EXPLANATORY STATEMENT. Issued by the Authority of the Minister for Ageing. Aged Care Act 1997 Flexible Care Subsidy Amendment Principles 2005 (No.

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1 EXPLANATORY STATEMENT Issued by the Authority of the Minister for Ageing Aged Care Act 1997 Flexible Care Subsidy Amendment Principles 2005 (No. 1) The Aged Care Act 1997 ( the Act ) provides for the funding of aged care services. Persons who are approved under the Act to provide flexible aged care services can be eligible to receive flexible care subsidy payments in respect of the care they provide to approved care recipients. Section 50-2 of the Act allows that the Flexible Care Subsidy Principles 1997 ( the Flexible Care Subsidy Principles ) may specify the kinds of care for which flexible care subsidy may be payable, and provides a range of criteria against which these kinds of care may be specified: (a) the nature of the care; (b) the circumstances in which the care is provided; (c) the nature of the locations in which it is provided; (d) the groups of people to whom it is provided; (e) the period during which the care is provided; and (f) any other matter. The kinds of care included in the Flexible Care Subsidy Principles for which flexible care subsidy may be payable include extended aged care at home services, multi-purpose services and innovative care services. The effect of the Flexible Care Subsidy Amendment Principles 2005 (No. 1) is to establish transition care as a further kind of care for which flexible care subsidy may be payable, and set down some of the requirements that must be met in order that an approved provider can receive flexible care subsidy for the provision of transition care. Principles made under the Aged Care Act 1997 Subsection 96-1(1) of the Act allows the Minister to make Principles providing for various matters required or permitted by a Part or section of the Act. Subsection 96-1(2) of the Act provides that any Principles made under subsection 96-1(1) of the Act are disallowable instruments. The Flexible Care Subsidy Principles is one of the sets of Principles made under the Act. Context of the Flexible Care Subsidy Amendment Principles 2005 (No. 1) This amendment is to give effect to the commitment by the Government in the Budget to provide up to 2,000 transition care places over three years to help older people make the transition from hospital care, under a new cost-shared model of care with the states and territories.

2 In this context, transition care refers to a kind of flexible care that is provided to a care recipient at the conclusion of an inpatient hospital episode (after the provision of any necessary acute and subacute care) and in the form of services that are goal-oriented, timelimited and therapy focussed. The services provided will be those necessary to complete the care recipient s restorative process, optimise the care recipient s functional capacity and assist the care recipient, family and carer to make appropriate long-term care arrangements. It can be provided in either a residential or community setting, and must be in a non-hospital, more home like environment. Transition care provides older people, depending on their assessed level of need, with nursing support, low intensity therapy (such as physiotherapy, occupational therapy and social work) to maintain physical and cognitive functioning and to facilitate improved capacity in activities of daily living, personal care, medical support such as GP oversight, and case management including establishing community supports and services and, where required, identifying residential care options. Consultation The parameters of transition care, as reflected in this instrument, have been developed through a consultation process with State and Territory Government representatives. All States and Territories were included in a Transition Care Task Group, along with appropriate clinical representatives. Regulation impact statement The Office of Regulation Review (ORR) assessed the proposed amendments and determined that the preparation of a Regulation Impact Statement was not required (ORR ID number 7225).

