Aged care - initial contact 065-01010070

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Questions and Answers

1

I need to go into Aged Care. What do I do?

My Aged Care is the starting point to access government funded aged care services.

Assist the caller to register for Aged Care Services on the My Aged Care website or offer to book a face-to-face appointment with an Aged Care Specialist Officer (ACSO) if there is one located in their area or warm transfer the customer to the My Aged Care phone service. The website provides information on topics such as:

• the types of aged care services available
• eligibility for services
• local service providers
• Aged care costs
• advocacy services
• how to make a complaint

2

I have been approved for a home care package/residential care - do I need to complete a calculation of your cost of care?

For care recipients who are in receipt of a means tested income support payment (ISP), their means assessment for home care will complete automatically. If a care recipient receives a means tested ISP and is a non-homeowner, their residential care means assessment will also complete automatically.

Customers can use the fee estimator tool on the My Aged Care website to get an indication of what they can be asked to pay. However, to receive a pre-commencement letter Services Australia (or Department of Veterans’ Affairs (DVA) where applicable) will need to complete a pre-entry means assessment. See Aged care means assessment - preliminary checks to start this process.

It is not compulsory for a care recipient to complete a calculation of your cost of care for either home or residential care.

If the care recipient does not complete a means assessment or chooses not to disclose their income and/or assets information, they will be liable to pay the maximum fee depending on their cost of care. Either of these will result in a means assessment being completed as Means Not Disclosed.

A care recipient may have high income and/or assets which may make them liable to pay the maximum fees. The outcome results will be the same as choosing not to disclose their means. Refer to My Aged Care - Residential Care Fee estimator for help to estimate aged care fees. See Aged care means assessment for more details.

3

Which Calculation of the cost of your care form will I need?

When a care recipient enters home or residential care, the Aged Care Payment System will check if Services Australia or the DVA hold the required information to complete a means assessment.

If Services Australia or where applicable, the DVA does not hold sufficient information to complete an assessment, a letter will be sent to the care recipient from Aged Care Management Payment System (ACMPS) or Aged Care Staff Portal (ACSP) advising that:

• They have not provided their means assessment information
• If they wish to provide their information, they should complete an Aged Care Calculation of your cost of care application
• The completed application needs to be returned to Services Australia (or DVA where applicable)
• In some circumstances, a form is not required and a verbal application may be completed. See Aged care means assessment for details about when a calculation of your cost of care (means assessment) is required
• If the application is not returned or cannot be completed, the maximum rate of fees and charges for their level of care may apply

Other aged care forms

• Aged Care - Claim for financial hardship assistance (SA462)
• For care recipients who do not have sufficient means to pay aged care costs and/or accommodation payments due to circumstances beyond their control
• Nominee form (SS313 and AC019)
• Refer to question 12 for details of the 'Authorising a person or organisation to enquire or act on your behalf form (SS313)' and the 'Aged Care Request for a nominee for Department of Veterans' Affairs customers form (AC019)'

If both members of a couple require an assessment they will each need to complete an application.

4

Where to find aged care forms

Aged care forms can be accessed and printed from the Services Australia website. The Resources page has a link to the forms. The care recipient should be encouraged to access the forms themselves where possible.

The Aged Care Calculation of your cost of care forms are available as either an online form or paper forms.

Explain the benefits to care recipients of accessing the online aged care calculation of your cost of care form. For example, the benefits are:

• streaming questions so they only provide information that is required
• providing less information while allowing the opportunity to update out of date details, as details from their Centrelink record will be pre populated into the online application
• being able to monitor the progress of their application as in progress, held or completed through their Centrelink online account

If a care recipient advises they are unable to access the required form online, the form may be issued via the Customer First Mail Forms guided procedure.

See below for links to:

• forms on the Service Australia website
• Aged Care Calculation of your cost of care forms
• Aged Care Carer or close relative assessment (SA483)
• Aged Care Claim for financial hardship assistance form (SA462)
• Authorising a person or organisation to enquire or act on your behalf form (SS313)
• Aged Care Request for a nominee for Department of Veterans' Affairs customers form (AC019)

5

Is my home included as an asset?

For home care

The principal home is exempt.

For residential care

The principal home is included as an asset unless it is occupied by a protected person at the relevant date.

