14. Allowable use of funding - AHPs • Allied Health Professional salaries/professional service fees - This should be the bulk of expenditure to ensure clinical care gets delivered to residents of residential aged care facilities. • • Reasonable Recruitment Costs • • Reasonable Retention Costs • • Service Support Costs - related to the direct provision of allied health services. These may include: • - Reasonable travel costs for allied health professionals to locations of service provision (and overnight accommodation costs where necessary) – rural areas only (ASGC Remoteness Areas 3 - 5); • - Costs related to renting a location for allied health service provision (eg a room in a multipurpose centre or bush nursing hospital)- rural areas only (ASGC Remoteness Areas 3 - 5);

15. Continued…. • - Employment of interpreters; • - Cost of obtaining criminal record checks for allied health providers contracted to perform services under this Initiative; and • - Professional indemnity insurance costs directly attributable to services (this will depend on whether the allied health professional is employed by the Division or subject to a contractual arrangement). • - Equipment which cannot easily be transported to the aged care facility. To ensure these costs do not take up a disproportionate amount of the overall Service Support Costs allocation, requests to purchase equipment should be discussed with the Department prior to agreeing to its purchase.

16. Aged Care Legislation Please note: It is a requirement under the Aged Care Act, 1997 (the Act) that the individual care and support needs, including allied health care needs of residents in aged care facilities, are assessed and documented with the assistance of appropriate health professionals, on a regular, on-going basis. Allied health services funded under the ACAI are not routinely available to residents with high care needs. Under the Act approved providers have an obligation, where an assessed need has been identified, to provide allied health services at no additional cost to the resident (Refer to Quality of Care Principles Schedule 1 Item, 3.11).

18. Performance Indicators Aged Care Access Initiative 1 The number of allied health services delivered (individual or group services must be reported separately), the number of services by provider type and the location of services provided per Division in your State or Territory.

19. Performance Indicators Aged Care Access Initiative 2 Evidence of shared planning and priority setting with other local organisations.

20. Medicare changes • Comprehensive Medical Assessment • Case Conferencing • Urgent after hours attendance items altered • NB: Routine and Non Urgent after hours services in RACF remain unchanged

21. Comprehensive Medical Assessment • CMA replaced by new time based health assessment items – 701, 703, 705, 707 • The use of these new items will not count towards the qualifying service levels for ACAI • Time based health assessments – target group = permanent residents of RACFs (can be provided annually) • RNs can assist with the health assessment process in accordance with accepted medical practice and under the supervision of a medical practitioner • Time taken with these assessments includes the time of a nurse • Previous Department proformas can be used with the new items

22. Case Conferencing • There will no longer be separate items according to the location of the service • The time periods will be adjusted to more closely align with the time periods used for level B, C and D consultations

23. Main Heading

24. Urgent After Hours Attendance • Urgent attendance after hours (other than between 11pm and 7am) • Commencement time 6pm weekdays and 12 noon Saturday • Urgent attendance- unsociable hours (between 11pm and 7am) • Explanatory notes

25. Main Heading

26. You made it!! • Surely anyone describing Guidelines and Medicare deserves a clap…..  • Thank you – any questions?