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Compensation and Support Reference Library
Departmental Instructions
1998
- C13/1998 AGED CARE REFORMS - COMMENCEMENT OF INCOME TESTING AND POLICY CHANGES SINCE 1 OCTOBER 1997
DATE OF ISSUE: 3 MARCH 1998
AGED CARE REFORMS - COMMENCEMENT OF INCOME TESTING AND POLICY CHANGES SINCE 1 OCTOBER 1997
Purpose of instruction |
The purpose of this departmental instruction is:
This instruction should be read in conjunction with Departmental Instruction C12/98 which details the Aged Care reforms effective from 1 October 1997. |
Authorised by |
R. J. HAY BRANCH HEAD INCOME SUPPORT |
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TABLE OF CONTENTS
POLICY CHANGES SINCE 1 OCTOBER 1997.....................................236
Summary of changes..........................................236
INTRODUCTION OF ACCOMMODATION CHARGES................................236
Background.................................................237
What is an accommoda-tion charge................................237
Who can be required to pay an accom-modation charge.................238
How much can a person be required to pay..........................238
DVA not involved in calculating charge.............................239
Income test assessment of accommoda-tion charge....................239
Assets test assessment of accommoda-tion charge....................240
Systems impact..............................................240
ACCOMMODATION CHARGE - EXEMPTION OF FORMER HOME UNDER ASSETS TEST....241
Background.................................................241
Eligibility for exemption.........................................241
Period of exemption...........................................241
Requirement for continuity of care.................................241
Cessation of exemption.........................................242
Interaction of 2 year and 5 year exemptions..........................243
Cessation of 5 year exemption - check status of 2 year exemption.........244
Flow-on to pension income test and aged care fee assessment...........244
Partnered cases..............................................245
Systems impact..............................................245
ACCOMMODATION CHARGES - EXEMPTION OF RENTAL ON FORMER HOME...........246
Eligibility for exemption.........................................246
Purpose of exemption..........................................246
How much rental should be exempted..............................246
Does resident have to satisfy a purpose test.........................246
Systems impact..............................................246
Manual review...............................................247
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE 248
Background.................................................248
Who is entitled to the concessions.................................249
How many such people are there.................................250
Assets test exemption.........................................251
Example...................................................252
Amount disregarded remains constant..............................253
Application of the exemption to members of a couple...................254
Income test exemption.........................................255
Example...................................................255
Amount disregarded remains constant..............................256
Application of the exemption to members of a couple...................257
Systems impact..............................................258
Exemption procedure..........................................259
FEES INCOME TEST EXEMPTIONS - PRE 20 AUGUST 1996 DISPOSALS................260
Background.................................................260
Purpose of exemptions.........................................261
Who is entitled to the exemptions.................................262
Exemptions apply to fees only....................................263
How long will the exemptions last.................................264
Application of the exemptions to members of a couple..................265
Systems impact..............................................267
COMMENCEMENT OF INCOME TESTING, RESIDENTS AFFECTED AND PERIOD OF GRACE — 268
Commence-ment date.........................................268
Residents affected............................................268
Period of grace..............................................269
Systems impact..............................................269
LEGISLATION..........................................................270
Aged Care Amendment Bill 1998..................................270
Commence-ment of provisions...................................271
Application of exemptions prior to Royal Assent.......................272
Amendments to residential care subsidy principles.....................273
Commence-ment of amendments.................................274
Location of provisions..........................................275
SYSTEMS CHANGES ATTACHMENT A..........................................276
Extract from systems impact document.............................276
PIPS PC Residential Situation Screen..............................276
Example of the Residential Situation screen..........................278
Table of pensioner circumstances and assessment codes...............279
Accommodation Bonds.........................................281
Warning and Edit Messages.....................................283
Residential Care Details screen - new fields..........................286
Example of the Residential Care Details screen.......................286
Income Testing of Aged Care Fees................................286
Calculate Pension............................................288
Simulated Assessment and What If................................288
Trial Assessment (PP.TR).......................................289
Daily Advices................................................289
Matching Process.............................................289
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POLICY CHANGES SINCE 1 OCTOBER 1997
The changes that have been announced since 1 October 1997, and the dates from which the changes take effect are summarised as follows:
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The changes that have an income support impact are described in the sections that follow. |
INTRODUCTION OF ACCOMMODATION CHARGES
From 1 October 1997, under the provisions of the Aged Care Act 1997, persons entering Government funded residential aged care could be required to pay an accommodation bond to the nursing home or hostel they were entering. These bonds were typically payable as a lump-sum upon entry to the facility although arrangements could be made to pay the bond as a periodic payment or a combination of lump-sum and periodic payment. The introduction of accommodation bonds generated significant adverse publicity for the Government - particularly in relation to the introduction of such bonds for nursing home residents. The Government's response was to replace the accommodation bonds payable under the 1 October 1997 arrangements with a new periodic fee known as an “accommodation charge”. In association with this, a number of other measures were introduced to assist residents in paying the charge using rental income from their former home. |