• A protected person is a:
• partner or dependent child
• carer who has lived with the care recipient in the same home for the past 2 years and the carer is eligible for an Australian income support payment at the relevant date
• close relative (such as a sister, brother, parent, child or grandchild) who has lived with the care recipient in their home for the past 5 years and is eligible for an Australian income support payment at the relevant date
• The relevant date is either:
• the date the assessment is completed (where the care recipient has not yet entered care), or
• the date the care recipient entered care (where the assessment is requested after their admission)

The exemption of the principal home for aged care means assessment purposes will cease if the protected person who had been occupying the home at the relevant date subsequently moves out, or if applicable, their income support payment eligibility is lost.

If the principal home is included as an asset, its value for the purposes of calculating the means tested fee where the property value is:

• above the 'first asset threshold', the value is capped at the ‘first asset threshold’
• below the ‘first asset threshold’, the actual value is used

See Department of Health and Aged Care's Schedule of Fees and Charges for Residential and Home Care for the current 'first asset threshold' rate.

If required, the care recipient may be booked in with an Aged care Specialist Officer (ACSO) if there is one located in their area, or referred to the My Aged Care website or phone service for:

• information on how the home is assessed
• access to the My Aged Care Fee Estimator using the Aged Care Home option

6

What are the fees for home care and how are they calculated?

My Aged Care provides assistance with estimating fees for aged care services.

The caller can be booked with an Aged Care Specialist Officer (ACSO) if there is one located in their area, or referred to the My Aged Care website or phone service for assistance with estimating the cost of their care.

• For an overview and estimate of home care fees, offer to book the caller in for an appointment with an Aged Care Specialist Officer (ACSO) if there is one located in their area
• For an overview of home care fees, refer callers to the My Aged Care - Home Care Package costs and fees home page
• To estimate home care fees, refer callers to the My Aged Care - Fee Estimator using the Home Care Package option

Care recipients commencing a home care service on or after 1 July 2014 may be asked to pay:

• a basic daily fee (BDF) only, or
• a BDF plus an income-tested care fee (ITCF)

Basic Daily Fee (BDF)

There are 4 levels of BDF, aligned to the 4 home care package levels (level 1, 2, 3 and 4). Refer to the Department of Health and Aged Care's Schedule of Fees and Charges for the current home care BDF.

Income-tested care fee (ITCF)

Services Australia (or DVA if applicable) are responsible for the assessment of income to determine liability for an ITCF.

A care recipient may be required to pay an ITCF if they have income over the relevant income free area. If the care recipient is:

• receiving a full pension, they will not pay an ITCF
• they will only pay a BDF
• a part pensioner, their ITCF will be the lowest of:
• 50% of their income above the income threshold
• the cost of their care, or
• the daily cap. Refer to the Department of Health and Aged Care's Schedule of Fees and Charges for 'Caps on Income Tested Care Fees in Home Care' - 'First Cap' for the current rate
• a self-funded retiree, their ITCF will be the lowest of:
• the daily cap for a part pensioner PLUS 50% of their income above the income for a part pensioner, or
• the cost of their care, or
• the daily cap. Refer to the Department of Health and Aged Care's Schedule of Fees and Charges for 'Caps on Income Tested Care Fees in Home Care' - 'Second Cap' for the current rate

Annual and lifetime caps apply to the ITCF

Any means-tested care fee (MTCF) paid during an admission to residential care also contributes to home care caps. See the Department of Health and Aged Care's Schedule of Fees and Charges for current cap rates.

• The annual cap is located under 'Caps on Income Tested Care Fees in Home Care'. Different cap rates apply depending on whether the care recipient is a full or part pensioner
• The lifetime cap is located under 'Lifetime Cap on Means-Tested Care Fees in Residential Care and Income Tested Care Fees in Home Care'

7

What are the fees for permanent residential care (post 1 July 2014 assessment rules) and how are they calculated?

My Aged Care provides assistance with estimating fees for aged care services.

The caller can be booked in with an Aged Care Specialist Officer (ACSO) if there is one located in their area, referred to the My Aged Care website or warm transferred to the My Aged Care  phone service  for help with estimating fees:

• For an overview and estimate of aged care fees, offer to book an appointment with an Aged Care Specialist Officer (ACSO) if there is one located in their area
• For an overview of residential care fees, refer them to the My Aged Care - Aged care home costs and fees home page
• To estimate residential care fees, refer them to the My Aged Care - Residential Care Fee Estimator
• Care recipients/nominees may also seek independent financial advice

Care recipients commencing a permanent residential care service on or after 1 July 2014 may be asked to pay a combination of fees depending upon their circumstances. Fee types include:

• Basic Daily Fee (BDF)
• Means-Tested Care Fee (MTCF)
• Accommodation Payment or Accommodation Contribution
• Extra Service Fee (if the care recipient has elected to receive extra services as part of their agreement with the service provider)

Services Australia (or DVA if applicable), are responsible for the assessment of assets and income to determine liability for:

• an MTCF (to contribute to the cost of care); and
• accommodation costs

Basic daily fee

This fee applies to all care recipients and is equal to 85% of the single basic age pension.

