Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Cth)
Treatment Principles (Australian Participants in British Nuclear Tests) 2006
Instrument 2006 No. R30 as amended
made under the
Australian Participants in British Nuclear Tests (Treatment) Act 2006
This compilation was prepared on 4 December 2012 taking into account amendments up to the
Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Removal of Prior Approval/New Dental Providers) Instrument 2012 (No. R29/2012) (F2012L02321)
Prepared by the Legal Services & Assurance Branch,
Department of Veterans' Affairs, Canberra
Part 1 of 2 Parts
[1] Definitions
In items [1] and [3] of this Instrument:
Treatment Principles means the document known as the “Treatment Principles” and prepared by the Repatriation Commission under section 90 of the Veterans’ Entitlements Act 1986 and incorporated in the Australian Participants in British Nuclear Tests (Treatment) Act 2006 by section 16 of that Act.
Repatriation Commission means the body corporate known as the Repatriation Commission and continued in existence under section 179 of the Veterans’ Entitlements Act 1986.
[2] Commencement
(a) Subject to paragraph (b), this Instrument commences on the day after it is registered on the Federal Register of Legislative Instruments.
(b) The following provisions, substituted by section 5, commence on the commencement of the legislative instrument entitled Veterans’ Entitlements (Treatment Principles - Access to Diabetes Educator Services) Instrument 2006:
(i) definition of “credentialled diabetes educator”;
(ii) definition of “diabetes educator services”;
(iii) paragraph 3.2.1(na);
(iv) paragraph 3.3.2(da);
(v) paragraph 4.8.1(ga);
(vi) paragraph 7.1.2(aa);
(vii) paragraph 7.6A.
[3] Modifications of the Treatment Principles
The Treatment Principles are modified in accordance with Schedule A.
SCHEDULE A
[4]. Title (twice occurring)
at the end, insert:
(Australian Participants in British Nuclear Tests) 2006
Note: the purpose of this provision is to ensure a part of the Treatment Principles as incorporated in the Act is retained to ensure the Treatment Principles are modified and not substituted.
[5]. All provisions other than the title:
substitute:
Australian Government
REPATRIATION COMMISSION
Table of Provisions
PART 1 — INTRODUCTION
1.2 Application of Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006
1.4 Interpretation
PART 2 — ELIGIBILITY FOR TREATMENT OF MALIGNANT NEOPLASIA
2.1 Treatment for eligible persons in Australia
2.2 Treatment for entitled persons travelling overseas
PART 3 — COMMISSION APPROVAL FOR TREATMENT OF MALIGNANT NEOPLASIA
3.1 Approval for treatment
3.2 Circumstances in which prior approval is required
3.3 Circumstances in which prior approval is not required
3.4 Other retrospective approval
3.5 Financial responsibility
PART 4 — MEDICAL PRACTITIONER SERVICES FOR MALIGNANT NEOPLASIA
4.1 Local Medical Officers / other General Practitioners
4.2 Providers of services
4.3 Financial responsibility
4.3A Disqualified Medical Practitioners
4.4 Referrals
4.5 Referrals by medical specialists
4.7 Referrals: prior approval
4.8 Other matters
PART 5 — DENTAL TREATMENT IN RESPECT OF MALIGNANT NEOPLASIA
5.1 Providers of services
5.2 Financial responsibility
5.2A Disqualified Dental Practitioners
5.3 Eligibility
5.4 Emergency dental treatment
5.6 General anaesthesia
5.7 Prescribing of pharmaceutical benefits by dentists
5.8 Other dental services
PART 6 — PHARMACEUTICAL BENEFITS
6.1 Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006
6.2 Eligibility under the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006
PART 7 — TREATMENT FROM ALLIED HEALTH PROVIDERS FOR CONDITIONS ASSOCIATED WITH MALIGNANT NEOPLASIA
7.1 Prior approval and financial responsibility for health services
7.1A Notes for Providers
7.1B Disqualified Health Care Providers
7.2 Registration or enrolment of providers
7.3 Community nursing
7.4 Optometrical services
7.5 Physiotherapy
7.6 Podiatry
7.6A Diabetes Educator Services
7.7 Chiropractic and osteopathic services
7.8 Other services
PART 9 — TREATMENT OF ENTITLED PERSONS AT HOSPITALS AND INSTITUTIONS FOR MALIGNANT NEOPLASIA
9.1 Admission to a hospital or institution
9.2 Financial responsibility for treatment in Hospital
9.3 Nursing-home - type care for entitled persons with malignant neoplasia
9.5 Convalescent care
9.6 Other matters
PART 10 — RESIDENTIAL CARE FOR ENTITLED PERSONS SUFFERING FROM MALIGNANT NEOPLASIA
Part A – residential care not involving residential care (respite)
10.1 Residential care arrangements
10.4 Payment of residential care amount for certain entitled persons
Part B – residential care involving residential care (respite)
10.6 Residential care (respite) arrangements
Part C – respite admissions not involving residential care (respite)
PART 11 — THE PROVISION OF REHABILITATION APPLIANCES TO ENTITLED PERSONS SUFFERING FROM MALIGNANT NEOPLASIA
11.1 Rehabilitation Appliances Program
11.2 Supply of rehabilitation appliances
11.2A Prior Approval
11.3 Restrictions on the supply of certain items
11.4 Visual aids
11.5 Hearing aids
11.6 Other rehabilitation appliances
11.7 Repair and replacement
11.8 Treatment aids from hospitals
11.9 Provision of aids and appliances for accident prevention and personal safety
PART 12 — OTHER MATTERS RELATING TO TREATMENT OF MALIGNANT NEOPLASIA
12.1 Ambulance transport
12.2 Treatment under Medicare
12.4 Prejudicial or unsafe acts or omissions by patients
12.6 Recovery of moneys
SCHEDULE 1 – DATES FOR INCORPORATED DOCUMENTS
PART 1 — INTRODUCTION
1.1.1 The Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (the Treatment Principles), prepared by the Repatriation Commission under section 16 of the Australian Participants in British Nuclear Tests (Treatment) Act 2006 (the Act), set out the circumstances in which, and conditions subject to which, treatment may be provided for eligible persons under Part 2 of the Act and are to be read subject to the Act.
1.1.2 The Treatment Principles state the policies under which the Repatriation Commission may accept financial responsibility for the cost of treatment of malignant neoplasia for persons eligible for such treatment under the Act.
1.2 Application of Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006
1.2.1 The Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006 (the RPPPs), determined by the Commission under subsection 17(2) of the Act, apply in all States in which a Repatriation General Hospital has been integrated into the State health system and in those States and Territories in which the Commission has declared, under section 90B of the Veterans’ Entitlements Act 1986, that the VEA Repatriation Private Patient Principles, made under section 90A of the Veterans’ Entitlements Act 1986, apply.
1.2.2 In those States or Territories where the RPPPs apply, a provision of the Treatment Principles does not apply if it is inconsistent with the RPPPs.
1.2.3 Nothing in these Treatment Principles is to be taken to require prior approval for admission at a public hospital in any State or Territory in which the RPPPs apply.
1.4 Interpretation
1.4.1 In these Treatment Principles, unless a contrary intention appears:
“Act” means the Australian Participants in British Nuclear Tests (Treatment) Act 2006
"Access Payment" means the amount set out in the DVA document entitled “Department of Veterans’ Affairs Fee Schedules for Medical Services”, in force on the date in Schedule 1, and called the “Access Payment” — being an additional amount payable by the Department to an LMO for a medical service provided by the LMO to an entitled person in accordance with these Principles and the Notes for Local Medical Officers.
Note: an Access Payment is an amount additional to any amount otherwise payable by the Department to an LMO for a medical service provided by the LMO to an entitled person in accordance with these Principles and the Notes for Local Medical Officers.
“acute care certificate” means a certificate given by a medical practitioner in similar form to the acute care certificate provided for in section 3B of the Health Insurance Act 1973 to the extent that the provisions of that section are applicable.
“allied health provider” means a category of provider mentioned in the Table in 7.1A.1.
“attendant care” means assistance with essential daily activities, such as bathing, dressing and eating.
“carer” means a person who provides ongoing care, attention and support for a severely incapacitated or frail person to enable that person to continue to reside in his or her home, and is not limited to a person who is receiving a carer service pension.
“Chief Executive Medicare” has the meaning it has in the Human Services (Medicare) Act 1973.
“clinical psychologist” means a psychologist:
(a) who has been given a provider number in respect of being a psychologist; and
(b) who, in the opinion of an employee of, or consultant to, the Department or the Department of Human Services, has appropriate qualifications in clinical psychology and practises as a clinical psychologist.
“Commission” means the Repatriation Commission.
"Commission-funded treatment" means treatment for which the Commission may accept financial responsibility.
Note: although the Commission may accept financial responsibility for treatment, actual payment for that treatment is made by the Commonwealth.
"community nursing services" means the community nursing services provided to an entitled person, in respect of which the Commission will accept financial responsibility for under Part 7 of the Principles.
"community nursing provider" means a health provider that has a contract with the Commission and, or, the Department, to provide community nursing services to entitled persons.
“community services” means services provided by Commonwealth, State, Territory or local government authorities or agencies (other than the Department of Veterans’ Affairs or the Repatriation Commission) and other community agencies (whether or not funded in whole or in part by a government).
“consumable rehabilitation appliance” means an appliance with a short term function and includes appliances such as continence products.
“Contracted Day Procedure Centre” means premises:
(a) at which any patient is admitted and discharged on the same day for medical, surgical or other treatment; and
(b) operated by a person contracted to the Commission or the Department in respect of treatment provided at the premises to entitled persons;
but does not include any of the following premises:
(c) premises conducted by or on behalf of the State;
(d) a public hospital or health service under the control of a public health organisation;
(e) a private hospital;
(f) a nursing home;
(g) a residential rehabilitation establishment.
“contracted private hospital” means a private hospital with which the Commission has entered into arrangements for the purposes of the VEA Treatment Principles or the VEA Repatriation Private Patient Principles for the care and welfare of eligible persons.
