Note: Part 3.3 of the Aged Care Act 1997 is about payment by the Commonwealth of a flexible care subsidy to approved providers for providing flexible care to care recipients.
Note: These Principles set out who is eligible for flexible care subsidy and on what basis flexible care subsidy may be paid.
Chapter 1—Preliminary
15.1 Citation
These Principles may be cited as the Flexible Care Subsidy Principles 1997.
15.2 Commencement
These Principles commence on 1 October 1997.
15.3 Definitions
In these Principles:
Act means the Aged Care Act 1997.
Aged Care Assessment Team has the same meaning as in the Aged Care Assessment and Approval Guidelines 2006.
Note: The Aged Care Assessment and Approval Guidelines 2006 are accessible on the Internet at http://www.health.gov.au
episode of transition care, in relation to a care recipient and an approved provider, means a continuous period during which the care recipient is provided with flexible care in the form of transition care by the approved provider.
existing program means a program being administered by a Commonwealth or State aged care or health agency.
further transition care needs, in relation to a care recipient, means the care needs of that care recipient, as assessed by an Aged Care Assessment Team, or a member of such a team, during an episode of transition care.
goal‑oriented, in relation to a care service, means targeted at achieving specific goals in relation to a care recipient’s functional improvement.
innovative care service means a flexible care service that provides care of a kind specified in section 15.24.
in‑patient hospital episode, in relation to a care recipient, means a continuous period during which the care recipient:
(a) is an in‑patient of a hospital; and
(b) is provided with:
(i) acute care and any necessary subacute care (if any); or
(ii) subacute care.
low intensity therapy, in relation to a care recipient, means therapy that:
Part Part 2 - Flexible Care Subsidy Principles 1997 - Eligibility for flexible care subsidy | Zoe
(a) maintains the care recipient’s physical and cognitive functioning; and
(b) facilitates an improvement in the care recipient’s capacity in respect of activities of daily living.
Example 1: Occupational therapy.
Example 2: Physiotherapy.
Example 3: Social work.
major city means one of the major cities of Australia within the meaning of the Australian Statistical Geography Standard (ASGS): Volume 5 ‑ Remoteness Structure, July 2011, produced by the Australian Bureau of Statistics.
multi‑purpose service means a flexible care service that is approved under subsection 15.14(1).
State includes a Territory.
subacute care means medical or related care or services provided to a care recipient who is not in the acute phase of an illness.
Example 1: Rehabilitation.
Example 2: Palliative care.
Example 3: Psychogeriatric care.
Example 4: Geriatric evaluation and management.
transition care has the meaning given by section 15.28.
Note: A number of expressions used in these Principles are defined in the Act, including the following:
(a) flexible care subsidy;
(b) residential care.
Chapter 3—Multi‑purpose services
Part 1—Approval of flexible care services
15.13 Purpose of Part (Act, s 50‑2)
This Part specifies arrangements for the approval of flexible care services provided by approved providers as multi‑purpose services.
15.14 Approval
(1) The Secretary may, in writing, approve a flexible care service provided, or proposed to be provided, by an approved provider as a multi‑purpose service.
(2) The Secretary may approve the flexible care service only if the requirements of subsections (3) to (7) are met.
(3) The flexible care service must provide, or propose to provide, an integrated service that includes:
(a) residential care; and
(b) at least 1 of the following:
(i) a health service provided by a State;
(ii) a home and community care service;
(iii) dental or other health care;
(iv) transport services;
(v) home care under the Act;
(vi) a service for which a medicare benefit is payable under the Health Insurance Act 1973;
(vii) the provision of a pharmaceutical benefit under the National Health Act 1953;
(viii) a service that the Minister nominates, in an agreement with the responsible Minister of the State, as an appropriate service.
(4) The approved provider must also be able to:
(a) provide the flexible care to people in an area that is not a major city; and
(b) target the care to meet the needs of people in an area that is not a major city; and
(c) improve access to the care; and
(d) increase coordination, flexibility and innovation in the delivery of the care; and
(e) ensure the care is cost‑effective; and
(f) ensure the care is culturally appropriate.
