ACFI Questions & Answers

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ACFI Questions & Answers

Question:
If the facility does NOT have a Dementia Diagnosis for a resident at the time of submitting the ACFI to the Department; is there a 3 months allowable time permitted eg. a Provisional Diagnosis in order to obtain the Diagnosis from the doctor as is the case for ACFI 10 Depression?

Answer:
No, you must have the diagnosis before you submit the ACFI.

Question:
Is there a time frame requirement for a ‘dementia’ diagnosis?

Answer:
No, the only diagnoses that are required to have been completed or reconfirmed within the past twelve months are those related to categories 540(Delirium), 550A(Depressions, mood and affective disorders), 550B(Psychoses e.g. schizophrenia, paranoid states) and 560(Neurotic, stress related, anxiety, somatoform disorders e.g. post traumatic stress disorder, phobic and anxiety disorders, nervous tension/stress, obsessive-compulsive disorders).

Question:
Complex Health Care: With regard to and “allied health professional directive”, can this directive be given by a Massage Therapist?

Answer:
The list of allied health professionals covered by the question are listed and a Massage Therapist is not listed.

Question:
Complex Health Care: With regard to an “allied health professional directive”, can this directive be given by an Aroma therapist?

Answer:
No. An Aroma therapist is not included in this classification.

Question:
Is a TENS machine included in the description of “technical equipment”

Answer:
Yes.

Question:
If a redisdent is on the RCS saved rate, when will they transfer to the ACFI Rate?

Answer:

If another ACFI assessment is completed on the resident (e.g. as a result of a major change or return from extended hospital leave), and the resulting ACFI payment rate is $15 or more above their current RCS payment rate, the resident will move to being ACFI funded OR if the resident has been reviewed by a Commonwealth Nursing Officer and the resident’s RCS claim has been downgraded to where it is now $15 or more below the ACFI payment rate.

Question:
I have heard that the Commonwealth Nursing Officers will not be looking at progress notes during the validation process. If a doctor writes a directive (or a diagnosis) in the progress notes, is this OK?

Answer:
Yes, and a copy of the relevant page should be included in the ACFI appraisal pack for validation. As long as the information meets the minimum evidence requirements it can be recorded anywhere. It is the day to day commentary of the resident in the progress notes that won’t be examined.

ACFI: Frequently Asked Questions
An updated list of the Frequently Asked questions is now available on the Department of Health and Ageing website. It can be found at:

http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-faq.htm.

Information Regarding Business Rules

Requirements for assests assessment for Resident Transfers

The need for a new assets assessment for residents who transfer from one RACS Id to another will depend on the circumstances of each of the residents -

A resident who was assessed by an aged care provider as a concessional resident in the current home will need to have a new assessment if they wish to enter the new home as a concessional resident.
A resident who was assessed by an aged care provider as an assisted resident in the current home will need to have a new assessment, if they wish to enter the new home as an assisted resident. However, if they do not, and if they are in high care, they cannot be asked to pay an accommodation charge in the new home which is higher than the maximum rate of charge they are eligible to pay in the current home (section 57A-8A of the Act refers). If they have paid a bond in the current home, they cannot be asked to pay a bond amount which is more than the balance of the bond that is rolled over to the new home (section 57-13 refers). If the resident does not apply for an assets assessment and/or the is not assessed as eligible to be an assisted resident in the new home, assisted resident supplement will not be paid to the new home.
An assisted resident who pays an accommodation charge may benefit from having another assessment for entry to the new home. They may be eligible to be a concessional resident in the new home if the value of their assets has decreased sufficiently.
A resident who was assessed by Centrelink or the Department of Veterans' Affairs (DVA) as a concessional or assisted resident in the current home will not need to have another assets assessment (subsections 44-7(1A) and 44-8(1A) refer). They will still be a concessional or assisted resident in the new home.
A resident (who is not a concessional or assisted resident) who has paid a bond to the current home does not need an assessment. Their maximum bond amount cannot be higher in the new home than it is in their current home (s.57-13).
A resident (who is not a concessional or assisted resident) who is paying an accommodation charge in the current home does not need an assessment. The maximum charge amount that they are currently eligible to pay will be the maximum charge amount payable in the new home (s.57A-8A). However, these residents can choose to have another assessment and their charge amount may be lower if the value of their assets has decreased since their entry to the current home. They may even be eligible to be a concessional or assisted resident.

