Challenging Aged Care Assessment Decisions: Internal Review and the ART

Which assessment decisions are reviewable

Reviewability is not general. It is conferred decision by decision. Section 557 sets out, in table form, the decisions of the System Governor that are reviewable decisions and, for each, the entity that is the affected entity. The decisions that matter most to an older person and their family after an aged care needs assessment include the following.

Two practical points follow. First, the assessment report is not the decision. An aged care needs assessment under section 61 and the report prepared under section 63 feed into a decision; it is the decision under section 65, 78, 83, 86 or 90 that is reviewable. Second, the notice itself is the primary document. Section 70 requires the System Governor to give written notice of a decision under subsection 65(1) or (2) within 14 days, and that notice must include the reasons for the decision and how the individual may apply for reconsideration. If a notice does not tell you the provision relied on or how to seek reconsideration, ask for that in writing before the 28 days elapse.

What reconsideration is not

Several different processes are commonly described as “appealing” an aged care outcome. They are legally distinct, and choosing the wrong one can waste the reconsideration period.

• A complaint is not a reconsideration. Complaints about the quality or delivery of care, or about a provider’s conduct, are handled through the complaints system rather than Part 2 of Chapter 8. A complaint does not stop the 28-day clock on a reviewable decision. See our guide to aged care complaints and the Complaints Commissioner.
• A reassessment is not a reconsideration. Asking for a fresh aged care needs reassessment under section 64, or for a classification reassessment under section 82, asks the system to look at current needs. Reconsideration asks whether the decision already made was correct. If circumstances have genuinely changed, a reassessment may be the better route; if the decision was wrong on the material before the decision-maker, reconsideration is.
• Changing a priority category is not a reconsideration. Section 90 allows a priority category to be changed. A decision under subsection 90(1) to change a priority category is itself a reviewable decision, but requesting a change and requesting reconsideration are different steps.
• The Statement of Rights is not a review pathway. The rights in section 23 are important and bite through provider registration conditions, but they are not directly enforceable in a court or tribunal. See the Statement of Rights under the Aged Care Act 2024 (Cth).

Step 1 — requesting reconsideration

Section 559 sets out the request. An affected entity for a reviewable decision may request the decision-maker to reconsider it. The request must be made in writing and must set out the reasons for the request. For a request to reconsider a classification level established under subsection 78(1), the request must also be accompanied by the application fee (if any) prescribed by the rules.

The timing rule is in subsection 559(3). The request must be given to the decision-maker within 28 days after the day the affected entity is notified of the reviewable decision. There are two qualifications: a request to reconsider a determination of an individual’s total assessable income under subsection 322(1) attracts a 90-day period, and the System Governor, the Commissioner or the Complaints Commissioner may determine a longer period. Subsection 559(4) separately allows an extension at the affected entity’s request.

Because the period runs from notification rather than from the date printed on the decision, evidence of when the notice arrived can be decisive. Section 592 permits the System Governor, Commissioner or Complaints Commissioner to notify by prepaid post to the last known postal address, personally, or in any other way the notifier considers appropriate, including electronically. Keep the envelope, the email header or the portal notification. If the deadline is close, lodge a short request in time and supplement it — a request that sets out reasons, however briefly, is better lodged than perfected late.

How the reconsideration is conducted

Section 560 governs a reconsideration on request and imposes real structure on the process.

• Acknowledgement within 14 days. The decision-maker must give written notice stating that the request has been received, specifying the day it was received, and setting out the effect of section 565 (the deemed-affirmation rule).
• A fresh decision-maker. The decision-maker must reconsider personally, or have the decision reconsidered by a delegate who was not involved in making the decision and who occupies a position at least at the same level as the original decision-maker. That person is the internal decision reviewer.
• Procedural fairness. The internal decision reviewer must have due regard to procedural fairness. For a classification decision under subsection 78(1), the reviewer must consider the classification assessment report given under section 77 and information given as referred to in subparagraph 76(1)(a)(ii) or (b)(ii).
• 90 days to decide. Paragraph 560(5)(c) requires the reviewer to reconsider the decision within 90 days after receiving the request.
• Residential classifications get a new assessment. For a decision under subsection 78(1) or 83(1) for the ongoing or short-term classification type for the residential care service group, subsection 560(6) requires the System Governor to arrange a new classification assessment, which the reviewer must take into account. Under subsection 560(7), if the individual cannot be assessed, no reconsideration decision may be made and the request is taken to be withdrawn.