3 ATTACHMENT NOTES ON CLAUSES Clause 1 provides that the Amending Principles are to be cited as the Flexible Care Subsidy Amendment Principles 2005 (No. 1). Clause 2 provides that the Principles commence on the day that they are registered. Clause 3 amends the Flexible Care Subsidy Principles 1997 as set out in the Schedule. Schedule 1: Amendments Item 1 inserts definitions for Aged Care Assessment Team (ACAT) and episode of transition care in section The meaning of Aged Care Assessment Team is referred to the Aged Care Assessment Program Operational Guidelines 2002, which provide details of the roles of ACATs and guidance about their membership. The definition of episode of transition care stresses that the care must be in relation to a care recipient and an approved provider, and that it must be for a continuous period of provision of transition care. Item 2 inserts definitions for further transition care needs and goal-oriented in section Further transition care needs refers to transition care needs, as assessed by an Aged Care Assessment Team during an initial period of transition care (which is limited to 84 days under new section 15.34). If an assessment by an ACAT concludes that 84 days of transition care is insufficient to meet a care recipient s further transition care needs, the ACAT may make an assessment that a longer period of transition care is necessary so that the total period of transition care may be increased up to a maximum of 126 days. Item 3 inserts definitions of in-patient hospital episode and low intensity therapy. The definition of in-patient hospital episode clarifies that the term includes any acute or subacute care required to ensure that a person is ready for discharge from a hospital. Low intensity therapy is a key component of transition care and is aimed at ensuring that a care recipient s optimal level of cognitive and physical functioning is achieved during a period of transition care. This is intended to optimise older people s capacities in respect of activities of daily living. The term refers to low intensity, to differentiate this form of care from subacute care (see new definition in section 15.3). Low intensity therapy is not a substitute for subacute care. Item 4 inserts definitions for subacute care and transition care in section Subacute care refers to care provided in a hospital to a patient who is not in the acute phase of an illness. The examples given include rehabilitation, palliative care, psychogeriatric care and geriatric evaluation and management. Transition care takes the meaning set out under section Item 5 inserts a new Chapter (Chapter 5) on transition care into the Flexible Care Subsidy Principles, comprising new sections to 15.33, as described in the following explanations.

4 The new section notes that Part 1 of the new Chapter explains what is meant by transition care. The new section describes what is meant by transition care. The definition stresses that transition care must follow an in-patient hospital episode (as defined in section 15.3) and comprise a package of services that must include low intensity therapy (as defined in section 15.3) and either nursing support or personal care. The latter reflects the requirement that transition care recipients should otherwise be eligible for at least low level residential care. Overall, the package of care must be goal-oriented (as defined in section 15.3), time-limited (as distinct from the more common ongoing nature of other forms of aged care, such as residential and community care), targeted towards older people and necessary to complete a transition care recipient s restorative process and optimise their functional capacity. The definition also recognises that another goal of transition care is to help the care recipient or informal carers to establish long-term care arrangements to follow on from transition care. The new section notes that Part 2 of the new Chapter specifies a kind of care for which flexible care subsidy may be payable. This is in addition to the kinds of care already specified in the other Chapters (extended aged care at home services, multi-purpose services and innovative care services). The new section specifies that, under the new Chapter, transition care, provided by an approved provider, is a kind of care for which flexible care subsidy may be payable. The meaning of transition care is provided in the new section The new section notes that Part 3 of the new Chapter specifies the arrangements for the payment of flexible care subsidy to approved providers for the provision of transition care, and the maximum period for which flexible care subsidy can be paid for a single episode of transition care. The new section specifies that two of the conditions under which flexible care subsidy can be payable for transition care, are that the relevant State or Territory Government also provides funding, at a level agreed with the Commonwealth, and that this funding is provided by the State or Territory for the purpose of meeting the needs of the recipients of transition care. The new section allows that the Secretary may, for the Commonwealth, enter into a payment agreement with an approved provider as one of the bases for the payment of flexible care subsidy and details a range of matters that the payment agreement may specify. The matters covered include administrative issues, such as the period of the agreement, that flexible care subsidy is paid monthly and in advance and how claims for flexible care subsidy are to be made. Other matters may include the rights and responsibilities of care recipients, reporting requirements, quality assurance mechanisms, user charges and expected standards of care (see section for a detailed list). The new section specifies the maximum periods for which flexible care subsidy can be paid for a single episode of transition care. For a given episode, flexible care subsidy may be paid for a period of up to 84 days. This may be extended up to a maximum total period of 126 days if the care recipient has additional transition care needs. Under the new definition of

5 further transition care needs in section 15.3, the additional need for transition care must be assessed by an ACAT.

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