Requirements for an ACAS re-assessment

The effect of a transfer on resident classification varies dependent upon whether they are currently classified using the RCS or the ACFI.
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Residents classified using the RCS

An RCS classification expires when the resident permanently departs the care of the original aged care service. The new aged care service would be required to submit an ACFI Application for Classification within 2 months of the date of entry into care. A new ACAS approval would also be required where a resident whose initial approval was limited to low care has aged in place to high care in the original service.

The resident may agree to pay an accommodation charge or rollover the balance of an existing accommodation bond so long as he or she enters the new service within 28 days.

Grand parenting of the RCS rate does not apply for these residents. This means that the amount of care subsidy received for the resident by the new service will be the ACFI rate.

Residents classified using the ACFI

An ACFI classification will not expire when the resident permanently departs the care of the original aged care service. A resident for whom an RCS saved rate is paid has an ACFI classification. The new aged care service has the option to submit an ACFI Application for Classification within 2 months of the date of entry into care.

ACAS approvals are not generally required as the approval for permanent residential care will not lapse and the classification will not expire so long as the resident enters the care of the new service within 28 days. However, an ACAS assessment may be requested where a resident whose initial approval was limited to low care has aged in place to high care in the original service and the resident wishes to pay an accommodation charge to the new service rather than rollover the balance of their accommodation bond. No ACAS approval is required where the resident wishes to rollover the retained amount of an accommodation bond.

The rate payable at the new service will be one of the following:

the existing RCS saved rate;
the existing ACFI rate; or
a new ACFI rate (where the new service chooses to submit an application within 2 months)

Financial Information
Events under ACFI that remove the 'Interim Low' Subsidy Limitation

Under ACFI the full ACFI high care subsidy may be paid for a resident with an ACAT approval limited to low care when one of the following events occurs:

The resident ages in place i.e. a high care ACFI reappraisal is conducted. The circumstances of the reappraisal might include:

expiry of an existing ACFI classification (e.g. following a period of extended hospital leave, or six months after entering care directly from hospital);
when there is a major change in care needs;
a voluntary reappraisal 12 months or more after a previous appraisal; or
a voluntary reappraisal following a transfer within 28 days¹;
an ACAT assessment is provided which is not limited to low care; or
a Departmental Review Officer confirms the resident requires an ACFI high level of care during a classification review.

Note 1: Under ACFI rules, if the resident moves within 28 days their ACFI classification will also transfer with them. The new facility can either accept this classification or reappraise them within 2 months of entry. If they choose to reappraise them this is equivalent to ‘ageing in place’ and in these circumstances an ACAT reassessment would not be required for the facility to receive the full high care ACFI subsidy.

ACFI: effect of RCS validation downgrade

ACCV has received some important information from the Department of Health and Ageing with regard to the change in resident funding as a result of RCS validations. If you have received a RCS validation and some residents have been downgraded, it is important to be aware of the potential positive impact that this may have on the resultant funding for some residents as they change to ACFI funding. (It is also important for a facility to assess the change to the resident’s funding level, balanced against the loss of funding due to the back dating of the downgrade, in their decision in lodging an appeal.- Not in original bulletin article.) An extract from a letter received from DoHA is included below.

“The Department of Heath and Ageing (DOHA) has received a number of appeals against decisions to change the classification of care recipients where in fact the facility is in receipt of a higher subsidy level as a consequence of the review. You would be aware that once an ACFI has been completed for an existing resident, the rate of subsidy will be either the new ACFI rate or the person's existing RCS rate. The new ACFI rate applies where the ACFI appraisal results in an increase in the daily subsidy of $15 or more. This means that there are situations where the ACFI appraisal results in a rate that is more that the RCS rate but less than $15 more and therefore the current RCS rate of subsidy continues to be paid.

“For residents on these RCS saved rates, a downgrade at review will result in the situation where the ACFI rate is now $15 more than the RCS rate. In this situation the ACFI rate, which was higher than the original RCS rate, is the rate that would now be paid.”

