How do I price services against the Support at Home schedule without breaching the caps?

• SAH ongoing services are organised into three categories: Clinical Care (fully government-funded), Independence (partial participant contribution), and Everyday Living (higher participant contribution). Assistive Technology & Home Modifications (AT–HM) is a separate funding stream with its own allocation pathway.
• Each service must map to a service item on the official SAH service list published by the Department of Health.
• Each service category has a government-set price cap — the maximum price providers can charge for any service in that category.
• Provider-set prices must be at or below the applicable cap. Charging above the cap is not permitted and claims at above-cap prices are rejected.
• Prices must be published transparently — participants have the right to see what they are being charged before services are delivered, not discover it on a monthly statement.
• When the Department publishes revisions to the service list or price caps, providers must update their price books promptly and consistently.

Reference: Aged Care Act 2024 Chapter 4 (Support at Home pricing and service category framework); Support at Home Program Manual — service list and pricing schedule sections; Department of Health published SAH service list and price caps; Services Australia SAH operational material.

• Mapping services to the wrong category — particularly around the boundary between Clinical Care (0% participant contribution) and Independence (up to 50% contribution). A service miscategorised as Independence when it should be Clinical overcharges the participant; miscategorised the other way leaves revenue on the table.
• Forgetting to update prices when the Department publishes a revision. The price book sits on the old schedule, claims are submitted at old rates, and reconciliation becomes a mess.
• Charging above the cap, then having claims rejected and needing to rebill and reconcile.
• Not exposing pricing transparently to participants. The first time the participant sees the price is on their statement, which is too late for them to ask 'why?' or compare against a cheaper option.
• Applying a single 'house rate' across all services without reference to the published price list. Providers can charge below the cap, but they still need to use the correct service list item code and category.
• Treating Assistive Technology & Home Modifications as if it's in the same budget flow as day-to-day services. AT&HM has its own allocation and its own workflow, and mixing it up with service delivery produces budget chaos.

• Built-in SAH service list with the official categorisation — Clinical Care, Independence, and Everyday Living as ongoing categories, plus Assistive Technology & Home Modifications as a separate stream — and the corresponding price caps.
• Provider price book per tenant with cap enforcement. Operators set their own prices for each service, and the system refuses to save a price above the applicable cap. Below-cap pricing is supported; above-cap is blocked.
• Price book version history — every change to the price book is recorded with date, operator, and reason, so the applicable price at any historical date can be reconstructed.
• Schedule update workflow — when the Department publishes a revision, operators update the caps centrally and any provider prices that are now above the new cap are surfaced for review and adjustment.
• Participant-facing pricing display through the family portal — participants can see the current service prices, so there are no surprises on the monthly statement.
• Service category mapping is built into every service record, so participant contributions and quarterly budget sub-allocations always know which category the service belongs to.
• Note: Automatic sync from a Department-published price schedule API is not yet available — Statura ships with the current schedule and operators update the caps when the Department publishes revisions. An auto-sync is on the roadmap once the Department exposes the schedule as structured data.

When an assessor asks for evidence on this obligation, here's what the platform produces on request — date-stamped, user-attributed, and exportable:

• Price book version history per tenant — every price change, effective date, operator who made the change, and the reason.
• Cap-enforcement log — every attempt to save a price above the cap, the attempted price, the applicable cap, the operator, and the outcome.
• Service-item-to-category mapping log showing the category assigned to each service in the provider's price book.
• Schedule revision sync log — when Department revisions were applied, the fields that changed, and any provider prices that were flagged for review.
• Participant pricing view history — what the participant saw on the portal at any historical date, so disputes can be evidenced against what was published at the time.