The HCP to Support at Home transition checklist

Have you flagged every participant who was on a Home Care Package on 12 September 2024?

These are the participants entitled to 'no worse off' transitional protections. They get a different (lower) lifetime contribution cap and retained HCP balances. Missing one is a refund liability.

Is the grandfathered status visible to the billing team and the care coordinators?

It can't live in a single spreadsheet. Every contribution calculation, every quarterly budget check, every claim must apply the correct rules per participant — which means the flag has to be on the participant record in the operating system.

Are grandfathered participants assigned the $86,185.23 lifetime cap (20 March 2026 indexed)?

This is the 'no worse off' cap. New SAH entrants have a higher cap of $137,917.01. Applying the new-entrant cap to a grandfathered participant overcharges them by up to $51,732 over their lifetime — a serious refund obligation.

Is the cumulative lifetime contribution running total tracked per participant?

Lifetime caps span every contribution the participant has ever made under aged care, including under HCP. Statura tracks the running total automatically — manual tracking is error-prone.

Do you have alerts when a participant approaches their lifetime cap?

Once the cap is reached, the participant pays no more contributions. The transition to zero-contribution must be seamless or the participant feels every overcharge personally.

Have you imported each participant's unspent HCP balance at the 1 November 2025 transition date?

Unspent HCP funds were carried across as the starting point for the SAH quarterly budget framework. If the balance was lost in transit, the participant has lost money — and the provider is liable.

Is the source documentation for each retained balance on file?

Department of Health requested final HCP statements as evidence of the migrated balance. Keep them as part of the participant's audit trail.

Has the SAH classification level (1–8) been recorded for every transitioned participant?

Classification was performed by the Single Assessment System assessor — providers don't reassign it themselves. But you do need to record the new level on the participant's profile so the budget envelope and care minute targets are correct.

Is the original HCP package level retained for the audit trail?

If asked at an assessment contact 'show me the transition history for this participant', you need to be able to reconstruct the journey from HCP level to SAH level, with the assessor's source document.

Have you recalculated quarterly budgets and care minute targets based on the new classification?

The 8 SAH classification levels have different annual budgets and care minute calibrations than the 4 HCP package levels. The recalculation should run automatically when the new level is recorded.

Have you issued updated SAH-compliant service agreements to transitioned participants?

The original HCP agreement is in force during the transition window but doesn't satisfy SAH agreement content requirements indefinitely. You need updated agreements that meet the SAH framework's prescribed content areas.

Does the updated agreement preserve the participant's chosen care plan?

Continuity of care matters. The legal framework can change without disrupting the actual care being delivered.

Is the consent and signature workflow auditable end-to-end?

From offer through review to signature, every step needs to be in the participant's record with timestamps.

Is your billing system calculating per-service contributions across the 4 means tiers and 3 service categories?

SAH replaced the HCP daily-fee model with per-service means-tested contributions. Clinical Care is 0% (fully government-funded). Independence is 5% (full pensioner) to 50% (self-funded). Everyday Living is 17.5% to 80%. Get this wrong and you either undercharge or trigger a refund.

Are part pensioners and CSHC holders using individually-assessed rates from Services Australia?

Both tiers use sliding-scale rates that MUST be sourced from the participant's Services Australia assessment letter — never a midpoint default. Applying a default overcharges by up to 3.5x and triggers a refund obligation.

Are contributions itemised on the monthly participant statement?

Participants must see the service, the category, the rate, the contribution amount, and the government-funded portion — every service, every month.

Have you stopped applying HCP-era care management percentages (15-25%) to transitioned participants?

SAH care management is hard-capped at 10% of the quarterly budget. Continuing to charge HCP-era percentages on transitioned participants is a contractual breach and a refund obligation.

Is the 10% cap tracked in real time per participant per quarter?

Care management time over the cap can't be billed. The Care Partner needs to see the cap utilisation before they schedule more time, not after.

Have you assigned a named Care Partner to every transitioned participant?

Every SAH participant has a Care Partner — a named individual at the provider responsible for care plan oversight, goal review and coordination. This is a statutory role under SAH that didn't exist in HCP.

Does every transitioned participant now have at least one documented wellness and reablement goal?

SAH care plans must be goal-based and reablement-oriented. HCP care plans were typically service-driven, not goal-driven. The transition is your opportunity to shift the model.

Are services traceable back to a goal?

An ACQSC assessor will ask 'why is this service being delivered to this participant?' The answer should be a participant goal, not 'because it was on the HCP plan'.

Is there a goal review schedule per participant?

The Care Partner is responsible for periodic goal reviews. Without a schedule, reviews get skipped.

Is your claim file generation producing ACPP-compliant SAH claims?

Claims now flow through the Aged Care Provider Portal (ACPP) under the SAH framework. Pre-submission validation should catch service category errors, price cap breaches, classification mismatches and overlap before the file is uploaded.

Are claims reconciled monthly against Services Australia payments?

Monthly reconciliation, not quarterly. The carry-over rules and the lifetime cap make month-three discrepancies very expensive to unwind.

Have all clinical records, care plans and progress notes carried across without gaps?

The participant's clinical history should be unbroken — pre-transition records and post-transition records in one continuous timeline.

Are advance care directives and substitute decision-maker authorisations still on file?

These are the most important documents and the easiest to lose in a system migration. Verify each one personally for high-risk participants.

If you also run CHSP, are you structuring CHSP data in a way that aligns with SAH reporting?

CHSP will transition to Support at Home no earlier than 1 July 2027. Providers using SAH-shaped data structures now will have a much cleaner CHSP transition than those running legacy CHSP-only systems.

Have you mapped your CHSP services to the closest SAH service category equivalents?

Most CHSP services have a clean mapping to SAH categories. Doing the mapping now is preparation work that won't go to waste.

Do you have a single transition record per participant showing the migration journey?

Grandfathered status, retained balance, original HCP level, new SAH level, agreement variations, contribution framework switch, care management cap reset — all in one auditable record per participant.

Is the transition documentation accessible during ACQSC assessment contacts?

Assessors will ask about the transition for the next 12-24 months. The documentation should be one click away from the participant's profile, not buried in a finance folder.