An accommodation charge is a periodic payment that an aged care facility (in most cases a nursing home) can ask certain residents to pay to cover the cost of their accommodation. The amount of the charge depends on a person's assets. None of the amount paid is refundable when the resident dies or leaves aged care. The charge can be levied for a maximum period of five years and is calculated on a daily basis. Typically, facilities require residents to pay the charge monthly. However, a range of payment options are available to the resident including deferral and payment of the charge from the person's estate. |
INTRODUCTION OF ACCOMMODATION CHARGES Continued
Only persons entering high level care from 6 November 1997 can be required to pay an accommodation charge. This means that most residents who pay the charge will be residing in nursing homes. However, small numbers of residents may be encountered who are residing in hostels but are receiving high level care in those facilities. These people may also be paying an accommodation charge. Concessional residents are exempt from paying the charge. Also excluded from paying an accommodation charge are persons who enter extra service places in nursing homes. These people would be required to pay an accommodation bond rather than an accommodation charge. |
People with assets up to and including $22,500 ($23,000 from 2 April 1998) pay nothing. These people are concessional residents. People with assets above $22,500 ($23,000 from 2 April 1998) up to and including $36,000 ($37,000 from 2 April 1998) pay an amount that increases with the level of their assets up to a maximum of $6.00 per day. These people are assisted residents. People with assets above $36,000 ($37,000 from 2 April 1998) up to and including $44,400 ($44,900 from 2 April 1998) pay an amount that increases with the level of their assets up to a maximum of $12.00 per day. People with more than $44,400 ($44,900 from 2 April 1998)pay a flat rate of $12.00 per day ($4,380 per year). A table summarising the amount a person can be required to pay, for different asset levels can be found in the DH&FS information sheet No. 7. |
INTRODUCTION OF ACCOMMODATION CHARGES Continued
As for accommodation bonds, it is important to note that DVA is not involved in any way in calculating or charging accommodation charges. Furthermore, pensioner asset data held by DVA is not passed to third parties for the purposes of calculating accommodation charges. However, DVA asset data may be used for Audit purposes where an aged care facility has been identified through the DH&FS risk management process. Where DVA is advised that a pensioner has entered high level care, our role is limited to ensuring that any changes to a person's income or assets associated with payment of a charge are updated in the person's pension assessment. |
Payment of an accommodation charge has no direct impact on a person's income. However, a person paying an accommodation charge is likely to make other changes to their financial circumstances to raise money to pay the charge (eg. they sell some shares). These changes may affect their income and this will need to be updated in their assessment. Also, special income test exemptions may apply to certain rental income where a person rents out their former home and pays an accommodation charge. See Accommodation Charges - Exemption of Rental on Former Home for more information. |
INTRODUCTION OF ACCOMMODATION CHARGES Continued
Unlike an accommodation bond, none of an accommodation charge is refundable. Accordingly, an accommodation charge has no asset value. Payment of an accommodation charge thus has no direct impact on a person's assets. However, a person paying an accommodation charge may make other changes to their financial circumstances that affect their assets and these changes will need to be updated in their assessment. Also, a special assets test exemption may apply to a person's former home if they rent that home and pay an accommodation charge. See Accommodation Charge - Exemptions of Former Home Under Assets Test for more information. |
As an accommodation charge is not assessable as income or an asset, no provision has been made on the system to record the amount a person pays as an accommodation charge. However, certain systems changes have been made to cater for exemption of the person's former home under the assets test for five years where a person is paying an accommodation charge and renting out their former home (see next section). |
ACCOMMODATION CHARGE - EXEMPTION OF FORMER HOME UNDER ASSETS TEST
With the introduction of accommodation charges, two special exemptions were introduced to assist residents to pay the charge using rental income from their former home. This was done to counter criticism that people would have to sell their former home to be able to pay the charge. The first of the exemptions enables a resident's former home to be exempt from assessment under the pension assets test in certain circumstances. |
A resident's former home will be exempt from assessment under the pension assets test where:
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As the exemption for the former home is linked to payment of an accommodation charge, the exemption will typically last for the five years that the charge is payable. In certain circumstances, the five year period may not be continuous. For example, a person may move from high level care to low level care after one year during which they were paying the charge. If they later return to high level care, the charge will become payable again and will run for another four years. The exemption of their home would do likewise. |
ACCOMMODATION CHARGE - EXEMPTION OF FORMER HOME UNDER ASSETS TEST Continued
The “five year” exemption for the former home is only available to a person if they have continuously been in a care situation since vacating their principal home. For example, in the situation where the health of a person who is receiving high level care improves to the extent that they depart aged care and take up alternative accommodation in the community they may no longer be in a care situation. Should their health later deteriorate to the extent that they again require high level care, they would not be entitled to the exemption of their former home since the continuity of care has been broken. |
The exemption will cease at any time that:
In regard to rental of the former home, the exemption should only be cancelled if the person has actually removed the home from the rental market. Periods of vacancy of the home would not be counted as a cessation of rental provided the home was still available on the rental market. |
ACCOMMODATION CHARGE - EXEMPTION OF FORMER HOME UNDER ASSETS TEST Continued
The current 2 year exemption of a person's former home, where they enter a care situation, and the new 5 year exemption can interact in a number of ways. The following situations are possible.
The person may enter high level aged care directly from the community, (ie without passing through some other care situation). Where this occurs the 2 year exemption and 5 year exemption would commence at the date of admission to high level care and would apply concurrently.
The person may enter a care situation other than high level care (eg. low level care or community based care) and within two years enter high level aged care. Where this occurs the 2 year exemption would commence at the date the person entered a care situation and the 5 year exemption would commence at the date of admission to high level care. There would thus be a period of overlap during which the two exemptions would apply concurrently. Where the two year exemption is close to expiring, the overlap will be minimal and in this circumstance, the resident's home may be exempt for a continuous period up to a maximum of 7 years.