“convalescent admission” means a short period of medically prescribed convalescence for a entitled person who is recovering from an acute illness, or an operation, associated with malignant neoplasia.
“country area” means that part of the State outside the metropolitan area of the capital city of that State, determined by the Commission to be a country area under paragraph 80(2)(b) of the VEA.
“Day Procedure Centre” means premises that would be Contracted Day Procedure Centre premises if the operator of the premises was contracted to the Commission or the Department.
“dental hygienist” means a person registered under the National Law that provides for the registration of dental practitioners but does not include a person:
(a) whose registration to practise as a dental hygienist has been suspended, or cancelled, following an inquiry relating to his or her conduct; and
(b) who has not, after that suspension or cancellation, again been authorised to practise as a dental hygienist.
“dental therapist” means a person registered under the National Law that provides for the registration of dental practitioners but does not include a person:
(a) whose registration to practise as a dental therapist has been suspended, or cancelled, following an inquiry relating to his or her conduct; and
(b) who has not, after that suspension or cancellation, again been authorised to practise as a dental therapist.
“dental prosthetist” means a person, however described, authorised under a law of a State or a Territory, to carry out the work of dental prosthetics without a written work order from a dentist or other person who may lawfully give a written work order for that purpose.
“dental specialist” means a qualified dental practitioner who:
(a) is registered with a Dental Board of the State or Territory in which he or she practises; and
(b) has obtained an appropriate higher qualification; and
(c) has been recognised as a specialist in the particular field by:
(i) a Dental Board of the State or Territory in which he or she practises, where the Dental Board of the State or Territory has available a mechanism for such recognition; or
(ii) another appropriate body mutually agreed in advance with the Australian Dental Association Incorporated.
“dentist”means a person registered or licensed as a dentist under a law of a State or Territory that provides for the registration or licensing of dentists but does not include a person so registered or licensed:
(a) whose registration, or licence to practise, as a dentist in any State or Territory has been suspended, or cancelled, following an inquiry relating to his or her conduct; and
(b) who has not, after that suspension or cancellation, again been authorised to register or practise as a dentist in that State or Territory.
“Department” means the Commonwealth as represented by the Department of Veterans’ Affairs.
“Department of Health” means the Commonwealth Department of State, however named, that from time to time is responsible for the administration of the National Health Act 1953 and the Aged Care Act 1997.
“Department of Human Services” means the Department administered by the Minister administering the Human Services (Medicare) Act 1973.
“DVA document” means a document prepared in the Department and available on the Internet at:
educator” means a person who:
(a) is credentialled as a diabetes educator by the Australian Diabetes Educators Association (ADEA); and
(b) is a member of, or eligible for membership of, the ADEA.
“diabetes educator services” means a program of education about diabetes with an emphasis on self-care, provided by a credentialled diabetes educator to a person with diabetes.
“elective surgery” means any non-urgent surgical procedure performed for diagnostic or therapeutic purposes.
“eligible person” means a person who is eligible for treatment under the Act.
“emergency” means a situation where a person requires immediate treatment in circumstances where there is serious threat to the person’s life or health.
“entitled person” means a person who is eligible for treatment under the Act.
"episode of care" means services provided to a patient by a health provider that:
(a) have been detailed in a patient care plan;
(b) are characterised by continuity of treatment or provision of service;
and an episode of care arises:
(c) every time a service provider sees a new patient; or
(d) where a service provider has not seen a patient for some time and therefore no continuity of service can be provided, and the original patient care plan is no longer applicable or appropriate.
“exceptional case process” means the process whereby the Commission may accept financial liability for community nursing services provided to an entitled person who, due to dependency or complex needs, requires community nursing services which, in the opinion of the Commission, fall significantly outside those referred to in any arrangement between the Commission and a community nursing provider, whether that arrangement was entered into under these Principles or the VEA Treatment Principles.
Note: paragraph 3.5.1 (after paragraph (f)) enables the Commission, in exceptional circumstances to, among other things, accept financial liability for fees higher than those set out in an arrangement.
“Fee Schedule” means a DVA document approved by the Commission or a member thereof, or by the Secretary to the Department, with the words “Fees” and ‘Schedule”, in relation to a category of health care provider, in the title to the document, that sets out the terms on which, and the conditions subject to which, the Commission will accept financial responsibility for treatment provided to an entitled person by the health care provider the subject of the document.
Note: the DVA documents called Fee Schedules set out amounts the Department will pay for health care services and can designate whether a service required the prior approval of the Commission before it could be provided.
“health care provider” means a person who provides treatment to an entitled person in accordance with these Principles.
"high level of residential care" has the meaning given in clause 1 of Schedule 1 to the Aged Care Act 1997.
Note (1): Clause 1 of Schedule 1 to the Aged Care Act 1997 provides that: ‘high level of residential care’ means a level of residential care corresponding to a classification level applicable to residential care (other than a classification level applicable only to respite care) that is not lower than the mid-point of all such classification levels that could apply to residential care.
Note (2): The phrases ‘classification level’ and ‘respite care’ used in this definition are also defined in the Aged Care Act 1997.
Note (3): This definition does not exclude entitled persons in respite care or convalescent care.
“home” includes:
(a) the premises, or part of the premises, where the person normally resides; or
(b) a share house where the person normally resides;
but does not include:
(c) a hospital; or
(d)the premises where the person is receiving residential care.
Note: ‘residential care’ is also defined in paragraph 1.4.1.”.
“in force on the date in Schedule 1”, in relation to a document, means that on the date in Schedule 1 for the document:
(a) if the document is required under the Principles to be approved by the Commission or approved by the Department or approved by either– the document has been approved as required.
Note: an example being the Notes for Local Medical Officers (para.1.4.1).
(b) if the document is prepared on behalf of the Department or the Commission but is not required under the Principles to be approved in a manner in paragraph (a) – the document has been approved in a manner in paragraph (a).
Note: an example being a Fee Schedule (para.1.4.1).
(c) if the document is not prepared for a purpose in paragraph (b) and is not required under the Principles to be approved in a manner in paragraph (a) – the document exists.
“inpatient” means a person formally admitted for treatment by a hospital.
“institution”, in Part 11, includes:
(a) a retirement village;
(b) a cluster of self-care units.
"Level A attendance" means a medical attendance described in an item in Level A, Group A1, Schedule of Services, Category 1-Professional Attendances, General Medical Services, of the Medical Benefits Schedule.
“LMO” means a medical practitioner who:
(a) is registered under the Notes for Local Medical Officers as a Local Medical Officer and who treats an entitled person in accordance with the terms, and subject to the conditions, in these Principles and in the “Notes for Local Medical Officers”; and
(b) has been given a provider number, in respect of being a medical practitioner, that has not been suspended or revoked.
Note: a provider number may be a number used by the Department and adopted by the Department of Human Services.
"low level of residential care" means a level of residential care that is not a high level of residential care.
“MBS” and “Medicare Benefits Schedule” mean, in the context of amounts payable for treatment under the Principles, a Fee Schedule, and in any other context means:
(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 4(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.
Note: an example of where “Medicare Benefits Schedule” is used in a non-payment context is paragraph 4.2.1.
“medicare benefit” has the meaning it has in the Health Insurance Act 1973.
“medicare program” has the meaning it has in the Human Services (Medicare) Act 1973.
“medical practitioner” has the same meaning as “medical practitioner” has in the Health Insurance Act 1973.
“medical specialist” means a medical practitioner who is recognised as a consultant physician or as a specialist, in the appropriate specialty, for the purposes of the Health Insurance Act 1973.
“minor procedure” means a surgical procedure that:
(a) does not involve hospitalisation or theatre fees; and
(b) is of a type that is undertaken routinely in doctors’ and specialists’ rooms; and
(c) does not require general anaesthesia; and
(d) is not undertaken in a private day facility centre.
“National Law” means a law of the Commonwealth, a State, or Territory, enacted pursuant to the Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions made on 26 March 2008:
means a person who:
(a) specialises in the assessment, diagnosis and treatment of psychological disorders associated with conditions affecting the brain such as difficulties with memory, learning, attention, language, reading, problem-solving, decision-making or other aspects of behaviour and thinking abilities; and
(b) in the opinion of an employee of, or consultant to, the Department or the Department of Human Services, has appropriate qualifications in clinical neuropsychology and practises as a neuropsychologist.
“Notes for Allied Health Providers” means the document approved by the Secretary to the Department entitled “Notes for Allied Health Providers”, and in force on the date in Schedule 1, that sets out the terms on which, and the conditions subject to which, an allied health provider is to provide treatment to an entitled person in order for the Commission to accept financial responsibility for that treatment.
“Notes for Local Medical Officers” means the document:
(i) approved by the Commission or a member thereof, or by the Secretary to the Department, entitled “Notes for Local Medical Officers”; and
(ii) in force on the date in Schedule 1; and
(iii) that sets out the terms on which, and the conditions subject to which, a LMO is to provide treatment to an entitled person in order for the Commission to accept financial responsibility for that treatment, except those parts of the document that deal with the formation of a contractual relationship between a LMO and the Commission or the Department.
Note: the intention is that the treatment provided by a Local Medical Officer (LMO) to an entitled person may be regarded as having been provided in accordance with the Principles and the “Notes for Local Medical Officers” despite the LMO not entering into any arrangement with the Commission or the Department as required by the Notes (without the parts mentioned above omitted). See: paragraph 5.3 of the Notes for Local Medical Officers.
“Notes for Providers” means a DVA document approved by the Secretary to the Department, or by the Commission or a member thereof, with the word ‘Notes’ in its title, and in force on the date in Schedule 1, that sets out the terms on which, and the conditions subject to which, a health care provider is to provide treatment to an entitled person in order for the Commission to accept financial responsibility for that treatment.
“occupational therapist” means an occupational therapist who has been given a provider number in respect of being an occupational therapist.
“occupational therapist (mental health)” means an occupational therapist:
(a) who has been given a provider number in respect of being an occupational therapist; and
(b) who, in the opinion of an employee of, or consultant to, the Department or the Department of Human Services, has appropriate qualifications in occupational therapy in the area of mental health and who practises as an occupational therapist in the area of mental health.
