Contents

Chapter 1—Introduction 1

Division 1—Preliminary matters 1

1‑1......... Short title [see Note 1]....................................................................... 1

1‑2......... Commencement [see Note 1].............................................................. 1

1‑3......... Identifying defined terms.................................................................... 1

1‑4......... Tables of Divisions and Subdivisions do not form part of this Act... 2

Division 2—Objects 3

2‑1......... The objects of this Act....................................................................... 3

Division 3—Overview of this Act 5

3‑1......... General................................................................................................ 5

3‑2......... Preliminary matters relating to subsidies (Chapter 2)........................ 5

3‑3......... Subsidies (Chapter 3)......................................................................... 5

3‑4......... Responsibilities of approved providers (Chapter 4).......................... 6

3‑5......... Grants (Chapter 5)............................................................................. 6

3‑6......... The structure of this Act.................................................................... 6

Division 4—Application of this Act 8

4‑1......... Application of this Act...................................................................... 8

4‑2......... Binding the Crown.............................................................................. 8

Chapter 2—Preliminary matters relating to subsidies 9

Division 5—Introduction 9

5‑1......... What this Chapter is about................................................................. 9

5‑2......... Which approvals etc. may be relevant................................................ 9

Part 2.1—Approval of providers 11

Division 6—Introduction 11

6‑1......... What this Part is about..................................................................... 11

6‑2......... The Approved Provider Principles.................................................. 11

Division 7—What is the significance of approval as a provider of aged care? 12

7‑1......... Providers of aged care must be approved to receive subsidy........... 12

7‑2......... Approvals may be restricted............................................................ 12

Division 8—How does a person become an approved provider? 13

8‑1......... Approval as a provider of aged care................................................. 13

8‑2......... Applications for approval................................................................ 14

8‑3......... Suitability of people to provide aged care........................................ 14

8‑4......... Requests for further information...................................................... 16

8‑5......... Notification of Secretary’s determination........................................ 16

8‑6......... States, Territories and local government taken to be approved providers 17

Division 9—What obligations arise from being an approved provider? 19

9‑1......... Obligation to notify certain changes................................................. 19

9‑2......... Obligation to give information relevant to an approved provider’s status when requested 20

9‑3......... Obligation to give information relevant to payments under this Act 21

9‑4......... Obligations while approval is suspended......................................... 21

Division 10—When does an approval cease to have effect? 22

10‑1....... Cessation of approvals..................................................................... 22

10‑2....... Approval lapses if services not provided for 6 months................... 22

10‑3....... Revocation of approval.................................................................... 23

10‑4....... Revocation of approval on request of approved provider............... 25

Division 10A—Disqualified individuals 26

10A‑1.... Meaning of disqualified individual................................................... 26

10A‑2.... Disqualified individual must not be one of the key personnel of an approved provider 27

10A‑3.... Remedial orders................................................................................ 28

Part 2.2—Allocation of places 30

Division 11—Introduction 30

11‑1....... What this Part is about..................................................................... 30

11‑2....... The Allocation Principles................................................................. 30

11‑3....... Meaning of people with special needs............................................... 31

11‑4....... Explanation of the allocation process............................................... 31

Division 12—How does the Commonwealth plan its allocations of places? 33

12‑1....... The planning process........................................................................ 33

12‑2....... Objectives of the planning process................................................... 33

12‑3....... Minister to determine the number of places available for allocation 33

12‑4....... Distributing available places among regions..................................... 34

12‑5....... Determining proportion of care to be provided to certain groups of people 34

12‑6....... Regions............................................................................................. 35

12‑7....... Aged Care Planning Advisory Committees...................................... 35

Division 13—How do people apply for allocations of places? 37

13‑1....... Applications for allocations of places.............................................. 37

13‑2....... Invitation to apply........................................................................... 37

13‑3....... Application fee................................................................................. 38

13‑4....... Requests for further information...................................................... 38

Division 14—How are allocations of places decided? 40

14‑1....... Allocation of places.......................................................................... 40

14‑2....... Competitive assessment of applications for allocations.................. 40

14‑3....... Compliance with the invitation........................................................ 41

14‑4....... Waiver of requirements..................................................................... 42

14‑5....... Conditions relating to particular allocations..................................... 43

14‑6....... Conditions relating to allocations generally...................................... 44

14‑7....... Allocation of places to services with extra service status................ 44

14‑8....... Notification of allocation.................................................................. 45

14‑9....... Allocations in situations of emergency............................................. 45

Division 15—When do allocations of places take effect? 47

15‑1....... When allocations take effect............................................................. 47

15‑2....... Provisional allocations...................................................................... 47

15‑3....... Applications for determinations....................................................... 47

15‑4....... Variation or revocation of provisional allocations............................ 48

15‑5....... Variation of provisional allocations on application of approved provider 49

