CAPS Funding
As part of our normal Continence Assessment the Continence Nurse Specialists will complete the CAPS application form and prepare a Health Report regarding your Incontinence. The nurse will lodge your form with a Health Report to Medicare for them to make a final determination on eligibility.
If the Nurse believes you are not eligible for the CAPS funding you will be told prior to the Nurse beginning the application.
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You may be eligible for CAPS if;
You are an Australian citizen or a permanent Australian resident that is over the age of five and experiencing one of the following:
Permanent and severe loss of bladder and/or bowel function caused by an eligible neurological condition – Appendix 1 In the Downloadable Guide
Permanent and severe loss of bladder and/or bowel function caused by another condition – Appendix 2 In the Downloadable Guide, provided the person has a Centrelink Pensioner Concession Card, whether as a primary cardholder or a dependant of a cardholder
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You may be ineligible for CAPS if;
- You have temporary, not permanent and severe incontinence
- Your incontinence is treatable or is night time bed wetting only
- You’re living in an Australian Government funded aged care home, and you have been assessed with a high Aged Care Funding Instrument rating in any category, or a medium in 2 categories
- You have a DVA Gold Card or White Card, and can get help through the DVA Rehabilitation Appliances Program
- You’re an Australian Government funded home care recipient and your plan includes continence support
- You have a funding package from the National Disability Insurance Scheme (NDIS) that includes continence aids
- You’re in prison, or
- You’ve been living overseas for 3 or more years in a row
The Full year Payment for CAPS in 2020/21 was $623.80. This amount is indexed annually.
Eligible recipients often choose to receive one full payment in July but if you find it easier to budget with two half payments in July and January each year, that can be also be arranged by selecting the payment method on the Application.
Clarify this with our Continence Nurse Advisor while conducting your assessment.
As part of your CAPS application you can authorise a Supplier, in this case Caremmunity, to manage your CAPS funding. This could be advisable for some people.
Where we see a benefit for you to nominate the CAPS payment to be made directly to Caremmunity we will explain the reason. It can’t (and won’t) happen without your consent.
- Maintain your account and records for every purchase on your behalf.
- Maintain your account balance so you can be updated at anytime.
- Debit your balance only for the cost of your purchase.
- If you desire, set regular programmed orders without requiring pre-payment over the phone by debiting the balance.
- Comply with Medicare Audits.
- Always return the balance to you at your request if you no longer find it a benefit.
- Inform Medicare if there is a change in your circumstances.
Payments aren’t included in any income calculations for tax purposes. This includes residential care in an Australian Government funded aged care facility and Centrelink payments.
- You would prefer Cashless transactions for Continence Aids deliveries.
- You don’t have a credit card or prefer not to give credit card details over the phone.
- You want to program regular deliveries without first having to settle the account – i.e. to receive x Packets every four weeks.
- You would prefer Caremmunity to manage your CAPS purchases and records.
- You would like to access one of the limited Fee Free Continence Assessments.
If you have permanent and severe incontinence you should maintain your advice and have a continence management plan in place with your health professional.
Children 5 to 15 years of age should have their continence reassessed at least every 2 years while all other applicants should have a regular review of their continence needs with their health professional.
Reviews of a client’s continence needs should be negotiated and agreed between the client and their health professional.
CAPS clients must promptly notify Medicare of any change in their circumstances that affects their eligibility and, from time to time, may be asked to confirm their eligibility for CAPS.