Amendments to ACFI - 1 March 2017

Page last updated: 14 March 2017

Following ongoing consultation with the sector, the Australian Government is implementing changes to the ACFI announced in the 2015‑16 Mid-Year Economic and Fiscal Outlook measure, Aged Care Provider Funding – improved compliance.

Amendments

On 1 January 2017, amendments were made to the Aged Care Act 1997 (the Act) to strengthen compliance actions as a result of the department’s reviews of ACFI claims from approved providers.

Amendments made to the Classification Principles 2014 (the Principles), effective from 1 March 2017:

  • the department will be able to take into account the manner in which care was provided, and the qualifications of the person providing the treatment in determining the level of care that a care recipient needs
  • a fee of $375 (GST exclusive) per ACFI question will be charged for a request for reconsideration of an ACFI review decision.

The government will consult further with the sector on the amendment to the Principles requiring re-appraisal where an ACFI review has identified that a care recipient’s care needs have significantly decreased.

Collection of documentation

Appraisal packs provided to review officers must contain all the information that will enable review officers to verify claims for subsidy.

From 1 March 2017, the department will no longer routinely seek additional information to verify ACFI subsidy claims after the ACFI review visit is completed.

  • The ACFI User Guide requires a care recipient’s pack to be made available on request when a review is undertaken by the department.
  • Approved providers are required to keep records so that claims for payments of subsidy to be properly verified and proper assessments to be made of whether the approved provider has complied or is complying with its responsibilities.
  • Approved providers are able to submit additional information for 48 hours (i.e. two working days) following the completion of an ACFI review visit.

Review officer powers

Review officers have the powers to inspect any document or record kept at the premises and to take extracts from, or make copies of, any document or record at the premises.

Failure to provide documents requested by a review officer

If an approved provider does not provide documents requested by a review officer, the officers may refer the matter to the ACFI compliance team to consider whether compliance action should be taken.

Valid directive

When appraising the care recipient for an item under ACFI Question 12, the approved provider must obtain a valid directive where it is required by the ACFI User Guide. The Classification Principles specify that the care may be taken into account only if:

  • a directive has been given for the care by the kind of health care practitioner mentioned in the User Guide in respect of that care [see page 38 of the ACFI User Guide for the list of health professionals]; and
  • the directive states the manner in which the care is to be provided and the qualifications of the person who is to provide the care; and
  • the care was, is or is to be provided in the manner, and by a person with the qualifications, stated in the directive.

Request for reconsideration fee

The fee for a request for reconsideration has been introduced to encourage approved providers to comply with the record keeping requirements of the Aged Care Act 1997.

  1. Your request for reconsideration must be submitted within 28 days from the date of the review decision.

    • Download the ACFI request for reconsideration template
    • The template must be completed, signed, dated and submitted to the department.
    • The request for reconsideration template sets out all the requirements for seeking a reconsideration.
    • The request for reconsideration MUST include all information that was seen at the review and where applicable any new information that was relied upon in completing your organisation’s ACFI Answer Appraisal Pack.
  2. Following submission of your request, the department will send you an invoice for $375 (GST exclusive) per ACFI question that you are seeking a reconsideration for.

     

    • The fee must be paid before the department will make a decision on the request for reconsideration.
    • The fee will be refunded if you do not provide any new information other than what was considered as part of the review and the decision made at review is varied or set aside.

More information

Please email ACFI@health.gov.au.