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Information for Occupational Therapists
Information for Occupational Therapists
Description and Clarification of the Home Modification and Maintenance Services Program for Occupational Therapists
Home Modification and Maintenance Services (HMMS) are split into three defined levels of service provision reflecting the monetary value and complexity of work completed by service providers.
With the release of the new Home Modification Guidelines, there are now overlapping monetary levels for the HMMS industry as follows:
Level 1 - $0 - $7,500
Level 2 - $5,000 - $25,000
Level 3 - $20,000 and above
Explanation of Overlapping Bands
If a Level 1 Service has the skill, spare capacity and budget to complete work up to the value of $7,500, then the work may be completed by the Level 1 Service. However, if the Service does not, then all work over the value of $5,000 must be referred to the Level 2 budget holder in the region.
If a Level 2 budget holder does not have adequate funding to complete work valued over $20,000, then they may refer the application to the Level 3 budget holder; the NSW Statewide Level 3 Project.
Maintenance Work
Applications for maintenance work will be in accordance with 1.8.5 Cap for One-Off Maintenance Work (page 8 of the new Home Maintenance Guidelines) which states that clients can only receive a maximum of $3,000 worth of maintenance work in a five year period.
About HMMS Services
There are 91 Level 1 HMMS, 13 Level 2 Service Providers and 1 Level 3 Statewide Service Provider.
It should be noted that Level 1 HMMS in all areas of NSW are the point of contact for client referrals requiring both minor and major modifications. The priority level determined by the referring OT or agency will assist in determining the progression of the work to be completed. Once the referral is received by the HMMS and eligiblity has been determined, the work will be prioritised according to the current workload of the HMMS.
HMMS are all funded to provide different services and therefore may not provide the full range of modification and maintenance work required. OTs will need to liaise with their local HMMS about the range of services provided i.e. modifications, maintenance, gardening, lawn mowing and occupational therapy services.
Familiarisation of Guidelines
As HMMS are blending the building industry with the Community Care sector, HMMS must comply with the following:
• the National HACC Program Guidelines
• the NSW Guidelines for HACC funded Home Modification Services which outline minimum mandatory obligations for providing home modification services to HACC clients
• the Building Code of Australia and relevant Standards, in particular AS1428
• legislative and statutory requirements as set out by the Office of Fair Trading
• policies and procedures as set out by HMMS management committees/management
• the Occupational Health and Safety Act 2001
• Local Government ordinances
To ensure there are no inappropriate referrals to HMMS, it is recommended that all OTs familiarise themselves with the above documentation and, in particular, to the eligiblity requirements contained in the National HACC Program Guidelines.
To view the NSW service type Guidelines for HACC funded Home Modification click here and Maintenance Services click here
To view the National Program Guidelines for the HACC Program click here.
Making a referral to a HMMS
OTs are encouraged to form collaborative working relationships with their local HMMS and take part in regular networking meetings with them. It is also recommended that all OTs attend joint home visits with the Builder/Co-ordinator of their local HMMS for all major modifications or when OTs are unclear about possible choices regarding building options for the recommendations being prescribed.
Minor Modifications
The minimum administrative requirements for all minor modifications to your local HMMS are:
• completion of the local HMMS referral form and/or CIARR;
• a clear and concise description of the work being recommended for the client; and
• drawings/plans which are drawn to scale with clearly marked measurements suitable for the client's individual requirements.
Major Modifications
Your local Level 1 HMMS is your point of contact for all major modifications. The local HMMS will ascertain if the modifications are of a complex nature and with a value over $5,000. The HMMS will then collate all the necessary information to be sent to the Regional Level 2 Service for assessment by their Panel. If the work is valued over $20,000, the Level 2 Service Provider then refers the work to NSW Statewide Level 3.
The minimum administrative requirements for all major modifications, which include Levels 2 and Level 3, are:
• the completion of a major modification application form which is undertaken by the local Level 1 HMMS in consultation with the client;
• a thorough Occupational Therapy report prepared by the OT providing a detailed recommendation of the work required by the client. Plans/drawings drawn to scale are required to be included in this report. These elements are needed to ensure all specifications provide a clear clinical justification for the modification and enables the OT to discuss recommendations with the client before the HMMS begins the quoting process. The clearly articulated OT report will then provide a platform for the HMMS to prepare a detailed scope of works which will form part of the quote and contract with the client.
• a scope of works and quote prepared by the HMMS.
It should be noted that it is not necessary for the OT to prepare a scope of works as the HMMS Builder will provide it based on the OT's recommendations as apart of the quote to the client. If a client requires specific items, e.g. quarter-turn taps, this should be stated during the referral process.