“Optical Coherence Tomography” means the treatment comprised of a non-contact, non-invasive high resolution imaging technique that provides cross-sectional tomographic images of the ocular microstructure through the thickness of the retina.
“oral health therapist” means a person registered under the National Law that provides for the registration of dental practitioners but does not include a person:
(a) whose registration to practice as an oral health therapist has been suspended, or cancelled, following an inquiry relating to his or her conduct: and
(b) who has not, after that suspension or cancellation, again been authorised to practice as an oral health therapist.
Note: oral health therapists are practitioners who are dually qualified as dental therapists and dental hygienists.
"ordinary income" has the same meaning it has under the definition of "ordinary income" in the "Social Security Act 1991" including where terms in that meaning are further defined save that "ordinary income" does not include a payment of Income support supplement.
Note: Income support supplement is described in Part IIIA of the VEA.
“other GP” means a medical practitioner who:
(a) treats an entitled person in accordance with the terms, and subject to the conditions, in these Principles; and
(b) has been given a provider number, in respect of being a medical practitioner, that has not been suspended or revoked.
Note: an other GP, unlike an LMO, does not provide treatment in accordance with the Notes for Local Medical Officers.
“outpatient service” means a health service or procedure provided by a hospital but not involving admission to the hospital.
"patient care plan" means a document that is completed by a health provider who provides a service to a patient and that contains details of:
(a) the patient's medical history;
(b) the injury or disease in respect of which the service is to be provided;
(c) the proposed management of the injury or disease; and
(d) an estimation of the duration and frequency of the service to be provided.
“PBS” means the Pharmaceutical Benefits Scheme authorised under the National Health Act 1953.
“physiotherapy” includes hydrotherapy.
“practitioner” has the same meaning as in section 124B of the Health Insurance Act 1973 in force from time to time.
“Principles” means the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 made under subsection 16(2) of the Act.
“prior approval” means that approval for the assumption by the Commission of the whole, or partial, financial responsibility for certain treatment must be given by the Commission before that treatment is commenced or undertaken.
“private hospital” means premises that have been declared specifically as private hospitals for the purposes of the Health Insurance Act 1973.
“provider number” means the number:
(a) allocated by:
(i) the Chief Executive Medicare or by his or her delegate or by a person authorised by the Chief Executive Medicare — to a practitioner; or
(ii) the Chief Executive Officer of Medicare Australia under the Medicare Australia Act 1973 — to a practitioner; and
(b) which identifies the practitioner and the places where the practitioner practises his or her profession.
Note: see regulation 2 of the Health Insurance Regulations 1975.
"psychologist” means a psychologist who has been given a provider number in respect of being a psychologist.
“public hospital” has the same meaning as “recognized hospital” as defined in the Health Insurance Act 1973.
Note: Section 3 of the Health Insurance Act 1973 defines “recognized hospital” in terms of hospitals recognized for the purposes of the Medicare agreement, or hospitals declared by the Minister who administers the Health Insurance Act 1973 to be recognized hospitals.
“RAP National Schedule of Equipment” means the document of that name approved by the Commission or a member of the Commission or by the Secretary to the Department, and in force on the date in Schedule 1, that lists the surgical aids and appliances for self-help and rehabilitation available to an entitled person under the Department’s Rehabilitation Appliances Program.
"Rehabilitation Appliances Program (RAP) National Guidelines"
means the document of that name approved by the Commission or a member of the Commission or by the Secretary to the Department, and in force on the date in Schedule 1, that assists Commission delegates when determining approval for surgical aids and appliances for self-help and rehabilitation (items) available under the Department’s Rehabilitation Appliances Program and which informs prescribers and suppliers of the processes necessary for an item to be provided to an entitled person.
“Repatriation Commission” means the body corporate known as the Repatriation Commission and continued in existence under section 179 of the Veterans’ Entitlements Act 1986.
"Repatriation Pharmaceutical Benefits Card" means the identification card entitled 'Repatriation Pharmaceutical Benefits Card' which is provided to a person for the purposes of the person obtaining pharmaceutical benefits pursuant to the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006.
“Repatriation Pharmaceutical Benefits Scheme” means the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006 made under subsection 18(2) of the Act.
“RPPPs.” means the RepatriationPrivate Patient Principles(Australian Participants in British Nuclear Tests) 2006 determined by the Commission under section 17(2) of the Act.
"residential care" means personal care or nursing care, or both personal care and nursing care, that is provided to a person in a residential care facility in which the person is also provided with:
(a) meals and cleaning services; and
(b)appropriate staffing, furnishings, furniture and equipment for the
provision of that care and accommodation;
but does not include any of the following:
(c) care provided to a person in the person’s private home; or
(d) care provided in a hospital or psychiatric facility; or
(e) care provided in a residential facility that primarily provides care to people who are not frail and aged.
"residential care amount" means:
(a) in relation to an entitled person in a hospital — an amount determined under the Health Insurance Act 1973 to be the resident contribution applicable under that Act to a nursing-home-type patient of that hospital; or
(b) in relation to an entitled person who is receiving, or received, residential care — an amount equivalent to the maximum daily amount of resident fees worked out under Division 58 of the Aged Care Act 1997.
Note:‘maximum daily amount of resident fees’ is worked out under section 58-2 of the Aged Care Act 1997.
"residential care (respite)" means residential care provided as respite.
"residential care subsidy" means an amount worked out under Chapter 3 of the Aged Care Act 1997 that is payable by the Commonwealth in respect of an entitled person’s residential care according to the classification level determined under Part 2.4 of that Act.
“respite” means a rest, break or relief for a person’s carer or a person caring for himself or herself, from the role of caring.
“respite admission” means the admission of an entitled person to an institution to provide rest or relief for that person’s carer, or admission to an institution of an entitled person caring for himself or herself.
“Repatriation Commission” means the body corporate known as the Repatriation Commission and continued in existence under section 179 of the VEA.
“retirement village” has the same meaning it has in the Veterans’ Entitlements Act 1986 and as applied by the Treatment Principles.
Note: retirement village is defined in section 5M of the Veterans’ Entitlements Act1986 (VEA) and is also applied by the Treatment Principles. The intention is that the Commission is to have the same power as the Repatriation Commission to determine premises have the same function as a retirement village for the purposes of Part 11 of the Principles.
"Rural Enhancement Scheme" means the scheme established by the Commission under subsection 84(1) of the VEA, in consultation with the Australian Medical Association Ltd, and which has the following features:
(a) LMOs who provide medical services (services) to entitled persons under the Rural Enhancement Scheme (Scheme) receive higher payments (as set out in the Principles) from the Department for those services than they would receive if the services were not provided under the Scheme;
(b) the Scheme only applies to LMOs who provide medical services to entitled persons at certain rural public hospitals (identified rural hospitals);
(c) an identified rural hospital is a hospital at which a medical practitioner may provide a medical service (service) to the public and receive from the state or territory government that, respectively, administers the state or territory in which the hospital is located, an extra amount (extra amount) for that service.
(d) the extra amount is an amount representing the difference between the amount the State or Territory actually pays the medical practitioner for the service and the fee for the service listed in the Medicare Benefits Schedule.
Note: as at 1 January 2005 the Rural Enhancement Scheme only operated in NSW, Vic, SA and WA.
“social worker (general)” means a social worker who in the opinion of an employee of, or consultant to, the Department, has appropriate qualifications in social work and practises as a social worker.
“social worker (mental health)” means a social worker:
(a) who has been given a provider number in respect of being a social worker; and
(b) who, in the opinion of an employee of, or consultant to, the Department or the Department of Human Services, has appropriate qualifications in social work in the area of mental health and who practises as a social worker in the area of mental health.
“testing” means conducting a recognised medical test to identify malignant neoplasia (whether or not the person being tested has already been tested for, or diagnosed with, malignant neoplasia), but does not include conducting a test that replicates an existing community-wide government screening program.
“VEA” means the Veterans’ Entitlements Act 1986.
“VEA Repatriation Private Patient Principles” means the principles known as the Repatriation Private Patient Principles determined by the Commission under section 90A of the VEA.
“VEA Treatment Principles” means the document known as the “Treatment Principles” prepared by the Repatriation Commission under section 90 of the VEA.
“Tier 1 Hospital” means a hospital in the category described as Tier 1 in 2.1 of the RPPPs.
“treatment” means treatment (within the meaning of subsection 80(1) of the Veterans’ Entitlements Act 1986) of malignant neoplasia, and includes testing.
"week" means the period from Sunday to Saturday, inclusive.
"White Card" means
(a) the identification card described as the Repatriation Health Card - For Specific Conditions and provided to a person who is eligible under the Act for treatment, subject to these Principles, of malignant neoplasia; or
(b) a written authorisation issued on behalf of the Commission under subparagraph 2.1.1(a)(ii).
1.4.2 In the Principles, if a Note follows a principle, paragraph or subparagraph, the Note is taken to be part of that principle, paragraph or subparagraph, as the case may be.
PART 2 — ELIGIBILITY FOR TREATMENT OF MALIGNANT NEOPLASIA
2.1 Treatment for eligible persons in Australia
2.1.1 Subject to these Principles, the Commission may accept financial responsibility for the treatment in Australia of entitled persons who have been issued with:
(i) a White Card; or
(ii) a written authorisation issued on behalf of the Commission.
2.2 Treatment for entitled persons travelling overseas
2.2.1 Subject to these Principles, the Commission may accept financial responsibility for the treatment of malignant neoplasia suffered by an entitled person in the situation where the treatment is provided to the person outside Australia and the person is outside Australia temporarily.
Note: to be eligible for treatment a person must be an Australian resident.
2.2.2 Except where the Commission decides otherwise, the Commission will not accept financial responsibility under paragraph 2.2.1 for costs incurred in the treatment of malignant neoplasia while an entitled person is temporarily absent from Australia unless, prior to departure, an office of the Department has been notified of the person’s intention to travel.
