Introduction

The National Home and Community Care (HACC) Program Guidelines and Draft Fees Policy (2007) promote the collection of fees from clients for the services they receive.  Client contributions are essential to ensuring that HHS has the capacity to meet the needs of clients and to augment the funding that HHS receives to meet expected levels of services to be delivered.

Aim

The aim of this policy is to establish guidelines and procedures to ensure a fair and equitable approach to determining client contributions for HACC funded services that will:

• ensure compliance with the National HACC program and fee guidelines,
• improve HHS risk management,
  • protect clients by keeping their costs to a minimum consistent with the level of services they receive, and
  • protect HHS people and reputation.

Policy Principles

All clients will be required to make a contribution towards the cost of the services they receive. Contribution rates will be levied in accordance with the client’s assessed level of income and capacity to pay. Clients will be informed of the contribution rate applicable to them at the time of initial assessment or service variation. Where a couple, or family, receive a service they will not be separately charged. Requests to waive a client contribution will normally not be considered.

A service will not commence until a client income and fee assessment is completed. Where a client has been assessed as not having the capacity to pay a determined contribution rate, the rate may be reviewed in accordance with this policy.

Inability to pay cannot be used as a basis for refusing or withdrawing a service to people who are assessed as requiring a service. However, unwillingness to pay may result in services being reduced or withdrawn, and no new or additional services will be provided until any outstanding debts are paid.

The full cost of a HACC funded service will be charged for work done for other agencies and where clients are receiving, or have received, compensation or other payments intended to cover the cost of community based care including home modifications / maintenance.

Clients may require or elect to have an advocate during any discussion on income and/or contribution or review, and have the right of appeal against a given contribution determination.

Contribution rates charged will be all-inclusive and cover all materials used in delivery of the service, labour / sub-contractor costs, and administration costs associated with service provision. Clients with similar levels of income (after considering levels of expenditure) and service usage patterns will be charged equivalent contribution rates for equivalent services.

All contribution rates will be reviewed annually. Where an increase is to be applied to a service, clients will be notified in writing including their rights to have their individual contribution rates reviewed.

Assessment of a person’s capacity to pay will be conducted with due regard for their privacy. All information obtained will be treated as confidential. Should the information be found to be incomplete or false, HHS reserves the right to withdraw services or a service offer.    

Fees do not apply to information, advocacy, assessment and review services. The revenue from client contributions will be used to maintain, enhance and/or expand services.

Income and Fee Assessment

Income is not the sole criterion used to determine a client’s fees. The costs incurred by the client because of their disability or other related circumstances will be taken into consideration and may result in the client having their contribution rate set at a level lower than their income would dictate. However, before considering a contribution rate review, the Assessor will check to ensure that the client is receiving all financial assistance available to them (e.g. rent assistance, Health Care Card concession on utilities, carer’s allowance etc). Clients are to be encouraged to raise with HHS any difficulties they have in paying their contribution and to advise HHS as soon as practical of any significant changes in their financial circumstances which may affect their income assessment or resulting level of contribution.

All clients will be required to complete an Income Self-Declaration Form at the time of initial client assessment. This requirement forms part of the client service assessment process and is an integral part of determining the appropriate client contribution rate to be charged for the service the client will receive. However, a client can choose not to provide details of their income. In this circumstance, the client is to be informed that under the National HACC Program Guidelines, HHS is entitled to charge the full cost of a service and that as a result, the client will likely be charged the full cost of the service.

To achieve consistency and fairness for clients, it is important to be clear about what and whose income is included in the income and fee assessment:

• where a client is living alone, or in a household of unrelated people living together, or is living with a family member (other than a spouse or partner) or carer (who is not a HACC client), the client’s income is assessed;
• where one member of a couple living together is the client, or a couple are both clients, the couple’s combined income is assessed;
  • where there is a child or children with a disability under age 16, the family’s income is assessed;
  • where there is a family with an adolescent or adult with a disability aged 16 years of age or over, the individual’s income is assessed.

It is not the intention of this policy to restrict access for people on higher incomes. If a person is eligible on the basis of assessed need, services may be provided, subject to availability and demand, and contributions charged appropriate to the income level of the individual.

Where a client has received a lump sum or other compensation payment intended to cover the cost of community care, the client contribution will be set at the full cost recovery rate. Up to the point of settlement, the client will be income assessed in the normal way and charged the appropriate contribution rate. At the point of settlement, any monies designated for community care costs will be recovered directly by HHS, net of contributions paid by the client. Services delivered after the point of settlement will be charged according to the identified amount set aside for community care in the compensation package. If no amount has been identified then the client will be charged according to their level of assessed income or may request to have their contribution rate reviewed if they are or would face financial hardship.

Review of Client Contribution

The level of client contribution may be reviewed at the request of a client or initiated by the HHS Assessor either as part of the initial client assessment or at anytime the client’s service requirements or their financial situation changes. Clients will be required to complete a Client Contribution Review Form and provide supporting information. If a client declines to complete any element of the Client Contribution Review Form or provide relevant supporting information they are to be informed that a contribution review will not be conducted and the client will be required to continue paying the originally assessed contribution rate.