Specified Care & Services

Specified Care & Services (information from DoHA- received 25/08/08.) - ACFI High Care and Low Care

The Quality of Care Principles 1997 state in Part 2: Responsibilities of approved providers that an approved provider must provide the care or service to residents as stated in Schedule 1, Part 3, Care and Services - to be provided for residents receiving a high level of residential care.

If a resident has an ACFI classification at any of the care levels below, they are considered to require a high level of residential care.

Medium or High in ADLs (Activities of Daily Living Questions. 1 - 5)
High in BEH (Behaviours Questions. 6 -10)
Medium or High in CHC (Complex Health Care Questions. 11 -12)

If a resident is categorised at any other care levels, they require a low level of residential care.

For example a resident classified as ADL High, BEH Nil and CHC Low is considered high care. By way of contrast, a resident classified as ADL Low, BEH Medium and CHC Low would be low care.

Note: An exception to this rule is a new resident with an ACAT approval limited to low care, but whose first ACFI classification rates them in a high care range. These residents are classified as an 'interim low' (low care) and are funded at a default rate of $44.14 per day. Therefore for these residents, the approved provider is not required to provide high level specified care and services.

ACFI: the requirement to provide high care specified care ans services

A question was raised by a participant at the Residential Care Seminar querying whether a facility was required to pay high care specified care and services for a resident who is now classified as high care under ACFI but who is only being paid at the grand parented lower rate. ACCV followed up this question with the DoHA in Canberra and have now received an answer to this (included below). The issue (and answer) has also been tabled by ACCV with our national peak bodies, ACAA & ACSA as a concern, because in these circumstances, facilities are now being required to provide resident services for which they are not being funded. The national peaks have reported that they have previously and will continue, to raise this as a concern.

“……… this issue is confined to 6 particular ACFI classifications NNH, NMM, NLM, NHL, NNM and NHN. I have confirmed that these classifications will require the provision of high level specified care and services as this requirement is dependent on the ACFI classified level not the saved rate RCS subsidy being paid.

The table below shows the saved rate subsidies and corresponding ACFI high classifications that do not reach the $15 threshold.”

RCS Saved Rate
S5 ($43.09)	NLM ($44.14)	NMM ($51.31)	NNH ($54.09)
S6 ($35.70)	NNM ($37.46)	NHL ($42.32)	NLM ($44.14)
S7 ($27.42)	NHN ($29.17)	NNM ($37.46)	NHL ($42.32)

(Information copied from an email received from Canberra office of the Dept of Health & Ageing)

High Care RCS/Low Care ACFI - provision of specified care & services

ACCV has received an answer from Canberra to clarify a question highlighted by a member regarding a resident who was rated as high care under RCS but is now classified as low Care under ACFI. The scenario is that this resident is now being funded at the saved rate of high care, although their ACFI is now rating this resident as low. The question was asked as to whether the facility was required to provide the high care specified care and services?

The answer is that if they were RCS high and now ACFI low that the service will still need to provide the high care specified care and services. This situation is covered in an amendment to the Quality of Care Principles: subsection 18.6 (3).

Other

ACFI: Potential impact on compliance with Code For Guidance - Medication Management for High Care Residents

A reminder to facilities that when an ACFI reappraisal causes a resident to change from ‘low’ care to ‘high’ care, the requirements of the Code for Guidance: Medication management for high care residents also become applicable. The main impact of this is on the increased requirement for registered nurse involvement in the resident’s medication management. Any facility who now requires submitting an “application for exemption” for this Code, while they are changing their staffing model, can contact Janice Hadgraft at ACCV, on 9805 9400 or janiceh@accv.com.au for advice on the requirements of the Code and for the inclusions of their application.

Residential Care Manual: Update

The revised edition of Chapter Five of the Residential Care Manual issued by the Department of Health and Ageing has been sent out to providers. This edition of Chapter Five incorporates the changes that occurred with introduction of the Aged Care Funding Instrument (ACFI).

If you have not received the revised chapter, Providers should contact the Aged and Community Care Information Line on 1800 500 853, or email acfi@health.gov.au.

The revised chapter is also available on the Department of Health & Ageing website at: http://www.health.gov.au/acfi.

Reminder: With all the changes that have been brought about by the introduction of ACFI, it is more important than ever, to check your monthly commonwealth subsidy return to ensure that there have been not errors and you are not missing out on any expected payments.

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