15‑6....... Surrendering provisional allocations................................................. 50

15‑7....... Provisional allocation periods........................................................... 50

Division 16—How are allocated places transferred from one person to another? 52

16‑1....... Transfer of places............................................................................. 52

16‑2....... Applications for transfer of places................................................... 52

16‑3....... Requests for further information...................................................... 54

16‑4....... Consideration of applications........................................................... 55

16‑5....... Time limit for decisions on applications.......................................... 56

16‑6....... Notice of decision on transfer........................................................... 56

16‑7....... Transfer day..................................................................................... 57

16‑8....... Transfer of places to service with extra service status..................... 58

16‑9....... Information to be given to transferee................................................ 58

16‑10..... Transferors to provide transferee with certain records.................... 59

16‑11..... Effect of transfer on certain matters................................................. 60

Division 17—How are the conditions for allocations of places varied? 61

17‑1....... Variation of allocations..................................................................... 61

17‑2....... Applications for variation of allocations.......................................... 61

17‑3....... Requests for further information...................................................... 62

17‑4....... Consideration of applications........................................................... 63

17‑5....... Time limit for decisions on applications.......................................... 64

17‑6....... Notice of decisions........................................................................... 64

17‑7....... Variation day.................................................................................... 64

17‑8....... Variation involving relocation of places to service with extra service status 65

Division 18—When do allocations cease to have effect? 66

18‑1....... Cessation of allocations.................................................................... 66

18‑2....... Relinquishing places......................................................................... 66

18‑3....... Proposals relating to the care needs of care recipients..................... 67

18‑4....... Approved providers’ obligations relating to the care needs of care recipients 68

18‑5....... Revocation of unused allocations of places...................................... 68

Part 2.3—Approval of care recipients 70

Division 19—Introduction 70

19‑1....... What this Part is about..................................................................... 70

19‑2....... The Approval of Care Recipients Principles................................... 70

Division 20—What is the significance of approval as a care recipient? 71

20‑1....... Care recipients must be approved before subsidy can be paid........ 71

20‑2....... Effect of limitation of approvals...................................................... 71

Division 21—Who is eligible for approval as a care recipient? 72

21‑1....... Eligibility for approval..................................................................... 72

21‑2....... Eligibility to receive residential care................................................. 72

21‑3....... Eligibility to receive community care............................................... 72

21‑4....... Eligibility to receive flexible care...................................................... 73

Division 22—How does a person become approved as a care recipient? 74

22‑1....... Approval as a care recipient............................................................. 74

22‑2....... Limitation of approvals.................................................................... 74

22‑3....... Applications for approval................................................................ 75

22‑4....... Assessments of care needs............................................................... 75

22‑5....... Date of effect of approval................................................................ 76

22‑6....... Notification of decisions................................................................... 76

Division 23—When does an approval cease to have effect? 78

23‑1....... Expiration, lapse or revocation of approvals.................................... 78

23‑2....... Expiration of time limited approvals................................................ 78

23‑3....... Approval lapses if care not received within a certain time............... 78

23‑4....... Revocation of approvals................................................................... 79

Part 2.4—Classification of care recipients 81

Division 24—Introduction 81

24‑1....... What this Part is about..................................................................... 81

24‑2....... The Classification Principles............................................................ 81

Division 25—How are care recipients classified? 82

25‑1....... Classification of care recipients........................................................ 82

25‑2....... Classification levels.......................................................................... 83

25‑3....... Appraisals of the level of care needed.............................................. 83

25‑4....... Suspending approved providers from making appraisals................. 84

25‑5....... Authorisation of another person to make appraisals....................... 85

Division 26—When do classifications take effect? 87

26‑1....... Appraisals received within the appropriate period—care other than respite care 87

26‑2....... Assessments not received within the appropriate period—care other than respite care 87

26‑3....... When respite care classifications take effect.................................... 88

Division 27—When do classifications cease to have effect? 89

27‑1....... Expiry dates for classifications......................................................... 89

27‑2....... Cessation of care............................................................................... 89

27‑3....... Extended hospital leave.................................................................... 90

Division 28—How are classifications renewed? 91

28‑1....... Renewing classifications................................................................... 91

28‑2....... Reappraisal of the level of care needed............................................. 91

28‑3....... Reappraisal period for classifications............................................... 92

28‑4....... Date of effect of renewal.................................................................. 92

28‑5....... Reappraisal given to the Secretary after the reappraisal period....... 93

Division 29—How are classifications changed? 95

29‑1....... Changing classifications.................................................................... 95

29‑2....... Date of effect of change.................................................................... 95

Part 2.5—Extra service places 96

Division 30—Introduction 96

30‑1....... What this Part is about..................................................................... 96

30‑2....... The Extra Service Principles............................................................. 96

30‑3....... Meaning of distinct part.................................................................... 97

