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7.3 Investigating a claim for Household Services
Making a claim for household services
Subsection 214(1)(c) of the MRCA and subsection 29(2) of the SRCA provides that for compensation for household services to be payable a person must make a claim for compensation in respect of household services. The person is required to provide information about their home situation and obtain supporting documentation from their treating doctor, specialist and/or allied health provider, such as a Physiotherapist, Occupational Therapist or other suitably qualified health professional.
The household services claim form must be used for both new claims and claims for renewal of services.
Assessment for household services
In most circumstances, the need for household services will need to be identified through a home assessment undertaken by a suitably qualified and experienced Occupational Therapist (OT) or other suitably qualified health professional*. The exception to this is, if due to the severity of the person's accepted conditions or circumstances, there is sufficient information from the person's treating doctor, specialist and/or health provider about their reasonable requirement for household services without an assessment being conducted. Even in these cases, it is recommended that a re-assessment be conducted from time to time, to ensure that the client's current needs and circumstances are being met. Please refer to section 7.4 of the Rehabilitation Policy Library for information about reviewing household services.
For guidelines about referring a client for a home/activities of daily living assessment, please refer to chapter 7 of the Rehabilitation Procedures Guide.
* OTs or other suitably qualified health professionals undertaking an assessment for household services do not need to be DVA accredited rehabilitation service providers. They must however, be Comcare accredited, appropriately qualified and experienced.
Nursing care needs
Where a client's conditions are such that they are likely to require nursing care, as well as personal care and/or household services, a Clinical Nurse Consultant recommended by DVA's Community Nursing Program should be utilised to conduct a detailed assessment of the person's needs and make recommendations about the type and level of services that they require. In this context, a Clinical Nurse Consultant can be regarded as having the appropriate skills and experience to provide evidence to inform household service determinations. Further information about review and approval processes for household services can be found in section 7.4 of this Guide.
Value for money
As a general rule, three quotes must be submitted with a new claim for household services to ensure the department is receiving value for money for the services being provided to our clients. However, if a person is able to provide valid reasons why they cannot submit three quotes, the delegate has the discretion to consider the claim on the basis of the quotes the client has provided so long as they are satisfied about value for money. For example, if the person is living in a rural area, there may be less than three providers who can deliver household services or, the person may be recovering from surgery and is having difficulty sourcing the three quotes. This is just one example, each client’s circumstances must be considered on their own merits.
In these types of circumstances, the delegate may waive the requirement for three quotes provided the delegate is satisfied that the Department is receiving value for money. If a standard hourly cost for the location can be identified, for example by reviewing the rates quoted for other claims in the same area, this rate can be compared to the quotes the client was able to obtain, to make a judgement about value for money. In addition, the Comcare prescribed maximum hourly rate, which can be found on the Comcare website, can be taken as a guide of a reasonable maximum hourly market rate for provision of household services and used comparatively against the quotes the client was able to obtain. Please note, the Comcare rate is not a mandatory, or gazetted maximum rate, but rather, a guide to reasonableness. For example, where a person is living in a rural or remote area of Australia, or in an area where there are a limited number of household services providers, a higher maximum hourly rate may need to be approved.
Quote requirements when renewing household services
Three quotes are not required where the claim is for a renewal of household services. This also applies where there has been a change in residence and the home/activities of daily living assessment for the new residence recommends a continuation of services. For example, if the client was receiving cleaning and mowing assistance in their former residence and the assessment recommends a continuation of these services in a new residence, three new quotes are not required.
If there has been a change in residence and the new assessment recommends a different type of service, three quotes will need to be provided. This applies unless the person is able to provide valid reasons about why these three quotes cannot be obtained. Please see section 7.4 of the Rehabilitation Policy Library for further information about renewing household services.
The amount of compensation payable for household services is capped by a statutory limit which is indexed as at 1 July each year, by reference to the Consumer Price Index. Details of the maximum household services limits are available in the current payment rates chart in the CLIK Compensation and Support reference library. The MRCA limit is listed on the MRCA Rates and Allowances page. The SRCA limit is listed on the SRCA and Defence Act payments page.
Rehabilitation Coordinators must not approve household services in excess of this statutory limit. Further information about the approval and review of household services can be found in section 7.4 of this Guide.
Note: Some persons, who are eligible for household services, may also qualify for attendant care services. In such cases, they may be entitled to payment up to the statutory limit for both household services and for attendant care services. In other words, the statutory limits that apply to household services and attendant care are mutually exclusive.
Provision of household services outside Australia
When a person moves overseas and requests assistance with household services, the same decision making principles should be followed. The person should still be asked to provide supporting documentation from their treating doctor, specialist or allied health provider. Evidence should also be provided about the size and type of their residence, and where gardening or lawn mowing services are requested, the size and characteristics of the garden (for example, is the garden sloped, the size of the grassed areas as compared to garden beds) to enable a decision to be made about the reasonableness of the level of support that the person is seeking. Information about reimbursements for household services payments for clients living overseas can be found in section 7.3.1 of this Guide.