2.2.3 Except in an emergency, financial responsibility under paragraph 2.2.1 will be limited to:
(a) except in the cases of residential care or residential care (respite), the cost of treatment provided in accordance with the mode and duration that would have been provided or arranged, under these Principles, in Australia; or
(b) except in the cases of residential care or residential care (respite), the cost of treatment provided by a health authority or facility nominated by the Commission; or
(c) in the case of residential care or residential care (respite) provided for a period to an entitled person, whether provided in an emergency or not — the lesser of:
(i) the amount charged the person; or
(ii) the amount of residential care subsidy (at classification level 1 for residential care or at classification level 3 for residential care (respite)) and the residential care amount (if any) that would have been accepted by the Commission in respect of the person if the person had received residential care or residential care (respite), as the case may be, at the classification level 1 or the classification level 3, respectively, for the same period in Australia;or
Note (1): "classification level 1" and "classification level 3" mean "residential care classification level 1"and "residential care classification level 3", respectively, under the Aged Care Act 1997. By virtue of Part 10 of the Principles the Commission, in the first instance, rather than the Commonwealth, accepts financial responsibility for the provision of residential care and residential care (respite) under the Aged Care Act 1997 to entitled persons .
Note (2): the "residential care amount", also commonly known as the "basic daily care fee" or "resident fee", is the amount to be worked out under section 58-3, or the amount to be worked out under subsection 58-4(1), of the Aged Care Act 1997 as amended from time to time, depending on which of those provisions applied to the circumstances of the entitled person.
(d) in the case of residential care (respite), the cost of that care (as worked out under paragraph (c)) for only a maximum of 63 days in any Financial year.
Note (1):the intention is that the Commission will not accept any further financial responsibility for "a respite admission" in a Financial year where in that year the person had already spent 63 days in residential care as a respite admission.
Note (2): for the purpose of calculating the number of days spent by an entitled person in residential care (respite) in a Financial year, any day spent in residential care (respite) in Australia in that year is also to be taken into account.
2.2.5 Notwithstanding paragraphs 2.2.2 or 2.2.3, the Commission will not be responsible for treatment costs incurred by any person who travels outside Australia from Australia where a significant reason for that travel is to obtain treatment or rehabilitation appliances.
PART 3 — COMMISSION APPROVAL FOR TREATMENT OF MALIGNANT NEOPLASIA
3.1 Approval for treatment
3.1.1 The Commission’s prior approval may be required for treatment.
Note: Schedule 3 provides that any approval given for treatment under the VEA Treatment Principles, as brought across by the Act, is deemed to have been given under, and for the purposes of, these Principles.
3.2 Circumstances in which prior approval is required
3.2.1 Treatment requiring prior approval includes:
(b)provision of services that are not made available under the Medicare Benefits Schedule except where otherwise stated.
Note: see paragraph 4.2.3.
(d)outpatient treatment at a private hospital where the requirement for prior approval for such treatment is specified in a contract entered into by the Commission and, or, the Department, for the purposes of these Principles, the RPPPs or the VEA Repatriation Private Patient Principles.
(e) treatment at a hospital according to the requirements contained in section 4 of the RPPPs.
Note: where the patient is a holder of a White Card and eligibility for the treatment required is uncertain, the Commission will not accept financial responsibility for the cost of care unless the Department has verified eligibility.
(f) admission to a hospital or the provision of hospital treatment not otherwise specified;
Note: see paragraph 9.1.9.
(h)respite or convalescent admission to an institution;
Note: see paragraph 9.6.1.
(j) in-home respite care;
(ja) emergency short term home relief (ESTHR) to be provided within 24 hours after a previous service of ESTHR;
Note: the intention is that 3 days (the max ESTHR per emergency) should be sufficient time for alternative respite care to be arranged and prior approval is required before a further immediately subsequent service of ESTHR may be provided.
(k) provision of residential care in Australia or outside Australia;
Note: see paragraph 2.2.4 and Part 10
(n) dental treatment specified as requiring prior approval in Part 5 or in a DVA document incorporated into the Principles;
(na) diabetes educator services specified in paragraph 7.6A.2;
(o) community nursing services specified as requiring prior approval in Treatment Principle 7.3;
(p) physiotherapy that exceeds the limits specified in paragraph 7.5.1;
(q) podiatry that is not specified in paragraph 7.6.1;
(r) provision of rehabilitation appliances specified as requiring prior approval in or under Part 11;
(s) provision of visual aids to an entitled person by an optometrist (or optical product dispenser) that is not permitted under the arrangement between the optometrist (or optical product dispenser) and the Commission or the Department;
(t) repair of a rehabilitation appliance specified as requiring prior approval in or under Part 11;
(w) ambulance transport, except for that provided by certain ambulance services specified in paragraph 12.1.1;
(x) cosmetic surgery;
(y) medical devices not included on the Department's schedule of 'Benefits Payable in Respect of Surgically Implanted Prostheses, Human Tissue Items and Other Medical Devices;
(z) psychiatric inpatient care or psychiatric day patient program care.
(za) treatment specified in any Notes for Providers (however described) and in any Fee Schedule as requiring prior approval.
3.2.2 In considering whether prior approval will or will not be given and what conditions, if any, will apply, the following will be taken into account:
(a) any specific requirements contained in these Principles or the Act;
(c) the extent of funds that are available;
(d) reasonable control over expenditure;
(e) the clinical need for the proposed treatment; and
(f) the suitability and quality of the proposed treatment.
3.3 Circumstances in which prior approval is not required
3.3.2 Treatment not requiring prior approval includes:
(a) treatment by LMO or other GP except where otherwise indicated in Part 4;
(b) medical specialist consultations in country and Territory areas, except where otherwise indicated in principle 4.7;
Note: Prior approval is not required for medical specialist consultations in States or Territories where the RPPPs apply — see paragraph 1.2.2.
(c) dental treatment specified as not requiring prior approval in Part 5 or in a DVA document incorporated into the Principles;
(d) dental prosthetic treatment specified as not requiring prior approval in Part 5 or in a DVA document incorporated into the Principles;
(da) diabetes educator services, except where otherwise indicated in Principle 7.6A;
(e) the prescription and supply of pharmaceutical items as set out in Part 6;
(f) subject to paragraph 7.3.5, the provision of community nursing services by a nurse in accordance with paragraph 7.3.3 after the services have been provided;
Note:see principle 7.3.
(g) optometrical treatment provided by an optometrist to an entitled person in accordance with these Principles and the dispensing of optical products by an optometrist (or optical product dispenser) to an entitled person where those optical products are dispensed in accordance with these Principles and an arrangement between the optometrist (or optical product dispenser) and the Commission or the Department;
Note: see principle 7.4.
(h) physiotherapy treatment, except where otherwise indicated in principle 7.5.
(j) podiatry treatment, except where otherwise indicated in principle 7.6.
(k) treatment at a hospital under the conditions set out in paragraph 9.1.8;
(m) ambulance transport in an emergency or where that is the arrangement between ambulance service providers and the Commission entered into for the purposes of the VEA Treatment Principles;
Note: see paragraph 12.1.5.
(n)referral to the Australian Hearing Service; and
(o)chiropractic or osteopathic treatment.
3.4 Other retrospective approval
3.4.1 On application, the Commission may approve, and pay the cost of, any treatment for malignant neoplasia that was undertaken in the period between:
(a) the effective date of eligibility under the Act; and
(b) the date on which the person is notified of entitlement.
3.4.2 The Commission may provide approval for treatment that has already been given or has commenced to be given in circumstances where:
(a) it would have accepted financial responsibility if prior approval had been sought before the service was provided; and
(b) there are exceptional circumstances justifying the failure to seek prior approval;
or where:
(c) a request for prior approval was incorrectly processed or failed to be processed due to an administrative error or processing error on the part of the Department or an officer of the Department.
3.4.3 The Commission will accept financial responsibility for emergency treatment of a condition associated with malignant neoplasia, for entitled persons, without prior approval only if approval is sought as soon as possible after the event.
Note:this Principle does not to apply to residential care or residential care (respite) provided outside Australia or in Australia. In such cases the extent of Commission liability is determined under paragraphs 2.2.3 (c) and (d), and Part 10, of the Principles.
3.4.4 The Commission’s financial liability under paragraphs 3.4.1 and 3.4.3 is limited to the difference between:
(a) the reasonable cost of treatment; and
(b) the amount that an eligible person has claimed or is entitled to claim from the Department of Human Services as a medicare benefit, a health insurance fund or another third party.
3.4.5 The Commission’s financial liability under paragraph 3.4.2 is limited to the difference between:
(a) the cost of treatment for which it is financially responsible under paragraph 3.5.1; and
(b) the amount that an eligible person has claimed or is entitled to claim from the Department of Human Services as a medicare benefit, a health insurance fund or another third party.
3.4.6 The Commission will not pay or reimburse the Medicare levy or the Medicare levy surcharge or pay or reimburse health insurance fund premiums.
Note: see the Medicare Levy Act 1986 for the Medicare levy and Medicare levy surcharge.
3.4.7 The Commission will accept financial responsibility under paragraphs 3.4.1, 3.4.2, and 3.4.3 if an application is supported by accounts, receipts, declarations or other evidence of the condition treated.
