Care Management Fees Explained: The 10% Rule

For nearly a decade, care management fees were the most opaque and most contested charge in Australian home care. Under the old Home Care Packages scheme, providers could charge whatever they wanted for care management, and many charged 25%, 30%, or even 35% of a participant's annual package. That money came directly out of the budget you'd otherwise spend on actual care.

Support at Home changed this with a simple, hard rule: care management is capped at 10% of your quarterly budget. Combined with a separate cap on package management, the total overhead a provider can take from your package is now limited to 20%, and many quality providers charge well below.

This guide explains what the cap covers, what it doesn't, and how to spot the rare provider still trying to game the system.

What care management actually means

Care management is the strategic and clinical oversight of your support package. It is performed by a qualified care manager (sometimes called a case manager or care coordinator), who is typically a registered nurse, social worker, or experienced personal-care professional with management qualifications.

The activities covered by care management are:

• Care planning, building, updating, and reviewing your individual care plan.
• Care coordination, liaising with your GP, allied health practitioners, and any specialists.
• Care reviews, formal reviews of your care plan (typically every 6-12 months and after significant events).
• Crisis response, managing the response when you're hospitalised, fall, or have a major change in needs.
• Family liaison, communicating with your nominated representative or family members.
• Goal-setting, defining and reviewing your wellness and lifestyle goals.
• Reassessment support, helping you navigate a My Aged Care reassessment.

These are intellectually substantial activities. They're not "scheduling shifts" or "running payroll", those fall under package management.

What care management is NOT

Where consumers most often get overcharged is when providers misclassify operational activities as care management. The following are not care management:

• Support worker recruitment and onboarding (operational, falls under package management).
• Roster building and roster changes (operational).
• Payroll processing and superannuation (administrative).
• Invoice generation and statement preparation (administrative).
• Software licensing and IT systems (operational overhead).
• Travel between client homes (operational).
• Marketing and sales activities (NOT chargeable to your package at all).

If a provider tries to bill activities like "scheduling time" or "rostering hours" as care management, that's misclassification. Push back.

The package management fee

Sitting alongside care management is the package management fee. This covers the administrative and operational running of your package:

• Roster building and adjustments
• Payroll for support workers
• Invoicing and statement preparation
• Software platform costs
• General compliance and reporting

Package management is also capped at 10% of your quarterly budget. So the combined ceiling for both care management and package management is 20% of your budget, and many quality providers operate well below.

How the cap is calculated

The 10% care management cap is applied quarterly, not annually. This matters in two ways:

• Spikes are absorbed. If you have an unusually demanding quarter, say, a hospital admission and a reassessment fall in the same three months, the provider absorbs the extra coordination time. They can't pass it on to you.
• Quiet quarters don't roll over. If a quarter ends with the provider only spending 6% of your budget on care management, they don't get to "save up" the 4% and charge 14% next quarter.

The practical effect: your care management fee should be relatively predictable, quarter to quarter. Wild swings are a sign of accounting issues at the provider.

Spotting fee misclassification

Here are the things we see when providers try to dodge the cap:

• "Care management" appears flat-rate at exactly 10%, every quarter. Suggests the provider is simply charging the cap rather than billing actual hours. Sometimes legitimate (high-needs participants); sometimes a sign of lazy charging. Ask for the breakdown.
• A new fee category appears that you don't recognise. "Wellness coordination," "lifestyle planning," "advocacy support" are sometimes legitimate, sometimes invented to push extra revenue.
• Per-hour clinical visits include "coordination time" baked into the hourly rate. Should be in the per-hour clinical rate, not as separate care management.
• Travel time charged as care management. Travel is not care management.
• Sales calls or onboarding marketing time charged. Onboarding admin is allowed up to a point; sales activity is not chargeable to your package.

If anything looks off, ask the provider for:

1. A line-item breakdown of the care management fee for the most recent quarter.
2. The names and qualifications of the staff whose time was billed.
3. The activities those staff performed.

A clean provider will produce this within 48 hours.

What good care management looks like

For 10% of your quarterly budget, you should be getting:

• A documented quarterly care plan review (or evidence of why it wasn't needed).
• At least one in-person visit per quarter from your care manager, more often when needs are high.
• Prompt response to clinical changes, within 24-72 hours of a hospital admission, fall, or significant decline.
• Coordination with at least your GP, and with allied health practitioners involved in your care.
• A named care manager with a real caseload (under 60 clients ideally).

If you're paying 10% and getting less, your provider is keeping money that should be funding your care. Worth a conversation.

Self-management and the cap

If you have a self-managed package, your care management fee will typically be lower, often 0-5%, because you're doing more of the coordination yourself. Some self-managed providers charge a flat monthly fee for care management instead of a percentage; that's also legal, provided the total stays within the 10% quarterly cap.

A self-managed Classification 5 participant on a $40,212 budget might pay:

• 3% care management = $301 per quarter
• 5% package management = $502 per quarter
• Combined: ~$803 per quarter, vs ~$2,011 for a fully-coordinated package at the cap.

Over a year, that's a $4,800+ difference, extra hours of actual care.

What to do if you suspect overcharging

The escalation path:

1. Ask the provider in writing for a fee breakdown. Give them 7 days.
2. Request an internal review if you don't like the response. Your provider must have a complaints process.
3. Contact the Aged Care Quality and Safety Commission on 1800 951 822. Fee complaints are a current priority.
4. Report systemic concerns to the Department of Health and Aged Care.

The Commission has the authority to require refunds if a provider has charged above the cap. Several refunds have already been ordered in the early SAH period.

A worked example of what 10% looks like

Take a Classification 5 participant on a $40,212 annual budget. Quarterly budget: $10,053.

Maximum permitted care management fee per quarter: $1,005.30 Maximum permitted package management fee per quarter: $1,005.30 Maximum combined overhead per quarter: $2,010.60

Annual maximum overhead: $8,042.40 Annual maximum service spend: $32,170, about 80% of the package.

Compare that to the old HCP scheme, where a provider charging 30% care management plus 10% package management would have left only 60% of the budget, about $24,127, for actual services.

The 10% rule has effectively given every Australian SAH participant an extra ~20% of their budget to spend on care.

Use your savings deliberately

If your provider is operating well below the 10% cap (some quality providers run at 5-7% combined), the extra hours add up fast. Talk to your care manager about how to deploy them, extra personal care, more substantial allied health, additional respite for a carer, or holding the budget in reserve for upcoming surgery or reassessment.

The Home Care Prices comparison tool surfaces care management fees explicitly. If your current provider is at 10% and competitors in your area are at 6-7%, the difference is real, and it's yours to keep.