Division 31—When is a place an extra service place? 98

31‑1....... Extra service place............................................................................ 98

31‑3....... Effect of allocation or transfer of places to services with extra service status 98

Division 32—How is extra service status granted? 99

32‑1....... Grants of extra service status........................................................... 99

32‑2....... Invitations to apply.......................................................................... 99

32‑3....... Applications for extra service status.............................................. 100

32‑4....... Criteria to be considered by Secretary............................................ 101

32‑5....... Competitive assessment of applications........................................ 102

32‑6....... Application fee............................................................................... 103

32‑7....... Maximum proportion of places...................................................... 104

32‑8....... Conditions of grant of extra service status..................................... 104

32‑9....... Notification of extra service status................................................. 105

Division 33—When does extra service status cease? 107

33‑1....... Cessation of extra service status..................................................... 107

33‑3....... Lapsing of extra service status........................................................ 107

33‑4....... Revocation or suspension of extra service status at approved provider’s request 108

Division 35—How are extra service fees approved? 109

35‑1....... Approval of extra service fees........................................................ 109

35‑2....... Applications for approval.............................................................. 109

35‑3....... Rules about amount of extra service fee......................................... 110

35‑4....... Notification of Secretary’s decision............................................... 111

Division 36—When is residential care provided on an extra service basis? 112

36‑1....... Provision of residential care on extra service basis......................... 112

36‑2....... Extra service agreements not to be entered under duress etc.......... 112

36‑3....... Contents of extra service agreements.............................................. 113

36‑4....... Additional protection for existing residents................................... 113

Part 2.6—Certification of residential care services 114

Division 37—Introduction 114

37‑1....... What this Part is about................................................................... 114

37‑2....... The Certification Principles............................................................ 114

Division 38—How is a residential care service certified? 115

38‑1....... Certification of residential care services......................................... 115

38‑2....... Applications for certification......................................................... 115

38‑3....... Suitability of residential care service for certification..................... 116

38‑4....... Secretary may require service to be assessed................................. 116

38‑5....... Requests for further information.................................................... 117

38‑6....... Notification of Secretary’s determination...................................... 117

38‑7....... Application fee............................................................................... 118

Division 39—When does certification cease to have effect? 119

39‑1....... Certifications ceasing to have effect............................................... 119

39‑2....... Lapse of certification on change of location of residential care service 119

39‑3....... Revocation of certification.............................................................. 119

39‑4....... Review of certification.................................................................... 120

39‑5....... Revocation of certification on request of approved provider......... 121

Chapter 3—Subsidies 122

Division 40—Introduction 122

40‑1....... What this Chapter is about............................................................. 122

Part 3.1—Residential care subsidy 123

Division 41—Introduction 123

41‑1....... What this Part is about................................................................... 123

41‑2....... The Residential Care Subsidy Principles........................................ 123

41‑3....... Meaning of residential care............................................................ 123

Division 42—Who is eligible for residential care subsidy? 125

42‑1....... Eligibility for residential care subsidy............................................ 125

42‑2....... Leave from residential care services................................................ 126

42‑3....... Working out periods of leave.......................................................... 127

42‑4....... Accreditation requirement.............................................................. 128

42‑5....... Determinations allowing for exceptional circumstances................. 129

42‑6....... Revocation of determinations......................................................... 131

42‑7....... Exceeding the number of places for which there is an allocation.... 131

42‑8....... Notice of refusal to pay residential care subsidy........................... 132

Division 43—How is residential care subsidy paid? 133

43‑1....... Payment of residential care subsidy............................................... 133

43‑2....... Meaning of payment period............................................................ 133

43‑3....... Advances........................................................................................ 133

43‑4....... Claims for residential care subsidy................................................. 134

43‑5....... Deductions for fees......................................................................... 135

43‑6....... Capital repayment deductions........................................................ 136

43‑7....... Deductions for additional recurrent funding................................... 137

43‑8....... Non‑compliance deductions........................................................... 138

43‑9....... Recovery of overpayments............................................................ 139

Division 44—What is the amount of residential care subsidy? 140

44‑1....... What this Division is about............................................................ 140

Subdivision 44‑A—Working out the amount of residential care subsidy 140

44‑2....... Amount of residential care subsidy................................................ 140

Subdivision 44‑B—The basic subsidy amount 141

44‑3....... The basic subsidy amount.............................................................. 141

44‑4....... Effect on classification levels of long periods in hospital............... 142

Subdivision 44‑C—Primary supplements 143

44‑5....... Primary supplements..................................................................... 143

44‑6....... The concessional resident supplement........................................... 143

44‑7....... Meaning of concessional resident................................................... 144

44‑8....... Meaning of assisted resident.......................................................... 146

44‑8AA. Determinations for sections 44‑7 and 44‑8.................................... 148

44‑8AB. Determination of value of person’s assets..................................... 150