Subject to verification of the information provided by the client, services will continue to be provided during the review and any appeal process on the undertaking by the client that any outstanding payments will be paid once a revised contribution rate is determined and agreed.

The following documents will be required to facilitate a contribution rate review:

• the client’s Income Self-Declaration Form,
• the completed Client Contribution Review Form with all relevant supporting information, and
  • the Assessor’s original client and contribution rate assessment.

Where a client who is receiving all relevant assistance would still experience financial hardship in paying the assessed contribution rate, the Assessor will negotiate with the client to determine what the client can contribute. Dependent on the negotiated rate, the Assessor may approve a reduced rate (if the level of reduction is within his/her delegation) or refer the matter to the Operations Manager or CEO for determination as appropriate. Subject to verification of information supplied by the client, requests for a contribution rate review will normally be finalised within 14 days of receipt of the request with all supporting documents, and the client advised of the outcome.

A contribution rate reduction may be approved for a set period of time or for the duration of the service to be provided. The reduction if approved would start from the date the client request was received. Reductions will not be approved for periods prior to a request being received. All approvals for long term contribution rate reductions will be reviewed annually.

Client Contributions Schedule

The Client Contributions Schedule will be reviewed annually in accordance with this policy. The contribution rates will reflect the level of funding required to meet the expected level of service to be delivered in the following year based on an assessment of:

• the amount of HACC funding to be received,
• the expected amount of indexation to be received,
• the expected amount of client contributions to be received (per service by client income level),
• the total cost of each service that is provided (total costs to include direct staff costs, operating costs and allocated administrative overhead costs), and
  • any gap between total funding expected to be received and the cost of service delivery.

If after an annual review of the Client Contributions Schedule a general rate increase is applied, the same percentage increase is to be applied to clients with reduced contribution rates.

Collection of Client Contributions

Clients will be charged on the basis of service times recorded either on electronic recording devices provided to Personal Care and Domestic Assistance clients, or on service provider timesheets countersigned by clients. HHS will issue monthly accounts detailing the client charges including the types and quantity of services provided in the previous month.

Accounts are due and payable by the date specified on the account. A late payment fee will be applied to account balances outstanding after the due date. Notwithstanding, a late payment fee may be reduced or waived in case of hardship. The amount of the late payment fee will be determined annually and be included in the Client Contribution Schedule.

If a service is cancelled by the client on the rostered day of service or the client is not at home when the Support Carer arrives, the client will normally incur a service cancellation charge equivalent to the client’s usual contribution rate for the cancelled service.

If a client is in arrears without prior arrangements, the Finance Section will implement the Debt Recovery and Overdue Payments Procedures. If, after all reasonable attempts to negotiate payment a client still has not paid their outstanding account, the matter will be referred to the Operations Manager for a review of services being provided to the client. The client will be advised in writing that HHS will exercise its right to reduce or cease services to address the non-payment. The advice will specify the hours of service that will be reduced if there is no effort made to pay or substantially reduce the debt. The client will be allowed 14 days from the date of this notification to either pay the outstanding debt in whole or substantial part, or negotiate a repayment plan so as to not impact the service hours they receive. If after this period the client makes no effort to pay or negotiate suitable payment arrangements they will be asked in writing to advise within 14 days of this second notification, why services should not be cancelled. If the client fails to respond or make any attempt to clear the outstanding payments, then they will be advised in writing that services will cease from a specified date.

Contribution Cap

Clients receiving HACC funded PC and DA services from one or more HACC service providers may need to be protected from paying fees they may not be able to afford. This can be achieved by HHS liaising with other service providers and collaboratively agreeing to apply a contributions cap. All requests from clients and / or other HACC service providers will be considered on their merits. For HHS clients the combined weekly PC/DA contribution cap is 15% of the maximum weekly aged care pension rate.

A contribution cap is not a service cap. Clients should receive the level of services they are assessed as requiring regardless of whether or not their contributions are capped. However, HHS is not obligated to accept to deliver all of a client’s assessed service needs.

Appeals

Clients, or their nominated advocates, have a right of appeal if they are unhappy with any aspect of their income assessment, contribution rate setting or review, or any dispute over outstanding payments. All clients will be advised of this right and the process of appeal under the HHS Complaints and Disputes Policy, at the time of assessment and subsequent reviews. If there is still no satisfactory resolution after an internal review, the client will be encouraged to refer their request to an external agency such as the Human Rights Commission for advice / review.

No client will be disadvantaged or penalised as a result of lodging an appeal.

Related policies and documents

• Income Self-Declaration Form
• Client Contribution Review Form
• Client Contributions Schedule
• Delegation of Authority to the CEO and Others
• Complaints and Disputes Policy
• Debt Recovery and Overdue Payments Procedures
  • Service Access Policy
  • Service Reassessment Policy
    • Risk Management Policy

Review

This policy is to be reviewed by the Board at least every two years. Minor changes may be approved by the CEO and advised to the Board.