The BDF covers daily living costs such as meals, laundry, cleaning, and utilities such as power and phones.

Refer to the Department of Health and Aged Care's Schedule of Fees and Charges for the current residential care BDF.

Means-tested care fee (MTCF)

The MTCF is a contribution towards the cost of care. It is determined by an assessment of combined income and assets and by the level of care that is required.

Accommodation payment

An accommodation payment covers accommodation costs.

It may be payable if the means-tested amount (as determined by the means assessment) on the date of entry to care is equal to or more than the maximum accommodation supplement (as determined in the Department of Health and Aged Care's Schedule of Fees and Charges). In this case:

• the care recipient will be assessed as 'not low means'
• they will not receive government assistance with their accommodation costs
• an accommodation payment will not be affected by changes to income and assets

Care recipients have 28 days from the date (or proposed date) of entry to care to choose how the accommodation payment will be paid. It can be paid either as a:

• Refundable Accommodation Deposit (RAD) paid in full, as a lump sum, or
• Daily Accommodation Payment (DAP) paid as a daily amount which calculated following conversion of the RAD amount, or
• combination of the RAD and DAP

Accommodation contribution

An accommodation contribution is a contribution towards accommodation costs.

It may be payable if the means tested amount (as determined by the means assessment) on the date of entry to care is less than the maximum accommodation supplement amount (as determined in the Department of Health and Aged Care's Schedule of Fees and Charges). In this case:

• the care recipient will be assessed as 'low means'
• the government will contribute towards accommodation costs
• an accommodation contribution will be affected by changes to income and assets

Care recipients have 28 days from the date (or proposed date) of entry to care to choose how the accommodation contribution will be paid. It can be paid either as a:

• refundable accommodation contribution (RAC) paid in full, as a lump sum; or
• daily accommodation contribution (DAC) paid as a daily amount; or
• combination of the RAC and DAC

Extra service fees

This fee is paid if the care recipient has elected to receive extra services as part of their agreement with the service provider. Extra services are available in extra service facilities only. These facilities are required to publish their extra service fees on the My Aged Care website.

Extra service facilities provide a higher standard of accommodation, not extra nursing care. They cover services such as:

• onsite hairdressing
• pay television
• special therapies such as massage
• improved choice of meals and inclusions such as beer and wine

8

What will my fees be if I opt in to the post 1 July 2014 assessment rules?

Care recipients can opt into the post 1 July 2014 assessment rules if:

• they received a home care or permanent residential care service before 1 July 2014, and
• they will be moving to a new service on or after 1 July 2014, and
• they have not yet moved to the new service, and
• the new service type is the same as the previous service type (that is, moving from home care into home care, or residential care into residential care), and
• they have not spent more than 28 days outside of care (other than on approved leave)

If the care recipient requests only an estimate of fees if they opt in offer to book the customer an appointment with an Aged Care Specialist Officer (ACSO), or refer them to the My Aged Care website or phone service for assistance with estimating fees when opting in. The website contains Fee Estimators for both home care and residential care.

Where the care recipient requests written advice of fees if they opt in

The care recipient will need to undergo an aged care means assessment (unless they elect not to disclose their financial details, in which case they will be deemed Means Not Disclosed and will pay the maximum fees applicable to their care type and level of care).

The care recipient may qualify for a verbal application or they may need to complete a calculation of your cost of care.

See Aged care means assessment for details about when a calculation of your cost of care is required.

How to opt in

In order to opt in, the care recipient must complete a Continuing Care Recipient opting into the New Aged Care Arrangements from 1 July 2014 form (AC022).

• this form must be lodged with the new service provider before moving to the new service

Note: completing a calculation of your cost of care is not considered to be a formal request to opt in.

9

When will I receive a letter advising what my aged care fees will be?

Once a means assessment has been completed, a letter will be generated in Aged Care Staff Portal in real time and be able to be viewed in ACSP. A care recipient or nominee can expect to receive the letter within 14 days from sent date. See above What is the progress of my assessment?