3.5 Financial responsibility
3.5.1 The extent of the financial liability accepted by the Commission for the provision of treatment to an entitled person by a health care provider is as follows:
(1) for fees charged by:
(a) a chiropractor ¾ the amount worked out under the DVA document entitled “Chiropractors Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the
Notes for Allied Health Providers (Section 1 General Information and Section 2(b)(Chiropractors));
(b) a dentist (Local Dental Officer), including for dental services provided by a dental hygienist, dental therapist or oral health therapist on behalf of the dentist ¾ the amount worked out under the DVA document entitled “Fee Schedule of Dental Services for Dentists and Dental Specialists”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects dentists));
(c) a dental prosthetist ¾ the amount worked out under the DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects dental prosthetists));
(d) a dental specialist, including for dental services provided by a dental hygienist, dental therapist or oral health therapist on behalf of the dental specialist ¾ the amount worked out under the DVA document entitled “Fee Schedule of Dental Services for Dentists and Dental Specialists”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects dental specialists, including as dentists));
(e) a diabetes educator ¾ the amount worked out under the DVA document entitled “Diabetes Educators Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(d)(Diabetes Educators));
(f) a dietitian ¾ the amount worked out under the DVA document entitled “Dietitians Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the
Notes for Allied Health Providers (Section 1 General Information and Section 2(e)(Dietitians));
(g) an exercise physiologist ¾ the amount worked out under the DVA document entitled “Exercise Physiologists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(f)(Exercise Physiologists));
(h) a LMO ¾ the amount worked out under the DVA document entitled “Department of Veterans’ Affairs Fee Schedules for Medical Services”, in force on the date in Schedule 1, pursuant to the following parts of that document:
Chronic Pain Honorarium Fees;
Clinical Note Fees;
Compensation Consultation Fees;
Diagnostic Imaging Fee Schedule
Dose Administration Aid (DAA) Service Fees for GPs and LMOs;
Guide to the Assessment of Rates of Veterans' Pensions (GARP) Fee;
Kilometre Allowance;
Local Medical Officers (LMOs) Fee Schedule;
Medication Review Fees;
Pathology Fee Schedule;
Ready Reckoner for LMOs
Relative Value Guide Fee Schedule;
Repatriation Medical Fee Schedule;
on condition that the treatment was provided in accordance with the Principles and the Notes for Local Medical Officers;
(i) a medical specialist ¾ the amount worked out under
the DVA document entitled “Department of Veterans’ Affairs Fee Schedules for Medical Services”, in force on the date in Schedule 1, pursuant to the following parts of that document:
Chronic Pain Honorarium Fees;
Clinical Note Fees;
Compensation Consultation Fees;
Diagnostic Imaging Fee Schedule
Dose Administration Aid (DAA) Service Fees for GPs and LMOs;
Guide to the Assessment of Rates of Veterans' Pensions (GARP) Fee;
Kilometre Allowance;
Medication Review Fees;
Pathology Fee Schedule;
Ready Reckoner for LMOs
Relative Value Guide Fee Schedule;
Repatriation Medical Fee Schedule;
on condition that the treatment was provided in accordance with the Principles;
(ia)a neuropsychologist — the amount worked out under the DVA document entitled “Neuropsychologists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects a neuropsychologist));
Note: prior approval for a neuropsychologist’s treatment is required under the “Notes for Allied Mental Health Care Providers”.
(ja) an occupational therapist ¾ the amount worked out under the DVA document entitled “Occupational Therapists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles, as they affect an occupational therapist other than as an occupational therapist (mental health), and the
Notes for Allied Health Providers (Section 1 General Information and Section 2(g)(Occupational Therapists));
(j) an occupational therapist (mental health) ¾ the amount worked out under the DVA document entitled “Occupational Therapists (Mental Health) Schedule of Fees”, in force on the date in Schedule 1, as the document relates to an occupational therapist (mental health), on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects occupational therapists (mental health));
(k) an optical dispenser of visual aids ¾ the amount worked out under the DVA document entitled “Pricing Schedule for Visual Aids”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optical dispensers));
(l) an optometrist ¾ the amount worked out under the DVA document entitled “Optometrist Fees for Consultation”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optometrists));
(m) an orthoptist ¾ the amount worked out under the DVA document entitled “DVA Schedule of Fees Orthoptists”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles
and the Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects orthoptists));
(n) an osteopath ¾ the amount worked out under the DVA document entitled “Osteopaths Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the
Notes for Allied Health Providers (Section 1 General Information and Section 2(i)(Osteopaths));
(o) an other GP ¾ the amount worked out under the Notes for Local Medical Officers in respect of an other GP;
(p) a physiotherapist ¾ the amount worked out under the DVA document entitled “Physiotherapists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and section 2(j)(Physiotherapists));
(q) a podiatrist ¾ the amount worked out under the DVA document entitled “Podiatrists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(k)( Podiatrists));
(ra) a clinical psychologist ¾ the amount worked out under the DVA document entitled “Clinical Psychologists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects clinical psychologist (including as a psychologist));
(r) a psychologist ¾ the amount worked out under the DVA document entitled “Psychologists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the
Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects psychologists (other than as a clinical psychologist));
(sa) a social worker (general) ¾ the amount worked out under the DVA document entitled “Social Workers Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects social workers (other than as a social worker (mental health));
(s) a social worker (mental health) ¾ the amount worked out under the DVA document entitled “Social Workers (Mental Health) Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects social workers (mental health));
(u) a speech pathologist ¾ the amount worked out under the DVA document entitled “Speech Pathologists Schedule of Fees”, in force on the date in Schedule 1, on condition that the treatment was provided in accordance with the Principles and the Notes for Allied Health Providers (Section 1 General Information and Section 2(l)(Speech Pathologists));
except where the Commission, having regard to the matters specified in paragraph 3.2.2, is satisfied that there are exceptional circumstances justifying payment of a higher fee.
3.5.2 The Commission will only accept financial responsibility for treatment:
(a) that is reasonably necessary for the adequate treatment of the eligible person;
(b) that is given by an appropriate category of health care provider; and
(c)if a claim for payment in respect of treatment:
(i)is in the form, if any, approved by the Commission for the purposes of paragraph 3.5.2 of the VEA Treatment Principles ('approved form'); and
(ii)contains, or is accompanied by, any information required by any direction in any approved form; and
(iii)is lodged at an appropriate place or with an appropriate person within the period of 5 years (or such longer period as is allowed in accordance with paragraph 3.5.2A) from the date of rendering the service to which the claim relates.
Note 1: a claim is taken to have been lodged on the day it is received.
Note 2: 'appropriate place' means an office of the Department in Australia, the Department of Human Services or a place approved by the Commission for the purpose of lodging claims for the purposes of the VEA Treatment Principles.
Note 3: 'appropriate person' means a person approved by the Commission for the purpose of lodging claims for the purposes of the VEA Treatment Principles.
Note 4: a claim may be lodged by means of an electronic transmission.
, the Department of Human Services
3.5.2A Upon application in writing, by a claimant, to the Commission, the Commission may, in its discretion, by notice in writing served on the claimant, allow a longer period for lodging a claim than the period of 5 years referred to in subparagraph 3.5.2(c).
Note: 'claimant' means an appropriate category of health provider seeking payment in respect of treatment provided under the Principles.
3.5.2B In exercising its power under paragraph 3.5.2A to allow a longer period for lodging a claim, the Commission shall have regard to all matters that it considers relevant, including, but without limiting the generality of the foregoing, any hardship that might be caused to the claimant if a longer period is not allowed.
Note: 'claimant' means an appropriate category of health provider seeking payment in respect of treatment provided under the Principles.
3.5.3 The Commission will not accept financial responsibility for the cost of the following treatment by health providers, including treatment by dentists, physiotherapists and podiatrists:
(a) services that have been paid for, wholly or partly, by the Department of Human Services, as a medicare benefit, or by a health insurance fund; or
(b) services where the cost is otherwise recoverable, wholly or partly, by way of a legal claim; or
(c) examination for employment purposes; or
(d) examination for a medical certificate for membership of a friendly society.
3.5.4 Where the Commission accepts financial responsibility under these Principles, it does so on behalf of the Commonwealth.
PART 4 — MEDICAL PRACTITIONER SERVICES FOR MALIGNANT NEOPLASIA
4.1 Local Medical Officers / other General Practitioners
4.1.2 Outline
4.1.3 The aim of the medical services program is to ensure that as far as practicable entitled persons have access to free, safe and cost-effective treatment for malignant neoplasia.
To achieve this objective the Commission or the Department deals with medical practitioners on three levels.
At the first level the Commission or the Department deals with medical practitioners called LMOs. Services provided by these medical practitioners must be in accordance with these Principles and the Notes for Local Medical Officers if the Department is to pay for the services.
The second level of engagement is where the Commission or the Department deals with medical practitioners who are willing to treat entitled persons under these Principles eg without charging the entitled person, but who are not prepared to provide their services in accordance with the Notes for Local Medical Officers. These medical practitioners are called other GPs.
Because LMOs provide services in accordance with the Notes for Local Medical Officers, which impose various requirements, some of which are exacting but which are aimed at maintaining a high quality of service and ensuring accountability, they receive higher rates of remuneration from the Department than do other GPs.
The feature that distinguishes LMO-treatment or other GP-treatment from treatment provided by medical practitioners not included in these categories is that LMOs and other GPs do not charge the entitled person for that treatment. They charge the Commission, the Department or Department of Human Services (hereafter in this Outline these bodies are referred to collectively as DVA).
It should be noted that while it is the Commission that accepts financial liability for treatment it is the Department (Commonwealth) that actually pays for the treatment.
The third level of interaction between the Commission or the Department and medical practitioners is where the medical practitioner is a specialist.
Unlike LMOs, medical specialists (as at 1 April 2006) are not prepared to submit to the same level of regulation as LMOs regarding services to entitled persons (at DVA expense) but if they are prepared to treat an entitled person at the rate set out in the Principles and charge DVA and not the entitled person, then the relationship between DVA and the specialist is covered by the Principles.
4.1.4 Subject to paragraph 3.5.1, the Commission may accept financial liability for medical treatment provided to an entitled person by an LMO, an other GP or a medical specialist but only if the medical treatment was for malignant neoplasia.
Note: paragraph 3.5.1 sets out the financial limits on Commission liability for treatment.
4.2 Providers of services
4.2.1 Unless otherwise indicated in these Principles, an entitled person may be provided with only those services included in the Medicare Benefits Schedule.
4.2.2 The services referred to in paragraph 4.2.1 may be provided only by:
(a) a LMO or other GP; or
(b) a medical specialist.
4.2.3 (1) An entitled person may be provided with services that are not made available under the Medicare Benefits Schedule ("unlisted services").
(2) Unlisted services are not to be provided to an entitled person if the Commission is satisfied that they are:
(a) a mere improvement on existing Medicare Benefits Schedule listed services; or
(b) experimental and have not been demonstrated to be effective or safe by extensive clinical trials.
4.2.4 Subject to paragraph 4.2.3(2), unlisted services are to be provided to an entitled person under paragraph 4.2.3(1) if the Commission is satisfied that the services will provide a substantial benefit to the health of the entitled person.
