Aged Care fees and payments – annual and lifetime caps 065-19103046

To decide the start date of aged care, access ACSP and/or ACMPS for periods of care for all care types including pre-entry leave. Confirm any annual or lifetime caps that have been applied.

In ACSP, locate care recipient using Care recipient search:

• for history of care periods:
• Care recipient summary page will display all periods of aged care in all care types
• From Care recipient tab, select Event summary
• Locate the care recipient’s current entry into permanent residential care and click on the status of Accepted to view entry details
• The first screen will display entry and pre-entry dates under Entry details
• To check annual or lifetime caps:
• Hover on Fees and charges tab
• Select Fees and charges details screen and scroll down

See Aged Care Staff Portal (ACSP) – Care Recipient in Context (CRiC) for more information.

For care recipient currently in home care, access ACMPS:

• Assessments & Events tab:
• Entry Details, including Service ID information
• Leave Details
• Departure Details
• Fees and Charges tab to confirm ongoing fees and annual and lifetime caps

Note: care recipients with an entry date prior to November 2018 will have a new start date set when they change care types. The anniversary date should have remained the same as the home care start date, however system limitations meant that the start date was not transferred into SPARC.

Further investigation is required when a care recipient:

• is paid MTCF in residential care or ITCF in home care and
• changed to a different type of care prior to November 2018 and
• has reached an annual cap or a lifetime cap based on current residential care fees

Does the care recipient meet all of the above criteria?

• Yes,
• create a Fast Note in Customer First. Select Auto Text option Aged Care > Enquiry> Aged Care Annual/Lifetime Cap Enquiry
• advise that case has been referred for investigation
• procedure ends here
• No, go to Step 2

In ACMPS, check:

• Reconciliation Data tab for any refunds that were not paid
• Payments Additions screen for any manual adjustments that were paid
• Payment Deductions screen for any manual recoveries that were deducted
• Notes tab for details of any manual refunds that were paid and/or manual adjustments that were made

In ACSP, check:

• Reconciliation > Reviews and refunds for refunds previously paid
• Care recipient > Care recipient notes for notes on any manual refunds paid

Check Customer First:

• Document Tools
• Document List

Has a manual adjustment been completed previously for this care recipient?

• Yes,
• create a Fast Note in Customer First. Select Auto Text option > Aged Care > Enquiry > Aged Care Annual/Lifetime Cap Enquiry
• advise that case has been referred for investigation
• procedure ends here
• No, go to Step 3

A care recipient’s ongoing MTCF/ITCF fee should be $0 after an annual or lifetime cap is reached and applied. If the ongoing fee has not been updated to $0, the assessment may be pending the lodgement of a monthly claim by the service provider.

If a cap is reached in a month that has not been claimed by the service provider, the ongoing fee will not have been updated. Once the monthly claim is lodged, the ongoing fee will then be set to $0 and any refund will be calculated at the next regular review.

In ACSP check the Fees and Charges - Client Summary for annual or lifetime cap reached date.

In ACMPS check the Fees and Charges tab.

Has an annual or lifetime cap been applied in ACMPS/ACSP?

• Yes, go to Step 4
• No,
• if the service provider's claim month has not yet been finalised, advise that the ongoing fee will be adjusted in due course/shortly, procedure ends here
• go to Step 5

In ACSP check Correspondence – Letter Summary.

In ACMPS, check Communication History tab.

Has a letter been issued that the care recipient has reached an annual or lifetime cap?

• Yes,
• resend letter from ACSP if required
• refer to Aged care letters - viewing and reissuing
• procedure ends here
• No,
• create a Fast Note in Customer First. Select Auto Text option > Aged Care > Enquiry > Aged Care Annual/Lifetime Cap Enquiry
• advise that case has been referred for investigation
• procedure ends here

In ACSP, review the paid MTCF for residential care:

• Fees and Charges - Client Summary to confirm:
• entry date
• anniversary date, and
• current fees
• Fees and Charges – Fees and charges details to see:
• ongoing fees
• start date and history of annual caps
• accrued amounts under annual and lifetime caps for all care types
• Care recipient – Care recipient notes for details of previous refunds held/released

In ACMPS, review the paid ITCF for home care fees:

• Fees and Charges tab under Means Tested Fee for fees that were charged and Annual and Lifetime Caps tab for accrued fees

Use the Aged Care Fee Calculator - Manual Adjustment calculator tab on the Resources page if required.

When the latest entry date is prior to November 2018, the following are not transferred into ACMPS/ACSP for care recipients who were previously in a different care type:

• start date, and
• fees paid

A link to Department of Health and Aged Care - Schedules of Fees and Charges containing annual and lifetime cap rates can be found in Resources page.

Does this investigation show that this care recipient may have reached an annual or lifetime cap?

• Yes,
• create a Fast Note in Customer First. Select Auto Text option > Aged Care > Enquiry > Aged Care Annual/Lifetime Cap Enquiry
• advise that case has been referred for investigation
• procedure ends here
• No,
• advise current annual and lifetime cap amounts and create a Fast Note in Customer First to record discussion
• procedure ends here