Following a Home Support assessment, an outcome may be that the client needs to be referred to an ACAT for a Comprehensive Assessment (with the client’s consent) where it is identified the client has more complex needs that may better be met by services under the Act. Self-referrals ACATs are able to self-refer clients to their organisation. This is required in instances such as when the ACAT is assessing one client and at the assessment the assessor identifies that the partner requires an assessment. Currently the RAS are unable to self-refer, but may facilitate a referral with the client’s consent via the contact centre to issue a referral to their organisation. In selected remote and very remote regions, identified RAS organisations have the ability to clients for an assessment, without the need to rely on the My Aged Care contact centre to issue the referrals. This functionality is being managed by the Department of Health. Referrals for urgent service Clients who require additional or new services who have a previous assessment in My Aged Care will be referred to the assessment organisation that undertook the most recent assessment for review and to arrange these services. The contact centre is unable to issue referrals for services that were not previously identified on the support plan. Priority for Referrals A referral for assessment will include a priority rating that relates to the timing of the assessment and the urgency in which services are delivered to a client. A priority category is also assigned when a client is referred to services. The allocation of a priority category for a referral is based on a client’s level of function, the level of risk in relation to the care situation, and any other relevant concerns. The assessor is able to change a priority allocation that does not align with the guidance on priority for RAS and ACATs in Tables 1 and 2 below. For web-form referrals, the priority is automatically set to medium. The majority of support plan reviews are to be completed within 10 days noting that some review requests will be actioned more urgently than others. Where it is indicated on the referral that the review needs to happen within 10 days assessment organisations should prioritise these clients over others (see 10.6 Support Plan Review and New Assessment). Many timeliness measures relate to Key Performance Indicators (KPIs) and other performance measures (see 27 Reporting and Performance). RAS
The approval and non-approval template letters are produced the assessment and delegation process is finalised. Delegates are also required to provide a printed copy of the client’s support plan to the client with the notification letter. Delegates should be aware that the templates include information about the client’s review rights. See Part E Complaints Section 20 and right of review Section 21 that Cease to Have Effect Approvals that Expire A subsidy cannot be paid to an approved provider for providing care to a person, unless the person is approved the Act as a care recipient and has a valid approval. If an approval has expired, the person is no longer approved for care and, if receiving care, is no longer able to receive that care. Approved providers must that the care recipient has a current approval for the care type and level they will be providing when a care recipient: from one service to another changes their care type needs a higher-level of care has a time-limit on their approval has a break in care. ACATs should be aware that a provider cannot receive subsidy for a day where a resident does not have valid approval for the care type received. The ACAT needs to take reasonable steps to ensure clients and providers are aware of any limitations on the approval. ACATs should refer to the Reassessment Table at Appendix 3 as a guide to check to whether an approval is valid or the person requires a reassessment. ACATs and providers are advised to access DHS payments systems to check if an approval has expired. If an ACAT member needs access to the DHS payment system, they should ask their state or territory manager for more information on the process. For difficult cases, ACATs should seek further advice from the Department through their state or territory manager. Administrative errors made by assessment organisations around approvals may result in Act of Grace claims which are managed by the Department of Finance. Approvals that Lapse Approvals for certain types of care can lapse under certain conditions such as if care is not provided within the entry period. This applies to TCP and STRC. For more information on lapsing conditions see Part D 18.1 Transition Care and 18.2 STRC. Approvals for the following types of care do not lapse unless they are time-limited:
21 To limit a person’s approval as a care recipient to one or more levels of care subsection 22-2(3) 22 To vary a limitation on a person’s approval as a care recipient subsection 22-2(4) 23 As to when a person urgently needed care and when it was practicable to apply for approval paragraph 22-5(2)(b) 24 To extend the period during which an application for approval as a care recipient can be made subsection 22-5(3) 25 To reject an application to extend the period during an application for approval as a care recipient can be made subsection 22-5(3) 25A To determine a person’s priority for home care services subsection 222A(1) 25B To vary a person’s priority for home care services subsection 222A(2) 26 To revoke an approval of a person as a care recipient subsection 23-4(1) Further information: Reviewable decisions: Part 6.1, Division 85-1 of the The Role of ACATs in the Reconsideration Process As part of the request for reconsideration, the Department delegate may discuss the request with the ACAT assessor and delegate to clarify matters relating to the case. If required, the Department’s delegate may request that an independent ACAT reassess the client. The independent reassessment is usually done by an ACAT that was not involved in the original decision. The ACAT undertaking the reassessment can consult the original assessors and delegate, and as many relevant parties as
Flexible care in an MPS service) or Innovative Care A person does not need to be approved to receive care in an MPS or innovative care service. However, the person might happen to be approved for residential care or home care. If a person wishes to leave the MPS/innovative care service to enter a mainstream residential care service or to begin receiving home care, the ACAT will need to check whether there is an existing approval and determine whether a new approval is needed. the Subsidy Principles 2014 the following persons do not need approval for flexible care: people who receive flexible care through an MPS, and people who receive flexible care through an innovative care service.