Reconsideration on the decision-maker’s initiative

A decision-maker does not have to wait to be asked. Under section 561 a decision-maker may reconsider a reviewable decision if satisfied there is sufficient reason to do so. Section 562 then mirrors section 560: written notice to each affected entity within 14 days of commencing, an independent internal decision reviewer, procedural fairness, and 90 days from the decision to reconsider.

One difference matters. Under section 563, if the internal decision reviewer needs further information or a document for a section 562 reconsideration, they may request it by written notice, and the affected entity must respond within 28 days or any longer period specified. If the entity does not respond in time, the reviewer may extend the period or simply make a reconsideration decision. If the entity does respond within the period, subsection 563(4) stops the 90-day clock for the days between the request and the response. Responding promptly, and in writing, protects both the timetable and the record.

The reconsideration decision

Section 564 sets the possible outcomes. After reconsidering under section 560 or 562, the internal decision reviewer must affirm the decision, vary it, or set it aside and substitute a new decision. That outcome is the reconsideration decision.

The reviewer must then give each affected entity written notice of the reconsideration decision, the day it was made, the reasons for it, and details of the entity’s right to apply to the Administrative Review Tribunal for review. The decision takes effect on the day it was made, or on a later day specified in the notice. The statement of reasons is the working document for any ART application: it identifies the material relied on and the findings made, and is where gaps in the evidence usually become visible.

Deemed affirmation if the 90 days pass

Section 565 prevents inaction from becoming a barrier. Where a request was made under subsection 559(1), or notice of an own-initiative reconsideration was given under subsection 562(2), and notice of the reconsideration decision is not given to each affected entity under subsection 564(3) within the applicable 90-day period, the decision-maker is taken to affirm the decision. The decision so affirmed is the reconsideration decision.

The consequence is procedural as well as substantive: an affected entity who has heard nothing at the end of the period is not stuck, but is instead holding a reviewable reconsideration decision — and a new, short Tribunal clock. Diarise the ninetieth day when the acknowledgement notice arrives.

Step 2 — review by the ART

Section 566 provides that an affected entity for a reviewable decision may apply to the Administrative Review Tribunal for review of the reconsideration decision to which the reviewable decision relates, and that this has effect despite section 17 of the Administrative Review Tribunal Act 2024 (Cth). Three points follow.

• Reconsideration first. The Tribunal reviews the reconsideration decision, not the original decision. Without a reconsideration decision — actual or deemed under section 565 — there is nothing for the Tribunal to review.
• It is merits review, not an appeal. The Tribunal stands in the shoes of the decision-maker and decides the correct or preferable decision on the material before it. It is not confined to identifying legal error.
• The clock is short. Section 18 of the Administrative Review Tribunal Act 2024 (Cth) requires an application within the period prescribed by the rules. Under section 5 of the Administrative Review Tribunal Rules 2024 the general period ends 28 days after the applicant is given written notice of the decision, or 28 days after a statement of reasons is given where one is provided. Section 6 of the Rules deals with decisions taken to be made because a timeframe expired — relevant to a section 565 deemed affirmation — and the period generally ends 28 days after the day the decision is taken to be made.

Section 19 of the Act allows the Tribunal to extend that period by order where it considers it reasonable in all the circumstances, and it may do so even after the period has expired. An extension is a discretion, not an entitlement; the safe course is to apply in time.

ART application fees

Fees are prescribed by the Administrative Review Tribunal Rules 2024. For the core assessment decisions, no fee is payable: item 2A of the table in section 30 covers an application to review a reconsideration decision under the Aged Care Act 2024 that relates to a decision under subsection 57(1), 64(1), 65(1), 65(2), 65(4), 71(2), 71(6), 74(1) or 78(1).

Other aged care decisions are not in that table. A priority category decision under subsection 86(1) or 90(1), and means-testing determinations such as those under sections 314, 322, 329 or 331, attract the standard application fee under section 22 of the Rules. The standard fee is $1,195, and applies to any application fee paid on or after 1 July 2026 even if the application was lodged before that date. The fee in concessional circumstances remains $100 — for example where the applicant holds a Commonwealth health care card, a pensioner concession card, a Commonwealth seniors health card or another card certifying entitlement to Commonwealth health concessions. The Tribunal may also reduce the fee on financial hardship grounds. Fees may be indexed annually, so check the Tribunal’s current fee schedule before lodging.

