Senate Community Affairs Legislation Committee, , 5:00:05 to 5:31:04
The department addresses concerns regarding the accuracy of the integrated assessment tool and the efficiency of the formal appeals process.
Topics: Health, Law reform
Speakers: Hon Anne Ruston, Blair Comley PSM, Sonja Stewart, Robert Day, Greg Pugh, Dorinda Cox, Jasmine Snow, Katie Holm, Rachel Blackwood
section continuing in outcome three uh aging and aged care and we will continue with questions. I will hand the call to
stuff that you were looking to print for
>> It's just with the office. So as soon as I can get that I'll give it to you.
Um, okay. So, we um I think I've done those. Sorry. We'll Um, just quickly um on the care management and transition load. Um, has there been any further discussion or consideration? you had a lot of feedback around the 10% care um management cap um in terms of the impact that that's having on services. Is there been any you got any feedback or you collecting any data that suggests this cap is
Uh and that that's something we'll be monitoring really closely obviously planning commencement in December. So that's one of the metrics we'll be looking at over the coming months.
>> Okay. So what sort of time frame have you given yourself to to analyze that because I mean the last thing we want to end up is leaving it too long and find out that you have consequences.
>> Uh I expect we'd be providing initial advice to government in the coming months as well.
>> Okay. Um so are you considering that that um [clears throat] you know the once the price caps are in that any um that that care management cap might need to be reassessed on the
Uh so Senator, [clears throat] the interactions between um the government's commitment to implement price caps from the 1st of July 2026 um potential changes to the care management um percentage uh and other uh factors will all form part of advice to government.
got my piece of paper? I'm hoping. No.
Just mentioning uh for the purposes of Hansard that the uh document has been tabled for pass of the 2025 26 MAFO measures and estimates variation as provided by department.
Okay, look, you know, sort of thank you for that, but I don't think it really achieves anything at all. Um because [clears throat] what I'm really trying to understand is how much money has been allocated when it was allocated to the new support at home program including the 83,000 packages that were promised. And I'll go and have a look at these pages that you've I mean I don't quite understand how you suggesting that a program that has been announced and supposedly funded becomes an estimates variation unless you've got a demand
so sorry just to orient to the two pages. So what we've got there before you are the two uh broad subjects that we covered earlier in the piece. One was around the transparency element around where in the budget papers the support at home program is published where the 83,000 uh were published and what the impact of the 947.8 million is. So that's what page one is. There was a separate conversation around the cost of deferral and that's what page two covers.
>> Look, you know, I I have to say Mr. Pew and through you Mr. Comley because you are the head of this department. This is an outrageous response to a serious set of questions that I asked you in relation to the funding that is being allocated on this piece of paper. you are referring to in relation to the supported home act. a significant amount of of money. I mean, we're talking about $8.9 is it just $8.9 million or is it $8.9 billion?
>> It's $8.9 billion.
>> $8.9 billion. and somehow we're playing games with this in terms of giving you the information that I've requested. Now, I this is intentionally that you're doing this because if you are, um, I think you should really seriously think about what because I think I've been pretty clear about what I wanted and you have absolutely not provided me with any detail whatsoever that would allow me to understand what you, Mr. calmly told me before we went to lunch that you understood what I was asking for. Do you seriously think this answers that?
>> Senator, you you were asking where is the funding reported? This is where the funding is reported for support at home. It also records where the variations occurred from the budget to my EFO to the portfolio additional estimates and makes it clear that the measure that was announced for deferral was additional which was a question you were asking or whether was embedded in the original estimates that that is what it's picking up. Now I I can understand that many uh many senators seek further disagregation of numbers but this is the this is the common way that's reported in the budget for programs showing the variation and expenditure and there's also obviously many policy announcements made by government that provide more detail. Okay. >> But this is the three parts of those key budget documents which records what the support at home program is.
>> Well I have already seen these. So, Mr. Commonly, do you think that you could answer me how much money has been allocated to date to provide the 83,000 supported home packages that have been promised this financial year? How much money? You've acknowledged there's $947 million of additional funding that's in my in total has been allocated to these packages.
And as we've previously answered, we we don't provide that disagregation that's embedded within the $4.2 billion overall allocation for support at home as Mr. Pew has said on a number of occasions.
>> So you don't know the answer.
>> The the issue of um it's embedded with that and it will vary depending on a range of factors in terms of composition of packages and when they're released.
>> So you're now telling me this is demand
>> No, I'm not saying it's demand driven. there's an intention to work within a funding envelope. We've also previously said to you that there um there is no um saving associated with the $83,000 $83,000 packages or the fact that there are interim packages in those.
