The government’s ACFI review is an ideal opportunity for providers to have their say on the funding instrument. Julie McStay offers advice for those drafting submissions.

The Minister for Ageing, Justine Elliot, recently released the terms of reference for the government’s review of the Aged Care Funding Instrument (ACFI). The government is seeking submissions from a diverse range of individuals and organisations that have had experience with using ACFI.

This is an excellent opportunity for aged care providers to consider the impact (both positive and negative) ACFI has had on their facilities and business. Providers should give careful consideration to their submission and ensure that, to the extent possible, their submission includes considered and viable alternatives to any of the ACFI processes that the provider considers have a negative impact on the ongoing viability of the industry as a whole or on their facility or business.

Preparing a submission

As a starting point, submissions should address the review’s terms of reference and provide justification for all comments and recommendations made. It is important, to the extent your submission calls for a change in any of the ACFI processes, that your submission is supported by evidence which shows why the current processes require change. It is also important to remember that all submissions will be published on the Department of Health and Ageing’s website. If you wish any information contained in your submission to be treated as confidential, you need to explicitly and clearly identify that information and outline why you consider it to be confidential.

It is not necessary for your submission to address all of the matters covered in the terms of reference. It is important however, that you clearly identify which points of the terms of reference you are responding to and set out your submission on those points in clear and concise terms. Where possible, you should provide evidence to support your position that a change in an ACFI process is appropriate.

While there is no specific format that a submission should take, it is important that it be an ordered response that clearly sets out:

• the terms of reference you are responding to

• your position in response to the individual terms of reference

• to the extent you submit that there should be a change in any process under the ACFI, details of the proposed change

• any evidence that you rely upon to support your position that a change is necessary

• details of how the change will result in a positive outcome for providers and residents.

You should also include an executive summary at the start of your submission which outlines key points of the submission.

Issues for review

The key issues to be examined in the review fall into five broad groups: matching funding to care needs; funding outcomes and impact on aged care providers; documentation and administrative arrangements; design issues including the roles of health professionals; and interface with other elements of aged care.

Matching funding to care needs

A key objective for ACFI is to better match funding to care needs, including providing better support for residents with high levels of care needs. The department seeks feedback in order to ascertain whether this objective is being met.

If providers are of the view that funding under ACFI does not match care needs, providers should consider making a submission on this issue. The submission should include appropriate examples and instances where the amount of funding received for a resident does not accurately match the resident’s care needs. In doing so, providers should identify which care needs are adequately accounted for and those which are inadequately covered. Providers may consider that ACFI does not provide adequate funding to meet care needs for either high care or low care residents and your submission should differentiate in this regard.

Providers may consider that the increase in funding has caused a direct impact on whether care needs of residents are being met more effectively than before ACFI was introduced. Providers may also consider incorporating in their submission their different percentage mix of high and low care residents and stating how this impacts on the viability of their facilities.

Funding outcomes and impact on aged care providers

The review will analyse the impact on funding available to the sector on a number of levels, including the impact of overall funding as well as the impact on different categories of aged care providers. This issue is pivotal for providers from all types of facilities (low care, high care and mixed care facilities and for profit, not-for-profit and state government providers) because while ACFI was designed to change the way funding is distributed amongst different types of residents, it was not intended to have a negative impact on overall funding.

If providers are of the view that the introduction of the ACFI has resulted in them receiving less funding overall, then consideration should be given to making a submission on this issue. Providers should consider issues in their submission such as:

• Has the introduction of the ACFI resulted in a change of mix of residents in your facility?

• If the mix is now more highly geared towards high care residents, did the change of mix create any difficulties for you in terms of service provision?

• How has the change in mix affected overall funding?

• How has the change in mix affected overall profitability/viability?

• Overall, are you in a better or worse position since the introduction of the ACFI?

Documentation and administrative arrangements

One of the key objectives for ACFI was to reduce the documentation and the administrative burden associated with the classification process.

In considering whether ACFI has achieved its purpose, providers might contemplate a submission which considers the following issues:

• Is the administrative burden created by ACFI less than existed under the old Resident Classification Scale (RCS)?

• Is the time required to justify appraisals worse under ACFI than under the RCS?

• Is more or less documentation required for appraisals?

• Would it be of assistance to providers if the department were to provide a more definitive prescription of the documents that have to be kept on file and for audits?

• How frequently do providers and the department disagree on appraisals and reviews?

• Have the frequency of disagreements increased since the introduction of ACFI?

• What is your experience of review visits? Are they too onerous? Are they repetitious?

• Are department staff who attend review audits appropriately qualified?

• Has your experience been that the quality of department assessors varies widely with some assessors basing their decisions on their personal preferences rather than an application of objective criteria?

• Are ACFI tools useful? If not, how could they be improved?

• Could the process be streamlined?

Design issues including the roles of health professionals

The review will examine if any potential design limitations exist in the current instrument, by determining whether there are any gaps or anomalies in ACFI in relation to care needs and whether ACFI appropriately recognises the various roles of staff involved in the delivery of care.

This is an opportunity for providers to reflect on any care needs that are not claimable under ACFI and to discuss to the extent possible (with examples), the practical implications or uncertainties that have resulted. Providers might also consider whether specific health professionals are being consulted more or less than before ACFI was introduced and how this affects their facilities and businesses.

Interface with other elements of aged care

The review will examine whether there are any areas where ACFI arrangements are not aligned with other aspects of the aged care system.

Once again, this is a great opportunity for providers to consider sharing their experiences with the new system and to the extent they think necessary, advocate for change.

If providers are of the view that there are elements of ACFI, which are inconsistent with other elements of the Aged Care Act, they should identify those inconsistencies in their submission. For example, the current processes which require an ACAT assessment and an ACFI assessment, do not sit well together because they involve different assessment tools. This may be an issue providers think is worthy of a submission.

Providers are reminded submissions are due by 5pm (AESDT) on Friday 12 March 2010.

Julie McStay is partner with Hynes Lawyers. She is available to assist providers in drafting submissions. Tel: (07) 3828 5530.