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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 DRCA 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 general practitioner.
The household services claim form D9319 must be used to gather information to inform the determination.
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*. Exceptions to this may be considered where extenuating circumstances exist, and sufficient information is available to demonstrate a reasonable requirement for household services exists because of the persons accepted conditions. Please refer to section 7.4 of the Rehabilitation Policy Library for information about reviewing household services.
* 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.
Standard maximum rate for household services
To expedite the process for approving household services for clients, a standard maximum rate of up to $65.55 per hour has been set. The standard maximum rate aligns with an equivalent Veterans Home Care (VHC) rate, which is indexed annually in January and the revised rate will be updated here accordingly.
This policy change means that there is no need for the client to source quotes from multiple providers. Clients can be given the option to source their own providers within the statutory limit, or if they require assistance from the provider, the provider must source three quotes and provide these for approval. Where the client is able to source a provider at a lower rate than the VHC rate, this lower rate should be approved.
If there are particular circumstances that in the delegate’s opinion, mean that the VHC rate is not a reasonable rate to use, there is flexibility for the delegate to use their discretion so long as they are satisfied about value for money. For example, if the 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 sometimes need to be approved. This is just one example, each client’s circumstances must be considered on their own merits.
One-off and irregular services
For services that are undertaken on a one-off or irregular basis, the delegate can determine the most appropriate hourly rate based on the service type, without reference to the VHC rate. This is because the market rate for these one-off services may be higher than the rate for regular services such as house cleaning and lawn mowing.
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 DRCA limit is listed on the DRCA 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.
Rehabilitation and the National Disability Insurance Scheme (NDIS)
Household services can be provided by both DVA, through the rehabilitation plan, or by the NDIS, through an individual care plan. Where DVA clients are accessing support through the NDIS, they can choose which of these options suits them best. However, an important principle is that the same household services must not be provided by both NDIS and DVA. Therefore, it is important for Rehabilitation Coordinators to advise Occupational Therapists or other allied health professionals undertaking assessments for attendant care services, that they should discuss with the client whether they are receiving anything from the NDIS. Providers should also be asked to notate in their report that the client has been made aware that they cannot ‘double dip’ for these services.