CAPS - Eligibility
- Who is eligible for the CAPS?
A person is eligible for CAPS if they are five years of age or older and meets either one of the following requirements:
A - has permanent and severe loss of bladder and/or bowel function (incontinence) due directly to an eligible neurological condition; OR
B - has permanent and severe loss of bladder and/or bowel function (incontinence) caused by an other eligible condition, and the person has a Centrelink Pensioner Concession Card or entitlement, whether as a primary cardholder or a dependent of a cardholder; OR
C - has permanent and severe loss of bladder and/or bowel function (incontinence) caused by an other eligible condition and the person has a Department of Veterans Affairs Pensioner Concession Card or entitlement, whether as a primary cardholder or a dependent of a cardholder.
- What is the definition of incontinence for the purposes of CAPS?
Permanent and severe incontinence is defined as the frequent and uncontrollable, moderate to large loss of urine or faeces which impacts on a person's quality of life and is unlikely to improve with medical, surgical or clinical treatment regimes.
- How do people get a Centrelink Pensioner Concession Card?
For questions regarding eligibility for a Centrelink Pensioner Concession Card please contact Centrelink on 132 717 (Disability, Sickness and Carers line) or 132 300 (Retirement Line) or visit www.centrelink.gov.au.
- Who is not eligible for the CAPS?
A person is not eligible for CAPS if:
- They are not an Australian citizen or a permanent Australian resident.
- They are a high care resident in an Australian Government funded aged care home.
- They are receiving an Extended Aged Care at Home (EACH) or an EACH Dementia (EACHD) package and continence products are negotiated as part of the person's care plan.
- They are eligible for assistance with continence products under the Rehabilitation Appliances Program (RAP) which is available through the Department of Veteran's Affairs.
- Their incontinence is one of the following types:
- Transient incontinence (not permanent);
- Incontinence that can be treated with an existing conservative treatment regime (eg pelvic floor exercises or bladder re-training), medication or surgery;
- Confined to night time bed wetting (enuresis).
- Their incontinence results from a condition other than an eligible neurological condition AND the person does not have a Centrelink or DVA Pensioner Concession Card entitlement.
- They are serving a prison sentence.
For people living in Australia Government funded aged care homes or receiving Australian Government funded aged care packages:
- If the person is living in an Australian Government funded aged care home, and is receiving high care the person is not eligible for CAPS, as the home is required to provide appropriate continence or continence related products.
- If the person receives assistance from an EACH or EACHD package and continence products or continence related products have been negotiated as part of the care plan the person is not eligible for CAPS.
- Will eligibility for CAPS be reviewed after a certain period of time?
People with permanent and severe incontinence should have a continence management plan in place that is reviewed by their health professional on a periodic basis. Reviews of a client's continence needs should be negotiated and agreed between the client and health professional, who is in a position to make an assessment of the client's incontinence.
CAPS clients are required to notify Medicare of any change in their circumstances that affects their eligibility, and from time to time, may be asked to confirm their eligibility