The person may enter a care situation other than high level care and more than two years later enter high level aged care. Where this occurs, the 2 year exemption would commence at the date the person entered a care situation but would expire before the five year exemption commenced (on the date of admission to high level care). In this circumstance, the person's former home would be an assessable asset for the period not covered by either exemption. |
ACCOMMODATION CHARGE - EXEMPTION OF FORMER HOME UNDER ASSETS TEST Continued
Cessation of 5 year exemption - check status of 2 year exemption |
If a resident paying an accommodation charge has their home exempted because they are renting it out, and they then cease to rent the home, the five year exemption will cease to apply. In this circumstance, it is important that examiners confirm whether or not the 2 year exemption remains in force. If the person first entered a care situation more than 2 years ago, the exemption will have expired and the person's home will be assessable as an asset. On the residential situation screen of PIPS PC, the person's residential situation should be changed from “Nursing Home - Previous Owner” to “Nursing Home” and the RA not payable flag “Client in Res Care - Owner 5 Years” should be changed to “Client in Residential Care Facility”. If the person first entered a care situation less than 2 years ago, the 2 year exemption will still be in force and the person's home will remain exempt. On the residential situation screen of PIPS PC, the RA not payable flag “Client in Res Care - Owner 5 Years” should be replaced with “Client in Res Care - Owner 2 Years”. |
Under the 2 year and 5 year exemptions, a person's former home is exempt from assessment as an asset. Accordingly, no income can be deemed to be earned on that asset. This means that where a person's former home is exempt from assessment as an asset for pension purposes, no income can be deemed to be earned on that asset for the purposes of the pension income test and hence the aged care fees income test. |
ACCOMMODATION CHARGE - EXEMPTION OF FORMER HOME UNDER ASSETS TEST Continued
If a person who enters residential aged care is a member of a couple and that person's partner continues to occupy the former home, the home continues to be assessed as the principal home until such time as the partner vacates it. Once the partner does vacate the home, the two year and/or five year exemptions will apply to the partner as they do to the member of the couple in aged care. If the partner who last vacates the home purchases another home to live in, both residences cannot be regarded as the principal home of the couple. Generally, the residence which is of greater value would be regarded as the principal home in this circumstance and the other residence would be assessable as an asset. In this circumstance, any rental derived from the home would continue to be exempted from assessment as income (see next section). |
To exempt a person's home while an accommodation charge is in payment and the person is renting their former home, a new RA not payable flag has been provided on the Residential Situation screen of PIPS PC. The new flag is “Client in Res. Care - Owner 5 years”. Setting the person's residential situation to “Nursing Home - Previous Owner” and the RA not payable flag to “Client in Res. Care - Owner 5 years” will enable the exemption. Refer to Attachment A for more details of these systems changes. |
ACCOMMODATION CHARGES - EXEMPTION OF RENTAL ON FORMER HOME
Where the former home of a person is exempt from assessment as an asset because the person is paying an accommodation charge and renting out that home (see section above), any rent derived from the former home is also exempt from assessment under the pension income test and hence the aged care fees income test. |
This exemption allows residents receiving high level (nursing home) care to utilise rental income to pay their accommodation charge without suffering a reduction in pension or increase in aged care fees due to that rental income. |
All rental from the former home should be exempted - even if it exceeds the amount of accommodation charge the person is paying. |
It is not necessary for a resident to prove that the whole or principal purpose of renting their former home was to pay the accommodation charge. All that is necessary for them to have access to the exemption is that they be paying an accommodation charge and renting their former home as stated under “Eligibility for Exemption” above. |
Where rental a person receives from their former home is exempted because they are paying an accommodation charge, the rental is simply not recorded in the person's assessment. There is thus no systems impact associated with this change. Note however that a person who has rental income exempted in this way should have the RA not payable indicator “Client in Res. Care - Owner 5 years” selected. |
ACCOMMODATION CHARGES - EXEMPTION OF RENTAL ON FORMER HOME Continued
A manual review should be set for a date 5 years after the date that the 5 year exemption commences. The person's full financial circumstances should then be re-examined. |
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE
On 1 October 1997, the Government introduced a new accommodation payment known as an accommodation bond for all aged care residents. Initially, the charge applied to all aged care residents irrespective of whether they were receiving high (nursing home) level care or low (hostel) level care. However, in response to public concern over the application of accommodation bonds to nursing home residents, the Government announced that with effect from 6 November 1997 new entrants to high (nursing home) level care would be required to pay a revised form of the accommodation payment known as an accommodation charge. The new accommodation charge was payable as a periodic amount rather than a lump sum as was the case with the accommodation bond. Because a number of people who entered high level care between 1 October 1997 and 6 November 1997 had already paid a bond or had sold their home to pay a bond, special pension concessions were introduced to ensure that these people were not financially disadvantaged if they wanted to commute their accommodation bond to an accommodation charge. |
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE Continued
The persons who are entitled to the concessions are those:
The partner of such a person is also entitled to the concessions, even if the member of the couple in respect of whom the bond was payable is now deceased. |
Examination of the DVA database indicates that approximately 50 DVA clients entered nursing homes and paid an accommodation bond between 1 October 1997 and 5 November 1997 (both inclusive). Less than 10 (nationally) of these residents are likely to switch from an accommodation bond to an accommodation charge and claim the concessions provided for this group. |
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE Continued
Under the concessions the amount that can be exempted under the assets test will be:
In the legislation, this is referred to as the “exempt bond amount”. |
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE Continued
A DVA pensioner owns a home worth $120,000 on which he owes $30,000. On 3 October 1997, the pensioner enters nursing home care and is required to pay an accommodation bond of $40,000 to the nursing home. On 20 October 1997 the pensioner sells his home for $120,000. He uses $40,000 of the funds to pay the bond and $30,000 of the funds to pay the loan secured by the home He incurs $5,000 of costs in completing the sale. With the introduction of the accommodation charge scheme on 6 November 1997, the pensioner decides he would prefer to switch to paying an accommodation charge and seeks a refund of his accommodation bond. The facility refunds $39,880 (the $40,000 paid less $120 of drawdown that has accrued over the 17 day period) to the pensioner. The amount that would be exempted under the assets test would be the greater of:
Thus $85,000 of the pensioner's assets would be disregarded under the assets test. |
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE Continued
The amount disregarded under the assets test will remain constant in all circumstances. Situations may arise where a person has less assessable assets than the amount to be disregarded. In this circumstance the person would be assessed as having nil assets. Should the person's assets later increase to the extent that their assessable assets exceed the amount to be disregarded, the full amount to be disregarded will be subtracted from their assessable assets. |
