Aged Care Access Initiative

Transcription

1 Aged Care Access Initiative Allied Health Component PROGRAM GUIDELINES July 2011

2 Table of Contents 1 Purpose 3 2 Program context and aims Background Current components Reform in Key principles. 4 4 Eligible allied health services Types of services Qualifications of allied health providers Eligible providers 5 5 Remuneration of allied health providers Relationship to other funding sources Roles and reponsibilities Department of Health and Ageing State Based Organisations Divisions of General Practice 7 8 Program plan Funding Funding allocations Allowable use of funding Carry over of uncommitted funds 9 10 Models for purchase of health services Aged care legislation Performance indicators Needs assessment. 12 Contacts.. 13 Page of 14 2

3 1 Purpose These guidelines outline the parameters and operation of the allied health component of the Aged Care Access Initiative (ACAI). They provide guidance on the allied health initiative for State Based Organisations, Divisions of General Practice, Residential Aged Care Facilities (RACFs), Multi-purpose Services (MPSs) and allied health providers. The guidelines are available at 2 Program context and aims 2.1 Background Residents of aged care facilities are amongst the frailest of Australians. They often have complex care needs requiring multidisciplinary care from two or more providers, but can experience difficulties in accessing the services of GPs and allied health professionals. The Aged Care GP Panels Initiative, which commenced in 2004, addressed some of these issues. Following recommendations arising from a review in 2007 and analysis of Medicare Benefits Schedule (MBS) data over the program s lifespan, funding for the Aged Care GP Panels Initiative was reviewed. In the Federal Budget, the Government announced that funding under the Aged Care GP Panels Initiative would be redirected from July 2008 to the ACAI Program, which was introduced in to improve primary care service provision for older Australians in Commonwealth-funded RACFs and MPSs. 2.2 Current components The ACAI program currently has two components: GP incentive payments for managing aged care residents of Commonwealth funded RACFs and MPSs; and funding for the provision of allied health services to those residents. GP incentive payments A GP incentive payment, operating through the Practice Incentives Program (PIP), is designed to encourage GPs to provide more services in RACFs and MPSs. The incentive recognises some of the difficulties faced by GPs in providing care in these settings and aims to encourage GPs to continue to provide increased and continuing services to residents. The PIP payments are administered through Medicare Australia. Separate guidelines for the GP incentive component of the ACAI are available at 3

4 Allied health services The allied health component of the ACAI program provides funding for the provision of allied health services to low-care level residents of Commonwealth funded RACFs or MPSs, where these services are not currently covered by Medicare or other government funding arrangements. Low-care residents require accommodation and personal care type services, but not 24- hour nursing care. If residents shift between low-level care and high-level care due to changing care needs, they are only eligible for allied health services under ACAI during the times they are classified as low-care residents. The allied health component of ACAI is managed by State Based Organisations (SBOs) in each state and territory. SBOs may purchase allied health services directly or through contractual arrangements with Divisions of General Practice. 2.3 Reform in 2012 From 1 July 2012, funding of $54.2 million will be provided as a flexible funding pool for use by Medicare Locals to target gaps in primary health care for older persons receiving aged care support, regardless of whether they live in a residential care facility or the community. New Guidelines will be developed for this initiative. 3 Key principles 1. Allied health services funded through the ACAI were initially identified through a allied health needs assessment undertaken by SBOs at the commencement of the program in In subsequent years, annual program plans have been based on a review of the initial needs assessment, taking into account experience in providing allied health services during the previous year and any changes in local circumstances. 3. In view of the limited program funding and a requirement for aged care facilities to provide allied health services to high-care residents where an assessed care need has been identified (see Section 11), allied health services under ACAI are only available to older Australians who are low-care residents of Commonwealth funded RACFs or MPSs. 4. ACAI funding cannot be used to pay for allied health services funded under Medicare or through other government sources, or to cover the payment gaps or copayments for services funded under Medicare or services where a private health insurance rebate is claimed. 5. Allied health services purchased under the ACAI must not incur out-of-pocket costs for the resident. 4

