Unspent Home Care Amounts

Page last updated: 21 September 2017

Fact Sheet

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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. Clients are able to choose a provider who best meets their goals and needs and to change their provider if they wish. If a client decides to make a change, their unspent home care amount (less any exit amount) will move with them to their new provider.

What is the unspent home care amount?

The unspent home care amount is the total amount of home care subsidy, supplements andhome care fees paid to an approved provider for a client (for a period of care), that have not been spent or committed on that client’s care.

The unspent home care amount is calculated for the period between:

  • 1 July 2015, or the date on which the client started receiving home care with the your organisation (whichever is later); and
  • the date on which your organisation stopped providing home care to the client (the cessation day).

If a client ceases care with your organisation, their unspent home care amount (less any exit amount) needs to be:

  • Transferred to the client’s new home care provider if the client is changing providers; or
  • Returned to the Commonwealth and the client (or their estate) if the client leaves home care (for example if they entered permanent residential aged care or passed away).

Unspent home care amounts are not required to be calculated if the client is transferring between home care services of the same approved provider. In this situation, the approved provider continues to be responsible for providing the client with a monthly statement which includes the available funds, expenditure and balance of any funds that have not been spent.

What do I need to do?

New Home Care Agreements must contain a statement that any care recipient portion or transfer portion of the unspent home care amount will be paid in accordance with the amended User Rights Principles 2014.

1. Calculate the unspent home care amounts

The steps and requirements for calculating a client’s unspent home care amount is detailed in the User Rights Principles 2014. Worked examples for calculating unspent home care amounts are also available on the department’s website.

Before completing the final reconciliation make sure claims for the client are up-to-date and that home care fees have been received and all expenses have been identified, including any outstanding invoices from subcontracted or brokered services.

Note: The calculation of a client’s unspent home care amount should not include:

  • Any home care fees paid in advance, as these should be must be separately refunded to the client by the provider; or
  • Home care subsidy for the cessation day, as home care subsidy is not paid for the client on that day.

2. Provide written notice of the unspent home care amount

Within 56 days after the cessation day, you must provide the client (or their authorised representative) with a written notice about their unspent home care amount. Before completing the final reconciliation make sure your claims for the client are up-to-date. You should also ensure that home care fees have been received and all expenses have been identified and processed, including any outstanding invoices from subcontracted or brokered services.

The written notice must include the:

  • cessation day for care and services to the client
  • exit amount  that has been deducted (if applicable)
  • client’s unspent home care amount, which is the balance of any unspent funds (less any exit amount) in the client’s package, broken down by the following portions
    • the care recipient portion, which is the unspent amount attributed to home care fees paid to the provider by the client, less any unpaid home care fees owed by the client
    • the Commonwealth portion, which is the unspent amount attributed to home care subsidy paid to a provider for a client
    • the transfer portion, which is the unspent amount that must be transferred to another provider when a client changes home care providers
  • any unpaid home care fees which have been deducted (if applicable).

The written notice must also explain how unspent home care amounts will be paid, so the client (or their estate) understands the process and the timeframes involved.

Note: Under the Quality of Care Principles 2014 (Section 13 and Schedule 3, Part 2), home care fees are an excluded item that must not be included in a package of care and services.

Home care subsidy cannot be used to account for unpaid home care fees. Any unpaid home care fees should include amounts that the care recipient owes, as reflected in the written individualised budget and the monthly statements given to the care recipient.

Where a care recipient has unpaid home care fees, this is a matter for the approved provider to manage with the care recipient under the terms of the Home Care Agreement.

The written notice must explain how the unspent home care amount will be paid, so the client (or their estate) understands the process and the timeframes involved.

3. Make payment of unspent home care amount

The time you have to make payment of a client’s unspent home care amount will depend on the circumstances, either changing providers or leaving home care.