If an OT experiences problems describing the work, it is recommended the OT contact the local HMMS Builder to arrange a joint home visit. Specialist information can also be obtained from the Regional Technical Officer in each Region of NSW or the Specialist OT appointed by the NSW HMMS State Council.
For details about the Specialist Occupational Therapist for State Council click here
For contact details for Regional Technical Officers click here
Who are the regional Level 2 Service Providers and what is their aim?
Regional Level 2 Service Providers are part of the HACC program jointly funded by State and Federal governments. Regional Level 2 Service Providers work in partnership with the local HMMS and focus on clients with greater and more complex needs and fund projects which require more extensive adaptations to a clients's home. Level 2 Service Providers fund work between $5,000-$20,000. The major emphasis of their work is to support a client's independence in the home and community, thereby enhancing quality of life and preventing inappropriate admission to long term residential care.
There is a Level 2 Service Provider in each region of NSW. To find the Level 2 Service Provider in your region, click here to view the NSW HMMS map.
What is the NSW Statewide, Level 3 project and what is its aim?
NSW Statewide Level 3 is also part of the HACC program jointly funded by State and Federal governments. It works in partnership with the local HMMS and Level 2 Service Providers and focuses on clients with greater and more complex needs. NSW Statewide Level 3 funds projects which require more extensive adaptations to a client's home over the value of $20,000. The major emphasis of their work is to support the client's independence in the home and community, thereby enhancing quality of life and preventing inappropriate admission to long term residential care.
Please note modifications over the value of $20,000 which are referred to NSW Statewide Level 3 by Level 2 Service Providers are usually a combination of modifications such as a ramp, a bathroom modification and a kitchen modification or could be a single modification such as the installation of a lift.
The NSW Statewide Level 3 is a statewide project auspiced by the Kurri Kurri Community Centre based in Kurri Kurri in the Hunter Region in NSW.
To find the Level 3 Service Provider, click here
Who assesses major modification applications?
Applications are assessed by panels of Level 2 Service Providers consisting of industry professionals such as OTs, HMMS Builders, HMMS Co-ordinators, Client Representatives, a HACC Service Provider and the Regional Technical Officer.
What type of modifications are funded by Level 2 Service Providers and NSW Statewide Level 3?
Examples of major home modifications recommended by an OT over the value of $5,000 include:
• access modifications such as ramps
• bathroom modifications
• kitchen modifications
• safety modifications
Please note modifications over the value of $20,000 which are referred to NSW Statewide Level 3 are usually a combination of modifications such as a ramp, a bathroom modification and a kitchen modification or could be a single modification such as the installation of a lift.
Whole of Need Assessment
When assessing a client, Occupational Therapists are asked to take into account the whole needs of clients. The “Whole of Need Assessment” refers to establishing all the needs of a client at the time of assessment including a client's long-term needs. Therefore at the time of referral to a HMMS for modifications, HMMS can receive one referral with multiple modification requests.
There are a number of reasons HMMS request that this be done and they are as follows:
• disruption to the client’s life and routine will take place only once and Tradespeople can be co-ordinated to modify the home within a set period of time;
• one referral with multiple modifications results in less administration and duplication of effort; and
• one referral with multiple modifications results in a smaller client contribution for clients. Please refer to the following example:
Major Modifications with one referral for multiple jobs
Bathroom Modification $15,000
Ramp $6,000
Kitchen Modification $10,000
Total $31,000
Client Contribution:
First $5,000
Plus 20% of the remainder is $5,200
Total Client Contribution $10,200
Major Modifications split into three referrals
Modification Cost Client Contribution
Bathroom Modification $15,000 $7,000
Ramp $6,000 $5,200
Kitchen Modification $10,000 $ 6,000
Total $31 000 $18,200
Therefore, when splitting a referral into three modification jobs, the client contribution equates to $18,200 rather than a client contribution of $10,200 when making one referral for three modification jobs.
Waiting Lists and Prioritisation of Work
Please note that at times, but not always, waiting lists exist for major modification work. Level 2 Service Providers and NSW Statewide Level 3 receive quarterly funding installments. However, due to a substantial increase in demand for home modification services as well as a shortage of contractors, funding is limited and waiting lists have needed to be established. Priority of service is therefore determined by Level 2 Service Providers' Panels and Level 3 against other applications and existing waiting lists.
For further information on prioritisation, please refer to 2.5.3 "Prioritising Eligible Clients for Home Modification Services" in the NSW Guidelines for HACC Funded Home Modification Services (page 33).
As complex modifications require detailed paperwork, there may be time delays while establishing and collecting all relevant documentation such as application forms, OT assessment reports, quotes, plans and drawings, authority to install, confidentiality agreements and Panel approvals. HMMS will do their best to minimise the time taken to complete these tasks. However, some applications may take longer than others.