Where a person who is a member of a couple is entitled to the assets test exemption, 50% of the amount to be disregarded will be applied to the person and the other 50% to their partner. Should one member of the couple die, 100% of the amount to be disregarded will be applied to the surviving member. |
Where an amount is exempted under the assets test exemption, a corresponding reduction will be made to the person's income. The amount of the reduction is calculated by multiplying the amount exempted under the assets test by the above threshold deeming rate. |
Continuing from the previous example, where $85,000 of a pensioner's assets are disregarded under the assets test, the reduction to be applied to the person's income would be calculated as follows: $85,000 × 5% = $4250 per year = $163.50 per fortnight |
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE Continued
As the reduction to be applied under the income test is based on the amount disregarded under the assets test, it too will remain constant, unless there is a change to the above threshold deeming rate. Situations may arise where a person has less assessable income than the reduction to be applied. In this circumstance the person would be assessed as having nil income. Should the person's income later increase to the extent that their assessable income exceeds the reduction to be applied, the full reduction will be applied to their assessable income. |
Where a person who is a member of a couple is entitled to the income reduction, 50% of the reduction will be applied to the person and the other 50% to their partner. Should one member of the couple die, 100% of the reduction will be applied to the surviving member. |
As the exemptions under the income and assets tests are catered for using the manual rates screen, no systems changes were required to implement the exemptions. Refer to “Exemption Procedure” below for more information on how to used the manual rates screen to implement the exemption. |
SPECIAL CONCESSIONS - RESIDENTS OF NURSING HOMES WHO PAID AN ACCOMMODATION BOND AND THEN COMMUTED TO AN ACCOMMODATION CHARGE Continued
The procedure to follow to implement the income and assets tests exemptions using the manual rates screen is as follows: 1.Update the person's pension assessment in accordance with their current income and asset details. 2.Determine the amount to be exempted under the assets test. This will be: -the amount of accommodation bond refunded to the person; or -the gross proceeds of sale of the person's former home, less any costs incurred in the course of the sale and less any debt secured by the home; or -if both of the above apply, the greater of the two amounts. 3.Determine the reduction to be applied to the person's income. This will be the amount to be exempted under the assets test multiplied by the above threshold deeming rate. 4.Deduct the income and asset exemption amounts for the person's total income and assets. For couples, apply 50% of the deductions to each member. 5.Go to the Manual Rates screen and select “Miscellaneous (manual assessment) Type”. Record the income and asset balances. Give a reason for the manual rate assessment in Text. |
FEES INCOME TEST EXEMPTIONS - PRE 20 AUGUST 1996 DISPOSALS
Under the pension income test, income is deemed to be earned on any disposition of assets, in excess of the $10,000 gifting limit, within the preceding five years. With the introduction of income testing for aged care fees, this meant that such income would also be counted for aged care fees purposes. This flow-on to aged care fees was criticised as being retrospective in nature. This is because a person who had decided to dispose of assets in the preceding five years should have been aware that it would affect their pension, but could not have been aware that it would affect the aged care fees they would pay in the future. In response to this matter, the Government decided that any income attributable to any excess disposition of assets before 20 August 1996 (the date that the Aged Care Reforms were announced) would be exempt from assessment as income for aged care fees purposes. For the same reasons, a similar exemption was extended to any disposition of income prior to 20 August 1996. |
The exemptions ensure that any income attributable to any excess disposition of assets before 20 August 1996 will not affect a person's rate of aged care fees. Likewise, any disposition of income prior to that date will not affect a person's rate of aged care fees. |
Any aged care resident who pays income tested daily fees and disposed of assets, or income, prior to 20 August 1996 is entitled to the exemptions. |
FEES INCOME TEST EXEMPTIONS - PRE 20 AUGUST 1996 DISPOSALS Continued
The exemption of income deemed on any excess disposition of assets prior to 20 August 1996 is for fees purposes only. The same applies to the exemption of any disposition of income prior to 20 August 1996. Thus there will be no change to the existing rules about any disposition of assets or income for the purposes of assessing a person's rate of pension. |
As an excess disposition of assets is only held in a person's assessment for five years, income will cease to be deemed on those assets five years from the date of disposal. As the disposition of the assets had to be prior to 20 August 1996 for a person to be entitled for the exemption, there will be a steady decline in the number of residents with deemed income exempted and no cases will remain after 20 August 2001. For cases involving disposal of income, the exemption continues indefinitely because a disposition of income will be included in a person's pension assessment indefinitely. |
Where a person who is a member of a couple is entitled to one or both of the exemptions, 50% of the amount exempted will be applied to the person and the other 50% to their partner. Should one member of the couple die, 100% of the amount exempted will be applied to the surviving member. |
FEES INCOME TEST EXEMPTIONS - PRE 20 AUGUST 1996 DISPOSALS Continued
Neither the exemption of disposed income from the aged care fees income test nor the exemption of income deemed on disposed assets from the aged care fees income test has any system impact. The amounts to be exempted are automatically subtracted from the income figures transmitted to DH&FS by the programs that process that income information. |
COMMENCEMENT OF INCOME TESTING, RESIDENTS AFFECTED AND PERIOD OF GRACE
Income testing of aged care fees will commence from 1 March 1998. |
Only residents who enter aged care for the first time on or after 1 March 1998 can be income tested for fees purposes. Residents who were living in a nursing home or hostel at any time between 30 September 1997 and 1 March 1998 will not pay income tested fees - even if they leave care for a while and return at any time after 1 March 1998. |
The 28 day period of grace announced by the Government provides a 28 day period for a person's care level to be assessed before the person can be required to pay income tested fees. During the 28 day period, the person is only required to pay the basic daily resident contribution applicable to their circumstances. That is $21.10 ($21.52 from 2 April 1998) if they are an income support pensioner or $26.40 ($26.91 from 2 April 1998) if they are a non-pensioner). Once the period of grace expires the person would be required to pay the income tested rate of daily fees applicable to their income and the level of care they require. |
The only systems impact associated with the change to the commencement date for income testing, introduction of the period of grace and limitation of income testing to new residents is that an income testing flag has been included on the Residential Care Details screen. This flag will indicate “yes” where a person has entered aged care after 1 March 1998 and is to be income tested. |
LEGISLATION
The majority of the amendments enabling the various changes announced by the Government since 1 October 1997 are contained in the Aged Care Amendment Bill 1998. The amendments to the Veterans' Entitlements Act 1986 that provide for the various income test and assets test exemptions are contained in schedule 3 of that Bill. |
