Aged Care fees and charges – care subsidy reduction to zero 065-19103005

The Australian Government contributes to the costs of aged care through subsidies paid to aged care providers. Once a care recipient enters care an assessment is completed. This determines the cost of care. A completed means assessment determines the care recipient’s contribution to the cost based on:

• their income and/or assets, or
• means not disclosed (MND) status

The fee reduces the care subsidy paid to the provider. This is known as a ‘care subsidy reduction’ (CSR).

• Residential care
• The CSR applies to the means tested care fee (MTCF)
• For Service Providers - in the Aged Care Staff Portal (ACSP) payment statements for providers this is displayed as a Means Tested Subsidy Reduction
• For Care Recipients – see Aged Care Staff Portal (ACSP) - Care Recipient in Context (CRiC))
• Home care
• The CSR applies to the income tested care fee (ITCF)
• In the Aged Care Management Payment System (ACMPS) payment statements for providers displays it as an Income Tested Subsidy Reduction (ITSR)

For example, a care recipient is assessed as requiring the highest level of care. The provider is eligible to receive maximum subsidies for the care recipient. A means assessment is then completed. This determines that the care recipient is liable to pay $50 per day for an ITCF/MTCF. The care subsidy paid to the provider is then reduced by $50 per day.

In certain circumstances a care recipient’s care subsidy reduction (CSR) can be ‘set’ to zero. The legislation outlines ‘classes’ (categories) of people where the CSR is taken to zero. Where applicable, it also outlines the duration the CSR to zero applies.

If a care recipient’s CSR is set to zero, they do not have to pay any ITCF/MTCF for that period. The government will pay the maximum eligible subsidy to the service provider. The care recipient will still have to pay any Basic Daily Fee (BDF) and Accommodation costs (for residential care).

Care recipients are eligible to have their CSR set to zero when they:

• have one or more dependent children
• are described in paragraph 85 (4)(b) of the Veterans’ Entitlements Act (which describes former prisoners of war)
• have an assessed care subsidy reduction that is less than $1
• have reached their annual or lifetime cap

OR

For residential care recipients, the CSR is set to zero when they:

• leave a residential care service (without entering another residential care service), or who die, before the approved provider has been informed of the care recipient’s care subsidy reduction (if any)
• are not within 6 months of entry to the residential care service, informed of the care recipient’s care subsidy reduction (if any)

For home care recipients CSR is set to zero when they:

• stop being provided with home care (without being provided with other home care), or who die, before the approved provider is informed of the person’s care subsidy reduction (if any)
• are not within 6 months of receiving home care, informed of the care recipient’s care subsidy (if any)

When a care recipient is in home or residential care they are issued with an initial fee advice letter. A pre-entry advice does not qualify as a fee advice. It provides an estimate of fees only. If a fee advice is not issued within 6 months of entry into care CSR to zero is automatically applied. It is applied by the aged care system and starts from the date of entry until the day before advice is issued.

• Home care
• CSR to zero is automatically applied by ACMPS
• Letters will be issued advising the period of CSR to zero and the care recipient’s ongoing fees
• Residential care
• CSR to zero is automatically applied by Aged Care Payment System
• Letters will be issued advising the period of CSR to zero and the care recipient’s ongoing fees
• To view care recipient’s fees and charges see Aged Care Staff Portal (ACSP) - Care Recipient in Context (CRiC))

See the Resources page for a link to the Aged care letter codes and descriptions document for information about CSR to zero letters.

When a care recipient has been departed from care before the approved provider receives a fee advice, CSR to zero is automatically applied. The approved provider is considered to have received the advice before departure. Care subsidies paid to the approved provider will be adjusted by the aged care system. No fee advice letters are issued, however may be requested by the care recipient or provider.

Service Officers can receive requests to issue fee advice letters confirming ITCF/MTCF has been set as $0 for the period of care. These letters are manually issued:

• Where the care recipient is deceased:
• only the executor of the estate is able to request a manual letter
• evidence is required to verify that the person requesting the letter is the executor or administrator of the estate
• Where the care recipient is not deceased, the care recipient or their nominee can request a manual letter

Where a care recipient enters a new facility, legislation does not state how long the break between care needs to be. Where there is a departure on an unmatched record, CSR to zero is applied, irrespective of whether another admission occurs.

For aged care recipients, the CSR is set to zero when they depart an aged care service (without entering another aged care service of the same care type).

Care recipients who move into a new service of the same care type, on the same date, the care recipient does not meet the CSR to zero eligibility criteria and this cannot be applied, unless other conditions are met, for example if they are a former prisoner of war. Refer above for all CSR to zero eligibility conditions.

See Aged Care Staff Portal (ACSP) - Care Recipient in Context (CRiC)) for information about how to:

• view fees and charges, remediation of fees, or
• update or delete existing remediation of fee record for residential care recipients

The current process for home care in ACMPS remains unchanged.

The Resources page contains links to the letter templates.

Care recipients assessed under pre 1 July 2014 assessment schemes can complete an income assessment. This determines the amount of income tested fee (ITF). If the care recipient has a means not disclosed status, they pay full ITF, based on the cost of their care. This reduces the amount of care subsidy paid to a provider. This is known as the Income Tested Subsidy Reduction (ITSR) in both SPARC and the ACSP.

Pre 1 July 2014 care recipients are eligible for their ITR to be assessed as zero when they:

• have 1 or more dependent children
• are described in paragraph 85 (4)(b) of the Veterans’ Entitlements Act (which describes former prisoners of war)
• have a care subsidy reduction that is worked out to be less than $1
• leave a residential care service (without entering another residential care service), or who die, before the approved provider has been informed of the care recipient’s care subsidy reduction (if any)
• are not, within 6 months of entry to the residential care service, informed of the care recipient’s care subsidy reduction (if any)