Support at Home is an operating-model problem, not a billing upgrade.
Most providers prepared for Support at Home as a systems and billing change. It is a larger thing than that. The reform changed how a care business has to run, and the providers who treated it as a software upgrade are meeting the gap now, in rejected claims, late payments, and margin they cannot see clearly enough to protect.
- By Qurrat Shafqat
- August 2026
- 13 min read
In this article
Every provider I speak to prepared for 1 November 2025. They read the guidance, mapped the new service list, briefed the board, and asked their software vendor what needed to change. Most of that preparation was necessary. Very little of it was sufficient.
The reason is that Support at Home did not simply change the rules of billing. It changed the shape of the work. A Home Care Package was a relationship a provider managed over months, with funding that sat in a recognisable envelope and reconciliation that happened on a comfortable rhythm. Support at Home is a stream of individual services, claimed close to the point of delivery, coded precisely, validated strictly, and priced under an obligation to show your working. The provider that only changed its software is now running a new operating model on old operating discipline, and the seams are showing.
This is the failure mode we keep meeting in aged care right now. Not the dramatic kind that arrives as a sanction or a headline, but the structural kind: an operating model that has not caught up with the reform it is being asked to deliver.
01
What actually changed
It helps to be precise about the operational shift, because the policy summaries do not capture it.
Under the old model, funding followed the package. A provider managed a client’s package over time, drew against it, and reconciled periodically. The discipline that mattered was relationship management and a broadly accurate account by the end of a quarter.
Under Support at Home, funding follows the service. Each supported service is claimed close to delivery, on a weekly or fortnightly rhythm rather than a quarterly one. It is coded against a more granular list, and the claim is validated on submission. A claim with the wrong code does not quietly pass through. It is rejected, and the payment attached to it waits until the claim is corrected and resubmitted. Care management is funded differently again: a fixed 10 per cent of each participant’s quarterly budget is deducted and pooled, it must be delivered and evidenced on a regular rhythm, and it asks providers to be clear about what is care management and what is service delivery.
Running underneath all of it is a pricing transparency obligation. Providers are expected to set, publish and defend their prices, and the regulator has already signalled that pricing transparency is one of the areas it is watching most closely.
That is operating-model architecture, not a system setting.
02
Why a software upgrade was never enough.
Software can submit a claim. It cannot decide, on your behalf, what the service was, which code it belongs to, whether the evidence supports it, or what your price should be and how you will defend it. Those are judgements the operating model has to make, consistently, every time, at volume.
When a provider treats the reform as a software project, the system goes live, the claims start flowing, and the gaps show up downstream. A rejection rate nobody owns. A care manager coding services differently from the one at the next branch. A finance lead rebuilding the cash position by hand because the claims data and the funding data do not yet agree. The software did exactly what it was configured to do. The operating discipline it was meant to sit on top of was never built.
The principle
03
The four places the operating model breaks
Across the providers we work with, the strain under Support at Home concentrates in four places. We name them because naming them makes them easier to fix.
1. Claiming operations and the cash rhythm
The claim cycle moved from quarterly to near-weekly, which means the discipline that produces a clean claim now has to run every week, not four times a year. Where one capable person used to carry it, the volume outpaces them, and the first sign is a rejection rate that climbs quietly while the payments behind those rejections sit unpaid. Cash flow, which used to be predictable, becomes a direct function of how clean your claiming is.
2. Pricing governance and transparency
Setting a price is no longer an internal decision made once. It is a published position a provider has to be able to justify on demand, and it is the area the regulator has flagged as a common weakness. The planned price caps were deferred, but the regulator can order refunds for overcharging and publishes provider prices every quarter, so the pricing has to stand up in daylight now, not when a cap eventually arrives. Most providers do not yet have a clear owner for pricing, a defined method behind each price, or a review rhythm. Until they do, the pricing feels improvised, because it is.
3. Care management funding allocation
The line between care management and service delivery, and the way pooled care management funding is allocated and accounted for, is one of the least understood parts of the reform. Providers that have not drawn that line clearly find it blurring in both directions: care management effort that is not funded, and funded care management that is not being delivered as intended. The onboarding gap compounds it: care management for a newly funded participant generally cannot be claimed until the following quarter, so every month of growth digs a small cash hole that only disciplined allocation planning covers.
4. The visibility gap
The reform made the operating data more granular and more frequent, and most providers’ reporting has not kept pace. Leadership teams that could once read the package position clearly now cannot see, week to week, where each client sits, which services are recovering their cost, and where margin is leaking, until the month-end pack arrives, by which point the position has already moved.
