Resource Allocation and Unit Pricing Framework Guidelines July 2013 Contents 1.0 1.1 2.0 Funding Context .............................................................................................................. 2 Government Principles of Resource Allocation ...................................................................................2 Funding to the Disability and Community Services Sector ........................................ 3 2.1 Unit Pricing Principles .................................................................................................................................3 2.2 Unit Pricing Model .......................................................................................................................................4 2.3 Unit Costing ..................................................................................................................................................5 3.0 How Unit Prices for Service Types are Determined ................................................... 6 3.1 Information, Referral, Advocacy and Recreation Services .................................................................6 3.2 Accommodation Support Services ..........................................................................................................6 3.3 Individual Support Programs (ISPs) (Attendant Care, Personal Support, Disability Respite Services (excluding centre-based)) ........................................................................................................................7 3.4 Centre Based Respite Services .................................................................................................................7 3.5 Community Support Services and Family Support Services ..............................................................7 3.7 Community Access Services .....................................................................................................................8 4.0 Other Price Considerations............................................................................................ 9 5.0 Unit Prices and Efficiency ............................................................................................. 10 6.0 Capital Funding .............................................................................................................. 11 6.1 Definitions................................................................................................................................................... 11 Appendix 1 - Current Unit Prices ........................................................................................... 13 Appendix 2- Rostering Adjustments for Disability Services Group Homes ....................... 16 Page 1 of 19 1.0 Funding Context 1.1 Government Principles of Resource Allocation The key principles underlying the Department’s resource allocation and unit pricing framework are: every Tasmanian has the right to safe, high quality, affordable health and human services when they need them. They also have the right to expect services to be coordinated and take their individual views and needs into account. The overriding purpose of funding relationships between the Department and community sector organisations is to ensure that this happens client focus and outcomes are paramount – funding approaches must empower people to make choices and there must be opportunities to seek and use client feedback funding decisions are based on an assessment of the suitability of a combination of funds allocation methods and quality assurance strategies that best advance the public interest. the basis for the funding relationship between the Department and community sector organisations is mutual respect, open and honest communication, and concurrence to ensure that the client is at the centre of all that we do effective working relationships are built on reciprocal links between the Department and community sector organsations that reflect the mutual and complementary roles of each in the planning and delivery of sustainable and efficient services the Department’s resource allocation and unit pricing framework aims to provide certainty for both the Department and community sector organisations. Certainty for the Sector covers funding periods, funding arrangements and funding levels. Certainty for the Department, covers funded activities, outputs, and quality and safety of service provision – leading to sustainable outcomes for the Tasmanian community the need for certainty must be balanced against the prerogative of Government to make funding decisions as part of the Budget process and changing priorities. Page 2 of 19 2.0 Funding to the Disability and Community Services Sector Funding to the Disability and Community Services sector is administered through the Department’s Resource Allocation and Unit Pricing Framework. Unit pricing commenced 1 January 2012. Unit prices incorporate a provision for salaries, allowances, long service leave, recreation and sick leave, public holidays, annual leave loading, workers compensation and superannuation. The unit prices also include provisions for operating and other costs. For most community sector organisations the Department has implemented three-year funding agreements to assist in making long-term investments and in retaining experienced and qualified staff. Under Unit Pricing service providers are able to roll over surplus funding within the three year funding agreements. Service providers are also expected to manage any annual deficits within the three year agreements. Three-year funding agreements make a clear distinction between base funding and funding for new and growth services. All funding rollovers are conditional upon service providers meeting minimum performance benchmarks and service quality standards. The prices are adjusted annually to reflect movements in wages and prices in accordance with the annual Department of Health and Human Services indexation allocation. 