5 4 Eligible allied health services 4.1 Types of services Under the ACAI, allied health providers can provide professional services relating to the examination and treatment of low-care residents of Commonwealth funded RACFs or MPSs. Services can be provided either on an individual or a group basis. Individual services may include one-on-one services, such as podiatry or physiotherapy, or an allied health provider s participation in case conferencing and care planning. Group services may include, for example, group psychology sessions or group exercise and falls prevention programs, provided these are conducted by registered or accredited allied health professionals. Provision of generalised group training by allied health staff for staff of RACFs should not be provided through ACAI funding, since improving direct service provision is the primary objective of the program. 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. 4.2 Qualifications of allied health providers Allied health providers employed under ACAI must: have recognised educational qualifications specific to the position for which they are employed; be accredited/registered/credentialled, if required for that profession; and have membership of the relevant professional association, if required for that profession. They must not require supervision to undertake the clinical tasks for which they are employed. 4.3 Eligible providers Allied health services can be provided by the following providers: Aboriginal health workers Aboriginal mental health workers Audiologists Chiropractors Counsellors Dental/oral hygienists Diabetes educators Dietitians/nutritionists Diversional therapists Exercise physiologists 5

6 Occupational therapists Orthoptists Orthotists/prosthetists Osteopaths Physiotherapists Podiatrists Psychologists Radiographers Registered nurses, with specialist roles Social workers Speech pathologists The services of allied health practitioners who are not listed above can be engaged if their individual participation was approved by the Department, following a specific request, prior to the release of the July 2011 ACAI Guidelines. Other types of allied health providers may be also considered if there is a shortage of eligible allied health providers to meet an identified need, and similar services can be provided by a provider who is not on the eligibility list. Substitute providers who are not on the list of eligible providers must meet the qualification requirements identified at 4.2, and can only be included subject to written approval from the Department. Registered nurses can be funded under the allied health component of the ACAI, but only in specialist roles, and they must have minimum qualifications appropriate to the functions that they are to undertake through the Initiative. Examples of roles for specialist nurses are wound management consultants, geriatric nurse consultants and aged care nurse practitioners. Nurses who have specialist qualifications and are already employed within an aged care facility can only be funded to the extent that they provide additional services over and above existing employment arrangements. Funding cannot be used to pay for an existing position. Practice or generalist nurses cannot be funded. 5 Remuneration of allied health providers Rates of remuneration for allied health professionals vary across the professions and across Australia. The allied health component of the ACAI does not mandate fee levels to be paid to allied health providers. Guidance on this issue can be sought from the relevant professional association. 6 Relationship to other funding sources Payments for professional services under the allied health component of the ACAI will not apply where the service by an allied health professional is paid for by the allied health professional s employment through a state or other government-funded program. 6

7 If allied health providers are receiving payment for service provision under an Australian Government program, such as the ACAI or the Rural Primary Health Services (RPHS) Program, they will not be able to also claim Medicare items for the same services. Where a Medicare rebate is claimed for an allied health service, the allied health component of the ACAI cannot be used to cover the gap between the Medicare rebate and the fee charged by the allied health provider. However, out-of-pocket costs will count toward the Medicare Safety Net for the patient. ACAI funding cannot be used to cover the copayment for residents with private health insurance. ACAI funding can not be used for an admitted patient of a public hospital. 7 Roles and responsibilities 7.1 Department of Health and Ageing The Australian Government Department of Health and Ageing funds the ACAI. It contracts SBOs to deliver the program on its behalf. The Department will monitor and review program activity. This will involve consultation with the Divisions network and other stakeholders, as well as using data submitted in six and twelve monthly reports. The Department may also review a specific ACAI service by a SBO, a Division, or Divisions, from time to time. Program Liaison Officers in the respective state or territory office of the Australian Government Department of Health and Ageing are the initial contacts for queries about the ACAI program. Contact details are provided on page 13 of these Guidelines. 7.2 State Based Organisations SBOs are responsible for managing the program and for service delivery based on identified need. SBOs may contract with individual or regional groupings of Divisions to provide allied health services under ACAI, or they may purchase services on a state/territory-wide basis. 7.3 Divisions of General Practice SBOs may contract with Divisions to purchase allied health services under the Initiative. Program delivery, budget and reporting expectations will be specified in each contract. It is the responsibility of SBOs and Divisions to identify stakeholders with whom they should liaise and consult. It is important that this happens through all stages of the Initiative s annual cycle from planning and implementation through to evaluation. This will need to be demonstrated in program reporting. This consultation will help integrate ACAI services with other programs, whilst not duplicating them. 7