Home care letters will be generated and sent from ACMPS

Letters will be issued automatically once all data has been transmitted to aged care systems:

• Check Aged Care Staff Portal (ACSP) - have fees been set? This should trigger a letter to be created
• Refer to Profiling and manual refresh of aged care means assessment data to confirm transfer of means test data and refresh if required

10

What happens if someone requests an urgent pre entry letter (RC60) or initial fee letter (RC62).

Has the means assessment been completed?

• Yes,
• check that fees have been set and check if a letter has been generated in ACSP - Correspondence - Letter Summary
• if a letter has been generated, it can be viewed, printed and faxed at the request of the care recipient or authorised third party
• See Aged care letters - viewing and reissuing
• No,
• complete means assessment if able to (within 25 minutes), or
• check that all required documents have been provided and create Fast Note - Auto text>Aged Care>Enquiry>Aged Care Req urgent means assessment for priority processing

Once means assessment is completed the letter should be generated in real time and be viewable in ACSP.

11

I want to ask about a letter I have received?

• Request to provide financial information (RC61) but I have already lodged a means assessment form?
• Receipt of a means assessment form does not stop a reminder being issued
• Explain the letter is automatically generated, thank the customer for responding and lodging the required information. Let them know they will get more correspondence when the assessment has been completed
• Letter advising that I am due to be paid a refund from my service?
• Any refund payable to a care recipient is managed by the service. The care recipient will need to follow up with their service as to how much they are owed, and how this will be refunded to the to them
• The refund due to the care recipient may not always correspond to the amount indicated in the letter issued by Services Australia as it is based on the care recipient paying fees as previously advised
• In some instances, a service may not have charged the advised fees
• The refund letter will always state that the customer may be due a refund
• Letter advising my fees have increased?
• Review means testing information in ACMPS for home care and ACSP for residential care to identify any changes that may have affected fees
• For residential care, the cost of care changed from 1 October 2022 when the Australian National Aged Care Classification (AN-ACC) funding model commenced. This may cause an increase or decrease in a care recipient’s cost of care

12

Why haven't my fees and charges been updated after I have advised of a change in my circumstances?

Changes in aged care fees following a change in circumstances will not usually occur until the next Regular Review (RR).

• The RR is a reconciliation process that aligns the fees that a care recipient has paid, with the fees associated with their care needs, over the last review period
• The care recipient will need to wait for the RR for the fee change to be applied, and for any refund owing to be paid

Care recipients who receive an Income Support Payment (ISP) may be confused about the need to wait until the next RR for their fees to change. When there is a change in circumstances related to their ISP, the system applies the change immediately and the care recipient can see an immediate effect on their ISP. This is not the case for aged care fees and charges.

If it is identified that a care recipient would be significantly disadvantaged (for example, placed in financial hardship) if required to wait until the next RR for a change in ongoing fees and charges following a change in circumstances, they may request an immediate Ad Hoc Review of their ongoing fees and charges.

• Ad hoc reviews can occur automatically (for residential care only, where there has been a significant change) or be undertaken manually (for both residential and home care)
• a manual ad hoc review should only be undertaken where it has been determined that:
• an automatic ad hoc review will not occur
• there has been a significant change in circumstances
• the care recipient would be significantly disadvantaged if an ad hoc review is not undertaken
• an ad hoc review will generate a refund (where a refund is due)
• approved funds will be issued with the next service claim

For more details about Regular Reviews, see Aged care reviews - Regular Reviews.

13

I am a nominee (or an authorised representative) and I want to discuss aged care

Arrangements can be made that allow a third party to enquire or act on behalf of a care recipient when dealing with Services Australia. This is referred to as a nominee arrangement.

The type of form used to create a nominee arrangement will determine:

• what information can be accepted from or provided to a third party for aged care purposes
• what correspondence the third party may receive from each of the aged care systems (Customer First/Process Direct, Aged Care Management Payment System (ACMPS) and Aged Care Staff Portal (ACSP)

There are 2 form types which will allow the appointment of a nominee:

• Authorising a person or organisation to enquire or act on your behalf form (SS313)
• Allows care recipients to nominate a person or organisation to enquire, act or update on their behalf for Centrelink payments and services including aged care. The SS313 is also within the Calculation of your cost of care forms
• See Adding or rejecting a nominee request
• Note: from 11 November 2020 aged care recipients can use the SS313 to appoint a nominee (excluding DVA care recipients)
• Aged Care Request for a nominee for Department of Veterans' Affairs customers form (AC019)
• Allows DVA care recipients to nominate a person or organisation to enquire, act or update on their behalf about their aged care costs.
• To appoint an aged care nominee email the digital image of the AC019 to the Aged Care - Payments Team.
• See Aged care request for a nominee or executor.
• Note: before 11 November 2020, the AC019 was used for all aged care recipients to appoint a nominee.

