Recommendations 26 - 30
That the Treasurer ensure that the review of Australia’s Future Tax System include consideration of options for tax concessions or rebates to apply to items associated with disability and caring such as medication, therapy, aids and equipment.
AGREE IN PART
The review of Australia’s Future Tax System will include consideration of the role the tax system should play in achieving non-tax policy objectives. To achieve this, the review will consider possible improvements to the current arrangements relating to the utilisation of tax expenditures including the use of tax concessions, rebates and offsets.
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That the Minister for Families, Housing, Community Services and Indigenous Affairs advocate for Health Care Cards to be issued under the same means test as Carer Payment to those receiving Carers Allowance.
The Commonwealth Government does not agree to issue Health Care Cards to those receiving Carer Allowance under the same means test arrangements as Carer Payment.
Carer Payment is an income-tested pension that automatically attracts a Pensioner Concession Card, partially recognising the barriers that carers face in supporting themselves through paid employment.
Carer Allowance, on the other hand, is a non-means-tested supplementary payment. Carer Allowance (child) attracts a Health Care Card for the direct benefit of the child only. That is, the card is issued in the name of the care receiver not the carer. This provision reflects the Commonwealth Government’s support for families with children with severe illnesses or disability. Despite this special provision, access to concession cards is generally provided on the basis of financial need.
The Commonwealth Government also notes that a current provision enables eligible recipients of Carer Allowance to receive a Low Income Health Care Card in their own name. Alternatively, they may automatically receive a Health Care Card or Pensioner Concession Card in respect of another payment or allowance being paid to them.
Additionally, adult care receivers may be entitled to:
- a Health Care Card, if they are in receipt of certain other payments or allowances, including Mobility Allowance
- an Ex Carer Allowance (child) Health Care Card, if they are aged between 16 and 25 years and were in receipt of a Carer Allowance Health Care Card on the day before their 16th birthday
- a Pensioner Concession Card, if they are in receipt of Disability Support Pension or the Age Pension.
The Commonwealth Government also supports individuals and families who experience additional medical expenses, through the Medicare and Pharmaceutical Benefits Scheme Safety Net provisions. The Medicare Safety Net supplements Medicare by providing additional assistance to individuals and families once they have reached the applicable expenditure threshold in a calendar year.
Individuals and families who have high expenditure on medications covered under the Pharmaceutical Benefits Scheme are given additional support through the Pharmaceutical Benefits Scheme Safety Net. Under the safety net once the expenditure safety net is reached, for the remainder of the calendar year, general patients pay for further Pharmaceutical Benefits Scheme prescriptions at the concessional co‑payment rate and concession card holders are dispensed Pharmaceutical Benefits Scheme prescriptions at no further charge.
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That the Minister for Families, Housing, Community Services and Indigenous Affairs direct the Department of Families, Housing, Community Services and Indigenous Affairs to investigate the benefits of introducing a national carer card for recipients of Carer Payment and Carer Allowance in order to verify the relationship between a primary carer and a care receiver.
The Commonwealth Government agrees to direct the Department of Families, Housing, Community Services and Indigenous Affairs to investigate the benefits of introducing a national carer card for recipients of Carer Payment and Carer Allowance to verify the relationship between a primary carer and care receiver.
This work will investigate any potential interaction with the National Companion Card Scheme. In 2009-10 the Commonwealth Government provided $1.8 million towards the development of a National Companion Card Scheme for people with disability and their carers. The National Companion Card Scheme will expand the arrangements offered in some states and territories to provide up to 200,000 people with disability with opportunities to attend affiliated sporting and entertainment events and venues without incurring the cost of a second ticket for a companion or carer.
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That the Minister for Families, Housing, Community Services and Indigenous Affairs and the Minister for Health and Ageing seek agreement through the Health, Community and Disability Services Ministerial Council to expand the nationally consistent assessment process based on the Carer Eligibility and Needs Assessment‑Revised questionnaire. This will need to ensure the inclusion of carers accessing services offered through the Department of Families, Housing, Community Services and Indigenous Affairs and the State and Territory governments.
AGREE TO FURTHER CONSIDER
The Commonwealth Government, through the Department of Health and Ageing, has undertaken significant work in developing two interconnected assessment tools within the one system, the Australian Community Care Needs Assessment—revised and the Carer Eligibility and Needs Assessment—revised, to support a holistic identification of the needs of both carers and care recipients. The application of carer and care recipient assessments is an important step towards achieving a system where information collection does not involve duplicated efforts.
The Australian Community Care Needs Assessment—revised is being trialled in three jurisdictions and a feasibility study for the development of the Carer Eligibility and Needs Assessment—revised is currently under way. The findings from these trials will inform the development of a nationally consistent assessment process for carers and care recipients.
While it is envisaged that the Carer Eligibility and Needs Assessment—revised will underpin assessment and referral in the National Respite for Carers Program, it is being developed with a view to assessing the needs of all carers and the people they care for and has the potential for broader application.
The Commonwealth Government notes that expanding a nationally consistent assessment process based on the Carer Eligibility and Needs Assessment—revised would require the Commonwealth and State and Territory Governments to agree to a consistent assessment process for the care recipient and carer services across the community care, aged care, disability and community mental health service systems.
The Commonwealth Government will seek agreement through the Community and Disability Services Ministers’ Conference to further consider this model as part of the National Disability Agreement priority to consider single access points and nationally consistent assessment processes, in line with nationally agreed principles, by the end of 2011.
The Commonwealth Government will further consider extending the consistent assessment approach to other programs within its responsibility.
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That the Minister for Families, Housing, Community Services and Indigenous Affairs and the Minister for Health and Ageing address the shortages of health and community care services for people living in regional and remote locations.
