Review of resident claim scale claims

This

week
Commonwealth staff will begin a number of reviews of funding claims made by aged care providers, to ensure Australian government financial payments are matching the level of care for the nation’s 170,000 people living in nursing homes.

This review was officially announced by the Treasurer in the 13 May budget.

From 1 July, Commonwealth Nursing Officers will conduct 5,000 reviews under the ‘Resident Classification Scale’ (RCS) in all States and Territories.

This follows data for the 1 July 2007 to 31 March 2008 period, which covers part of the previous Government and the Rudd Labor Government.

The data from the Office of Aged Care Quality and Compliance within the Department of Health and Ageing, shows 37% of claims upon examination had to be downgraded by Department of Health and Ageing assessors.

In addition, in some cases the reviews did occasionally result in the Commonwealth paying aged care providers additional funds, if it was found that they were under-claiming. This upgrading occurred in 3.9 % of cases.

Review procedures and background

In the coming months, Commonwealth Nursing Officers will visit facilities and examine all relevant information about a resident’s care needs and consider the comprehensive care plans that detail how those needs are being met.

If documentation does not support the claim, review officers are required, under the Aged Care Act 1997 (the Act), to substitute the appropriate classification for that resident.  This may be to increase, confirm or downgrade the funding level claimed.

Over claimed amounts are recovered through an adjustment to the monthly advance for up to six months if required, rather than a lump sum payment from the provider.

There is no financial penalty for incorrect claiming of a subsidy, merely a correction of the incorrect classification and claim, with backdating to the time of the facility’s appraisal and classification, or six months, whichever is the lesser.

Even if a provider has received funding for more than six months for a resident who is subsequently reclassified at a lower level, funding is only recovered for six months. This is in line with the requirements of the Aged Care Act.

However, the Act allows the Secretary of the Department of Health and Ageing to suspend an approved provider from classifying residents for funding where it repeatedly fails to conduct classification appraisals in a proper manner.