(5) The approved provider must provide, or propose to provide, the flexible care in an area (the multi‑purpose service site) with the following characteristics:
(a) the multi‑purpose service site does not meet the criteria of existing programs for establishing a full range of aged care and health services;
(b) the multi‑purpose service site can sustain a viable multi‑purpose service;
(c) there is broad support within the multi‑purpose service site for a change in the aged care and health service delivery in the multi‑purpose service site;
(d) the agencies that administer existing programs for the multi‑purpose service site agree to take part;
(e) the Commonwealth and the State concerned agree that the multi‑purpose service site needs a multi‑purpose service.
(6) The approved provider must be a voluntary or private organisation, local government agency, residential aged care service, or a State health agency, that:
(a) has sufficient representation from the multi‑purpose service site to reflect a broad cross‑section of the multi‑purpose service site; and
(b) is acceptable to the Commonwealth, the State, and broadly within the multi‑purpose service site; and
(c) has entered into an agreement with the Commonwealth and State to ensure that the flexible care service achieves agreed targets for the aged care and health needs of the multi‑purpose service site.
(7) The Secretary must be satisfied that:
(a) there has been broad‑based consultation about the flexible care service within the multi‑purpose service site, including consultation with existing service providers and agencies; and
(b) the service has been endorsed within the multi‑purpose service site; and
(c) an evaluation strategy has been established for the service that includes:
(i) consideration of the service as a whole, the outcomes that the approved provider intends to provide, and the impact of the service on other services in the multi‑purpose service site; and
(ii) an information collection system to support the decision‑making processes of the service and to allow for extraction of aggregated data to assist in the evaluating of the service.
15.14A AAT review of decision not to approve flexible care service as multi‑purpose service
Application may be made to the Administrative Appeals Tribunal for the review of a decision by the Secretary under section 15.14 not to approve a flexible care service as a multi‑purpose service.
Part 2—Eligibility for flexible care subsidy
Division 1—Care recipients who do not need approval
15.15 Purpose of Division (Act, s 50‑1)
This Division specifies a class of people who do not need approval under Part 2.3 of the Act in respect of flexible care.
15.16 Class of people
The class of people is care recipients who receive flexible care through a multi‑purpose service.
Division 1A—Circumstances in which flexible care is taken to be provided
15.16A Purpose of Division (Act, s 50‑1)
This Division sets out circumstances in which an approved provider is taken to provide flexible care.
15.16B Circumstances
An approved provider is taken to provide flexible care during a day if the provider holds, in respect of that day, an allocated place that is in force under Part 2.2 of the Act (other than a provisional allocation) for the provision of care through a multi‑purpose service.
Division 2—Kind of care
15.17 Purpose of Division (Act, s 50‑2)
This Division specifies a kind of care for which flexible care subsidy may be payable.
15.18 Kind of care
The kind of care for which flexible care subsidy may be payable is flexible care provided through a multi‑purpose service.
Part 3—Payment of flexible care subsidy
15.19 Purpose of Part (Act, s 51‑1)
This Part sets out the arrangements for payment of flexible care subsidy for flexible care provided through multi‑purpose services.
15.20 Payment agreement
(1) Flexible care subsidy for flexible care provided through multi‑purpose service is payable only if:
(a) the Minister enters into an agreement with a State for the funding of flexible care services; and
(b) the agreement applies to the multi‑purpose service, or the multi‑purpose service site in which it provides flexible care; and
(c) the agreement meets the requirements of subsections (2) to (4).
(2) Funding under the agreement must be provided on the basis that the funds will be included as part of a funding pool that may include the total of some or all of the funds for existing services.