The Commonwealth Government agrees with this recommendation and has implemented a range of measures to help address the shortages of health and community care services for people living in regional and remote locations.
The Commonwealth Government is currently working with State and Territory Governments, through the Rural Health Standing Committee of the Australian Health Ministers’ Advisory Council, to develop a new national strategic approach to rural and remote health. This will take into account reform directions identified by the National Health and Hospitals Reform Commission report, A healthier future for all Australians. The development of a new national strategic framework for rural and remote health is a key initiative that aligns with the implementation of outcomes of the 2008–09 review of Commonwealth Government funded rural health programs and supports the implementation of the Council of Australian Governments’ objectives.
In the 2009-10 Budget the Commonwealth Government provided a significant injection of funding amounting to $134.4 million, to address the shortage of health and community care services for people living in rural and remote locations in Australia. Reforms implemented under the rural health package mean that:
- almost 500 communities around Australia will become eligible for rural incentive payments for the first time
- retention payments will be based on the level of remoteness
- more than 2,400 rural doctors will now become eligible for the first time for grant payments to remain in rural and remote areas
- more than 3,600 overseas trained doctors with restrictions on where they can practise will be able to discharge their obligations sooner if they work in rural and remote communities
- under the Higher Education Contribution Scheme Reimbursement Scheme, the rate of reimbursement of Higher Education Contribution Scheme payments will be adjusted to give more credit according to the remoteness of the location
- locum relief will be available to doctors working in difficult locations with more than 400 locum placements planned to enable rural General Practitioners to take a holiday or undertake further education and training
- more than 150 urban doctors can be up-skilled in exchange for undertaking four week locum placements in rural and remote communities.
Under this package a new classification system, the Australian Standard Geographical Classification – Remoteness Areas system, which reflects how Australia’s population and demographic make-up has changed over time, has been phased in from July 2009. This system, which replaces the Rural, Remote and Metropolitan Areas system, has been developed by the Australian Bureau of Statistics, using 2006 Census data and will improve targeting of incentives for attracting health services to areas of genuine need.
The Commonwealth Government has also invested in mental health programs specifically targeted to meet the needs of rural and remote communities:
- $6.7 million to extend the Mental Health Services in Rural and Remote Areas Program
- $5.2 million to extend mental health support for drought affected communities
- $7.5 million for additional psychological support for communities affected by the Victorian bushfires
- Ten Personal Helpers and Mentors Program remote service delivery sites.
As set out in response to Recommendation 32, the Commonwealth Government has also made a significant investment into remote service delivery to Indigenous people. The National Partnership on Remote Service Delivery will provide a total of $291.2 million over six years (with $187.7 million provided by the Commonwealth Government) to improve the delivery of services across 29 remote locations. Current baseline mapping and analysis, to be completed by early next year, includes examination of the number of disability services in the priority communities.
This funding is in addition to previous work that has been undertaken to address the shortage of community care services for people living in regional, rural and remote locations including:
- Recognising people living in rural and remote areas as people with special needs through the Aged Care Act 1997.
- Recognising Aboriginal and Torres Strait Islander people as people with special needs under the 2007 Home and Community Care Program Review Agreement, as it has been recognised that this group may find it more difficult than most to access services.
- Requiring new applications for new aged care places (including community-based places) to demonstrate how they will address the particular care needs of people living in rural, regional and remote areas, including their understanding of social isolation issues, coordination of and access to allied health services, and assistance in maintaining contact with local support groups and the community.
- Providing up to $300 million in zero real interest loans to residential aged care providers to build or expand aged care facilities in areas of high need under the New Directions for Older Australians: Improving the transition between Hospital and Aged Care packages announced in the 2008–09 Budget.
- Identifying people in rural and remote areas as a target group in the planning of and allocation for the National Respite for Carers Program. The National Respite for Carers Program specifically targets Indigenous communities as an area of need through 80 Indigenous specific services across Australia, with funding of more than $16 million in 2008-09. This funding represents 9 per cent of the total budget for the National Respite for Carers Program.
- Allowing State and Territory Governments to adjust service levels for specific service types in line with changing consumer needs and regional community requirements for the Home and Community Care Program.
- Introducing Key Performance Indicators in the Home and Community Care Program from 2007-08, including Indicator 2 - Percentage of Aboriginal and Torres Strait Islander clients as a proportion of this group in the total population (to ensure that there is comparability over years within the Program, which will assist in addressing any gaps in service delivery to Aboriginal and Torres Strait Islander people).
- Providing funding of over $22 million each year, through the National Aboriginal and Torres Strait Islander Flexible Aged Care Program, to support the delivery of aged care services to Aboriginal and Torres Strait Islander people, mainly in remote locations. This includes funding for the provision of residential, respite and community aged care services through the Program. Funding is also provided for minor capital works and equipment and furniture purchases to support aged care recipients and carers.
- Implementing a capital grants program for capital works to upgrade or expand Aboriginal and Torres Strait Islander aged care services, under the $46 million Indigenous Aged Care Plan announced on 22 September 2008.
- Providing a support program to give providers of aged care services to Aboriginal and Torres Strait Islander people access to a range of professional services on care management, quality, governance and financial management.
- Providing short-term financial support to eligible providers of aged care to Aboriginal and Torres Strait Islander people, under an emergency assistance program.
- Creating approximately 700 permanent part-time positions for Aboriginal and/or Torres Strait Islander people in aged care services nationally from changes to the Community Development Employment Projects program. The majority of these positions have been in Home and Community Care services.
- Providing a range of respite options such as Troopie Van, outreach services, peer support and education options in remote areas under the Mental Health and Respite Program.
- Providing outreach services in regional rural and remote areas and developing a remote service model for the Personal Helpers and Mentors Program.
- Providing outreach services and community-based respite models in regions where service gaps have been identified under the Mental Health Community Based Program.