ACFI UPDATE
This year promised to bring changes to ACFI. Details of adjustments to the Complex Health
Care Domain have been announced. Validations are proving to be more intense with
planned unlimited claw backs for claims errors. Getting the ACFI Appraisal Packs absolutely
right will be the key as well as understanding what content is expected by the validators.
ACFI CHANGES
Firstly, existing resident’s ACFI funding and domains will not change. Their subsidy funding
levels will be ‘grandparented’. The changes will only affect new residents admitted on or
after the 1st July, 2016 or ACFI’s lodged for existing residents on or after 1st July.
What this means: An existing resident is currently funded as HHH and there is no reason to
lodge another ACFI, their funding levels will not change.
A new resident is admitted on the 10th July 2016, some of the changes will apply to them.
An existing resident admitted from hospital in May will have an expiring ACFI in November
2016. All the current funding and levels will apply until November but when the next ACFI is
lodged in November the new July changes will apply.
Announced changes from the 1st July 2016
50% indexation for the Complex Health Domain from 1 July 2016.
What this means: Assuming there is the usual small increase in ACFI funding for the next
twelve months from 1st July 2016 the ADL Domain and Behavior Domain will increase by the
full indexed amount but the Complex Health Care (CHC) Domain will only go up by half (or
50%) of the indexed amount. This arrangement is only planned for the 2016 2017 financial
year, full indexation for all three domains will occur from and including 2017 2018.
Changes to the matrix combination of ACFI Q11 Medication and ACFI Q12 Complex Health
Care procedure. The department has planned this to occur in two steps.
Step 1 Applies only from 1 July 2016 to 31st December 2016
Medication
A
B
C
D
Complex
A
0
0
1
1
Health
B
0
1
1
2
Care
C
*2 to 1*
2
2
*3 to 2*
Procedures
D
2
3
3
3
What this means: An ‘A’ in Medication in combination with a ‘C’ in CHC now scores a 2
which is MEDIUM funding of $46.27 per day reduces to score 1 which is LOW funding of
$16.25 per day. A profile might be now a resident is self-medicating hence ‘A’ for medication
and is on an ACFI 12.4B Pain Program a ‘C’ in CHC currently funded for $46.27.
One voice representing: Not -for-profit | Community | Public | Private | Mission -based
Under the new arrangements for an ACFI lodged after July 1st for a similar scenario will drop
to LOW of $16.25 per day.
Next a ‘D’ in Medication in combination with a ‘C’ in CHC now scores 3 which is HIGH funding
of $66.82 per day reduces to a score of 2 which is MEDIUM funding of $46.27 per day. A
common claim might be a resident is a Diabetic on insulin injections daily a ‘D’ in Q11
Medication together with 12.2 BGL’s daily together with 12.5 Change of Position a ‘C’ in Q12
CHC. This scenario is now funded as HIGH but for an ACFI lodged after 1 st July this will be
MEDIUM funding.
Announced changes from the 1st January 2017
Changes to the points for select procedures in ACFI Q12 Complex Health Care.
What this means: and remember this only applies to ACFI lodged after 1st January 2017!
1) ACFI 12.1 Daily Blood Pressures reduce from current 3 points to 1 point
2) ACFI 12.4A RN or Physio Massage/TEN’s minimum weekly and 20 minutes staff time
from current 3 points to 2 points
3) ACFI 12.4B Physio Massage/TEN’s the score will be reduced from 6 points to 4 and in
addition a timing requirement will be added requiring 120 minutes of delivery of
treatment over a week
4) ACFI 12.12 Fitting of compression garments TED’s/TUBI grips reduces from 3 points
to 1 point
Comment: An ACFI 12.4B Pain Management Program will need an additional CHC procedure
to achieve MEDIUM funding in this domain. A pain treatment you could add is an ACFI 12.3
Heat Pack/massage by care staff and under the new matrix the resident will also need to be
at least a ‘B’ for medication for MEDIUM funding.
Note: Common claims not changed include – ACFI 12.2 BGL’s, 12.5 Change of Position,
12.8 Catheter Care, 12.10 Chronic Wounds all retain their previous points.
Note: Rating levels unchanged:
 1-4 points still a ‘B’
 5-9 points still a ‘C’
 10 points or more a ‘D’
Changes to Matrix Step 2 Applying from 1 January 2017
“The new matrix reduces the rating categories for medication under Question 11 from four
rating points to three rating points. If assistance is needed with medication this will now in
all cases receive the middle ‘B’ rating, rather than the previous matrix which provided an
incentive to take longer to deliver medication by allocating the highest level of funding
where medication assistance was required for more than 11 minutes per day.” Quote from
Department fact sheet.
Medication
No Assistance
Needed
(New A)
Assistance
Needed
(New B)
Injections
(New C)
Complex
A
0
Health
B
0
Care
C
1
Procedures
D
2
1
1
2
3
1
2
2
3
“A rating of ‘A’ (No Assistance Needed) will apply where there is no medication or
medication is self-administered. A rating of ‘B’ (Assistance Needed) will apply where any
assistance is required daily with medications or patches are required to be applied at least
weekly. A rating of ‘C’ (Injections) will apply where daily administration of a listed injection is
required.” Quoted from Department Fact Sheet May 2016.
What this means: From January 1st next year there will be no more timing of medications.
The current A, B, C, D, Ratings will no longer apply. A resident who gets any assistance with
medication is an automatic new ‘B’ rating unless they get daily injections where the new ‘C’
rating applies.
A scenario – A resident receives oral medications delivered by staff - ACFI 11 Medication
rating ‘B’ plus receives a 12.4A RN massage (2 points) and 12.5 Change of Position (3 points)
totaling 5 points a ‘C’ in CHC. So the new Q11 ‘B’ plus Q12 ‘C’ will equal MEDIUM funding.
How do we get HIGH funding in the CHC Domain?
A number of ways:
1) Daily Injections plus 10 points of Complex care, say BGL’s (3 points) + 12.4B Physio
Massage/TEN’s (4 points) + 12.5 Change of Position (3points)
2) Oral Medications plus 10 points of Complex care, say Chronic Wound + O2 therapy +
12.3 heat packs
3) Oral Medication or patches plus 10 points of Complex Care, say Managing MRSA
infection (6 points) + RN feeding for Dysphagia one meal daily (3 points) + weekly
suppository (1 point)
4) Sub cut injection plus Palliative Care.
Other comments:
Residents currently on the ACFI 12.4B Pain Management Program (PMP) will continue
unchanged under the current business rules unless a new ACFI is lodged next year. New
residents can be commenced on the ACFI 12.4B PMP under the current rules right through
the balance of this year. Due to ‘grandparenting’ of pre-1 January 2017 ACFI 12.4B residents,
next year there will be some PMP residents under the current rules and new residents
having to comply with the new 120 minutes per week requirement. Suggest that excellent
records will be needed to validate claims with Physiotherapist rosters available and clear
documentation showing which business rules a 12.4B claim is operating under.
Acknowledgements:
This paper was prepared by Leigh Welling and Associates. Leigh Welling is an Aged Care
Consultant specializing in ethical ACFI optimization and Care Planning/documentation. Leigh
is available for in-house ACFI audits/maximization and staff training.
On behalf of LASA Victoria, we would like to thank Leigh Welling and Associates who has
provided insight and expertise that has greatly assisted in the development of this paper.
Disclaimer: This information sheet is offered as a guide only and all staff are directed to
the Dept. of Social Service’s publications and newsletters.