>> So how have you managed to ascertain that you need $947 million more to provide those packages if you don't know
>> 47 was not solely related to that. A large part of was the cost of deferral which I'm happy for Mr. Pew to run through. A lot of that is related to the fact that uh there are home care packages being issued for longer. You don't have the single assessment tool which has an impact on how efficient that is and it also has an interaction with grandfathering arrangements which is the principal cause of the $947 billion. But Mr. Pew could provide you more information on that.
>> Yeah. Now, with the greatest amount of respect, what I'm trying to understand here is like if you can't answer my questions in any way, shape, or form, um, and you're using all sorts of, um, reasons why you can't just provide a simple piece of information. Um, I think if you can't answer my questions, and I've been badgering you now for six hours or something on these questions, how on earth can the Australian public have any confidence whatsoever that the administration of close on 10 billion dollars of taxpayers funds um are being administered appropriately because you have no capacity to be held accountable for how you're spending this money because you can't tell me what you're spending it on. Well, >> so you know, I like I'm I am absolutely at a loss how you can sit here today despite the fact that the government promised the delivery of these packages. >> There is under no circumstance in the world that you shouldn't know how much they're going to cost or how much you are estimating the budget. To turn around and tell me this is an estimates variation is insulting my intelligence.
>> I'll ask Mr. to comment on why it's an estimate variation rather than a measure. But to come back to the accountability question, [clears throat] the commitments that have been made is to have 83,000 packages out by 30 June. The packages are publicly reported on how many have been released after each period. There is also a commitment to get to a 3month average waiting list by 30 June 2027, which the government clearly will be held to account for. There is an overall funding allocation over the period of support at home of $4.2 billion dollars. That that is the funding. The government has not made subcommmitments about funding allocations within those periods.
>> But how do they know they need that much money if they don't have the granular detail of understanding what they need on that journey? Um you know that's not how budgets work and I think you know that Mr. Comley. But look to be perfectly honest um you know I I just think um you know is I just want to know how much money has been made available in 2526 to deliver 83,000 home care packages or supported home packages as has been promised from the government. The fact that you cannot answer me that question, I think is going to leave every Australian shaking their head as to where is the transparency and accountability of the expenditure of taxpayers money by your department. Mr. Comley, I can't put it any other way.
>> We're happy to take that on notice, Sander.
>> Well, if you could provide that for me by the end of the day to clear up the fact um you know, I've sat in ERC for 3 years. I know how this works. So unless somebody is playing stupid games in terms of how they're doing it and if they are they need to come clean because this has got to be the trickiest thing I have ever seen in my life and I know you know how this works and the fact that you can't answer the question I think is very very concerning.
>> I think Mr.
He's got
>> Tomley has taken your question on notice. Senator
>> Ruston, [clears throat] I'll move on to something else. >> Um Okay. Um I'm just I know that Senator PCO asked some questions around the um the integrated um assessment tool. Um so has there been any changes um in terms of the eligibility criteria um for older Australians to be eligible for home care since the support at home >> outside of the financial >> we didn't change eligible um so one of the concerns and I I said I think Senator Pocock did touch on some of inability of or some concerns around the the um the assessment tool accurately identifying things like allied health needs. Is is that something that you've
>> Not a problem. We we are receiving a range of feedback on the way that the system is operating in terms of the design of the integrated assessment tool itself and the operation of the additional algorithms that work to determine classification and prioritization. So as part of our normal program management activities, we are taking those on board and considering
>> So how many appeals have been lodged in relation to inaccurate results since supported home commenced?
me, Senator. Um, so between the commitments commencement of the support at home program and the 23rd of January, we had 414 requests for review.
>> 414 requests for review. Um, how many of those have been completed? the reviews have been completed.
>> Um, none at this stage, Senator.
>> So, what was the date? So, from the 1st >> November,
>> November
>> to the 23rd of January, you've had 414.
>> Senator, I can I can actually update that for you. Katie Holm, assistant secretary, quality and assurance division. There's been understand your question was how many have been completed?
You ask how many appeals have been lodged >> and then how many of those?
>> There's been two completed in that time.
>> Two. So you had 414 7 weeks and you've completed
um to to be clear on the evidence um the team have completed more than two reviews in that period. But we had a um a load of cases that related to the home care package program that have continued to work through the system as well. Um and so of those that have been made in terms of the support at home or since the commitments of the support at home program, it's two.
>> Mr. D, I might just ask whether you could just um give some context in terms of the review process and the time frames that we can. Um, so I think the
first first thing to point out is that an an individual has 28 days from the day they receive their assessment decision to lodge their application. Um, and then the statutory period for a review to be completed after that application is lodged is 90 days. >> Um, and in terms of 90
>> So what was the first time?
