Aged care entry requirements for providers

Annual and lifetime caps

Since 1 July 2014, annual and lifetime caps apply to the income-tested care fee in home care packages, and means-tested care fee for residential care.

These arrangements apply to care recipients who entered care on or after 1 July 2014.

They only apply to care recipients who were in care before 1 July 2014 if they:

  • leave their residential care home or home care package for more than 28 days, other than on approved leave and then re-enter care, or
  • choose to opt in to the new fee arrangements when changing home care services or aged care homes after 1 July 2014

Basic daily fees, accommodation payments, accommodation contributions and fees for extra services aren’t included in the annual and lifetime caps. They remain payable after the caps have been reached.

We write to you and your care recipient when we’ve processed the claim for the month in which the care recipient reached the annual or lifetime cap. Once the cap is reached, we pay the income or means-tested fees through subsidy payments to you, and the care recipient pays the basic daily fee and any accommodation costs.

Changing providers or care types

The annual and lifetime caps follow a care recipient as they move between providers, services and care types. Home care package income-tested fees and residential care means-tested fees accrue against a person’s annual and lifetime cap from the date of their first entry into home care or residential care on or after 1 July 2014.

Any means-tested care fees paid in residential care counts towards the annual cap in home care in the year a care recipient moves to a home care package. These fees also count towards the lifetime cap in home care.

If a care recipient was receiving residential care before 1 July 2014 and moves into home care after 1 July 2014, only the income-tested care fees paid from the time the care recipient starts home care count for the annual and lifetime caps.

Any income-tested care fees paid in a home care package count towards the annual cap in residential care in the year that a care recipient moves into residential care. These fees also count towards the lifetime cap in residential care.

If a care recipient was receiving home care before 1 July 2014 and moves into residential care after 1 July 2014, only the means-tested care fees paid after the move are counted for the annual and lifetime caps.

Subsidy adjustment

Caps are reconciled as part of monthly claims processing. If the cap is reached in the month being processed, the care recipient and service are notified after the claim is finalised. Any delays in lodgement also delay the subsidy adjustment for a care recipient who has reached their cap.

We refund any payments made by a care recipient for the part of the month after the cap takes effect, where the subsidy adjustment hasn’t been made yet. We refund the amount in their next quarterly review.

This information was printed Friday 24 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/services/aged-care-entry-requirements-providers/you-need-know/annual-and-lifetime-caps It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 22 February 2019