8 8 Program plan SBOs will be required to submit a program delivery plan each year. The plan must be based on the updated needs assessment and take into account subsequently identified levels of needs and experience in delivering the program to date, including any recent changes in circumstances such as workforce availability. The plan must include proposed arrangements for delivery of allied health services under the allied health component of the ACAI and proposed budget, including the estimated number and type of services to be purchased, location of services to be provided and which Division(s) (if applicable) will be contracted to deliver the services. SBOs are also required to show how state/territory funding allocations will be applied to services purchased in each Division and provide a rationale for proposed distribution of funds across participating Divisions. 9 Funding 9.1 Funding allocations Funds allocated to SBOs for the ACAI allied health component are based on allocations provided in the previous year, adjusted for changes in the number of RACFs and operational beds in each state and territory and program indexation. 9.2 Allowable use of funding Allied health professional costs A minimum of 75% of the funds provided in the ACAI funding agreement between the Department and the SBO must be allocated to allied health professional costs, which includes the following: Allied health salaries and professional service fees. Recruitment costs. Retention costs. Service support costs related to the direct provision of ACAI allied health services, including: o o o o o Reasonable travel costs for allied health professionals to locations of service provision (and overnight accommodation costs where necessary) in rural areas only (ASGC Remoteness Areas 3-5). Costs related to renting a location for allied health service provision (e.g. a room in a multipurpose centre or bush nursing hospital) in rural areas only (ASGC Remoteness Areas 3-5). Employment of interpreters. Cost of obtaining criminal record checks for allied health providers contracted to perform services under this Initiative. 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). 8

9 Program administration costs A maximum of 25% of the funds provided in the ACAI funding agreement between the Department and the SBO is available for program administration costs. Within this amount, funds can be applied flexibly between SBOs and Divisions depending on the service delivery arrangements for the state/territory. SBOs will be required to show how program administration costs are applied in their budget and financial reporting to the Department. Program administration costs include costs incurred by SBOs and Divisions in the administration of the Program (e.g. staff time for writing plans and reports, evaluation and monitoring, coordinating services, or costs incurred in conducting the needs assessment). 9.3 Carry over of uncommitted funds An automatic carryover of up to $5,000 (GST Exclusive) of any Unspent or Uncommitted ACAI funds from into can occur without the need for a written application. The purpose of this automatic carryover is to reduce further administration in applying for lesser amounts of Funds to be carried over from one financial year to the next. If Funds are automatically carried over, the respective State or Territory Office of the Department of Health and Ageing should be notified of this carryover. Written approval is required for carryover of more than $5,000 (GST Exclusive). 10 Models for purchase of allied health services Allied health services are expected to be delivered in a way that best meets the assessed care and support needs of low-care residents of RACFs and MPSs. The Department supports using models of allied health service delivery which are practical and acknowledge the local characteristics (e.g. geographic, demographic). Delivery models must address the outcomes of the needs assessment and program plan and take into account the aim of the ACAI. Models can include: Full-time or part-time employment by an SBO/Division of an allied health professional. Topping up existing part-time positions/expanding existing services in a RACF or MPS to deliver synergies through use of arrangements currently in place. For example, a allied health provider who provides services to high-care residents in accordance with the requirements of the Aged Care Act 1997 (the Act) may be funded to provide services funded under the ACAI to low-care residents. Sharing an allied health position across Divisions or between a Division and another organisation. 9