(3) Funding under the agreement must also be provided on the following bases:
(a) for funding under the residential aged care places program—the planned number of places must be consistent with Part 2.2 of the Act;
(b) for funding of the home and community care services program—the current level of that funding must be maintained for the multi‑purpose service site concerned and must be supplemented only in accordance with Commonwealth and State priorities;
(c) for funding under the medical services program:
(i) all funding from Commonwealth and State sources for medical services may be included, but the funding may vary according to the structure of existing services, including fee for service and salaried schemes; and
(ii) the total benefits paid to residents of the multi‑purpose service site for medical services provided by local general medical practitioners may be calculated as an annual average and may be included in the pool of funds for the multi‑purpose service;
(d) for funding of pharmaceutical benefits—payments made in the multi‑purpose service site for pharmaceutical benefits included in the Pharmaceutical Benefits Scheme, and the expenditure from drugs dispensed from public hospitals, may be included;
(e) for funding under the hospital, dental and community health programs—funding in the context of the overall hospital, dental and community health services of the multi‑purpose service site may be included;
(f) for funding under the transport program—the current level of funding for ambulance and community transport services may be included;
(g) inclusion of any funding set out in this subsection must be on the basis of agreement within the multi‑purpose service site and with the existing providers of the services and programs;
(h) any cost savings resulting from the restructuring of aged and health care services for the multi‑purpose service site must be applied to the provision of aged care and health services in the multi‑purpose service site unless otherwise agreed between the Commonwealth and State.
(4) The agreement must provide that approvals of, and announcements about, funding of the multi‑purpose service will be made jointly by the Commonwealth and State.
Chapter 4—Innovative care services
Part 1—Eligibility for flexible care subsidy
Division 1—Care recipients who do not need approval
15.21 Purpose of Division (Act s 50‑1)
This Division specifies a class of people who do not need approval under Part 2.3 of the Act in respect of flexible care.
15.22 Class of people
The class of people is care recipients who are receiving flexible care through an innovative care service.
Division 2—Kinds of care for which flexible care subsidy may be payable
15.23 Purpose of Division (Act s 50‑2)
This Division specifies kinds of innovative care services for which flexible care subsidy may be payable.
15.24 Kinds of care
(1) The following kinds of care are specified for subsection 50‑2(1) of the Act:
(a) care that, by its nature, provides alternative care options;
(b) care provided in circumstances that require the delivery of alternative care options;
(c) care provided in a location that, by its nature, requires the delivery of alternative care options;
(d) care provided to a group of people who are in need of alternative care options;
(e) care provided for a limited period to facilitate alternative care options;
(f) other kinds of care that, to the satisfaction of the Secretary:
(i) are provided in a residential or community setting; and
(ii) provide alternative care options.
Note: Examples for paragraph (a):
1 The provision of care for older persons with complex conditions.
2 The provision of care for older persons who require coordination and integration of care.
Note: Examples for paragraph (b):
1 Care provided in an emergency such as natural disasters including fire or flood.
2 Initiatives to address access by older persons to, or the viability of, aged care services.
3 Care provided where the care needs of a care recipient are not being adequately met by available residential care services or home care services.
4 Joint initiatives between the Commonwealth and a State or Territory to promote alternative care options for older persons.
Note: Example: For paragraph (c), care provided in an area that is not a major city.
Note: Examples for paragraph (d):
1 Care provided to older persons who require coordination and integration of care.
2 Care provided to older persons with complex, chronic conditions.
3 Care provided to older persons who need short term aged care following hospitalisation.
Note: Examples for paragraph (e):
1 Care provided by a pilot service or project.
2 Care provided to care recipients in places that have been allocated for a limited time in an emergency.
(2) In this section:
alternative care options means options for providing flexible care to older persons that meets the needs of care recipients in alternative ways to the care provided through residential care services and home care services.
Part 2—Payment of flexible care subsidy
15.25 Purpose of Part (Act s 51‑1)
This Part sets out the requirements for payment of flexible care subsidy to approved providers for flexible care through innovative care services.