In the field: one provider, one rebuild
Consider a multi-site home care provider that entered Support at Home with its systems configured and its team briefed. Within the first two months the symptom was cash: payments were arriving later and lighter than the board expected. The cause was not the software. Care managers across branches were coding the same service in different ways, a share of claims were being rejected on first submission, and nobody owned the resubmission cycle, so rejected claims simply sat.
The fix was operating-model work, not a new system. One coding standard applied across every branch. One owner for the claim-to-payment cycle. A weekly claiming rhythm with a rejection review built into it. A pricing method the finance lead could defend on demand. The systems did not change. The discipline around them did, and the cash position followed within the quarter.
04
Why mid-market providers are most exposed.
There is a structural reason mid-market providers feel this most, and it is not competence.
The largest providers had the back-office scale to industrialise their claiming and pricing quickly, with dedicated revenue and finance functions. The smallest have a narrow enough service footprint that one disciplined person can still hold it. In between sits the mid-market provider, large enough to carry real volume across multiple branches, small enough that the operating discipline still depended on a handful of capable people holding it in their heads. That model worked under packages. It does not survive the move to weekly, coded, validated, transparently priced claiming at volume.
Nobody redesigned the operating model, because there was no obvious moment to do it. The reform date came, the software was updated, the team did its best, and the discipline that fitted the old model was stretched to cover the new one. The cost shows up not as a single failure but as a pattern: later payments, tense finance meetings, a quality lead and a finance lead who quietly disagree about the numbers, and a leadership team that can feel the friction without being able to point to its source.
05
What to put in place first
Once the gaps are visible, the temptation is to fix everything at once. That is the wrong move for a provider already absorbing the reform on top of delivering care. The order that has held up is this.
01
Start with claiming operations and the cash rhythm. The cycle is short and the feedback is immediate. One coding standard, one owner for the claim-to-payment cycle, a weekly rhythm with rejection review built in. A claim that is clean on first submission is the foundation everything else sits on.
02
Move to pricing governance next. Give pricing a single owner, a defined method behind each price, and a review rhythm, so the price is defensible the day the regulator or a client asks for it.
03
Draw the care management line clearly. Define what care management is, how the pooled funding is allocated, and how it is accounted for, so effort and funding stop drifting apart.
04
Close the visibility gap last. It depends on the first three being clean. Build the weekly view that shows leadership where each client sits, which services recover their cost, and where margin is moving, sourced from the same data the operations team uses.
There is a near-term reason to move on this now rather than later. From 1 October 2026, personal care services such as showering, dressing and continence support move into the clinical stream and are fully government funded, with participant contributions no longer applying to those services, while contributions continue on non-clinical services. For a provider whose claiming and pricing operating model is clean, that is a configuration update and a participant letter. For a provider still running old discipline on new rules, it is another shock absorbed by the same overstretched people.
06
The discipline that holds.
The providers we have seen come through this well share one quiet characteristic. Their leadership team can look at the same weekly view as their operations team, agree on where each client and each service sits, and trust it without a second mental check. Claims go out clean and come back paid. Pricing is defensible on demand. Care management is defined, funded and delivered as one thing, not three.
That, more than any single system, is the signal that the operating model has caught up with the reform. Support at Home did not ask providers to get better at software. It asked them to run a different business. The providers who understand that are rebuilding the operating model underneath the reform, and letting the systems carry what the model defines. The ones still waiting for the software to fix it are the ones watching the cash arrive late.
The service that is claimed clean the week it is delivered is worth more than the one corrected and resubmitted a month later. That is the whole argument.
QS
Qurrat Shafqat
Director, Aged Care Practice
Qurrat works with aged care, disability and allied health providers on the operating models behind reform-ready delivery under the Aged Care Act 2024. She also leads Infinikey Consulting’s aged care research track with Western Sydney University. She writes from inside the engagements.
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02
Start Here
Begin with a Transformation Diagnostic.
A short, structured engagement that shows where control is breaking down across claiming, pricing, care management and reporting. And what to fix first.
- 2–4 Weeks
- Senior-Led
- Fixed Scope
- A clear view of the biggest operational bottlenecks across your claiming, pricing, care management and reporting.
- A 90-day plan that prioritises the changes most likely to protect cash and margin under Support at Home.
- Conducted personally by senior consultants, not handed to a team of analysts.