2.1 Unit Pricing Principles The Unit Pricing Principles set out the ‘market rules’ that define the general scope of costs that pricing is intended to cover and the relationship between the funder (DHHS) and the recipients of funds (service providers) in relation to the management and discharge of costs and price based issues within service funding. The Principles are as follows: pricing should recognise the primacy of the client and enhance the capacity of clients to exercise choice and access the most appropriate services prices paid for services should enable service providers to recover costs for a nominated service over the short and long terms prices paid for services should provide incentives to promote effectiveness, innovation and quality prices paid should be based on a reasonably accepted definition of efficient services and allow service providers to benefit from increasing their efficiency prices should be predictable over time and provide certainty to service providers. pricing should be transparent prices should promote equitable access to services by clients and promote client choice where appropriate pricing should enhance sector and individual service provider sustainability and viability. Page 3 of 19 pricing should be based on open and ethical relationships between funder and service provider. The Pricing Principles reflect six general areas of government policy priority, namely: Area of focus Efficiency Allocation of services, general productivity and innovation Simplicity Easy implementation, transparency and low administrative burden Sector sustainability 2.2 Encompasses Funding certainty and sufficiency Equity Avoiding discrimination on ability to pay, avoiding discrimination in relation to location of demand, and levels of care being appropriate to level of need Quality A focus on continually improving aspects of services, standards, and services being high quality Choice Empowering clients and providing them with discretionary choice Unit Pricing Model The unit pricing model used by Disability and Community Services is the ‘fully distributed cost’ model. Under this model the price for a unit of service is based on the total average cost per unit of output (fixed cost, variable direct costs and overheads). This method of unit pricing is widely used to fund human services because it offers a relatively simple way of allocating joint costs and corporate overheads, it also reconciles most closely with the pricing principles. Fully distributed costing has a further benefit in that its simplicity is relatively easy to reflect within funding agreements and hence lends itself well to the establishment of government funded human services. It should be noted that the mechanisms through which services are funded under fully distributed costing are subject to some variation, for instance: the type and volumes of services contained within a funding model may be such that the resulting costs are expressed either in units of service (unit funding) or in totality (block funding) a service may be expressed in different units (e.g. hours, places, instances of service) within unit pricing. The selection of a unit will primarily reflect the nature of the service some costs may be excluded from a unit or block funded amount and funded in a different manner. This exclusion may be to add simplicity and clarity regarding what is being funded,( for example, some types of capital costs). Page 4 of 19 Not all service types are suitable for unit pricing. In some rare instances a service will be covered by a number of distinct unit prices and a mixture of different levels of each type of service. In these cases a price will have to be established based on the individual staffing needs and other supports required to deliver the particular service. 2.3 Unit Costing Essential to the construction of a Resource Allocation and Unit Pricing Framework is a detailed understanding of the ‘fully absorbed cost’ of service delivery. All unit prices are fundamentally based on the median cost of labour derived from an online survey and adjusted to account for non-labour costs and overheads. This cost accounts for all labour related cost inputs, which are known to include: underlying variations in awards levels and classifications shift penalties for non-core hours, weekends and public holidays salary related costs such as superannuation and workers’ compensation backfill for vacation, public holidays, sick leave, training and ‘buddy’ shifts. In addition to the basic cost of labour required to manage the client needs for each service, a series of adjustments have been made that result in an overall increase in the total hours of staff time required. These adjustments (where appropriate) provide for service management, service coordination, staff meetings and where applicable client sick days and closure of Community Access services. To ensure accuracy in the final pricing mechanism a further adjustment was made to the observed labour cost for some accommodation support services. The adjustment was mandated by the significant increase in the amount paid for a sleepover shift under the Disability Services Industry Wages Agreement 2008-09 (DSIWA). The impact of this allowance was removed from the survey-related labour cost. Subsequently the actual cost of a sleepover was added in separately for applicable residences/placements. Page 5 of 19 3.0 How Unit Prices for Service Types are Determined 3.1 Information, Referral, Advocacy and Recreation Services There