15.26 Payment of subsidy
(1) Subject to subsection (2), flexible care subsidy is payable to an approved provider in accordance with the conditions, if any, set by the Secretary under section 14‑5 of the Act in relation to the allocation of places to the provider.
(2) If an approved provider is providing innovative care in accordance with a joint initiative of the Commonwealth and a State or Territory, flexible care subsidy is payable to the approved provider only if:
(a) the State or Territory also provides funding, at a level agreed with the Commonwealth, for the approved provider; and
(b) the State or Territory funding is directed to meeting the needs of care recipients that are the responsibility of the State or Territory.
Note: Examples for paragraph (b):
1 Rehabilitation.
2 In‑patient services.
Chapter 5—Transition care
Part 1—What is transition care?
15.27 Purpose of Part (Act s 50‑2)
This Part explains what is meant by transition care.
15.28 What is transition care?
Transition care is a form of flexible care that is provided to a care recipient:
(a) at the conclusion of an in‑patient hospital episode; and
(b) in the form of a package of services that includes, at least:
(i) low intensity therapy; and
(ii) either:
(A) nursing support; or
(B) personal care; and
(c) as care that can be characterised as:
(i) goal‑oriented; and
(ii) time‑limited; and
(iii) therapy‑focussed; and
(iv) targeted towards older people; and
(v) necessary to:
(A) complete the care recipient’s restorative process; and
(B) optimise the care recipient’s functional capacity; and
(C) assist the care recipient, and his or her family or carer (if any), to make long‑term arrangements for his or her care.
Part 2—Eligibility for flexible care subsidy
15.29 Purpose of Part (Act, s 50‑2)
This Part specifies a kind of care for which flexible care subsidy may be payable.
15.30 Kind of care
The kind of care for which, under this Chapter, flexible care subsidy may be payable is flexible care provided by an approved provider in the form of transition care.
Part 3—Payment of flexible care subsidy
15.31 Purpose of Part (Act, s 51‑1)
This Part specifies:
(a) the arrangements for payment of flexible care subsidy to approved providers for the provision of flexible care in the form of transition care; and
(b) the maximum number of days for which flexible care subsidy is payable in relation to an episode of transition care.
15.32 Payment of subsidy
Flexible care subsidy is payable if:
(a) a State also provides funding, at a level agreed with the Commonwealth, for the approved provider; and
(b) that funding is directed to meeting the needs of transition care recipients.
15.33 Payment agreement
The Secretary may, for the Commonwealth, enter into an agreement with an approved provider specifying the following matters:
(a) the period of the agreement;
(b) that flexible care subsidy is to be paid monthly, and in advance;
(c) how claims for flexible care subsidy are to be made;
(d) care recipients’ entitlements and obligations, including procedures for formal agreements between the approved provider and the care recipient;
(e) reports and information to be given to the Secretary by the approved provider for:
(i) evaluating the care; or
(ii) accountability purposes;
(f) an appropriate quality assurance framework in respect of the provision of transition care by the approved provider;
(g) outcome standards against which the provision of transition care services by the approved provider is to be evaluated;
(h) the circumstances justifying variation and termination of the agreement;
(i) appropriate conditions to be met by the approved provider for the payment of flexible care subsidy;
(j) other conditions considered by the Secretary to be necessary for the effective provision of care;
(k) the maximum amount of fees the approved provider may charge a care recipient;
(l) conditions relating to the charging of fees for the provision of transition care by the approved provider;
(m) indemnity and insurance requirements that the approved provider is required to satisfy.
Note: The amount of flexible care subsidy that is payable in respect of a day is the amount determined by the Minister in writing under paragraph 52‑1(1)(a) of the Act.
15.34 Maximum number of days
The maximum number of days for which flexible care subsidy is payable in respect of an episode of transition care is:
(a) 84 days; or
(b) such greater number of days, to a maximum of 126 days, as is necessary to ensure that the care recipient’s further transition care needs are met.