Claiming for home care services

Page last updated: 07 August 2017

FactsheetClaiming for home care services 

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The Australian Government is improving the way home care services are delivered to older Australians. These changes are important for a sustainable and quality aged care system that is more consumer driven, market based and less regulated. This fact sheet provides information about the claiming arrangements managed through the Department of Human Services (DHS).

A client is only eligible to receive subsidised aged care services when they have been assigned a home care package from the national prioritisation system. Once assigned a package the client will be sent a letter that includes their unique referral code and the date that they must enter into a Home Care Agreement. If a client has any concerns, you should ask encourage them to call the My Aged Care contact centre on 1800 200 422.

Claims validation

You can only claim home care subsidy for clients that have been assigned a home care package from the national queue. The DHS payment system checks provider claims against the My Aged Care listing of care recipients with an assigned home care package. DHS cannot process a claim for a client if they do not have a home care package that is assigned and active.

Notifying DHS of client starting care

Once a client has been assigned a home care package they have 56 calendar days (with the option for a 28 day extension) to enter into a Home Care Agreement. Before you can make a claim for home care subsidy for a client you need to:

  • Accept the client’s referral for service in the My Aged Care Provider Portal;
  • Enter into a Home Care Agreement with the client; and
  • Provide client entry information to DHS within 28 calendar days of a client commencing their home care services either through the Aged Care Online System (ACOS) or through the submission of an Aged Care Entry Record (ACER).

Entry information must be provided to DHS as early as possible and before the client’s package take-up deadline to ensure their package is not withdrawn.

Notifying DHS of client ceasing care

Within 31 calendar days of a client ceasing services, you must notify DHS through the aged care payment system of:

  • The client’s name;
  • Their cessation day; and
  • The reason for their departure, which may be because  the client moved to residential aged care, passed away, or changed providers.

Note: If a client passes away, in addition to making the necessary changes on the provider portal it is advisable that you call My Aged Care on 1800 200 422 so they can update the client’s record. Alternatively, you can advise the client’s authorised representative to call My Aged Care.

Calculation of home care subsidy

Home care subsidy for a client is calculated daily as follows:

  • the basic subsidy amount (the daily rate for the package level);
  • plus any primary supplements (oxygen supplement, enteral feeding supplement, dementia and cognition supplement, veterans' supplement);
  • less any reductions in subsidy (e.g. income-tested care fee); and
  • any other supplements (hardship supplement, viability supplement).

Home care subsidy is paid monthly and is calculated by adding together the daily amounts for each day a client received care under their Home Care Agreement during the month. This is based on information provided in the monthly claim form submitted to DHS through Aged Care Online Claiming.

Commonwealth portion of the unspent home care amount

If a client ceases home care or passes away, you must notify the Commonwealth of the Commonwealth portion of the client’s unspent home care amount (including zero amounts) through the DHS claims process within 70 calendar days. The home care claim form will include a new part for you to complete the Commonwealth portion of a client’s unspent home care amount.

You also need to notify the Commonwealth of the Commonwealth portion of the client’s unspent home care amount (including zero amounts) within 70 calendar days if your client has changed providers and they have not notified you within 56 calendar days after the cessation day of their new provider.

The home care claim form includes a section for you to notify the Commonwealth of the Commonwealth portion of a client’s unspent home care amount. The Commonwealth portion will be recovered, either through deductions in future home care subsidy payments made to you, or through a debt notice. 

Payment statements

Payment statements are issued by DHS to provide you with information about the Australian Government subsidy and supplements paid for care recipients receiving a Home Care Package in a specified month. They also reflect adjustments from recovery of the Commonwealth portion of the unspent home care amount.

Key points to remember

  • You can only claim for clients that have been assigned a home care package from the national queue.
  • The DHS payment system checks provider claims against the My Aged Care listing of care recipients with an assigned home care package.
  • Clients have 56 calendar days (with the option for a 28 day extension) to enter into a Home Care Agreement before their package is withdrawn.
  • You need to accept a client’s referral in the My Aged Care Provider Portal and enter into a Home Care Agreement with the client before submitting an Aged Care Entry Record (ACER).
  • Submit an ACER within 28 calendar days of a client commencing their home care package.
  • The early submission of an ACER is important to reduce the chance of a client’s home care package being withdrawn in error.
  • You are required to notify DHS within 31 calendar days of a client ceasing care through the aged care payment system.
  • You also need to notify the Commonwealth of the Commonwealth portion of a client’s unspent home care amount (including zero amounts) within 70 calendar days of the client’s cessation day.

Further information

Related documents

Fact sheet – Changing Home Care Providers

Fact sheet – Unspent Home Care Amounts 

This fact sheet provides general guidance to support the implementation of the Increasing Choice in Home Care reforms. It does not constitute legal advice, nor is it a substitute for responsibilities under the legislative framework.