Dementia & Behaviour Supplement: Important Info

The new Dementia & Behaviour Supplement is now available. The additional supplement of $16.15 per day ($5,894.75 annually), per resident recognises the added costs associated with caring for people with dementia and mental health conditions.

There are two eligibility requirements to claim the Dementia & Behaviour supplement in Residential care and residents must satisfy both assessment criteria to be eligible for the supplement.

• A medical diagnosis
• An assessment of the severity of behaviours and psychological symptoms

Read on to learn how best to approach the assessment.

How a focused approach can save you time!

During a recent onsite visit, Mirus Australia worked with facility staff to determine eligibility for one resident who met the diagnosis criteria. The NPI-NH assessment took about half an hour (excluding time to submit the claim). However, we found that we could narrow down eligibility faster by first determining which residents achieved a rating of Severe AND Very Often (12 points) in the Frequency and Severity of the following 6 Domains:

A Delusions                                                        D Depression/Dysphoria

B Hallucinations                                                E Anxiety

C Agitation/Aggression                                   H Disinhibition

Only residents which achieved a rating of Severe AND Very Often (12 points) in at least 2 of these Domains were then put through the full assessment process.

Frequently Asked Questions

DoHA FAQs available here

1.       Does the Mental & Behavioural diagnosis need to be obtained after completing the NPI-NH assessment?

No. As long as there is an existing Mental & Behavioural diagnosis and the NPI-NH assessment has been completed, eligibility can be determined. Also, the NPI-NH assessment can be no older than 3 months at the date of application.

2.       If a resident’s symptoms improve because of implementation of effective care plans rather than disease progression will eligibility for the supplement continue? Yes, however the criteria used to determine ongoing eligibility is yet to be determined.

3.       Can I undertake the assessment for new and existing residents? Yes

4.       How soon can I submit an application for a new resident who is eligible? The NPI-NH Assessment cannot be completed within the first 7 days of care. An application cannot be submitted within the first 28 days after a resident enters care. Payments will be backdated to the date of eligibility (or entry) or a maximum of 56 days from receipt of a valid application – whichever is the shorter period