In the 2016 budget the Minister Sussan Ley flagged a range of punitive reductions to slow the dramatic above-trend growth in ACFI funding. In December the Assistant Minister for Health and Ageing, Ken Wyatt, announced that instead of significant adjustments to the pain management and physiotherapy components of the Complex Health Care (CHC) domain, there will be a one year freeze on indexation of ACFI and in the second year a 50% freeze on indexation of the CHC domain.

You could almost hear the collective sigh of relief across the aged care industry.

Read the department’s factsheet on the new ACFI changes here

So what happened? Aged care peak bodies appear to have found an ally in Aged & Community Services Australia (ACSA), with their representation playing a strong role in mitigating the ACFI changes. But the budget problems remain. The Minister and health department bureaucrats have argued that the growth in ACFI funding is being driven by higher than expected claiming in the CHC domain. This is just the latest piece of ACFI tinkering as successive governments try to fit the funding to the budget. It is safe to presume that the forward estimates were incorrect to begin with.

The important news that isn’t getting much attention concerns the increased monitoring of ACFI claims. Quietly tucked away at the end of a recent media release, Ken Wyatt stated that ‘The Department of Health will be closely monitoring provider claiming patterns and additional funding has been allocated to improve compliance systems.’ Minister Ley has also flagged The Department’s focus on increased scrutiny of ACFI claims.

The prospect of tougher reviews and higher penalties mean that it’s now more important than ever to make sure all claims are correctly documented and supported with the right evidence. If you are concerned about the validity of claims at your facility, please contact AHP to discuss our comprehensive ACFI auditing and optimisation services.

In the case of 4a and 4b claims, all good service providers should already have a robust system in place that documents resident assessments, treatments and regular reviews. In the case of 4a and 4b claims, all good service providers should already have a robust system in place that documents resident assessments, treatments and regular reviews.

The pressure on managers to maximise their ACFI funding will continue unabated. As the main source of operating revenue, it’s incumbent upon management to continually monitor and review claims. Recognising that all facilities have unique characteristics, managers should focus on optimising results for their specific residents. There is no ‘one size fits all’ ACFI model, so it wise to scrutinise all the available information before diving in. At AHP, we offer extensive training packages and on-site support to assist management with maximising revenue.

It’s inevitable that any needs-based funding model will have the unintentional outcome of creating incentives to maximise claims (remember aromatherapy?). Recognising the need for an improved system, The Department has commissioned the University of Wollongong to develop an alternative funding model. Encouragingly, they’ve given assurances the development process will be shorter than the five years it took to develop the original ACFI!

The good news is that ethical providers and contractors don’t have to change the way they do business. At AHP, we never experience any pre-validation panic because our business model is already compliant. At AHP we offer highly competitive physiotherapy pain management rates, with a range of options to ensure you receive the maximum entitlements. Please contact AHP to discuss our range of services and the best way to proceed.