are significant variations in the way these services operate and they are therefore not considered suitable for transition to a unit price. Services such as Information, Referral and Advocacy (i.e. those classified under both Disability and Family Support Services) effectively define a number of unique service types under a narrow array of service definitions, which exhibit a number of key variances related to: the nature of the services themselves the defined unit of service the level of resourcing required to deliver each unit of services critical variations within the underlying cost base. The Department continues to fund these services under a block funding arrangement. However individual Funding Agreements now clearly define service delivery targets and performance measures. Funding Agreements define the level of service being purchased and the price being paid constructed on the basis of the median cost of labour, uplifted to include non-labour and overhead costs, associated with that level of service. Funding is provided in terms of the number of FTE staff positions required linked to a level of service (e.g. hours per year). Current funding for one FTE position purchases 1,300 hours of direct service delivery annually (which represents a ‘utilisation’ rate of 65.62 per cent i.e. the average percentage of time per FTE spent on direct client and client related activity). 3.2 Accommodation Support Services 3.2.1 Large Residential Models of service delivery among these service types vary significantly in a number of areas, ranging from relatively low support hostel accommodation to nursing home facilities providing substantial medical support to increasingly frail and elderly clients. The underlying cost base also varies with some services receiving alternate sources of funding (i.e. from Commonwealth, client fees and staffing costs depending on the model of care and professional mix of staff). The Department will continue to fund these services on a block funding arrangement. The Department will make an assessment of the number of FTE staff required to deliver the service to the number of clients being supported. 3.2.2 Supported Accommodation – Group Homes The unit of service is one FTE place. The unit price links the derived labour requirements per place to the observed labour cost and incorporates non-labour costs and overheads, which were elicited from service providers during the online survey. The unit prices recognise three characteristics, these are: Page 6 of 19 1. client requirement for an active night, sleep-over shift or no night support 2. client with low, standard or complex (medical/behavioural) support needs 3. facility size (i.e. number of beds). The cost of a unit of service (price per place) is based on the cost of one FTE staff position derived from the median cost of labour and adjusted to account for non-labour costs and overheads. The cost per house is established by converting the total hours of observed roster support plus rostering adjustments into required FTE staff (see Appendix 2) and multiplying by the median cost of labour. The cost of labour is then uplifted by the non-labour costs and overheads component (35.14 per cent, in line with survey findings) to derive the total cost per house and cost per place (see Appendix 1). 3.3 Individual Support Programs (ISPs) (Attendant Care, Personal Support, Disability Respite Services (excluding centre-based)) The unit of service is one hour of support. The unit price is developed by taking the observed median cost of one FTE staff position and dividing this by the median number of direct ISP support hours delivered annually. This provides the cost of direct labour incurred, which represents 67 per cent of the total cost. Non-direct labour and overheads account for 33 per cent of total cost. This price represents the ‘fully absorbed’ cost of service delivery – namely it includes service delivery on weekdays, weekends, mornings, afternoon, evenings and public holidays. These times are covered because the observed cost of labour (on which unit prices are constructed) has been uplifted by approximately 12.6 per cent above the observed cost in the survey findings and services are therefore purchased at a single unit price only. This also includes a component for coordination. 3.4 Centre Based Respite Services The unit of activity is ‘days’ of respite provided. The unit price is aligned to the cost per place in a 4 bed ‘standard/active night’ group home, This purchases 365 days of respite or one full time equivalent client placement. Prices per house are constructed on the basis of the facility’s housing configuration, so for example if we have a 6 bed respite centre, funding would be based on that number of beds providing 2,190 respite days. 3.5 Community Support Services and Family Support Services The unit of service for both of these service types is one hour of client and client related activity/support. The unit price is constructed on the basis of the following components: The ‘utilisation rate’ represents the average percentage of time direct service delivery staff spend on direct service delivery to clients. The agreed utilisation target is 70 per cent. The Unit Price is composed of the following elements: Page 7 of 19 Observed direct labour costs per FTE staff position Utilisation rate Adjusted direct labour cost per FTE (observed cost x 104.38 per cent) Hours available for client support (65.62 per cent of 1,976) Direct labour cost per hour Non-labour and overhead costs per hour 3.7 Community Access Services The unit of service is one Full Time Equivalent place (which equals 6 hours per day, five days per week for 47 weeks per year). The unit price is based on the expected level of staffing