Beyond the ART

A party to a Tribunal proceeding may appeal to the Federal Court of Australia on a question of law under section 172 of the Administrative Review Tribunal Act 2024 (Cth). Section 174 generally requires the appeal to be made no later than 28 days after the Tribunal gives its statement of reasons, where reasons are required or requested. An appeal on a question of law is a fundamentally different exercise from merits review, and legal advice should be obtained before that step is contemplated.

Evidence that carries weight

Reconsideration is decided on material, not indignation. The strength of a request usually turns on whether it engages with the criteria the decision-maker had to apply, and whether it supplies evidence that was missing or misread.

• The notice and reasons. Identify the provision the decision was made under and the reasons given. Address those reasons specifically.
• The assessment record. If the assessment understated function, cognition, continence, mobility, behaviour or carer availability, say so precisely and explain what a full picture would have shown, including on the days the assessor did not see.
• Contemporaneous clinical material. GP, geriatrician, occupational therapy, physiotherapy and hospital discharge material addressed to the criteria carries more weight than general letters of support.
• Carer and family evidence. A short factual diary of a typical week — falls, night waking, prompting, incidents, hours of care actually supplied — is often the most persuasive document available.
• Fluctuation and deterioration. Explain conditions that fluctuate, and any deterioration since the assessment. Where the change is genuinely post-decision, consider whether a reassessment sits alongside the reconsideration.

Supporters, attorneys and guardians

The Act draws a careful line between supporting a person to act and acting for them. Under section 27, a registered supporter may, in line with the individual’s will and preferences, request, access or receive information and documents and communicate information, including the individual’s will, preferences and decisions — but a supporter does not make decisions on the individual’s behalf.

Section 28 addresses substitute decision-making. A person must not do a thing on behalf of an individual under the Act unless authorised as a person covered by subsection 28(2) — which includes a guardian under a Commonwealth, State or Territory law, a person appointed by a court or tribunal with power to make decisions for the individual, and the holder of an enduring power of attorney or like power granted by the individual. Section 29 requires information or documents given to the individual also to be given to a consenting individual’s supporter, and to a person covered by subsection 28(2) regardless of consent.

In practice this means an adult child who has not been registered as a supporter and who holds no enduring appointment may not be entitled to receive the notice that starts the 28-day clock. Registering a supporter, or confirming the scope of an existing enduring power of attorney, is worth doing before a decision arrives rather than after. Our guides to powers of attorney for aged care decisions and Support at Home and legal capacity deal with those appointments in detail.

Timeline at a glance

Each period is calculated from a specific event, not from the date you read the document. Record the date of receipt on every notice as it arrives.

When legal advice is needed

Many reconsideration requests are prepared without a lawyer, and the system is designed to allow that. Advice tends to be worthwhile where:

• the notice does not identify the provision relied on, or does not explain the reconsideration pathway required by section 70(2);
• the 28-day period has passed and an extension under subsection 559(4) or section 19 of the ART Act must be sought;
• a residential classification or priority category decision has significant financial consequences, or interacts with accommodation payments and means testing;
• authority is contested — for example where family members disagree, where capacity is in question, or where a guardianship or administration application may be needed; or
• a Tribunal application is being considered and the statement of reasons must be tested against the statutory criteria.

Conclusion

The Aged Care Act 2024 (Cth) replaced a patchwork of review arrangements with a single, sequenced pathway: a listed reviewable decision, a written reconsideration request within 28 days, an independent internal reviewer, a 90-day outer limit backed by deemed affirmation, and merits review in the Administrative Review Tribunal. The pathway is workable, but it is unforgiving about dates and precise about who may act. Identify the decision, diarise the deadline, gather evidence directed at the criteria, and make sure the person acting for the older person is authorised to do so.

Frequently Asked Questions

Sources and further reading

• Aged Care Act 2024 (Cth) — ss 27–29, 61–65, 70, 71, 74, 78, 83, 86, 90, 556–566, 592
• Administrative Review Tribunal Act 2024 (Cth) — ss 17, 18, 19, 172, 174
• Administrative Review Tribunal Rules 2024 (Cth) — ss 5, 6, 22, 29, 30, 33
• My Aged Care — how aged care assessment works
• Administrative Review Tribunal — applying for review of other decisions, including how to apply
• Administrative Review Tribunal — fees, concessional circumstances and the no-fee aged care category
• Administrative Review Tribunal — application fee increase from 1 July 2026 (standard fee $1,195; concessional fee $100)

This article is general legal information about Commonwealth law as at 19 August 2026. It is not legal advice and does not take account of your circumstances. Legislation, rules, fees and administrative guidance change; check the current authorised versions and obtain advice before acting.