Aged Care Calculation of your cost of care (means assessment) forms

Aged Care Calculation of your cost of care forms contain an 'Authorising a person or organisation to enquire or act on your behalf form (SS313) section which allows for the appointment of a nominee.

See Aged care means assessment.

14

I have sold my home and paid a Refundable Accommodation Deposit (RAD)

See Aged care fees and charges - accommodation payments.

If the care recipient is residing in residential care and they have recently sold their home, in the majority of cases this will result in an increase to their fees. This is because, after the home is sold the value assessed is no longer capped at the First Asset Threshold. The whole value of the proceeds is assessed according to what has been done with the proceeds. The result is that the care recipient’s assessable assets increase, even though they may not have increased in ‘real terms’. This may not be anticipated by the care recipient and/or their nominee.

15

I have moved from one service to another - do I have to complete a new means assessment?

Home care

If the break in care is less than 28 days, a new means assessment form will not be required. The RCA/HOM activity can be completed with details currently recorded. If the care recipient or authorised third party are on the phone, confirm current income details that are recorded.

Residential Care

When a new entry into care is notified, an RCA/NCL activity will be created. It will complete automatically if the care recipient is in receipt of an income support payment and is a non-homeowner. If the care recipient has moved within 120 days of a means assessment being completed, the RCA/NCL can be completed with details currently recorded. If the care recipient or authorised third party are on the phone, confirm current income and asset details that are recorded.

See Aged care means assessment - preliminary checks.

16

I am an aged care provider and I need assistance

Aged care providers may contact either the Aged Care Means Testing Line or the Aged Care Provider Enquiry line directly.

Calls may also be transferred (announced) from the Aged Care Provider Enquiry Line to the Aged Care Means Testing Line when the original caller is on the line and the query relates to means testing (for example, the fee letter they have received appears to be incorrect).

• When this occurs, a Services Australia Workspace screen pop will appear and staff on the Provider Enquiry Line will have obtained the required information from the service provider to document the record
• If the Provider Enquiry Line Service Officer does not have the service provider on the line, the correct procedure is for the Provider Enquiry Line Service Officer to transfer the call unannounced to the Aged Care means testing line while the original caller is on the line. Confirm if the caller is a nominee or an authorised representative before transferring. See Aged care request for a nominee or executor for details
• For contact details, see Office Locator (search RCA)

Aged care providers are considered to have 'implied consent' however, Services Australia is prevented from releasing any personal information about the care recipient to the provider.

These contacts are usually single issue or one-off types of contact by third parties on behalf of a customer. It is essential the care recipient's privacy is maintained. See Implied consent regarding third parties for more details if required.

Where an aged care provider enquiry is not related to a means assessment, transfer the call (announced) to the Aged Care Provider Enquiry line.

The following information must be obtained from the aged care provider and documented in the care recipient record:

• The service provider's service ID and service name
• Return contact details of the service provider (phone and email if possible) and the details of the care recipient (name, DOB and reference number)

When an aged care provider contacts as they have not received a fee advice:

• Check the applicable aged care system to determine whether a fee letter has been issued, and whether the information in the letter is correct. If required, re-issue the fee letter to all parties
• See Aged care letters task card in Aged care letters for assistance if required
• To see if a letter has been held or stopped, see Step 5 of Using the Aged Care Staff Portal to manage residential care letters via the Correspondence search screen

Considerations when providing information to an aged care provider about fees:

• If the fee letter is incorrect, remediation of the care recipient's record should be undertaken to correct the issue and allow an updated letter to be generated as soon as possible. It is not necessary to seek more information from the care recipient where an administration error occurred
• Services Australia is prevented from releasing any personal information about the care recipient to the provider
• Do not ask the service provider why they think that information contained in a fee letter is incorrect
• If the service provider claims that the care recipient has additional income and/or assets that have not been reported to Centrelink, suggest that the service provider advises the care recipient to contact Services Australia to provide their correct information
• If the care recipient declines, the service provider should be directed to the Australian Government Services Fraud Tip-off Line

Item

Description

RCAA

Residential Care Assets Assessments

RCAD

RCAA Assessment Determination

RCIRC

RCA Circumstance

RCTS

RCA Task Selector

RDEP

RCA Dependants

RIAS

RCA Income Assessment Summary

RIS

RCA Institution Summary

RMND

RCA Means Test Details