Note 1: the prior approval of the Commission is required before unlisted services may be provided (Paragraph 3.2.1 (b)).
Note 2: the availability of funds and the need to reasonably control expenditure are factors to be considered in granting prior approval (Subparagraphs 3.2.2 (c) and (d)).
4.2.5 The services referred to in paragraph 4.2.3 may be provided only by:
(a) a LMO or other GP; or
(b) a medical specialist.
4.2.6 Optical Coherence Tomography
4.2.7 The Commission may accept financial responsibility for Optical Coherence Tomography (OCT) provided to an entitled person by an Ophthalmologist for the assessment or management of retinal disease.
Note: While OCT remains an unlisted treatment it is subject to all the requirements for an unlisted treatment except prior approval.
4.3 Financial responsibility
4.3.1 Subject to paragraph 3.5.1, and unless otherwise indicated in these Principles, the Commission will accept financial responsibility for treatment costs in respect of malignant neoplasia suffered by an entitled person where an LMO or other GP or specialist provides or arranges for treatment of:
(a)an entitled person who has been issued with a White Card; or
(b) an entitled person who has been issued with a written authorisation on behalf of the Commission.
Note: Principle 3.5.1 also deals with financial liability for medical practitioner fees.
4.3.2 In relation to any occasion of service to an entitled person under these Principles, a LMO or other GP or specialist shall bill only:
(a) the Department; or
(b) the Commission; or
(c) Department of Human Services;
and that bill shall be for full settlement of the account for the service provided to the entitled person.
4.3.3 Any billing method described in paragraph 4.3.2 may be used on each occasion of service.
4.3.4 Subject to paragraph 4.7.3, the Commission will accept financial responsibility for any of the services described in paragraph 4.4.1, irrespective of the billing arrangement chosen under paragraph 4.3.2 by the referring LMO or other GP or specialist.
4.3A Disqualified Medical Practitioners
4.3A.1 The Commission is not to accept financial responsibility for the cost of a medical service provided to an entitled person by, or on behalf of, a LMO, other GP or a medical specialist if, at the time the service was provided, a medicare benefit would not have been payable in respect of the service under section 19B or section 19C of the Health Insurance Act 1973 (in force from time to time) if the LMO, other GP or medical specialist had provided the service as a practitioner under that Act.
4.4 Referrals
4.4.1 An LMO or other GP may refer an entitled person for:
(a) treatment of malignant neoplasia from a medical specialist, subject to paragraph 4.7.1, and principles 4.5 to 4.8;or
(b) treatment of malignant neoplasia from a LMO or other GP who has expertise or recognition in a particular field but is not a qualified medical specialist, subject to principles 4.5 to 4.8;or
(c) treatment of malignant neoplasia in a hospital or other institution as indicated in these Principles; or
(d) other health-care services for malignant neoplasia not requiring prior approval, as indicated in principles 7.3, 7.5 and 7.6.
4.5 Referrals by medical specialists
4.5.1 In providing treatment for malignant neoplasia, a medical specialist, to whom an entitled person is referred under these Principles, may:
(a) arrange diagnostic tests;or
(b) refer the entitled person to another specialist in the same way as may a LMO or other GP;or
(c) arrange treatment in a hospital or other institution as indicated in these Principles; or
(d) refer the entitled person to a health-care provider in accordance with principles 7.3, 7.5 or 7.6, in the same way as may a LMO or other GP.
4.6.2 Referrals under paragraph 4.6.1 shall be valid from the date of the specialist’s or consultant physician’s first service.
4.7 Referrals: prior approval
4.7.1 In all instances other than those described in paragraph 4.7.3 and the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006, prior approval is required for the referral of entitled persons to medical specialists.
4.7.2 Prior approval is required for the provision of services under paragraph 4.2.3.
4.7.3 Prior approval is not required when a LMO, other GP or medical specialist refers an entitled person to a medical specialist for diagnostic imaging or pathology services not requiring admission and the medical specialist direct bills the Department of Human Services at 100 per cent or less of the fee set out in the Medicare Benefits Schedule as full settlement of the account for the service rendered.
Note: Prior approval is not required in States or Territories where the RPPPs apply — see paragraph 1.2.2.
4.8 Other matters
4.8.1 The Commission will not accept financial responsibility for the cost of:
(a) elective surgery undertaken without prior approval with the exception of elective surgery in a public hospital, minor procedures carried out in a LMO or other GP’s or specialist’s rooms where the only charge is equivalent to the charge that would be applicable under the Medicare Benefits Schedule for that procedure; or
Note: Prior approval is not required for elective surgery undertaken in public hospitals in States or Territories where the RPPPs apply — see paragraph 1.2.2.
(b) examination for a medical certificate for life assurance purposes; or
(c) examination for a medical certificate for membership of a friendly society; or
(d) examination for employment purposes; or
(e) multi-phasic screening; or
(f) services where the cost is otherwise recoverable wholly or partly, by way of a legal claim; or
(g)services that have been paid for, wholly or partly, by the Department of Human Services, as a medicare benefit, or by a health insurance fund; or
(ga) diabetes educator services under this Part that may be provided under Part 7 (Treatment Generally From Other Health Providers); or
(h) treatment for infertility for the partner of an entitled person, unless that partner is personally eligible for treatment for the disability under the Act; or
(k) vaccination or inoculation in connection with overseas travel.
PART 5 — DENTAL TREATMENT IN RESPECT OF MALIGNANT NEOPLASIA
5.1 Providers of services
5.1.1 The Commission may accept financial responsibility for dental treatment in respect of a dental condition associated with malignant neoplasia if the treatment is provided to an entitled person by a dental prosthetist, dentist or dental specialist in accordance with these Principles and in accordance with the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects a dental prosthetist, dentist or dental specialist, as the case may be)).
5.1.1A For paragraph 5.1.1, dental treatment provided by a dentist or dental specialist includes dental treatment provided by a dental hygienist, dental therapist or oral health therapist on behalf of the dentist or dental specialist, as the case may be.
5.1.2 The Commission will accept financial responsibility for dental treatment provided to an entitled person in a Tier 1 Hospital or Contracted Day Procedure Centre without the need for prior approval.
Note: the Notes for Allied Health Providers, the “Fee Schedule of Dental Services for Dentists and Dental Specialists” and the “Fee Schedule of Dental Services for Dental Prosthetists”, as incorporated-by-reference into the Principles, could be relevant to dental treatment provided to an entitled person in a hospital.
5.1.2A Except in an emergency, the Commission’s prior approval is required before dental treatment is provided to an entitled person in a hospital other than a Tier 1 Hospital or on premises other than a Contracted Day Procedure Centre unless the “Fee Schedule of Dental Services for Dentists and Dental Specialists” or the “Fee Schedule of Dental Services for Dental Prosthetists” provides that prior approval is not required for the treatment.
5.1.3 Subject to prior approval, an entitled person may be referred to a dental specialist by a dental prosthetist, dentist or other dental specialist in respect of a dental condition associated with malignant neoplasia.
5.2 Financial responsibility
5.2.1 The DVA document entitled “Fee Schedule of Dental Services for Dentists and Dental Specialists”, in force on the date in Schedule 1, and comprised of Dental Schedules A, B and C, lists the dental services (for malignant neoplasia) provided by dentists, or dental specialists, for which the Commission will accept financial responsibility, when provided to an entitled person, and sets out the limits of that financial responsibility.
5.2.2 The DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, in force on the date in Schedule 1, lists the dental services (for malignant neoplasia) provided by dental prosthetists for which the Commission will accept financial responsibility, when provided to an entitled person, and sets out the limits of that financial responsibility.
5.2.3 Dental Schedule C in 5.2.1 imposes a monetary limit (annual monetary limit) in respect of dental services provided to an entitled person under that Schedule in a Calendar year.
5.2.4 Subject to 5.1.2 and 5.1.2A (treatment in Tier 1 Hospital/Contracted Day Procedure Centre), where a Schedule in 5.2.1 or 5.2.2 specifies a need for prior approval in respect of a service, the Commission is not to accept financial liability for the service unless it has granted prior approval or retrospective approval for the service.
5.2.6 Subject to paragraph 5.5.1, the Commission will not accept financial responsibility for dental treatment after a person is no longer eligible.
5.2A Disqualified Dental Practitioners
5.2A.1 The Commission is not to accept financial responsibility for the cost of a dental service provided to an entitled person by, or on behalf of, a dental prosthetist, dentist or a dental specialist if, at the time the service was provided, a medicare benefit would not have been payable in respect of the service under section 19B of the Health Insurance Act 1973 (in force from time to time) if the dental prosthetist, dentist or dental specialist had provided the service as a practitioner under that Act.
5.3 Eligibility
5.3.1 Subject to these Principles, an entitled person who holds a White Card or written authorisation issued on behalf of the Commission, may be provided with dental services in respect of a dental condition associated with malignant neoplasia at the expense of the Commission.
5.3.2 Persons who hold a White Card are entitled to dental treatment of a dental condition associated with malignant neoplasia and may be provided with:
(a) the dental services listed in the DVA document entitled “Fee Schedule of Dental Services for Dentists and Dental Specialists”, in force on the date in Schedule 1 — on condition the services are provided in accordance with that Schedule; and
Note: Schedule C of the Fee Schedule imposes an annual monetary limit
(b) the dental services listed in the DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, in force on the date in Schedule 1 — on condition the services are provided in accordance with that Schedule.
5.4 Emergency dental treatment
5.4.1 Prior Approval is not necessary for emergency dental treatment provided to an entitled person where the treatment is provided in accordance with:
(a) the Principles;
(b) the “Fee Schedule of Dental Services for Dentists and Dental Specialists”, in force on the date in Schedule 1;
(c) the “Fee Schedule of Dental Services for Dental Prosthetists”, in force on the date in Schedule 1; and
(d) the Notes for Allied Health Providers;
as those documents relate to the treatment, but if prior approval is required for the treatment then the Commission’s retrospective approval for the treatment must be sought as soon as possible after the treatment is provided and approval must be granted if the Commission is to accept financial liability for the emergency dental treatment.