The provisions of the Aged Care Amendment Bill 1998 will commence from the date of Royal Assent. It is expected that Royal Assent will be obtained in mid April. |
As the income and assets test exemptions provided for in the Aged Care Amendment Bill 1998 are intended to apply to residents from 6 November 1997, the exemptions will have to be provided in the form of Act of Grace payments until Royal Assent is obtained. The Department of Finance have allocated funds for this purpose. |
The provisions that exempt disposal related income from assessment for aged care fees purposes were inserted into the Residential Care Subsidy Principles by Residential Care Subsidy Principles Amendment (No. 1) 1997. |
The amendments to the Residential Care Subsidy Principles were gazetted on 3 November and commenced retrospectively from 1 October 1997. |
LEGISLATION Continued
The location of key provisions relevant to the assessment of DVA pensioners is set out in the table below: |
PROVISON |
LOCATION |
Exemption of former home under pension income and assets tests (and hence for fees purposes) extended from 2 to 5 years. |
Subsection 5L(6A) VEA |
Rental from former home exempted from pension income test (and hence for fees purposes). |
Paragraph 5H(8)(nc) VEA |
Exemptions under the pension income and assets tests, for residents of nursing homes who paid an accommodation bond between 1 October 1997 and 5 November 1997 (both inclusive) and then commuted to an accommodation charge. |
Part 2 of Schedule 5 VEA |
Deemed income attributable to gifts made prior to 20 August 1996 not assessed for aged care fees purposes. |
Section 21.32A of the Residential Care Subsidy Principles |
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SYSTEMS CHANGES — ATTACHMENT A
The material below has been extracted from the systems impact document prepared by Peter Feinler of SA State Office. However, the table of pensioner circumstances and assessment codes has been re-worked to convert it to a useful pin-up guide as to which residential situation code and RA not payable flag to enter in given pensioner circumstances. |
PIPS PC Residential Situation Screen
A pensioner's former home will be exempt under the assets test if they enter nursing home level care and rent the home out to pay the accommodation charge. Typically the exemption will last for 5 years because the accommodation charge is payable for that time. The rental income from the home is also exempt under the income test in this circumstance.
Identifying these cases on the system will be catered for by:
- changing the existing residential situation code of Nursing Home - Owner 2 Years to
- Nursing Home - Previous Owner;
- and adding 2 new RA Not Payable flags of
- Client in Res. Care - Owner 2 Years; and
- Client in Res. Care - Owner 5 Years.
The new RA Not Payable flag of Client in Res. Care - Owner 5 Years will be sufficient to indicate that a client is renting out the home to pay an accommodation charge; and, because this rental income is exempt from the income test, there is no actual need for the amount of rental income to be recorded on the system.
DH&FS classify Aged Care accommodation as high or low level care, and either level of care may be provided in Nursing Homes or Hostels (including retirement village hostels); therefore the distinction between these Residential Situation types will eventually become immaterial. Therefore, these Residential Situation types should be regarded as virtually interchangeable regardless of whether the level of care is high or low, and it will be at the discretion of an examiner to select whichever Residential Situation they consider most appropriate for a case. Because of this there aren't any edits which link high or low level care to any particular aged care related Residential Situation.
A new field is required to display the level of care provided by DH&FS. The field name will be Level of Care:. This field will be a display only field with valid values of High or Low when this data has been provided by DH&FS. If the DH&FS/DVA match has been successful but DH&FS have not provided the level of care, or if the DVA pensioner is not on the DH&FS data file, this field will be “greyed out”.
Example of the Residential Situation screen
The table on the following page sets out valid combinations of Residential Situation and RA Not Payable flag for given circumstances of the pensioner
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Table of pensioner circumstances and assessment codes
CIRCUMSTANCES OF PENSIONER |
WHAT TO ENTER ON SYSTEM |
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Type of Facility |
Nature of Care Received (1) |
Homeownership Status |
Residential Situation Code to use |
RA Not Payable Flag to enter: |
Record Accommodation Bond or Entry Contribution |
Nursing Home |
Government subsidised care - high level |
Resident was not a home owner or has sold former home |
Nursing Home |
Client in Residential Care Facility |
Neither |
Resident has retained former home but is not paying an accommodation charge |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 2 Years |
Neither |
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Resident has retained former home, is paying accommodation charge but is not renting out former home |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 2 Years |
Neither |
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Resident has retained former home, is paying accommodation charge and is renting out former home |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 5 Years |
Neither |
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Government subsidised care - high level |
Resident was not a home owner or has sold former home |
Nursing Home |
Client in Residential Care Facility |
Accommodation bond if paid and in form of lump sum |
|
Extra Service Place (Exempt Nursing Home) |
Resident has retained former home. |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 2 Years |
Accommodation bond if paid and in form of lump sum |
|
Government subsidised care - low level |
Resident was not a home owner or has sold former home |
Nursing Home |
Client in Residential Care Facility |
Accommodation bond if paid and in form of lump sum |
|
Resident has retained former home. |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 2 Years |
Accommodation bond if paid and in form of lump sum |
||
Not Government |
Resident was not a home owner or has sold former home |
Nursing Home |
None (2) |
Neither |
|
subsidised |
Resident has retained former home. |
Nursing Home - Previous Owner |
None (2) (4) |
Neither |
|
Hostel |
Government subsidised care - high level |
Resident was not a home owner or has sold former home |
Retirement Village - Hostel |
Client in Residential Care Facility |
Neither |
Resident has retained former home but is not paying an accommodation charge |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 2 Years |
Neither |
||
Resident has retained former home, is paying accommodation charge but is not renting out former home |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 2 Years |
Neither |
||
Resident has retained former home, is paying accommodation charge and is renting out former home |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 5 Years |
Neither |
||
Government subsidised care - low level |
Resident was not a home owner or has sold former home |
Retirement Village - Hostel |
Client in Residential Care Facility |
Accommodation bond if paid and in form of lump sum |
|
Resident has retained former home. |
Nursing Home - Previous Owner |
Client in Res. Care - Owner 2 Years |
Accommodation bond if paid and in form of lump sum |
||
Not Government subsidised |
Resident was not a home owner or has sold former home. |
Retirement Village - Hostel |
None(2) (3) |
Entry Contribution if one was paid |
|
Resident has retained former home and is better off assessed with home exempted for two years |
Nursing Home - Previous Owner |
None(2) (4) |
Enter Entry Contribution as a loan on the Loans screen if one was paid |
||
Resident has retained former home and is better off assessed under Entry Contribution (retirement village) rules. |
Retirement Village - Hostel |
None(2)(3) (4) |
Entry Contribution if one was paid |
||
Note 1: The presence of a High or Low level of care indicator on residential situation screen should be taken as confirmation that the person is receiving Government subsidised care. If indicator is not present, check with facility.
