Compliance Monitoring and Support
The Australian Government Hearing Services Program (the program) is delivered by over 290 contracted service providers (providers). Providers are expected to comply with the program requirements as set out in legislation, including the Hearing Services Administration Act 1997 (the Act), the Service Provider Contract (the Contract) and program standards. These requirements are outlined under legislation and contracts.
Legislative Authority for Compliance Monitoring
The obligations to monitor compliance with the program requirements are guided by a range of legislative and best practice documentation including
- Clause 16(a) of the Public Governance, Performance and Accountability (PGPA) Act 2013, which requires authorities to establish and maintain appropriate systems for risk oversight and management.
- Section 16 of the Hearing Services Administration Act 1997 (Conditions of accreditation), which specifies that providers must comply with the conditions of their accreditation.
- Clauses 16 of the Service Provider Contract which outlines auditing and access to sites/records.
Compliance Monitoring and Support Framework
A risk-based approach to monitoring program compliance is used. The principles and processes are outlined in the Compliance Monitoring and Support Framework (the Framework). The Framework is a plan for monitoring and supporting providers to achieve and maintain compliance with the program requirements.
Find out more about the Compliance Monitoring and Support Framework.
Evidence Guide for Compliance Monitoring
To ensure compliance with program requirements, risk based audits and claims reviews are routinely performed. The previous Evidence Guide for Compliance Monitoring has now been incorporated in the Schedule of Service Items and Fees. This provides an overview of the evidence reviewed to confirm services and claims are compliant with program requirements, and supports the principles of openness, transparency and consistency.
Read the Schedule of Service Items and Fees.
Provider Self-Assessment
All providers must complete an annual self-assessment. The Self-Assessment Tool (SAT) is an online questionnaire that gives providers an opportunity to review their compliance with the program requirements. New providers are also encouraged to complete the previous year’s SAT as part of their orientation to the program.
Find out more about the Provider Self-Assessment process.
Provider Audits
Risk-based audits are undertaken to assess providers’ compliance with program requirements. Audits are undertaken by qualified auditors. Provider audits may be undertaken based on the results of claiming data analysis, claims audits, complaints and other risk signals. Some providers are also randomly selected for audit to complement the risk-based audits and support quality assurance.
Find out more about Provider Audits.
Compliance Support
The program has a range of supports available to assist providers to maintain compliance with program requirements. These include the program website, program fact sheets, Contracted Service Provider Notices (CSPN's), user guides, online eligibility checking, self-assessment and annual reports. Guidance is also provided during follow-up actions resulting from audits, complaints or other compliance monitoring.
Find out more about compliance support.
Reimbursements
Both the Act and the Contract require any claims for services that are not provided in accordance with legislation, the Contract or program standards to be reimbursed to the Commonwealth.
Find out more about reimbursements.
Feedback
Providers are given the opportunity to provide feedback on the audit process at the time their audit is closed.
Feedback about any other element of the program’s compliance monitoring approach can be provided by contacting the Department of Health (the Department). Information on how to contact the Department is available on our contacts page.