Quoting Major Modifications
It should be noted that work completed by HMMS whether it involves minor or major modifications, is not free of charge. The client contribution is determined once a quotation for the work has been completed by the HMMS. If the client has difficulty paying for the work or is financially disadvantaged, the HMMS will negotiate the client contribution and/or organise a repayment option.
It is not the role of the OT to negotiate or establish the client contribution. This is the responsibility of the HMMS.
It is the aim and the responsiblity of the HMMS to provide the most cost effective modification option for the client. HMMS will liaise with OTs to meet this criteria. Limited funding and guidelines allow HMMS to supply only functional works deemed necessary by the OT and the HMMS. Extra work may only be considered at the client’s request if the client has paid the full client contribution. Extra work “may” be supplied at the client’s request, however the client will be asked to bear the full cost of these extras.
For more information about costs, click here
Quality Assurance Program
The NSW HMMS State Council is in receipt of funding to implement a Quality Assurance Program for all HMMS in NSW. The concept of the Quality Assurance Program has arisen to ensure that clients’ needs, occupational therapists’ specifications and a level of quality and conformity are achieved in the HMMS program. The Quality Assurance Program is provided through the implementation of systemic management techniques ensuring control of activities carried out by each party in the HMMS industry. The proposed outcomes of the Quality Assurance Program are as follows:
• Improved client outcomes.
• Implementation of an effective risk management program to reduce exposure for liability of sub-standard/poor quality work.
• To resource the NSW HMMS State Council on emerging issues in the HMMS industry.
• More effective service delivery and better utilisation of resources.
• Dissemination of relevant and appropriate information creating consistency across NSW with better service delivery and improved equity of access.
• Ensuring compliance with the Office of Fair Trading and Workcover/OH&S, licensing and contractual requirements and DADHC Guidelines.
• The development and standardisation of procedures and resources in the HMMS industry.
For minor modification and maintenance work at a local level, HMMS will have quality assurance mechanisms in place to ensure work meets OT specifications and quality building practices.
Leading practice at a local level ensures:
• Work is supervised by the Nominated Work Supervisor.
• Occupational Therapists perform post modification sign off to ensure completed minor modifications suit the client’s functional status and are consistent with their original recommendations.
• Client surveys are completed to gather information regarding the suitability of service delivery.
Leading practice for major modifications:
• Work is supervised by the Nominated Work Supervisor.
• Regional Technical Officers nominated in each region complete post modification sign off on all major modifications in NSW.
• Occupational Therapists complete post modification sign off to ensure the modifications completed suit the client’s functional status and are consistent with their original recommendations.
• Client surveys are completed to gather information regarding the suitability of service delivery.
Appeals for Major Modifications
Feedback, complaints and appeals from clients/carers and Occupational Therapists are essential as they ensure that HMMS continue to provide the best possible service delivery in accordance with specified standards and Guidelines. All clients/carers and Occupational Therapists have the right to appeal a decision made by a HMMS or the Panel of a Level 2/3 budget holder and can expect appeals to be dealt with promptly. Clients/carers and Occupational Therapists have the right to use an advocate of their choice to negotiate on their behalf with the HMMS or Level 2/3 budget holder.
Advocates
With the authority of the client/care, an Advocate represents the client’s interests. Clients/Carers and Occupational Therapists may use an advocate of their choice to negotiate on their behalf.
Complaints and Appeals Policies
Each HMMS, Level 2/3 budget holders will have their own Complaints and Appeals Policies and Procedures which are applicable to their regions. This information should be made available to clients/carers in Client Handbooks and Service Brochures. If the information has not been distributed, please contact the HMMS for a copy of their policy.
Confidentiality of Appeals
Appeals made by a client/carer and/or an Occupational Ttherapist to appeal a decision made by the Panel of the Level 2/3 budget holder, will be kept confidential and dealt with in a courteous, respectful and prompt manner.
Appealing a decision made by the Panel of a Level 2/3 Budget Holder
If client/carer and Occupational Therapist would like to appeal a Panel decision in reference to a major modification application, please contact the Service Manger by phone in the first instance to discuss the application or alternatively place your appeal in writing addressed to the Chairperson of the Level 2/3 Budget Holder. You will receive a written response acknowledging receipt of the appeal within 7 working days.
If you are still not satisfied with the appeals process and resolution/outcome of the appeal, please contact the:
NSW Ombudsman for Community Services
Level 24
580 George Street
Sydney NSW 2000
Toll free: 1800 451 524
Quick Links
Home Modification and Maintenance Services (HMMS) in NSW are funded by the Department of Ageing, Disability and Home Care (DADHC) under the Home and Community Care Program (HACC), a joint initiative of Commonwealth and State Governments, and are available to residents of NSW.