The provider must allow each family to determine the proportion of their funding package they would like to allocate toward the cost of each service. Examples of the financial arrangements a family might make are in the section below.
The opportunity must also exist for families and carers to renegotiate this arrangement on each visit. This provides the family with the option of spreading the terms of the payment by adding their own contribution to the cost of each service.
FaHCSIA will make payments to Panel members on behalf of families and carers for services delivered. Payments will only be made to the provider in arrears on a fee for service basis.
9.1 How will service providers be paid when they deliver services?
Once the provider has commenced delivery of the agreed services the provider submits claims, with the approval of the family, to FaHCSIA for payment.
Note: FaHCSIA will not make payments to providers for early intervention services delivered to eligible children prior to the start date of the Deed of Agreement.
It is important to note that the funding package of up to $12,000 cannot be used:
- To subsidise or cover the gap between the cost of allied health services under the new autism-specific Medicare items. Separate to the allocated 20 services under these new Medicare items, families can use their funding package to offset or cover the ongoing cost of the early intervention services eligible under the package. For information about the new Medicare items for diagnosis and early intervention treatment for children with ASDs refer to the Department of Health and Ageing website;
- For interventions other than the interventions deemed eligible within the context of the early intervention component of the HCWA package;
- To reimburse the provider for services that are not measurable against the planned outcomes of the early intervention component of the HCWA package.
Providers enter the details of the services provided to the child, the family and/or carer and invoice the Department through FOFMS. For a provider to interact with FOFMS, it is necessary for the provider to be recorded in the system as a provider. Further information about the training provided by FaHCSIA to support the use of FOFMS is in the Operational Guidelines Part B, Section 1.5.
A family or carer may choose to advise the service provider of the proportion of their funding package they would like to allocate toward the cost of each service. Families can choose to either use all of their funding to cover service delivery or they can use part of it and also make their own financial contribution to the cost of services.
For example, if a provider invoices a client for $150.00 the family might ask the provider to claim the full amount from FaHCSIA. Alternatively the family might decide to pay the provider $50.00, and consent to the provider submitting a claim to FaHCSIA for payment of the balance (i.e. $100). In either case, only the amount claimed from FaHCSIA will be deducted from the child’s overall funding package balance.
The opportunity must exist for families and carers to renegotiate this arrangement on each visit to give them the option to spread the term of the funding package by adding their own contribution to the cost of each service.
Within FOFMS, providers will be able to view the balance of the funding package for each child they deliver services to. Details of conditions for payment are in Operational Guidelines Part B, Section 4.5.
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9.2 GST
There are 2 types of GST relationships. There is one between client and provider which may or may not be a GST-able relationship, depending on the service provided. This relationship is not relevant to FaHCSIA.
Then there is the relationship between provider and FaHCSIA. This relationship is not GST-able. FaHCSIA does not receive anything from the provider; the Department is merely a remitter of funds. Therefore what the provider puts to FaHCSIA is a total amount to be claimed.
What this means
The amount FaHCSIA pays the provider is GST exclusive (for FaHCSIA purposes) – irrespective of whether it is a GST-able item between the client and provider. Therefore the amount FaHCSIA pays is just the total amount claimed and is GST exclusive for FaHCSIA purposes, even if the total amount the provider claims includes GST with respect to the client provider relationship.
FOFMS is not an accounting system for providers; it is a mechanism for providers to claim a payment from FaHCSIA. This means that providers will have their own accounting system and methods for remitting GST to the tax office.
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9.3 Activity Statements
FaHCSIA will generate a monthly report known as the Monthly Activity Statement for each child who has had claims processed in FOFMS during the preceding month. The Monthly Activity Statement will detail the child’s name, provider name and contact details, the services received during the month, the amount paid by FaHCSIA on the child’s behalf and the remaining balance of the funding package.
Families who have not had claims processed in FOFMS during the month will not receive an Activity Statement. Activity Statements will be emailed to families via FOFMS. Families who do not have an email address will be able to receive their Monthly Activity Statement via ordinary mail. Further information about Activity Statements is in the Operational Guidelines Part B, Section 3.3.
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9.4 Change of address
If a client moves from one address to another the provider may update the client details in FOFMS provided they have been given proof of the new address before making those changes. Proof of address may include, for example, a utilities bill or a tenancy agreement. At the same time, the provider must also complete the checklist in FOFMS indicating that they have seen proof of a change of address. Please retain on file the documentation for the proof of address. Information about changing a family’s residential address in FOFMS is in the Operational Guidelines Part B, Sections 4.1 and 4.8.
If a family moves to an outer regional or remote area
If a family becomes eligible for the Outer Regional and Remote one off payment of $2,000 as a result of moving from one address to another, the Outer Regional and Remote (R&R) eligibility flag in FOFMS will be automatically checked. When this occurs, the provider will inform the family of the change to their record. Providers are unable to claim for the outer regional and remote payment on behalf of families.
Families must go to their Autism Advisor to verify their change of address. The Autism Advisor will make the claim on their behalf. The provider must inform the family if the R&R flag is checked.
If a family moves from an outer regional or remote area
A family is not liable to repay the $2,000 payment to FaHCSIA if they move from an outer regional or remote area to an area where they are no longer eligible for the payment.
Further information on changing the client’s information in FOFMS is in the Operational Guidelines Part B, Section 4.1.
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9.5 Conflict of Interest
FaHCSIA advises that staff who are parents of carers of a child (or children) receiving services from an organisation through the HCWA package, must not enter or approve the claims for payment in FOFMS. This is to ensure that potential conflicts of interest do not occur.