10 Contracting visiting allied health professionals. This is not an exhaustive list and different models may be combined for different activities. In developing a model, the emphasis should be on planning a cost-effective approach that results in the maximum services on the ground. 11 Aged care legislation High-level care is the care provided for older people who have been assessed as having high care needs. Under the Aged Care Act (1997) (the Act) and its Quality of Care Principles, approved providers of residential aged care have an obligation, where an assessed care need has been identified, to provide allied health services to high-care residents at no additional cost to the resident, except for intensive long-term rehabilitation services following serious injury, surgery or trauma. High-care residents should already be receiving the allied health services mentioned above, at no cost to them, through the aged care facility, and it is important that approved providers of residential aged care continue to meet their obligations under the Act. In view of this requirement and limited ACAI funding, allied health services funded under the ACAI are not available to residents who are assessed as high-care residents. 12 Performance indicators There are two performance indicators for the ACAI allied health component, as outlined below. The Department will require reports against these indicators for the allied health component in the six and twelve month reports. Performance indicator 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. State Based Organisations are required to submit the following data via a template on the Primary Health Care Research and Information (PHCRIS) online reporting website at the number of allied health services provided. the number of allied health providers by provider type (see Table A below). the number of services provided to individuals. the location of services provided (RACFs). 10

11 the number of group sessions provided. the number of residents who participated in group sessions. (This should be the sum of the number of residents and group sessions attended e.g. if 6 residents attend 4 group counselling sessions the total number of residents who participated is 6 X 4 = 24.) Table A: Provider types Aboriginal health worker Aboriginal mental health worker Audiologist Chiropractor Counsellor Dental/oral hygienist Diabetes educator Dietitian/nutritionist Diversional therapist Exercise physiologist Occupational therapist Orthoptist Orthotist/prosthetist Osteopath Physiotherapist Podiatrist Psychologist Radiographer Registered nurse, with specialist role Social worker Speech pathologist Other The services of allied health practitioners not listed above can be engaged if their individual participation was approved by the Department, following a specific request, prior to the release of the July 2011 ACAI Guidelines. Other allied health providers may be also considered if they have been approved by the Department because they can provide a similar service to an eligible allied health occupation that is in short supply. Substitute providers who are not on the list of eligible providers must meet the qualification requirements identified at 4.2, and can only be included subject to written approval from the Department. If another type of professional was employed or contracted with the approval of the Department previously, then the professional should be listed as Other, with the specific type of profession noted in brackets. `Performance indicator 2 Evidence of shared planning and priority setting with other local organisations When reporting against this indicator, a description must be provided of engagement with relevant stakeholders in the planning, delivery and evaluation of ACAI, for example: General practice Allied health professionals Allied health peak organisations Aboriginal health services Consumer groups 11

12 Other relevant programs that link with ACAI initiatives should also be identified, such as: Other Commonwealth government programs Other state or territory health programs 13 Needs assessment State Based Organisations were required to consult with Divisions and other relevant stakeholders in developing the needs assessment for the first year of operation of the initiative. As in , in there is not a requirement to undertake a new needs assessment. However, it is expected that SBOs will continue to consult with relevant stakeholders in formulating annual program plans and respond to changes in availability of allied health services in the area or the experience of providers in providing services to the resident population. 12

13 Contacts Department of Health and Ageing Communications relating to the ACAI should be directed to the relevant State or Territory Office identified below. New South Wales SYDNEY NSW 2001 Phone: (02) South Australia ADELAIDE SA 5001 Phone: (08) Victoria MELBOURNE VIC 3001 Phone: (03) Tasmania HOBART TAS 7001 Phone: (03) Queensland BRISBANE QLD 4001 Phone (07) ACT MDP 42 CANBERRA ACT 2601 Phone (02) Western Australia PERTH WA 6848 Phone: (08) Northern Territory DARWIN NT 0801 Phone (08)

14 State Based Organisations New South Wales General Practice NSW GPO Box 5433 SYDNEY NSW 2001 Phone: South Australia General Practice SA First floor, 66 Greenhill Road WAYVILLE SA 5034 Phone (08) Victoria General Practice Divisions Victoria Level Swanston St CARLTON VIC 3053 Phone: (03) Tasmania General Practice Tasmania Ltd GPO Box 1827 HOBART TAS 7001 Phone (03) Queensland General Practice Queensland GPO Box 2546 BRISBANE QLD 4001 Phone: (07) www. gpqld.com.au ACT ACT Division of General Practice PO Box 3571 WESTON CREEK ACT 2611 Phone: (02) Western Australia Western Australian General Practice Network Suite 1 4 Sarich Way, Technology Park BENTLEY, WA, 6102 Ph: (08) Northern Territory General Practice Network NT GPO Box 2562 DARWIN NT 0801 Phone: (08)