44‑8A.... The charge exempt resident supplement........................................ 151

44‑8B.... Meaning of charge exempt resident................................................ 152

44‑9....... Person taken not to be a concessional resident or an assisted resident if asset information not provided 153

44‑10..... How to work out the value of a person’s assets............................ 153

44‑11..... Definitions relating to concessional residents and assisted residents 154

44‑12..... The respite supplement.................................................................. 155

44‑13..... The oxygen supplement................................................................. 157

44‑14..... The enteral feeding supplement...................................................... 158

44‑15..... Requests for further information.................................................... 159

44‑16..... Additional primary supplements................................................... 159

Subdivision 44‑D—Reductions in subsidy 159

44‑17..... Reductions in subsidy.................................................................... 159

44‑18..... The extra service reduction............................................................. 160

44‑19..... The adjusted subsidy reduction...................................................... 160

44‑20..... The compensation payment reduction........................................... 161

Subdivision 44‑E—The income test 163

44‑21..... The income test.............................................................................. 163

44‑22..... Daily income tested reduction taken to be zero in some circumstances 164

44‑23..... Effect on daily income tested reduction of failure to give requested information 165

44‑24..... The care recipient’s ordinary income............................................. 166

44‑25..... Ordinary income of war widows and war widowers...................... 168

44‑26..... The care recipient’s ordinary income free area............................... 168

Subdivision 44‑F—Other supplements 169

44‑27..... Other supplements......................................................................... 169

44‑28..... The pensioner supplement............................................................. 169

44‑29..... The viability supplement............................................................... 171

44‑30..... The hardship supplement............................................................... 173

44‑31..... Determining cases of financial hardship......................................... 174

Part 3.2—Community care subsidy 176

Division 45—Introduction 176

45‑1....... What this Part is about................................................................... 176

45‑2....... The Community Care Subsidy Principles...................................... 176

45‑3....... Meaning of community care........................................................... 176

Division 46—Who is eligible for community care subsidy? 177

46‑1....... Eligibility for community care subsidy.......................................... 177

46‑2....... Suspension of community care services......................................... 177

46‑3....... Exceeding the number of places for which there is an allocation.... 179

46‑4....... Notice of refusal to pay community care subsidy......................... 179

Division 47—On what basis is community care subsidy paid? 180

47‑1....... Payability of community care subsidy........................................... 180

47‑2....... Meaning of payment period............................................................ 180

47‑3....... Advances........................................................................................ 180

47‑4....... Claims for community care subsidy............................................... 181

47‑5....... Recovery of overpayments............................................................ 181

Division 48—What is the amount of community care subsidy? 182

48‑1....... Amount of community care subsidy.............................................. 182

Part 3.3—Flexible care subsidy 183

Division 49—Introduction 183

49‑1....... What this Part is about................................................................... 183

49‑2....... The Flexible Care Subsidy Principles............................................. 183

49‑3....... Meaning of flexible care.................................................................. 183

Division 50—Who is eligible for flexible care subsidy? 184

50‑1....... Eligibility for flexible care subsidy................................................. 184

50‑2....... Kinds of care for which flexible care subsidy may be payable....... 184

50‑3....... Exceeding the number of places for which there is an allocation.... 185

50‑4....... Notice of refusal to pay flexible care subsidy................................ 186

Division 51—On what basis is flexible care subsidy paid? 187

51‑1....... Payment of flexible care subsidy.................................................... 187

Division 52—What is the amount of flexible care subsidy? 188

52‑1....... Amounts of flexible care subsidy................................................... 188

Chapter 4—Responsibilities of approved providers 189

Division 53—Introduction 189

53‑1....... What this Chapter is about............................................................. 189

53‑2....... Failure to meet responsibilities does not have consequences apart from under this Act 189

Part 4.1—Quality of care 191

Division 54—Quality of care 191

54‑1....... Responsibilities of approved providers......................................... 191

54‑2....... Accreditation Standards.................................................................. 192

54‑3....... Residential Care Standards............................................................. 192

54‑4....... Community Care Standards............................................................ 193

54‑5....... Flexible Care Standards................................................................... 193

Part 4.2—User rights 194

Division 55—Introduction 194

55‑1....... What this Part is about................................................................... 194

55‑2....... The User Rights Principles............................................................. 194

Division 56—What are the general responsibilities relating to user rights? 195

56‑1....... Responsibilities of approved providers—residential care.............. 195

56‑2....... Responsibilities of approved providers—community care............ 196

56‑3....... Responsibilities of approved providers—flexible care................... 197

56‑4....... Complaints resolution mechanisms................................................ 199

56‑5....... Extent to which responsibilities apply........................................... 199

Division 57—What are the responsibilities relating to accommodation bonds? 201

57‑1....... What this Division is about............................................................ 201

Subdivision 57‑A—The basic rules