When a client changes providers:

  • The client must notify their existing provider within 56 calendar days after the cessation day of the new provider that they have entered into a Home Care Agreement with, in order for their existing provider to arrange payment of the transfer portion of the unspent home care amount. If the existing provider is not notified within this period, they must treat any unspent home care amount as if the client has left home care.
  • The existing provider is required to make payment to the new provider within 70 calendar days after the cessation day.
  • The existing provider must also provide a copy of the client’s written notice of the unspent home care amount to the new provider at the time the payment is made. This allows the new provider to identify the transferred amount for the client.
  • The new provider must separately identify the transfer portion of the client’s unspent home care amount in the client’s monthly statement once it has been paid the amount from the previous provider. 

When a client leaves home care or passes away:

  • The provider must notify the Commonwealth of the Commonwealth portion (including nil amounts) within 70 calendar days through the claims process managed by the Department of Human Services.
  • The provider must transfer the care recipient portion to the client or client’s estate.
  • The Commonwealth portion will be recovered through deductions in future home care subsidy payments made to the approved provider.

The table below outlines the circumstance and the timeframes required for the transfer for unspent home care amounts.

Timeframes for making payment of unspent home care amount

  Client changes home care providers Client leaves home care Client passes away
Timeframes for payment of the unspent home care amount transfer portion
Transfer portion to be
paid to the new
approved provider
within 70 days after the
agreed cessation day
n/a
n/a
Timeframes for payment of the unspent home care amount care recipient portion
n/a
Care recipient portion to be paid to client within 70 calendar days after the agreed cessation day
Care recipient portion to be transferred to client's estate within 14 calendar days of being shown the probate of the will or letters of administration
Timeframes for notifying the unspent home care amount commonwealth portion
n/a
Notify the Commonwealth of the Commonwealth portion (including nil amounts) within 70 calendar days of cessation day
Notify the Commonwealth of the Commonwealth portion (including nil amounts) within 70 calendar days of cessation day

^ The existing provider must provide a copy of the written notice of the client’s unspent home care amount to the client’s new provider at the time the payment of the transfer portion is made.

* Providers must notify the Commonwealth of the Commonwealth portion through the claims process managed by the Department of Human Services. The Commonwealth portion will be recovered, either through deductions in future home care subsidy payments made to the approved provider, or through a debt notice.

4. Retain appropriate records 

The existing provider must retain the written notice of the client’s unspent home care amount, as well as records relating to the payment of a client’s unspent home care amount to another provider, or to the client (or their estate).

Non-compliance and sanctions 

If a provider has not paid all or part of a client’s unspent home care amount to the client or another provider within the required timeframes, the department can take regulatory action. The department will determine what the most appropriate and proportionate action is for the provider to return to compliance. This may include imposing sanctions.

If a sanction is imposed, the provider will be required to make payment within the period specified in a sanctions notice.  Notices of non-compliance and sanctions are published on the non-compliance and Home Care Package service finders on the My Aged Care website.

Providers that have not received the transfer portion of a client’s unspent home care amount within the legislated timeframes should:

  • Notify the client that their unspent home care amount transfer portion has not been received from their previous provider
  • Liaise with the client and the previous provider about the delay, as appropriate
  • Where necessary, support the client to raise the issue with the Aged Care Complaints Commissioner.

Key Points to Remember

  • If a client changes providers their unspent home care amount (less any exit amount) will transfer with them to their new provider.
  • If a client leaves home care their unspent home care amount (less any exit amount) will be returned to the client (or their estate) and the Commonwealth.
  • Within 56 calendar days of a client's cessation day you must provide the client with a written notice of their unspent home care amount.
  • You are required to make payment of a client’s unspent home care amount within the required timeframes.
  • The new provider must separately identify the transfer portion of the client’s unspent home care amount in the client’s monthly statement once paid.
  • You must keep records of the written notice provided to the client and records relating to the payment of unspent home care amounts.
  • Unspent home care amounts are not required to be calculated if the client is transferring between home care services of the same approved provider.

Further Information 

Visit the department’s website or email agedcarereformenquiries@health.gov.au.

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Related Documents

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.