What exactly is allowable expenditure?
This is probably the question we get asked the most! What can and cannot be included in a Home Care Package has more grey areas than clear black or white.
So, let’s start with what we know, the legislative intent of the Home Care Package (HCP) Program is to deliver care and services that help older Australians to live independently in their homes for as long as it is safe to do so.
The care and services provided need to meet the care needs set out in their My Aged Care Support Plan and Care Plan. These are based on the needs identified during the ACAT or RAS assessment when first entering the HCP program. Simply having items listed in the care plan and budget does not automatically make them allowable.
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Things To Know
Although there is some uncertainty, the Department of Health and Aging is very clear on stating that HCP funding:
- Is not a source of extra income to be used for everyday items and costs.
- Is only for expenditure directly linked to aging (for example, expenditure related to a Chronic Disease is not allowable).
- Is not for expenses that all Australians have.
- Must be considered an acceptable use of a government subsidy that is funded through taxpayers’ money.
- Saving up for items at the expense of the delivery of care and services is not allowed.
In addition, all HCP spending:
- Must be within the limits of the budget and the scope of the Program.
- Must only benefit the care recipient directly, funds cannot be spent on or seen to be benefiting the carers or family members.
- Cannot be for expenditure that is already covered by another government scheme.
- Must be documented in both the care plan and the budget.
- Must be agreed upon in advance of making the expenditure.
In order for aids or equipment to be approved
In most cases any aids or equipment will need a recommendation from the appropriately qualified allied health professional, this is generally an Occupational Therapist, but might be a Physio or Registered Nurse depending on the equipment.
Aids and equipment purchases MUST be:
- supported by an assessment completed by a suitably qualified Allied Health Professional
- supported by a written recommendation provided by the assessor
- considered evidence-based (not a self-promoted item for sale on the internet)
- in line with the intent of the HCP
- documented in the Care Plan and Budget
- considered a good use of government funding
Aids and equipment purchases must NOT be:
- available elsewhere in the community
- pose a risk to the client or others
- an excluded item
- self-prescribed
- impact the delivery of care and services
Click here to find out more about equipment approval timeframes.
All items need to be in the care plan and budget prior to committing any funds, this is the opportunity to discuss the expenditure with your Care Advisor. If there is additional information needed or specialist recommendations required, this will be communicated to you. Providing a detailed description will assist in assessing if the expenditure is allowable. You will be notified by your Care Advisor if the expenditure has been approved.
If we determine that the expenditure is not in scope for the package, we will discuss the reason why with you. We can also provide a written explanation of why the item was rejected.
If you are not satisfied with this outcome you may wish to seek assistance for dispute resolution from an independent advocacy service. The Aged Care Advocacy Service accepts enquiries at www.opan.com.au or 1800 700 600.
Should you wish to appeal the decision or make a complaint, contact the Aged Care Quality and Safety Commission: https://www.agedcarequality.gov.au/ . The Commission’s telephone number is 1800 951 822.
Allowable expenditure is one of the biggest minefields for approved providers. There is always new information and clarifications on inclusions/exclusions being released. Different providers adhere to the expectations to varying degrees, meaning that there are discrepancies between what clients have approved with different providers. Even with the same provider an item that was approved in the past, may no longer be approved.
Despite there being many items that can’t be included in the package, there are still plenty of opportunities for clients to fully utilise their package funding. If you need assistance with ideas, you can consult the Allowable Expenditure – Inclusions Page and/or contact your Care Advisor who can work through your needs to see what else can be included.
The Decision Making Process
When making decisions about approvals or rejections, we take time to consider the Decision Making Process, which covers considerations such as:
- Does it relate to aging?
- Is it an expense that all Australians have?
- Is it in scope for the package?
- Does it impact the provision of care or services?
- Is it a reasonable use of taxpayer funds?
- Are funds available?
- Is it evidence-based?
- Has it been self-prescribed?
- Is it a capital improvement or a major work?
- Is there a safety risk?
Home Care Package Inclusions
From assistance with daily activities like personal care, meal preparation, and household chores, to support for social outings, transport, and allied health services, a Home Care Package provides tailored care and support to help maintain your quality of life and independence for as long as possible.
Home Care Package Exclusions
Home Care Packages are designed to assist you with your day to day living tasks, so that you can remain in your own home for as long as possible. They are not designed to cover things like your general household bills, groceries, travel, your rent or mortgage.