Note: Schedule C of the “Fee Schedule of Dental Services for Dentists and Dental Specialists” imposes an annual monetary limit
5.4.2 Financial responsibility for emergency dental treatment for persons who hold a “White Card " will only be accepted for treatment of a dental condition associated with malignant neoplasia for which the person is receiving treatment under principle 2.4.
5.6 General anaesthesia
5.6.1 Financial responsibility for a general anaesthetic provided as part of dental treatment will be accepted only if:
(a) the anaesthetic is administered by a specialist anaesthetist or approved medical practitioner in a hospital, Day Procedure Centre or dental surgery where adequate resuscitation equipment is provided; and
(a) any misrepresentation; or
(b) any mistake of fact; or
(c) any mistake of law; or
(d) any other cause.
Note: Division 3 of Part 5 of the Act applies to payments induced by false statements etc
12.6.2 Further to paragraph 12.6.1, the Commission may recover moneys for any excess amounts that should not have been paid to that person or body:
(a) in a single demand; or
(b) by instalments; or
(c) subject to section 48 of the Act, by offsetting moneys for any excess amounts against any later claims for payment by that person or body; or
Note: Section 48 provides, in effect, that where amounts have been overpaid, the Commission may, if the person agrees, offset moneys owed against later claims.
(d) by a combination of any of these methods of recovery.
12.6.3 Nothing in this principle is to be taken to restrict any other right or action for recovery of moneys.
SCHEDULE 1 DATES FOR INCORPORATED DOCUMENTS
The date for :
1. Notes for Local Medical Officers (paragraph 1.4.1);
2. Department of Veterans’ Affairs Fee Schedules for Medical Services (paragraph 3.5.1);
3. Notes for Allied Health Providers (paragraphs 3.5.1 and 7.1A.1);
4. Optometrist Fees for Consultation (paragraph 3.5.1);
5. DVA Schedule of Fees Orthoptists (paragraph 3.5.1);
6. Pricing Schedule for visual aids (paragraph 3.5.1);
7. The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (commonly known as DSM-IV) (paragraph 2.4.2A);
8. Fee Schedule of Dental Services for Dentists and Dental Specialists (paragraph 3.5.1);
9. Fee Schedule of Dental Services for Dental Prosthetists (paragraph 3.5.1);
10. Chiropractors Schedule of Fees (paragraph 3.5.1);
11. Diabetes Educators Schedule of Fees (paragraph 3.5.1);
12. Dietitians Schedule of Fees (paragraph 3.5.1);
13. Exercise Physiologists Schedule of Fees (paragraph 3.5.1);
14. Occupational Therapists Schedule of Fees (paragraph 3.5.1);
15. Osteopaths Schedule of Fees (paragraph 3.5.1);
16. Physiotherapists Schedule of Fees (paragraph 3.5.1);
17. Psychologists Schedule of Fees (paragraph 3.5.1);
18. Podiatrists Schedule of Fees (paragraph 3.5.1);
19. Social Workers Schedule of Fees (paragraph 3.5.1);
20. Clinical Counsellors Schedule of Fees (paragraph 3.5.1);
21. Speech Pathologists Schedule of Fees (paragraph 3.5.1);
22. Australian Government Department of Veterans’ Affairs Classification System and Schedule of Item Numbers and Fees — Community Nursing Services;
23. Notes for Coordinated Veterans' Care Program Providers;
24. Rehabilitation Appliances Program (RAP) National Guidelines (paragraph 11.2A.1);
25. RAP National Schedule of Equipment (paragraph 11.2A.1);
is 31 August 2012.
Notes to the Treatment Principles (Australian Participants in British Nuclear Tests) 2006
Note 1
The Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (in force under the Australian Participants in British Nuclear Tests (Treatment) Act 2006) as shown in this compilation comprise the legislative instruments indicated in the Tables below.
Table of Legislative Instruments
Year and
numberDate of FRLI
registrationDate of
commencementApplication, saving or
transitional provisions2006 No. R30 29 January 2007
(see F2007L00202)30 January 2007 2007 No. R8 18 June 2007
(see F2007L01229)18 June 2007 Paragraph 4 (see Table A) 2007 No. R11 9 August 2007
(see F2007L02430)10 August 2007 2007 No. R19 25 September 2007 (see F2007L03676) 26 September 2007 2007 No. R27 22 February 2008
(see F2008L00555)22 February 2008 Paragraph 4 (see Table A) 2008 No. R17 25 August 2008
(see F2008L03189)26 August 2008 2009 No. R47 22 October 2009
(see F2009L03959)20 November 2009 2010 No. R9 7 October 2010
(see F2010L02630)For instrument generally – day after day of registration (8 October 2010)
For Schedule 1 (fee items) – 1 November 2009 (for period 1 November 2009-1 May 2010)
For Schedule 1 (fee items) – 1 May 2010
For Schedule 1 (non-fee items) - 1 November 2009 (for period 1 November 2009-1 May 2010)
For Schedule 1 Part 1 (non-fee items) – 8 October 2010
For Schedule 1 Part 2 – 1 November 2010
See Table A
Paragraph 3 and paragraph 4 (see Table A). 2011 No. R13 16 March 2011
(see F2011L00428)1 November 2010 Paragraph [3] (see Table A) 2011 No. R21 27 July 2011
(see F2011L01540)1 May 2011 Year and
numberDate of FRLI
registrationDate of
commencementApplication, saving or
transitional provisions2011 No. R31
1 September 2011
(see F2011L01787)
For instrument generally – day after day of registration ( 2 September 2011)
For section 5 - in respect of Part B of Schedule 1 – 1 July 2011
2011 No. R34 1 September 2011
(see F2011L01790)
2 September 2011 (immediately after F2011L01787) Paragraph [3] (see Table A) 2011 No. R49 8 November 2011
(see F2011L02284)
1 November 2011 2012 No. R18 7 May 2012
(see F2012L00997)
For instrument generally – day after day of registration (8 May 2012).
For section 1, in respect of item 25 of the schedule substituted by section 1 – 21 December 2011.
2012 No R29 4 December 2012
(see F2012L02321)
31 August 2012
Table of Amendments
ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted Provision affected
How affected
Para.[2](b) rep. 2007 No. R8 Para.1.4.1 am. 2007 No. R8; 2007 No. R11;2007 No. R27;ad. 2008 No. R17; am. 2010 No. R9; am. 2011 No. R13; am. 2011 No. R21; am. 2011 No. R31; am. 2011 No. R34; am. 2011 No. R49; am. 2012 No. R29 Para.2.2.3
am. 2007 No. R8
Para.3.2.1 am. 2007 No. R8; 2007 No. R19 Para. 3.2.1(a) rep. 2012 No. R29 Para. 3.2.1(b) am. 2011 No. R21; am. 2011 No. R49 Para. 3.2.1(f)(Note) am. 2012 No. R29 Para. 3.2.1(n) am. 2012 No. R29 Para. 3.2.1(u) rep. 2012 No. R29 Para. 3.2.1(v) rep. 2012 No. R29 Para. 3.2.1(z) rs. 2012 No. R29 Para. 3.2.1(za) ad. 2012 No. R29 Para.3.3.2
am. 2007 No. R8
Para. 3.3.2(c)
am. 2012 No. R29
Para. 3.3.2(d)
am. 2012 No. R29
Para. 3.3.2(o)
am. 2012 No. R29
Para. 3.4.4
am. 2011 No. R34
Para. 3.4.5
am. 2011 No. R34
Para. 3.4.6
am. 2011 No. R34
Para.3.5.1 rs. 2007 No. R8; rs. 2010 No. R9;am. 2011 No. R13; am. 2011 No. R34; am. 2011 No. R49; am. 2012 No. R29 Para.3.5.1A.1 ad. 2007 No. R8; am. 2007 No. R27; rep. 2010 No. R9 Para.3.5.1A.2 ad. 2007 No. R8; am. 2007 No. R27; rep. 2010 No. R9 Para.3.5.1A.3 ad. 2007 No. R8; rep. 2010 No. R9 Para. 3.5.2 (Note) am. 2011 No. R34 Para. 3.5.2(b) am. 2010 No. R9 Para. 3.5.2(c)(iii) am. 2010 No. R9 Para. 3.5.2A am. 2010 No. R9 Para. 3.5.3 am. 2011 No. R34 Para.4.1.3 rs. 2007 No. R8; am. 2011 No. R34 Para.4.2.6 ad. 2011 No. R21 Para. 4.2.7 ad. 2011 No. R21 Para. 4.3.1 am. 2010 No. R9 Para. 4.3.2 am. 2011 No. R34 Para. 4.3A ad. 2007 No. R27 Para. 4.6 rep. 2012 No. R29 Para. 4.7.1 am. 2012 No. R29 Para. 4.7.3 rs. 2011 No. R34 Para.4.8.1 am. 2007 No.R8; am. 2010 No. R9; am. 2011 No. R34 Para. 4.8.1(a) am. 2012 No. R29 Para. 4.8.1(Note) rep. 2012 No. R29 Para.5.1 rs. 2007 No.R8; am. 2007 No. R27; am. 2010 No. R9 Para. 5.1.1 am. 2010 No. R9; am. 2011 No. R34 Para. 5.1.1A ad. 2012 No. R29 Para. 5.1.2 (Note) rs. 2010 No. R9; am. 2011 No. R34 Para. 5.1.2A ad. 2010 No. R9 Para. 5.2.1 rs. 2010 No. R9 Para. 5.2.2 ad. 2010 No. R9 Para. 5.2.3 ad. 2010 No. R9 Para. 5.2.4 ad. 2010 No. R9 Para.5.2A ad. 2007 No. R27 Para. 5.3.2 ad. 2010 No. R9 Para. 5.3.4 rep. 2010 No. R9 Para. 5.4.1 rs. 2010 No. R9; am. 2011 No. R34; am. 2012 No. R29 Para. 5.6.1 rs. 2010 No. R9 Para. 7.1.1 rs. 2011 No.R13; am. 2011 No. R34; rs. 2012 No. R29 Para.7.1.2 am. 2007 No. R8 Para.7.1A ad. 2007 No. R8; am. 2007 No. R27; am. 2010 No. R9 Para. 7.1A.1 rs. 2010 No. R9; rs. 2011 No. R13; rs. 2011 No. R34 Para. 7.1A.2 rep. 2010 No. R9 Para. 7.1A Table ad. 2007 No. R8;am. 2007 No. R27; rs. 2010 No. R9 Para. 7.1A.3 rep. 2010 No. R9 Para. 7.1B ad. 2007 No. R27 Para.7.4 am. 2007 No. R8 Para. 7.4.1 am. 2011 No. R34 Para. 7.4.2 am. 2011 No. R34 Para. 7.4.3 am. 2010 No. R9 Para. 7.4.4 am. 2011 No. R34 Para. 7.4.5 am. 2011 No. R34 Para. 7.5.1 am. 2011 No. R34 Para.7.6 am. 2007 No. R8 Para. 7.6.1 am. 2011 No. R34 Para. 7.6.3 am. 2011 No. R34 Para.7.6A am. 2007 No. R8 Para. 7.6A.1 am. 2011 No. R34 Para. 7.7.1 am. 2011 No. R34 Para. 11.1.1 (Note) ad. 2011 No. R31 Para.11.2.1 am. 2007 No. R11 Para.11.2.2 rep. 2007 No. R19 Para.11.2A ad. 2007 No. R19; am. 2007 No. R27; ad.2008 No. R17; am. 2010 No. R9 Para. 11.2A.1 am. 2010 No. R9 Para.11.3.6 am. 2007 No. R11; rs. 2011 No. R31 Para.11.3.6A ad. 2007 No. R11; rs. 2011 No. R31 Para.11.3.6B ad. 2007 No. R11; rs. 2011 No. R31 Para.11.3.2 am.2007 No. R8 Para.11.4 am.2007 No. R8 Para. 11.4.1 am. 2011 No. R34 Para. 11.4.2 am. 2010 No. R9 Para. 11.4.3 am. 2010 No. R9 Para. 11.4.6 am. 2010 No. R9 Para. 11.9.1 rs. 2009 No. R47 Para. 11.9.5 rs. 2011 No. R31 Para. 11.9.6 rep. 2011 No. R31 Para. 11.9.1A ad. 2009 No. R47 Para. 11.9.1B ad. 2009 No. R47 Para. 12.2 (Heading) rs. 2011 No. R34 Para. 12.2.1 am. 2011 No. R34 Para. 12.2.2 am. 2011 No. R34 Para. 12.2.3 am. 2011 No. R34 Sched.1 ad. 2010 No. R9; rs. 2011 No. R13; rs. 2011 No. R31; rs. 2011 No. R34; rs. 2011 No. R49; rs. 2012 No. R18; rs. 2012 No. R29 Sched.2 rs.2007 No. R8; rep. 2010 No. R9 Sched.3 ad. 2007 No. R27; am. 2008 No. R17; rep. 2010 No. R9 Table A Application, saving or transitional provisions