Note 2: Normally RA would be payable to these people in respect of any fees they pay to the nursing home or hostel. However, other factors may prevent payment of RA. If so, an RA not payable flag may have to be entered.
The flags that are available for these puposes are: “Fees paid (eg, POW)” (4); “Rent Amount not Verified” (4); “Miscellaneous Reason” (4).
Note 3: If an amount of $90,000 or more is entered into the entry contribution field, the RA not payable flag will be greyed out. This is because such people are assessed as homeowners and are not entitled to rent assistance.
Note 4: The owner 2 year rules apply to all cases where the “Nursing Home - Previous Owner” residential situation is selected - even if the RA not payable flag “Client in Res. Care - Owner 2 Years” is not selected.
Note 5: Under a policy change implemented on 28 January 1997 (refer DI C05/97), persons who pay an entry contribution for entry to a hostel can be assessed under the Entry Contribution (retirement village) rules, or the
owner 2 year rules - whichever is to their advantage.
1
1
If an examiner selects a Residential Situation of Nursing Home or Retirement Village - Hostel, the RA Not Payable Flag will default to Client in Residential Care Facility. The RA Not Payable Flag will still be able to be changed from this default.
If an examiner selects a Residential Situation of Nursing Home - Previous Owner, the RA Not Payable Flag will default to Client in Res. Care - Owner 2 Years. The RA Not Payable Flag will still be able to be changed from this default.
The following messages are required:
- If a client with a Date of Entry that is less than 2 years old and an RA Not Payable flag of Client in Res. Care - Owner 5 Years has this flag changed to anything other than the RA Not Payable flag of Client in Res. Care - Owner 2 Years, a warning message will appear stating “(insert client's name)'s Residential Situation is Nursing Home - Previous Owner with a Date of Entry of (insert date of entry), please check if client remains eligible for 2 year exemption of home. If so, and client remains in approved aged care, please select RA Not Payable indicator of Client in Res. Care - Owner 2 Years.”
- If a client's Date of Entry is more than 5 or 2 years old than the respective RA Not Payable flag of Client in Res. Care - Owner 5 Years or 2 Years, a warning message will appear stating “(insert client's name)'s home has been exempted for (insert 5 or 2 years as applicable) following entry into aged care. However, the Date of Entry is more than (insert 5 or 2 years as applicable) ago. You may need to investigate client's residential situation and whether the client's former home should be assessed as an asset.”
- If an examiner selects an RA Not Payable flag of Client in Res. Care - Owner 5 Years, a warning message will appear stating “Owner 5 Years exemption is only available to clients in High (nursing home) level aged care who have rented out their home to pay an accommodation charge.” This message will appear whether or not any level of care is recorded.
- If a client does not have a Residential Situation appropriate for residing in aged care accommodation such as Nursing Home, Nursing Home - Previous Owner or Retirement Village - Hostel, and the client's level of care is recorded as High or Low, a warning message will appear stating “DH&FS records show that (insert client's name) receives (insert High or Low as appropriate) level aged care but current Residential Situation of (insert actual Residential Situation) is incompatible with this. Please investigate client's Residential Situation.”
Accommodation Bonds
The rules for accommodation bonds for hostel residents and for residents of exempt nursing homes are unchanged from those introduced from 1 October 1997 and therefore the system rules for accommodation bonds are largely as previously advised, ie:
- An accommodation bond is assessable as an asset when paid as a lump sum or part lump sum, regardless of a client's homeowner status and regardless of the amount of the bond. An accommodation bond is not income tested, ie, is not subject to deeming.
- The Accommodation Bond field will only be accessible for the following residential situation types.
Situation |
Qualification |
Description |
MI |
- |
Nursing Home |
MI |
O |
Nursing Home - Previous Owner |
RV |
H |
Retirement Village - Hostel |
From 6 November 1997 a nursing home (high level care) resident (except for a resident of an exempt nursing home now known as an extra service facility) cannot pay an accommodation bond. They can only pay an accommodation charge. In addition, the 5 year exemption on rental and asset value of family home is only where an accommodation charge is payable. The option to record an accommodation bond with a Residential Situation of Nursing Home or Nursing Home - Previous Owner will be retained as some people paid the accommodation bond prior to 6 November 1997 and for residents of extra service facilities (exempt nursing homes) who can still be required to pay an accommodation bond.
The following table summarises changes to the assessment rules for entry into approved aged care from 1 October 1997:
NOTE THAT IF THE PERSON HAS ENTERED AGED CARE THAT IS NOT APPROVED FEDERAL GOVERNMENT SUBSIDISED RESIDENTIAL CARE, THE PRE 1 OCTOBER 1997 RULES APPLY.
