New amendments will allow the department to override automated Support at Home funding decisions, but Professor Kathy Eagar says the process is neither independent nor a return to clinical decision-making.
The Department of Health, Disability and Ageing will effectively be marking its own homework under a new pathway allowing it to override funding and priority decisions generated by the controversial Integrated Assessment Tool, aged care expert Professor Kathy Eagar says.
Federal aged care minister Sam Rae moved two government amendments to the Aged Care Legislation Amendment (Aboriginal and Torres Strait Islander Aged Care Commissioner and Other Measures) Bill 2026 this morning, establishing what the government calls an “escalation pathway” for home support assessment decisions.
But Professor Eagar said the changes failed to address the underlying problems with the IAT and left the department responsible for the assessment system effectively reviewing its own decisions.
“These amendments are nothing more than a fast track of the appeals process that already exists,” Professor Eagar told HSD.
“They do not fix the problem. The algorithm is fatally flawed and an algorithm should not replace clinical judgment.
“Funding decisions require clinical judgment, not just human judgment. The Department has a conflict of interest and departmental public servants are not qualified to decide appeals.”
Under the amendments, an additional review must be undertaken personally by the System Governor (the secretary of the department) or by a delegate who was not involved in the original decision but who must occupy a position within DoHDA.
The department said it intends to establish a multidisciplinary review team containing a mix of staff with clinical and non-clinical qualifications, supported by a proposed clinical governance framework providing oversight and access to specialist expertise as needed.
The reviewer will be able to affirm or vary an IAT-generated decision, or set it aside and substitute a new decision.
Crucially, the reviewer will not have to follow the usual criteria, methods, or procedures governing the original classification or priority decision and can substitute an outcome even where the person does not meet the ordinary eligibility criteria for that classification or priority category.
The new pathway itself is therefore an internal departmental review rather than an independent clinical review.
The existing reconsideration and external merits review rights remain available separately, including eventual review by the Administrative Review Tribunal.
Independent Kooyong MP Dr Monique Ryan welcomed the restoration of human oversight but questioned who would make the new review decisions.
“I’d also like more detail on who’s going to be undertaking the reviews under this amendment,” Dr Ryan told Parliament.
“It specifies that the system governor or their delegate, who has to occupy a position within the Department of Health, will be responsible for that decision.
“It’s absolutely crucial that those delegates have clinical experience. They cannot be just public servants without the ability and the expertise to undertake that sort of review.”
Dr Ryan also raised concerns about the seven-day application window, saying it was “a very small window”.
She nevertheless described the proposed framework as “a positive and constructive step”.
“I’m really pleased to see that the reviewer can vary decisions about both the classification and the priority of older Australians undertaking these assessments,” she said.
“In other words, the reviewer will be able to determine how much funding those individuals receive and how quickly.”
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‘Needs cannot be fully captured’
Mr Rae told the House the amendment was designed for older people with “complex, extenuating circumstances that don’t fit neatly into existing assessment processes”.
“Where an older person’s needs cannot be fully captured by the assessment, assessment organisations will be able to refer that assessment to the Department of Health, Disability and Ageing,” he said.
“The system governor will then be able to substitute a different outcome where the case meets the criteria.”
Those criteria have not yet been settled.
“The circumstances in which this applies will be set out in the Aged Care Rules, and we’ll take the time to consult on exactly what those criteria need to be, to ensure that we’re delivering a sustainable, workable pathway,” Mr Rae said.
The supplementary explanatory memorandum said the changes were informed by targeted consultation undertaken as part of the government’s rapid review into the Support at Home prioritisation mechanism – not yet made public – and by a review of more than 400 individual case studies contained in correspondence to the minister or department or referred by assessment organisations.
The new process will apply to certain home support classification decisions and priority decisions covering home support, assistive technology and home modifications.
But older people will not be able to initiate the additional review themselves.
A request can only be made by an approved needs assessor connected with the original assessment, with the older person’s consent.
It will generally have to be lodged within seven calendar days of the original decision, although the System Governor can allow additional time.
The amendments are due to commence on 11 January 2027, with the government saying the delay will allow reviewers to be onboarded and engagement to take place with assessment organisations.
‘Merely’ another review pathway
Greens aged care spokesperson Senator Penny Allman-Payne said the amendments did not change the underlying algorithm or restore clinicians’ ability to override its decisions.
“The amendment merely provides for an additional review pathway to the department to alter decisions,” she said.
“This tool was deployed without adequate testing or consultation and yet was immediately given absolute power to decide older peoples’ care needs.
“The implementation of the tool has been a disaster, but this amendment shows Labor still doesn’t understand how badly this has gone wrong.
“Simply adding another review pathway is a wholly inadequate response by the minister to address an assessment tool that is fundamentally unfit for purpose.”
The Greens’ criticism follows months of controversy over the IAT and the inability of assessors to override the classification produced by its algorithm.
Mr Rae told Parliament the government had already made people with motor neurone disease automatically urgent, was enabling assessors to correct input errors in the tool and was conducting the rapid review of the Support at Home prioritisation mechanism.
“Assessment organisations, peak bodies, advisory group members, and representative groups told us the system needed a way to deal with the exceptions to the rules,” he said.
Independent Curtin MP Kate Chaney also supported the amendment but warned much would depend on the Aged Care Rules, which were not before Parliament today.
“The substance of this reform sits in the rules that will be made under it,” Ms Chaney said.
“A human override with narrow rules and short windows would not fix this.”
She said that for close to a year assessors with decades of clinical experience had been unable to override IAT outcomes they believed were wrong.
“So when the government brings forward a schedule that restores a form of human override, I welcome it,” she said.
“But these types of safeguards should not be an afterthought, and they should not be at the whim of each minister.”
‘Band-Aid patch-up’
Independent Mayo MP Rebekha Sharkie said the escalation pathway did not address what she described as the “systemic and structural flaws” in the IAT.
Ms Sharkie referred to earlier evidence from Professor Eagar and former Inspector-General of Aged Care Ian Yates questioning the assessment methodology and the role of the algorithm.
“This is a band-aid patch-up. I don’t even think it’s going to work,” she said.
“Why are you not properly listening to the experts?”
Greens MP Elizabeth Watson-Brown similarly told Parliament the government’s amendments showed it was beginning to recognise problems with the system.
“Older people don’t need another escalation pathway,” she said. “They need human override by clinicians and a new assessment tool.”
The government amendments were agreed to by the House today and the bill, as amended, was given its third reading.