Payment not required in certain circumstances
31 Payment not required in certain circumstances
The LTCS commissioner is not required to make a payment in relation to the following:
treatment, care, support or services provided to a participant in the LTCS scheme for which the participant has not paid and is not liable to pay;
Example nursing care provided by a spouse or parent on a gratuitous basis
any treatment, care, support or services required to be provided to a participant by an approved provider but is provided by a person who is not, when the treatment, care, support or services is given, an approved provider.
However, the LTCS commissioner may elect to make a payment in relation to treatment, care, support or services mentioned in subsection (1) if the LTCS commissioner considers that special circumstances exist that justify making the payment.
The LTCS guidelines may make provision for working out whether special circumstances exist that justify payment in relation to treatment, care, support or services mentioned in subsection (1).
To remove any doubt, this section applies even if the treatment, care, support or services mentioned in subsection (1) are provided in connection with the assessed treatment and care needs of the participant.
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