NOTE: EXEMPT NURSING HOMES SHOULD NOT BE CONFUSED WITH UNAPPROVED RESIDENTIAL CARE. AN EXEMPT NURSING HOME (EXTRA SERVICE FACILITY) IS AN APPROVED FACILITY WHICH HAS AN EXEMPTION FROM DH&FS TO CHARGE HIGHER THAN NORMAL FEES DUE TO THE PROVISION OF ADDITIONAL SERVICES TO RESIDENTS.
RESIDENTIAL SITUATION: |
VACATED HOME ASSESSABLE? |
ASSET LIMIT: |
ACCOMMODATION PAYMENT ASSESSMENT: |
High (nursing home) level care (except exempt nursing home) |
Exempt for 2 years unless sold; or Exempt while rented and accommodation charge payable or liable to be payable if sanctions did not apply (typically 5 years) |
LOW if vacated home exempt. HIGH in other cases. |
From 6/11/97 a nursing home resident (other than a resident of an exempt nursing home) cannot pay an accommodation bond but may pay an accommodation charge. (Any bonds paid from 1/10/97 to 5/11/97 can remain on system as an assessable asset - if such bonds are cashed in then case is assessed under manual rates). Accommodation Charges are not subject to income and asset testing and do not need to be recorded on system. |
Low (hostel) level care & Exempt Nursing Home (Extra Service Facility) |
Exempt for 2 years unless sold. 5 year exemption not available. |
LOW if vacated home exempt. HIGH in other cases. |
Balance of accommodation bond (ie amount paid less any drawdown that has occurred) assessable regardless of homeowner status or amount Note 1: Exempt nursing homes are the only approved nursing homes which can charge an accommodation bond from 6/11/97. Note 2: The system does not need to calculate the balance of the accommodation bond. This is calculated and entered into the system by examiner action. |
In the case of Illness separated couples who were assessed with a Low Asset Limit prior to the illness separation, the following rules apply:
Where one member of a couple enters low level care and has Residential Situation recorded as Retirement Village - Hostel and pays an Accommodation Bond and the other member of the couple retains a Residential Situation of Homeowner:
- the family home remains an exempt asset
- the Low Asset Limit applies
- the full amount of the Accommodation Bond is assessed as an asset and is recorded on the Residential Situation screen of the member of the couple whose Residential Situation has changed to Retirement Village - Hostel
Where, prior to the illness separation, the residential situation was Retirement Village - Selfcare with a Low Asset Limit because the joint Entry Contribution exceeded the Extra Allowable Amount, and one member of a couple enters low level care and has residential situation recorded as Retirement Village - Hostel and pays an Accommodation Bond:
- the joint Entry Contribution remains an exempt asset with the full amount of the entry contribution recorded on the Residential Situation screen of the member of the couple who retains the Residential Situation of Retirement Village - Selfcare
- the Low Asset Limit applies
- the full amount of the Accommodation Bond is assessed as an asset and is recorded on the Residential Situation screen of the member of the couple whose Residential Situation has changed to Retirement Village - Hostel
Warning and Edit Messages
The following edits and warnings are related to accommodation bonds:
- An edit message will appear if an Accommodation Bond and Entry Contribution are both entered for a client: “This combination is not permitted.”
- If the Date of Entry is pre 1 October 1997 for Residential Situation of Retirement Village - Hostel and an examiner enters an amount in the Accommodation Bond field, a warning message will appear “Accommodation Bond is only valid for a pre 1 October 1997 entry date if client has moved to another facility or the client has requested the new accommodation bond rules be applied instead of previous entry contribution rules.”
- If the Date of Entry is pre 1 October 1997 for Residential Situation of Nursing Home or Nursing Home - Previous Owner and an examiner enters an amount in the Accommodation Bond field, an edit message will appear “Date of Entry cannot be before 1/10/97 for Accommodation Bond.”
- A warning message will appear when an examiner tries to delete any of the RA Not Payable flags of Client in Residential Care Facility, Client in Res. Care - Owner 2 Years, Client in Res. Care - Owner 5 Years and will state “Client cannot receive rent assistance if in an approved Residential Care Facility and receiving subsidised care.” This message is required because rent assistance may still be payable to clients residing in approved facilities but who do not receive subsidised care or who are residing in unapproved facilities. This warning message will appear whether or not an accommodation bond is recorded.
- Other warning messages will appear for clients with a Date of Entry on or after 1 October 1997 depending on the combination of Residential Situation, Level of Care, and data entered in the Entry Contribution or Accommodation Bond fields. These messages are shown in the table on the following page.
Residential Situation |
Level of Care |
Entry Contribution |
Accommodation Bond |
Warning message |
Nursing Home (inc Previous Owner option) or Retirement Village - Hostel |
None recorded |
Not accessible or left blank by examiner |
amount entered by examiner |
An Accommodation Bond is valid only if the client receives approved Low (hostel) level aged care or approved High level care in an Extra Service Facility (formerly known as an exempt nursing home). No amount should be entered if no bond was charged or the payment option for the bond is solely by periodic payments. |
Retirement Village - Hostel |
None recorded |
amount entered or left blank by examiner |
left blank by examiner |
An Accommodation Bond should be recorded unless the client is not residing in approved aged care, or unless no bond was charged or the payment option for the bond is solely by periodic payments. |
Nursing Home (inc Previous Owner option) or Retirement Village Hostel |
High |
left blank by examiner |
amount entered by examiner |
DH&FS records show that (insert client's name) receives a High level of care. An Accommodation Bond cannot be charged if the client entered High level aged care after 5 November 1997, unless in an Extra Services Facility (formerly known as an exempt nursing home). Therefore, the Accommodation Bond field should be left blank unless client is in an Extra Services Facility.” |
Retirement Village - Hostel |
High or Low |
amount entered by examiner |
left blank by examiner |
DH&FS records show that (insert client's name) receives a (insert High or Low as appropriate) level of approved age care. Therefore, an entry contribution is not valid if client remains in approved aged care. |
Retirement Village - Hostel or Nursing Home (inc Previous Owner option) |
Low |
left blank by examiner |
left blank by examiner |
DH&FS records show that (insert client's name) receives a Low (hostel) level of care. An Accommodation Bond should be recorded, unless no bond was charged or the payment option for the bond is solely by periodic payments. |
Residential Care Details screen - new fields
DH&FS will be providing information about level of care and this will be displayed on the Residential Care Details screen in a new Level of Care field. DH&FS have 8 care level categories: categories 1-4 are for high level care in a nursing home and categories 5-8 are for low level care in a hostel. Therefore, the Level of Care field will display values of High or Low which default from the information provided by DH&FS.
