The organisations that oversee and administer the aged care system make many decisions under the Act while carrying out their roles. The Act allows certain people to ask for a review of certain decisions.
Decision-makers in the aged care system include:
- the Aged Care Quality and Safety Commissioner (the Commissioner)
- the Complaints Commissioner
- the System Governor (in practice, the department)
- the Independent Health and Aged Care Pricing Authority (the Pricing Authority) – the Pricing Authority provides independent advice to the government in relation to funding for aged care services.
What are reviewable decisions
Many of the decisions governors of the aged care system make are reviewable decisions.
A reviewable decision is a decision that can be reconsidered under the Act. This means a person or organisation affected by the decision – called the affected entity – can ask for the decision to be looked at again if they don’t agree with it. The decision maker can also choose to review their decision for their own reasons. For example, if they learn new information that’s related to the decision.
Chapter 8 lists reviewable decisions included in the Act. For example:
- if the Commissioner decides not to register a provider
- if the System Governor decides that someone doesn’t need access to funded aged care services.
Any rules created to support the Act can also include reviewable decisions. For example, the Aged Care Rules 2025 includes various reviewable decisions.
Review process
To apply for a review – reconsideration – of a decision, the affected entity needs to make a request to the decision maker. The request must be in writing and needs to explain why they are asking for the review.
If a decision maker starts a review themselves, they have to tell the affected entity within 14 days. This must be in writing.
An internal decision reviewer will review the decision. They can be:
- the original decision maker
or
- someone in a role at an equal level to the original decision maker who wasn’t involved in the original decision.
The internal decision reviewer has 90 days to reassess the decision. They must use the relevant information and follow the steps that are appropriate for the type of decision. They can also ask the affected entity for documents or more information to help them with the review.
The result of the review process is called the reconsideration decision.
Outcome
The internal decision reviewer can either:
- uphold the original decision
- change the original decision
- make a new decision.
Once the internal decision reviewer makes their reconsideration decision, they have to tell the affected entity. This includes explaining how they can ask for further review. If the affected entity wants further review of the decision, they can apply to the Administrative Review Tribunal.
Reviewing decisions in practice
Case study: Margaret is a 78-year-old person who has a mild cognitive impairment and lives alone. She has been approved for access to cleaning and personal care services under the Medium priority category. But Margaret believes this decision was incorrect because her health has declined significantly and she feels she has an urgent need for care. She’s recently had several falls and is struggling to manage daily tasks.
Action: She writes to the department, explaining her situation and asking for the decision to be reviewed. She includes updated medical records and a letter from her GP describing her increased risk of harm without urgent support.
The department assigns an internal reviewer who wasn’t involved in the original decision. Within 90 days, the reviewer considers the case. Based on the additional information, the reviewer reassesses the original decision, changing the priority category to High.
Outcome: Margaret receives a written notice of the new decision, along with information on how she could apply for further review through the Administrative Review Tribunal if needed. She is able to access home support services that meet her needs more quickly because of the higher priority category.