Aged care – correction to resident status 065-22022446

Scenario

Aged Care Payment System (ACPS) behaviour

Manual action required

Not low corrected to Low

ACPS will pay full MTAS to provider from date of entry into care.

• Manual calculation of any MTC liability
• MTC payable - M series letter
• BDF only - N series letter

Low corrected to Not Low

ACPS will refund all MTC, refund is manually stopped.

MTCF is reconciled by ACPS.

N series to confirm not low means resident status.

Multiple corrections

If an update corrected resident status and was wrong, initial letters are only required if previously issued at last correction.

If restoring original resident status to:

• Not low means - no N series required unless MTC letter previously issued
• Low means - calculation and M series required if MTC is payable as previous MTC has been disregarded
• Low means, BDF only - no N series required unless correction letter previously issued

Scenario

Current system behaviour

Manual remediation process

Resident status has been corrected to low means and care recipient liable to pay an Accommodation Contribution (MTC).

Incorrect MTC refunds would be stopped.

ACPS will:

• calculate the correct amount from date of entry into care as reconciliation and waive

Staff need to:

• complete manual calculation of MTC
• issue letters and email to HSDD with correct MTC

Resident status has been corrected to not low means and care recipient liable to pay a Means Tested Care Fee (MTCF).

ACPS will:

• calculate the correct amount from date of entry into care as reconciliation and waive

Staff should not:

• backdate MTCF liability, hold any MTCF refunds that are within $5000 of correct refund amount

Resident status of Not low means corrected to Low means

- current provider

ACSP will:

• pay Full Means Tested Accommodation Supplement (MTAS) paid to provider from date of entry until QR effective date
• MTCF refund generated in QR - where applicable (taking into account that some low means resident status have a liability for MTCF)
• MTC charged from QR or Ad hoc effective date and automatic letter generated

Staff need to:

• issue new corrected initial fee letter incorporating any MTC (if applicable) from date of entry:
• BDF only - N series letters
• MTC liability - M series letters
• email HSDD using approved email template, including:
• details of MTC calculated since date of entry
• all refunds due

Resident status of Not low means corrected to Low means

- previous provider

• No reconciliation would occur as the care recipient is already discharged from the service

Staff need to:

• refer or complete a manual discharge review when a request is received
• calculate any MTC (if applicable) from period of care with the previous provider
• email HSDD using approved email template, including:
• details of MTC calculated since date of entry
• all refunds due

Resident status of Low means corrected to Not low means

- current provider

• MTAS is no longer payable to provider
• Next QR will generate refund of all MTC which will be manually stopped
• No debt raised for MTCF (at QR, the system will reconcile the notional MTCF from date of entry and display these amounts however no debts are raised)
• MTCF will commence from effective date of QR/Ad hoc

Staff need to:

• stop MTC refund in QR
• issue new initial fee letters
• check letters have a $0 MTCF from date of entry until QR effective date (as debt are not raised) or if Ad hoc completed - letters to have $0 MTCF until Ad hoc date

Resident status of Low means corrected to Not low means

- previous provider

• No reconciliation would occur as the care recipient is already discharged from the service
• MTAS is not payable to provider

Staff need to:

• complete a manual discharge review - when a request is received (process to follow as above)
• email HSDD amount of refunds (if applicable)

Multiple corrections to resident status

Care recipient commences care as not low means (MND)

Means assessment completed and care recipient now low means

Update then made to correct details from date of entry and status now not low means

Correction actioned and care recipient assessed as low means

ACPS will:

• set maximum fees for MND
• pay Full Means Tested Accommodation Supplement (MTAS) to provider from date of entry until QR effective date and generate any MTCF refund due
• MTAS is recovered from provider. MTCF is set from QR (if applicable)
• pay Full Means Tested Accommodation Supplement (MTAS) to provider from date of entry until QR effective date and any MTCF refund generated

Note:

• No action required from Smart Centre
• MTC is manually calculated back to date of entry and initial fee letters created and manually issued confirming resident status
• MTC refund is stopped. Corrected manual initial fee letters created and manually issued
• A new manual assessment of MTC is completed from date of entry into care. Any previous fees of MTC are disregarded