required to deliver the service. The observed labour cost for one FTE staff position, costed on the basis of a 32-hour work week comprises 70 per cent of the total cost, this is uplifted to incorporate non-labour costs and overheads (which comprise 30 per cent of the total cost), giving a total cost per annum. The observed client to staff ratio is 2.64 to 1. Based on the observed client to staff ratios and the known costs of the labour, non-labour and overheads components, it is possible to develop an average cost per place across the sector. For clients receiving one-to-one support funding (for 30 hours per week) will equate to the cost of 1 FTE staff. Page 8 of 19 4.0 Other Price Considerations Calculations for each of the service types deemed suitable for a move to unit pricing are constructed on the basis of the observed labour cost across the sector. This observed labour cost includes amounts that reflect: the varying level of staff (qualifications and experience) employed the use of employment agency and/or casual staff (where applicable) shift penalties that account for the day (or time of day) that services are delivered senior staff time directed to clinical and staff supervision case management or service coordination time. In addition to these observed labour costs standard uplifts for non-labour and overheads have been incorporated into the unit price and are expected to cover all expenses that are not considered direct labour or long term fixed capital costs, such as: travel training management expenses and corporate/facilities costs consumables. The inclusion of representative allowances for all these key cost components is intended to reflect the true, total cost of contemporary service delivery. Page 9 of 19 5.0 Unit Prices and Efficiency Unit prices are based upon an assessment of the fully distributed cost of delivering current services. These costs reflect the range of inputs (labour and general resources) used in delivering services under existing service providers models of service delivery. The unit prices developed have not been based on any assessment regarding what constitutes an efficient model for each service type and hence does not mandate what labour and general resources should be employed. Under continuing service system reforms, particularly the adoption of best practice models, the consideration of what constitutes an efficient resourcing model will be relevant. In the event of further system reforms, the basis of future unit prices may be altered. It is noted, however, that where service providers access efficiency savings through other innovative practices and through factors such as economies of scale, the benefits of these savings will remain with the service providers, as noted in the pricing principles. Page 10 of 19 6.0 Capital Funding 6.1 Definitions Working capital The collective term for the resources of an organisation that cycle through its cash flows to allow it to operate day to day – includes cash and easily convertible investments, stock, debtors and creditors. Fixed capital The collective term for the resources of an organisation that are employed with a longer-term focus. In most cases this will primarily be physical infrastructure, but may include longer-terrm investments and long-term borrowings. Short-term fixed capital This refers to capital assets that have a short life. For most service providers this will predominantly be vehicles and computers, but may include furniture, equipment, fixtures and fittings. Long-term fixed capital This refers to capital assets that have a long life. For most service providers these will predominantly be buildings and large one-off pieces of equipment (i.e. specially modified buses). Unencumbered grants Grants that do not impose any conditions that result in the grant making body retaining an interest in the asset. 6.2 Funding of Capital Under Unit Pricing The unit pricing framework is based on fully funding efficient operating costs and as such, in regard to ‘working capital’ no additional capital funding arrangements, beyond the unit price funding, are required. The unit pricing framework divides the maintenance of ‘fixed capital’ into short and long term fixed capital requirements. The unit pricing framework makes allowances for ‘short term fixed capital’ costs as they are highly predictable and effectively recurrent in nature. Under unit pricing, these costs (as represented by depreciation charges) have been included in the established unit prices. ‘Long term fixed capital’ assests have higher levels of uncertainty regarding future value to an organisation and to potential resale value. This is mainly the case because the markets for long-term fixed capital assets can be limited and subject to arbitage and to obsolescence. The cost to an organisation of employing and subsequently replacing a long-term fixed asset is difficult to determine and hence not suitable for inclusion in operating funding. Also when an organisation needs to replace a long-term fixed asset it may not have accumulated sufficient resources through depreciation to acquire a replacement asset. Separate capital funding support may therefore be required for these assets. This is most likely in cases where: Page 11 of 19 asset prices have been subject to significant inflation (for instance in relation to the replacement of land/buildings) asset replacement is not ‘like-for-like’ (for instance impact of industry standards may require enhanced building designs, layout, number and design of rooms) there is no market to sell the existing asset, other than for scrap, (for instance run down modified buses which are close to being written off). In these cases the Department recognises that the capital risk should be shared