Legislative Instrument 2006 No.R30
Schedule 3
[5] Transitional Provisions – VEA Treatment Principles brought across by the Act
(a) any decision made, or action commenced, by the Repatriation Commission, the Department of Veterans’ Affairs, Medicare Australia, a health provider or an entitled person, under the Treatment Principles (as incorporated in the Act) before those principles were modified by these principles, being a decision or action that, immediately before the commencement of these Principles, was still in force or uncompleted, as the case may be, is taken, respectively, to have been made or instigated under these Principles.
Legislative Instrument 2007 No.R8
4. Application
The variations made by this instrument to the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 do not apply to the provision of treatment by a health care provider to an entitled person if, at the time the treatment is provided, the health care provider has a current arrangement with the Repatriation Commission or the Department of Veterans’ Affairs, in respect of the treatment being provided, and that arrangement was required by the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 immediately before the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 were amended by this instrument.
Note: the intention is that until arrangements between health care providers and the Repatriation Commission or the Department expire or are terminated, the provision of treatment under those arrangements is governed by the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 as if they had not been amended by this instrument but when the arrangements end, the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 apply as amended by this instrument.
Legislative Instrument 2007 No. R27
4. Application
Any procedure or other action, or decision, commenced or made, as the case may be, under Notes for Providers, before the commencement of this instrument that, on the commencement of this instrument remains incomplete or not implemented, as the case may be, is taken to have been made under the relevant Notes as incorporated into the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 by this instrument and the procedure or other action, or decision, may be completed or implemented, as the case may be, under those Notes.
Legislative Instrument 2010 No. R9
[2] Commencement
(a) Subject to (b), (c) and (d) this instrument commences on the day after the day on which it is registered on the Federal Register of Legislative Instruments.
(b) Paragraph 24 (which inserts the Schedule 1 in the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Treatment Principles) is taken to have commenced, in respect of the items in Part 1 of the Schedule 1 that relate to fees, on 1 November 2009. Paragraph 24 commences in respect of the remaining items in Part 1 of Schedule 1 on the day after the day on which this instrument is registered on the Federal Register of Legislative Instruments.
(c) The variation made by paragraph 24 (which inserts the Schedule 1 in the Treatment Principles) is, immediately after commencement of this instrument, revoked, or taken to have been revoked, on 1 May 2010.
(d) The variation made by paragraph 24A (which inserts the Schedule 1 in the Treatment Principles) is taken to have commenced after the revocation of the variation made by paragraph 24 and:
(i) in respect of the items in Part 1 of the Schedule 1 that relate to fees, on 1 May 2010. In respect of the remaining items in Part 1 of Schedule 1, on the day after the day on which this instrument is registered on the Federal Register of Legislative Instruments;
(ii) in respect of the items in Part 2 of the Schedule 1, on
1 November 2010.
[3] Application
(1) (a) Where, before the commencement of this instrument, a health care provider treated an entitled person and, on the commencement of the instrument, had not lodged a claim for payment for the treatment, the situation is governed by the Treatment Principles as varied by this instrument.
Note: this means that the provider has 5 years from the date of service in which to lodge a claim with the possibility of that period being extended.
(b) Where, before the commencement of this instrument, a health care provider treated an entitled person and, on the commencement of the instrument:
(i) had lodged a claim for payment for the treatment within 6 months after the treatment but the claim had not been determined;
(ii) had lodged a claim for payment for the treatment more than 6 months after the treatment and the claim had not been determined;
the situation is governed by the Treatment Principles as varied by this instrument.
Note: for case (i), this means that the claim is within the claim period of 5 years from the date of service.
for case (ii), if the claim is within the claim period of 5 years from the date of service, it will be assessed routinely. If the period is greater than 5 years from the date of service it may be assessed under late-lodgement guidelines.
(c) Where, before the commencement of this instrument, a health care provider treated an entitled person and, on the commencement of the instrument, had applied to the Repatriation Commission for an extension of time in which to lodge a claim for payment for the treatment and the application had not been determined:
(i) if the application had been made within 5 years after the treatment had been provided, the Repatriation Commission is to accept the claim in respect of which the application is made;
Note: applications tend to have claims attached.
(ii) if the application had been made more than 5 years after the treatment had been provided the application is governed by the Treatment Principles as varied by this instrument;
Note: this means the application will be assessed under late-lodgement guidelines.
(2) Where, under [2](b) and [2](d), a document setting out a fee is incorporated into the Treatment Principles on
1 November 2009 and 1 May 2010 respectively, then for the periods 1 November 2009 to 1 May 2010 and 1 May 2010 to the commencement date in [2](a) (day after registration), only that part of the document that sets an increased fee applies, and on the commencement date in [2](a), the remainder of the document applies
[4] Saving
Despite the omission of the Schedule 3 by paragraph 24, the documents in that Schedule entitled “RAP National Schedule of Equipment” and “Rehabilitation Appliances Program (RAP) National Guidelines” in force on 1 September 2008 remain incorporated in the Principles until 1 November 2010.
Legislative Instrument 2011 No. R13
[3] Application
(a) The variations to the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Principles) made by this instrument do not apply to a person who immediately before the commencement of this instrument is contracted to the Department and/or the Commission to provide services to entitled persons as a social worker (clinical counsellor) — until the contract under which the person is engaged expires and is not renewed or is terminated.
Note: this means that social workers (clinical counsellors) are covered by the Principles as the Principles existed before being varied by this instrument. When the contracts of this category of social worker end, the variations to the Principles by this instrument will apply to them, effectively ending their coverage by the Principles which means their occupations will no longer be recognised by the Department as a category of health care provider.
(b)The variations to the Principles made by this instrument that have the effect of requiring a psychologist to have a provider number obtained from Medicare Australia only apply to a psychologist after the day this instrument is registered on the Federal Register of Legislative Instruments.
Legislative instrument 2011 No. R34
[3] Transitional
(a) Where, under the Principles, a person has lodged a claim with Medicare Australia, or had some other dealing with Medicare Australia, before the commencement of this instrument, but on the commencement of this instrument the claim or dealing had not been finalised, then on the commencement of this instrument the claim or dealing is taken to have been made or entered into under the Principles as varied by this instrument as if Medicare Australia had been the Department of Human Services.
(b) Where, under the Principles, and on or after 1 July 2011 and before this instrument commences, a person purportedly lodged a claim with Medicare Australia, or had some other dealing purportedly with Medicare Australia, then on the commencement of this instrument the claim or dealing is taken to have been made or entered into with the Department of Human Services.
Note 1: a person includes a health care provider, an entitled person, the Commission or the Department.
Note 2: a term used in [3], including in the Notes, that is defined in the Treatment Principles (Australian Participants in British Nuclear Tests) 2006
under the Australian Participants in British Nuclear Tests (Treatment) Act 2006 has the same meaning it has in the Treatment Principles (Australian Participants in British Nuclear Tests) 2006.
Note 3: 1 July 2011 is when the Human Services Legislation Amendment Act 2011 commenced. This Act, among other things, transferred the functions of Medicare Australia to the Department of Human Services.
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