65Approval of access for funded aged care services

65  Approval of access for funded aged care services

Approval for funded aged care services

 (1) The System Governor must consider an assessment report for an individual provided under section 63, or information relating to an individual that is provided to the System Governor in accordance with paragraph 64(2)(b), and decide whether or not the individual requires access to funded aged care services.

Note 1: If the assessment report relates to a decision under subsection 64(1) to reassess the individual’s need for funded aged care services, a new decision is made under this section.

Note 2: Paragraph 64(2)(b) allows the System Governor to make a reassessment of an individual’s need for funded aged care services on the basis of certain kinds of information being provided to the System Governor (which results in a new decision being made under this section).

Access approval for service groups, classification types for service groups, service types and funded aged care services

 (2) If the System Governor decides under subsection (1) that an individual requires access to funded aged care services, the System Governor must decide:

 (a) whether to approve one or more service groups for the individual and the classification types for the service groups; and

 (b) if the service group is home support, assistive technology or home modifications and the individual is not an Aboriginal or Torres Strait Islander person:

 (i) whether to approve one or more service types in that group for the individual; and

 (ii) if the service type is prescribed by the rules for the purposes of this paragraph—whether to approve one or more funded aged care services in that type for the individual.

Note: An individual may choose which funded aged care services covered by an approval they wish to access and when.

 (3) However, the System Governor must not approve a service group, service type or funded aged care service under subsection (2) for an individual unless:

 (a) section 66, 67 or 68 applies in relation to the individual and the service group, service type or service; and

 (b) any eligibility requirements prescribed by the rules for the service group, or the service group in which the service type or service are included, are met.

Exceptional circumstances

 (4) Despite an individual not having undergone an aged care needs assessment under section 62, the System Governor may make a decision under subsections (1) and (2) to approve access to funded aged care services for the individual if:

 (a) the System Governor is satisfied that there are exceptional circumstances that justify making the decision without an assessment; and