>> 28 days.
>> 28 plus 90.
Um, and I guess in terms of process, Senator, um, when, and Miss Home might have more detail on this to to offer you, when an application is made, um, initially there will be a conversation between one of our review officers and the older person or their representative to understand the concerns they have about the decision that they've received. Um, and that will then allow us to target requests for for evidence from the individual to support their their request for review.
>> And of those two reviews that you've undertaken, were they successful, unsuccessful, or a combination of both?
>> A combination of both, Senator. So, one
>> Um I just want to read to you um and I'm sure you've probably seen this as well um because it has been reported in the so a um a provider said from Queensland said that one of his clients who um was living with dementia and other health conditions who was on a home care package um had seen their condition escalated and sought for um her package to be reassessed on the basis that u of her deterioration. After the reassessment, she received a letter stating that she didn't qualify so your letter in response to that said, your access to funded age care services has not been approved. You have not been approved to access any additional funded age care services. Um, so I'm just keen to understand how can we have a situation where we've got a this integrated assessment tool that's working. You've got a situ. So what is the capacity for that to be overridden as an assessment? Is it have to go through this process of 28 days and 90 days?
>> it would be open for the individual to seek a review of that decision. Yes. So
person on a home care package condition deteriorating which has instigated her seeking for a review to And then through this process she's had all of her funding removed because they've said she doesn't need any age care services. And you're saying that there's potentially at least 108 days for the process to be undertaken for this person to get this reassessed.
>> I think Senator another trigger could be to actually seek a reassessment by the assessing organization if there was a change of circumstances. So um but otherwise
>> I think that's what she did seek was a reassessment.
>> Uh if there was an additional change of circumstances, a person would be eligible to ask for another reassessment. the alternative would be to seek a review of that outcome.
So I think the thing that's probably concerning me here is that you're obviously using a level of automation in terms of the assessment tool and that assessment tool in in this instance would appear very clearly that there has been a significant mistake made if she was eligible for a home care package and she's got dementia and mobility needs. One imagines that dementia doesn't go away. Um, so how how can this be happening and how can it be a reasonable expectation that this person who has dementia by the way is able to go back through the whole process to try and deal with the fact that your assessment tool appears to have made a mistake. Can
>> I just make a couple of points of clarification before Miss Home answers? Just in terms of um the periods of time, I think it's important to clarify that there's two aspects to this. One of them is the amount of time when somebody has received that decision that they can go and seek a review which is the 28 days and then the other is the period of time by which um we you know that we give ourselves um to make that uh review. The second point that I wanted to clarify is um it's just important to think about this in two there's two aspects to it. One is an integrated assessment tool and that is based on significant evidence um and clinical assessment and a range of uh training and manuals and the other is a rule that then gets applied about the prioritization and the category. So I think that's very important to distinguish those two and that a lot of evidence has gone into uh the tool which is applied by people who were trained to do that and then there's a rule that's applied in terms of that categorization and that prioritization. Um Senator it is um thank you for bringing this to our attention. It is um somewhat difficult to respond when we don't know all the circumstances. However, um you know, if they're I would encourage that person to seek that review, but also um
>> they did seek a review and you reviewed them and told them they couldn't have any package even though you already had one.
>> and I was just going to also say that if um [clears throat] there's also the opportunity to refer to um you know, one of my colleagues and we can have a look at that. But it is somewhat difficult to because um I acknowledge that somebody's perception about how they're going and then how the clinical assessment happens is some sometimes different and I acknowledge that person might be upset and distressed by that. However, that that can happen in some cases. Miss home, did you have anything else to say?
>> And well, this is a provider that's actually provided this piece of advice to us. Um but they also made the comment that that they were providing this as an example of the situations that they were finding in. So um maybe I could ask you then so in relation to these 414 um uh appeals that have been lodged, how many of those um are people contesting assessments and reassessments for inaccurate assessments? Well, they're saying it's for inaccurate assessment or reassessment.
>> Uh there's 167 relating to classification levels. >> Mhm. >> 133 in relation to priority category and 36 relating to both four for supported home.
And what what were the rest? They're just a mismatch of all the rest other
>> Yes. other other appeal points.
>> Okay. So, so the majority of them are in relation to >> um what the person is perceiving as an inaccurate assessment.
Senator just to to put that those numbers in context for you um in terms of the number of assessments performed in November and and December it would be um less than half of 1% of the assessments conducted in those months
>> I was going to say maybe tell that to the person who's making the appeal.
