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.