DH&FS will provide a flag of yes or no indicating whether or not a client should be income tested. A new Income Tested Fees field on the Residential Care Details screen will display Yes or No which defaults from the flag provided by DH&FS.
Example of the Residential Care Details screen
Income Testing of Aged Care Fees
Income tested fees will apply only to residents who enter aged care from 1 March 1998. No income tested fees will be payable for the first 28 days after entry into aged care. The assessment rules for income testing are unchanged from those previously introduced except as noted below.
Disability pension will be counted as income for aged care fee purposes for clients who enter residential care after 1 March 1998 and have the DH&FS income testing flag set to yes and have their DSS Age Pension paid by DVA on or after 26 March 1998 under the BEB provisions.
Deemed income assessed from assets disposed prior to 20 August 1996 (ie, disposed up to and including 19 August 1996) is exempt income for aged care fee purposes only. This deemed income remains assessable for pension purposes.
Therefore for aged care fees purposes the total of financial assets used to calculate deemed income will have to exclude the assessable amount of any deprived assets disposed prior to 20 August 1996.
An example of this is:
Single pensioner has financial assets as shown below:
Type of Asset: |
Assessable Amount: |
Financial Institutions: |
$20,000 |
Managed Investments |
$40,000 |
Deprived Asset (gift of $20,000 on 10/1/96) |
$10,000 |
Total: |
$70,000 |
For the purpose of aged care fee assessment, deemed income would be assessed on total of $60,000 (ie, $70,000 less $10,000 deprived asset). Whereas for the purpose of pension assessment, deemed income would be assessed on the total of $70,000.
Calculate Pension
If a client does not have a Residential Situation appropriate for residing in aged care accommodation such as Nursing Home, Nursing Home - Previous Owner or Retirement Village - Hostel, and the client's level of care is recorded as High or Low, a warning message will appear stating “DH&FS records show that (insert client's name) receives (insert High or Low as appropriate) level aged care but current Residential Situation of (insert actual Residential Situation) is incompatible with this. Please investigate client's Residential Situation.”
If a client's Date of Entry on the Residential Situation screen is more than 5 or 2 years old than the respective RA Not Payable flag of Owner in Res. Care - Owner 5 Years or 2 Years, a warning message will appear stating “(insert client's name) home has been exempted for (insert 5 or 2 years as applicable) following entry into aged care. However, the Date of Entry is more than (insert 5 or 2 years as applicable) ago. You may need to investigate client's residential situation and whether the client's former home should be assessed as an asset.”
Note, although these warning messages would also appear on the Residential Situation screen, they need to appear on Calculate Pension in order to cater for cases in which examiners don't access the Residential Situation screen. If one of these warning messages has been displayed on the Residential Situation screen, it will not also be displayed on Calculate Pension.
Simulated Assessment and What If
Simulated Assessment and What If will reflect changes to assessment rules and Residential Situation screen.
Trial Assessment (PP.TR)
Trial Assessment needs to reflect changes to assessment rules and Residential Situation screen.
The following will be a valid combination of values for Residential Situation of Nursing Home - Previous Owner with either RA Not Payable flag of Client in Res. Care - Owner 5 Years or Client in Res. Care - Owner 2 Years:
RENT: 369.60 ASSETLIM: L RESSIT: MI RESQUAL: O
93 RA SAV: ACCOMPUR: N CANCELRA: Y OSEASID:
This is unchanged from current display - there is no need to distinguish owner 2 years from owner 5 years on PP.TR. The ACCOMPUR field could have values of Y or N depending on whether or not the client has actually paid an accommodation bond (eg, for residents of exempt nursing homes).
The HO field will need to include the total of any accommodation bond plus other assessable home assets of household contents or entry contribution if assessed:
ASSETS FINANCIAL ASSETS: 57042.20
HO: 23000.00 BU: FA: PR: IA:
Daily Advices
The paragraph explaining that DVA will notify DH&FS of changes to income for aged care fee assessment purposes needs to be inserted in advices in cases where the DH&FS flag indicating that clients are income tested has been set to Yes (ie, only for clients who enter aged care from 1 March 1998).
Accommodation Bonds will also be included in income and asset lists.
Matching Process
The matching process is largely unchanged from that previously advised. Some changes are noted below.
Data matching will be enhanced by the use of the DVA file number.
DH&FS have a requirement for a DVA Assistance Date which is used by them to work out pensioner supplementation. This date will be derived from the PCC date of eligibility. If the date of admission to aged care is after the PCC date of eligibility, the DVA Assistance Date will be the date of admission. If the date of admission is prior to the PCC eligibility date, the DVA Assistance Date will be the PCC eligibility date.
An Income Required (INC RQD) column has been added to matching reports and displays Y or N depending on whether or not income information is required by DH&FS for income testing purposes. If income information is required the amount is displayed in an INCOME AMOUNT column.
The level of care provided by DH&FS will also be displayed on matching reports, in a column headed LVL CAR with valid values of H or L for high or low level care. This might be useful when investigating clients who have an incorrect Residential Situation recorded and as an indication of whether or not an accommodation bond has been paid.