>> I I'm I'm not disputing the the case. I'm putting in context what 414 appeals looks like in terms of the size of the >> I think just to clarify one other point of evidence for you in terms of the time frames that I outlined Senator um I obviously outlined the the maximum legislative period that that's in place. Um the team when they are bringing in a new review application will do a triage process and so there's an opportunity in that to pick up someone who appears to be in genuinely desperate circumstances and expedite that. Um, I don't know this case from with enough familiarity to to describe to you if it came through our review team and how it was handled when it came in, but if you've got the details, happy to look into that for
>> Sure. I mean, it's interesting. I mean, you've had 414 um, appeals and you've responded to two in that time period is not giving me a great deal of confidence. But I mean um there
>> sorry Senator I can provide some additional information there for you as well. So [clears throat] in in that period um the team reach out to the individual there's contact that's made there's uh a process of gathering information uh that's driven by uh our team but also by the applicant or someone supporting them and gathering that further information about those change of circumstances can take time from providers uh medical professionals and others.
Um, Adrien Morgan, who is the general manager of Queensland Home Flexiare, which I'm sure you're aware, um, wrote on his LinkedIn page that 37% of their requests for care levels to be upgraded due to increased client needs are with lower levels of care recommended instead. So they're making a request for higher levels of care because their patients are have a level of deterioration. And in 37% of the cases when they ask for a reassessment because they believe their client needs more care, 37% of them will result in an allocation of lower care. I'm just interested to understand. I mean, look, I'd love to think that older Australians were needing less care, but the reality of the aging process usually suggests that's not going to happen. So, I'm really keen to understand, you've introduced this new integrated assessment tool. We're having lots of people complaining about the inaccuracy of the assessments, you know, whether and we're not passing any judgment on on the outcomes of that. And then you've got a large provider saying that 37% of the times that they ask for an assessment for an increase in support, they're actually getting a response for a decrease in support. So just keen to understand, do do you do you stand by the um the accuracy of your um integrated assessment tool? Um and do you acknowledge that the kind of quantum that we're talking about here is caused for a concern and immediate response? So
so I do stand by this tool who's somebody who is responsible for um the system. This tool provides equity. This tool provides um fairness and it also removes bias from the system. So I do acknowledge that there is uh and Mr. Day has quoted that figure and um I think proportionality is important here and those cases will be dealt with on their merit. However, this tool is a necessary part of the system and it ensures that um that people no matter where you are, whether it is in Queensland or somewhere else, that people are assessed in the same way and the rules apply in the same way and if there is a individual reason why that has not worked in these very small number of cases, it will be looked at on merit um in accordance with the legislation.
>> Can I just um separate supplement as well, Senator? Um, we will follow up with um the provider who you mentioned. Uh, as far as I'm aware, we haven't had any direct contact from Mr. Morgan or from uh anyone else from that agency as yet. I'll have to go back and double check that. Uh, 37% does seem unusually high. So, we'll go and and follow that one through. But, yeah, I mean, if it's one thing to put it on LinkedIn, there's another thing to come and follow up with the department as a this is a systematic issue. So, we'll make that outreach with
him instead. It's been published in the media as well. Um so and I actually understand that you know there are quite a lot of people that seem to be aware of but um nonetheless um so if you could take on notice to um to tell me how many provide the information of how many times a reassessment is sought that the person um reassessment results in them getting less support. y >> than when than the support that they were currently on um would be a really um useful piece of information. Um that same sort of level of change was present when you weren't using the integrated assessment tool. So has the integrated assessment tool resulted in a higher number of people being having their package levels dropped back as a
So haven't heard that on notice. Uh probably just one comment on that comment. Senator, we have given evidence in this committee before uh that one of the driving forces behind moving to an IAT in addition to having a combination of what was previously a whole vast range of paperbased tools was to apply that consistency and equity lens. Um so you know we can absolutely happy to to look at that and take it on notice. Some of the things that were driving that change was that um uh in the home care packages program we were seeing up to 25% of people being overallocated what our assessment of where they should be um provided care was so we can make sure that you know that um hasn't swung
>> 25%
>> up to 25%. That was under the previous
So basically you've replaced one fundamentally broken system with another fundamentally broken system.
>> Um I mean that no I think that evidence has been given consistently is that the integrated assessment tool was validated against I think 22,000 individuals to see whether it's providing consistent results is trying to get genuine equity by using as objective measures as possible based on human assessors putting inputs in. Uh it is the common feature of many um social support systems that it is very hard to deliver equity because often the people assessing um see the individual in front of them want to give the best outcome for this individual. The individual integrated assessment tool is trying to make it as objective as possible >> and that is part of the attempt to make the hare system sustainable.