between the sector and the Department and should not impose any unreasonable burden on service providers. At present the Department will negotiate on ‘unencumbered grants’ on a case by case basis. Page 12 of 19 Appendix 1 - Current Unit Prices Recommended Unit Prices – 2013-2014 (All Unit Prices include 2.25 per cent indexation for 2013-14) Service Type DISABILITY SERVICES Unit Price Individual Support Program Hour $41.70 Attendant Care Services Hour $41.70 Personal Support Services Hour $41.70 Respite Services (own home) Hour $41.70 Group Homes Place Respite Services (Centre-based) Large and small residential See table below Place (active night facility) $145 973 (sleep-over facility) $111 534 Block funded (per FTE Place) Varies Hour $94.07 Place (FTE) In-groups - $24 475 institutions Community Support Services Community Access Services One-to-one - $64 612 Information, Referral and Block funded (per FTE staff) $117 593 Advocacy Services Block funded (per FTE staff) $117 593 Information and Advisory Block funded (per FTE staff) $117 593 Block funded (per FTE staff) $117 593 Hour $85.28 Recreation Services FAMILY SUPPORT SERVICES Services Advocacy Services All other services Page 13 of 19 Appendix 1- Current Unit Prices Unit Prices for Disability Services Group Homes – 2013-2014 Configuration ONE BEDROOM Rostering Low Support Standard Complex Sleep over Active night Sleep over Active night Cost per place NOT 241 229 378 982 420 101 557 856 Cost per house APPLICABLE 241 229 378 982 420 101 557 856 87 143 163 219 Hours of client support per week Configuration TWO BEDROOM Low Support Standard Complex Sleep over Active night Sleep over Active night Cost per place NOT 174 400 243 278 225 787 294 669 Cost per house APPLICABLE 348 801 486 556 451 575 589 338 122 178 168 224 Hours of client support per week Configuration THREE BEDROOM Rostering Low Support No Standard Complex Sleep over Sleep over Active night Sleep over Active night sleepover Cost per place 87 676 95 265 143 995 189 916 195 553 241 475 Cost per house 263 028 285 795 431 986 569 749 586 661 724 425 Hours of client 92 92 153 209 220 276 support per week Configuration Rostering FOUR BEDROOM Low Support No Sleep over Standard Sleep over Active night Complex Sleep over Active night Page 14 of 19 sleepover Cost per place 78 739 84 572 111 534 145 973 155 271 189 712 Cost per house 314 959 338 290 446 139 583 892 621 087 758 849 Hours of client 113 113 158 214 234 290 support per week Configuration Rostering FIVE BEDROOM Low Support No Standard Complex Sleep over Sleep over Active night Sleep over Active night sleepover Cost per place 88 248 92 914 106 815 134 366 136 513 164 066 Cost per house 441 240 464 572 534 076 671 832 682 569 820 332 Hours of client 164 164 193 249 259 315 support per week Configuration Rostering SIX BEDROOM Low Support No Standard Complex Sleep over Sleep over Active night Sleep over Active night sleepover Cost per place 85 246 89 103 103 514 126 474 122 372 145 332 Cost per house 511 480 534 619 621 087 758 849 734 234 871 996 Hours of client 198 198 234 290 280 336 support per week Page 15 of 19 Appendix 2- Rostering Adjustments for Disability Services Group Homes 1. Adjustments (where applicable) provide additional hours, for Community Access Services closure, client sick time, house management and staff meetings. 2. All hours are Annual Hours 3. One staff FTE equals 1,976 hours per annum as per the Disability Services Providers Award Configuration Rostering ONE BEDROOM Low Support Direct labour Standard Complex Sleep over Active night Sleep over Active night 4 524 7 436 8 476 11 388 710 787 639 716 5 234 8 223 9 115 12 104 2.6488 4.1614 4.6129 6.1255 hours Direct labour adjustments hours Total hours per NOT APPLICABLE residence Total FTE (staff) per residence Configuration Rostering TWO BEDROOM Low Support Direct labour Standard Complex Sleep over Active night Sleep over Active night 6 344 9 256 8 736 11 648 1 224 1 301 1 062 1 139 7 568 10 557 9 798 12 787 3.8300 5.3426 4.9585 6.4712 hours Direct labour adjustments hours Total hours per NOT APPLICABLE residence Total FTE (staff) per residence Page 16 of 19 Configuration Rostering THREE BEDROOM Low Support No Standard Complex Sleep over Sleep over Active night Sleep over Active night 3 450 3 450 7 956 10 868 11 440 14 352 1 334 1 334 1 417 1 494 1 289 1 366 4 784 4 784 9 373 12 362 12 729 15 718 2.4210 2.4210 4.7434 6.2561 6.4418 7.9545 sleepover Direct labour hours Direct labour adjustment hours Total hours per residence Total FTE per residence Configuration Rostering FOUR BEDROOM Low Support No Standard Complex Sleep over Sleep over Active night Sleep over Active night 4 474 4 474 8 216 11 128 12 168 15 080 1 402 1 402 1 464 1 541 1 308 1 385 5 876 5 876 9 680 12 669 13 476 16 465 2.9736 2.9736 4.8988 6.4114 6.8198 8.3325 sleepover Direct labour hours Direct labour adjustment hours Total hours per residence Total FTE per residence Page 17 of 19 Configuration Rostering FIVE BEDROOM Low Support No Standard Complex Sleep over Sleep over Active night Sleep over Active night 6 970 6 970 10 036 12 948 13 468 16 380 1 558 1 558 1 552 1 629 1 342 1 419 8 528 8 528 11 588 14 577 14 810 17 799 4.3157 4.3157 5.8644 7.3770 7.4949 9.0076 sleepover Direct labour hours Direct labour adjustment hours Total hours per residence Total FTE per residence Configuration Rostering SIX BEDROOM Low Support No Standard Complex Sleep over Sleep over Active night Sleep over Active night 9 037 9 037 12 168 15 080 14 560 17 472 1 259 1 259 1 308 1 385 1 371 1 448 10 296 10 296 13 476 16 465 15 931 18 920 5.2105 5.2105 6.8198 8.3325 8.0622 9.5749 sleepover Direct labour hours Direct labour adjustment hours Total hours per residence Total FTE per residence Page 18 of 19