Seamen's War Pensions and Allowances Regulations (Amendment) (Cth)
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I, The Governor-General of the
Commonwealth of Australia, acting with the advice of the Federal Executive
Council, make the following Regulations under the
Dated 22 January 1993.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
ben humphreys
Minister of State for Veterans’ Affairs
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1.1 The Seamen’s War Pensions and Allowances Regulations are amended as set out in these Regulations.
[NOTE: These Regulations commence on gazettal: see
2.1 Subregulation 26ab (3):
Add at the end:
“; (d) a reference in the Treatment Principles to an entitled person includes a reference to a person referred to in subregulation 34 (1);
(e) a reference in the Repatriation Pharmaceutical Benefits Scheme to an eligible person includes a reference to a person referred to in subregulation 34 (1).”.
3.1 After regulation 26ab, insert:
“26ac. (1) In this regulation,
The Commission must provide medical treatment in a relevant State or Territory to an Australian mariner as a private patient in accordance with this regulation and the Principles set out in the Schedule.
A relevant State or Territory is a State or
Territory to which a notice under subsection 90b (1)
of the
Medical treatment is taken to be provided to an Australian mariner as a private patient if it is provided to the mariner:
(a) as a person who is, for the purposes of the
Health Insurance Act 1973 , a private patient of a hospital; or(b) by a medical specialist to whom the mariner has been referred but is not provided at a hospital.”.
4.1 Omit the regulation, substitute:
(1) Subject to subregulation (2), the Commission is not liable for medical treatment that is given before the Commission has authorised it.
Subregulation (1) does not apply if:
(a) the medical treatment is given under regulation 26ac; and
(b) under Principles set out in the Schedule, the Commission’s authorisation is not required before the treatment is given.
This regulation applies in spite of any other provision of these Regulations.”.
5.1 Add at the end of the Regulations:
Paragraph 27 (2) (b)
PRINCIPLES FOR THE PROVISION OF MEDICAL TREATMENT
TO AN AUSTRALIAN MARINER AS A PRIVATE PATIENT
1. In these Principles, unless the contrary intention appears:
(a) a medical practitioner appointed as a Local Medical Officer under the Local Medical Officer scheme conducted by the Department; or
(b) a medical specialist;
(a) Schedule 1 to the
Health Insurance Act 1973 as substituted by regulations made under subsection 4 (2) of that Act; and(b) Schedule 1a to the
Health Insurance Act 1973 as substituted by regulations made under subsection 4a (2) of that Act; and(c) the table of diagnostic imaging services prescribed under subsection 4aa (1) of that Act as in force from time to time;
2. Hospital care for Australian mariners will be arranged on a private patient basis.
3. With a primary objective of ensuring that an Australian mariner obtains access to the nearest suitable facility, the Commission has identified the following order of preference for admission to a hospital:
(a) public hospitals;
(b) contracted private hospitals;
(c) other private hospitals.
The accommodation level upon admission will be consistent with private patient (shared accommodation) status.
4. Under these Principles, an Australian mariner will have direct referral to a public hospital of choice for treatment as a private patient. The choice will include access to services available at former Repatriation General Hospitals.
5. Australian mariners may obtain direct referral from their Local Medical Officer or a medical specialist to medical specialists operating at either hospital or rooms facilities for medical treatment as a private patient, subject to the fees being no greater than those prescribed in the Medicare Benefits Schedule.
6. Further to principle 5, if hospital treatment is required, the choice of doctor under these arrangements is also subject to the doctor having visiting rights to the public or private hospital in which the medical treatment will occur.
7. If, after taking into account the matters outlined in paragraphs 9 (a) to (i) (inclusive), the Commission is satisfied that a suitable public hospital bed is not available, an Australian mariner may be admitted to a contracted private hospital at the expense of the Commission if financial authorisation for the admission is obtained (other than in the circumstances set out in principles 11 and 12).
8. If, after taking into account the matters outlined in paragraphs 9 (a) to (i) (inclusive), the Commission is satisfied that a suitable bed is not available in a public hospital or a contracted private hospital, an Australian mariner may be admitted to a private hospital other than a contracted private hospital at the expense of the Commission if financial authorisation for the admission is obtained.
9. In determining whether financial authorisation will be given for admission to, or continuing medical treatment in, a private hospital, the Commission will consider where the medical need can most appropriately be met within a reasonable time by seeking advice from the treating doctor on:
(a) the condition or conditions being treated; and
(b) the clinical necessity of the proposed medical treatment; and
(c) the suitability and quality of the proposed medical treatment; and
(d) the degree of the Australian mariner’s pain or discomfort; and
(e) the effect of the proposed medical treatment on the quality of the mariner’s life;
and, in the light of the reported severity of the mariner’s clinical condition, giving due consideration to:
(f) relative waiting times in the public and private sectors; and
(g) the distance that the mariner would be required to travel; and
(h) reasonable control of expenditure; and
(i) any specific requirements of these Principles or the Act.
10. If the admission of an Australian mariner to a contracted private hospital has received financial authorisation, he or she may instead elect to obtain access to a private hospital, other than a contracted private hospital, of his or her own choice. In this case the Department will meet accommodation, pharmaceutical and theatre fees and other incidental expenses to a level determined by the Commission. Any expenses above this level will be the responsibility of the Australian mariner.
11. The Commission’s financial authorisation is not required for in-patient medical treatment of an Australian mariner in a contracted private hospital if an agreement between the Commission and the hospital specifically excludes the need for prior authorisation.
12. The Commission will provide retrospective financial authorisation for the admission of an Australian mariner to any private hospital in an emergency that made normal referral arrangements to a public hospital emergency accident centre inappropriate, provided that an office of the Department is notified on the first working day after the admission, or as soon thereafter as is reasonably practicable.
13. The Commission will monitor the access to, and
quality of, hospital care arranged for Australian mariners through the National
Treatment Monitoring Committee and Treatment Monitoring Committees established
in accordance with the Repatriation Private Patient Principles determined under
subsection 90a (1) of the
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1. Notified in the
Commonwealth of Australia Gazette on 29 January 1993.2. Statutory Rules 1961 No. 105 as amended by 1961 No. 145; 1963 No. 120; 1964 No. 107; 1965 No. 89; 1966 No. 110; 1967 No. 44; 1968 Nos. 106 and 120; 1969 Nos. 109 and 179; 1970 Nos. 84 and 155; 1972 Nos. 119 and 194; 1973 Nos. 27, 35, 84 and 290; 1975 No. 97; 1977 No. 170; 1978 No. 188; 1979 Nos. 54, 117 and 227; 1980 No. 326; 1981 No. 312; 1982 No. 301; 1983 No. 251; 1984 No. 294; 1985 Nos. 49, 271 and 280; 1986 Nos. 98 and 315; 1987 Nos. 121 and 283; 1988 Nos. 49 and 334; 1989 Nos. 105 and 389; 1991 No. 392; 1992 No. 74.
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