Untitled document
Australian Government
Military Rehabilitation and Compensation Act 2004
MRCA TREATMENT PRINCIPLES
Instrument 2013 No. MRCC 53
I, Michael Ronaldson, Minister for Veterans’ Affairs, pursuant to section 286(3) of the Military Rehabilitation and Compensation Act 2004, approve this instrument made by the Military Rehabilitation and Compensation Commission.
Dated this 26th day of November 2013
Michael Ronaldson……………………….............................................
MICHAEL RONALDSON
The Military Rehabilitation and Compensation Commission:
(a) pursuant to section 286(2) of the Military Rehabilitation and Compensation Act 2004 (the Act) revokes the instrument made under section 286(1) of the Act known as the MRCA Treatment Principles (Instrument 2004 No. M21); and
(b) pursuant to section 286(1) of the Act hereby determines the places at which, the circumstances in which, and the conditions subject to which, a particular kind or class of treatment may be provided under Part 3 of Chapter 6 of the Act; and determines the matters in paragraphs 286(1)(d), (e) (f) and (g) of the Act.
Dated this 13th day of November 2013
The Seal of the )
Military Rehabilitation )and Compensation Commission )SEAL
was affixed hereto in the )
presence of: )
Simon Lewis………………Shane Carmody………………Major General Mark Kelly………....
SIMON LEWIS SHANE CARMODY MAJOR GENERAL MARK KELLYAO DSC
CHAIR MEMBER MEMBERKylie Emery……………………… …..........Rear Admiral Robyn Walker AM, RAN
MS KYLIE EMERY REAR ADMIRAL ROBYN WALKER AM, RANACTING MEMBER ACTING MEMBER
Table of provisions
PART 1 — INTRODUCTION/COMMENCEMENT
1.2 Application of MRCA Private Patient Principles
1.3 Delegation
1.4 Interpretation
PART 2 — ENTITLEMENT TO TREATMENT
2.1 Treatment for entitled persons in Australia
2.2 Treatment for entitled persons residing or travelling overseas
2.2.8 No Overseas MRCA Home Care or Homefront
2.3 Treatment of associated non-service injury or disease injuries or diseases
2.6 Referrals by Vietnam Veterans' Counselling Service
2.7A Centre for Military and Veterans' Health Treatment
2.7B Australian Centre for Posttraumatic Mental Health Treatment
2.8 Loss of eligibility for treatment
PART 3 — COMMISSION APPROVAL FOR TREATMENT
3.1 Approval for treatment
3.2 Circumstances in which prior approval is required
3.3 Circumstances in which prior approval may not be required
3.4 Other retrospective approval
3.5 Financial responsibility
PART 4 — MEDICAL PRACTITIONER SERVICES
4.1 Medical Practitioner Services
4.2 Providers of services
4.3 Financial responsibility
4.3A Disqualified Medical Practitioners
4.4 Referrals by Local Medical Officer or other GPs
4.5 Referrals by medical specialists
4.7 Referrals: prior approval
4.8 Other matters
PART 5 — DENTAL TREATMENT
5.1 Providers of services
5.2 Financial responsibility
5.2A Disqualified Dental Practitioners
5.3 Entitlement
5.4 Emergency dental treatment
5.5 Orthodontic treatment for children
5.6 General anaesthesia
5.7 Prescribing of pharmaceutical benefits by dentists
5.8 Other dental services
PART 6 — PHARMACEUTICAL BENEFITS
6.1 MRCA Pharmaceutical Benefits Scheme
6.2 Entitlement under the MRCA Pharmaceutical Benefits Scheme
PART 6A — COORDINATED VETERANS' CARE PROGRAM
6A.1 Outline
6A.2 Treatments under the Coordinated Veterans' Care Program
6A.3 LMO Approval of Subsequent Period of Care
6A.4 Commission Financial Responsibility for Treatment under the Coordinated Veterans' Care Program
6A.5 Entitlement to Participation in the Coordinated Veterans' Care Program and to Coordinated Veterans' Care Program Treatment under the program
6A.6 Ineligibility for participation in the Coordinated Veterans' Care Program (program) and for Coordinated Veterans' Care Program Treatment and LMO Home Care service (category C) Referral under the program
6A.7 Date of Admission for Participation in the Coordinated Veterans' Care Program
6A.8 LMO Home Care service (category C) Referral
6A.9 Procedures under the Coordinated Veterans' Care Program
PART 6B — TELEMONITORING TREATMENT INITIATIVE
6B.1 Telemonitoring Treatment
6B.2 Participation in the In-Home Telemonitoring for Veterans Initiative
6B.3 Approval of LMO as Participating LMO
6B.4 Payment for telemonitoring treatment
6B.5 Coordinated Veterans’ Care Program Rules to Apply
6B.6 Authorised Representative - Agent of LMO
PART 7 — TREATMENT GENERALLY FROM OTHER HEALTH PROVIDERS
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
7.3A MRCA Home Care Program
7.4 Optometrical services
7.5 Physiotherapy
7.6 Podiatry
7.6A Diabetes Educator Services
7.7 Chiropractic and osteopathic services
7.7A Outreach Program Counselling
7.8 Other services
PART 9 — TREATMENT OF ENTITLED PERSONS AT HOSPITALS AND INSTITUTIONS
9.1 Admission to a hospital or institution
9.2 Financial responsibility for Treatment In Hospital
9.3 Nursing-home-type care
9.5 Convalescent care
9.6 Other matters
PART 10 — RESIDENTIAL CARE
Part A - residential care not involving residential care (respite)
10.1 Residential care arrangements
10.4 Payment of residential care amount for certain members with dependants
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
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 TREATMENT MATTERS
12.1 Ambulance transport
12.2 Treatment under Medicare
12.4 Prejudicial or unsafe acts or omissions by patients
12.6 Recovery of moneys
Transitional Provisions
Schedule 1 Dates for Incorporated Documents
Australian Government
MILITARY REHABILITATION AND COMPENSATION COMMISSION
Military Rehabilitation and Compensation Act 2004
Section 286
MRCA Treatment Principles
Instrument 2013 No. MRCC 53
PART 1 — INTRODUCTION
1.1.1 This Instrument is known as the MRCA Treatment Principles and is prepared by the Military Rehabilitation and Compensation Commission (Commission) under section 286 of the Act.
1.1.2 The MRCA Treatment Principles set out the places at which, the circumstances in which, and the conditions subject to which, a particular kind or class of treatment may be provided for entitled persons under Part 3 of Chapter 6 of the Act and are to be read subject to the Act. The MRCA Treatment Principles also set out:
(a) the places at which, the circumstances in which, and the conditions subject to which, a particular kind or class of treatment may be provided under Part 3 of Chapter 6 of the Act;
(b) the kinds or classes of treatment that will not be provided under Part 3 of Chapter 6 of the Act;
(c) the places at which, the circumstances in which, and the conditions subject to which, treatment will not be provided under Part 3 of Chapter 6 of the Act;
(d) whether the Commission’s prior approval of a particular kind or class of treatment is required under Part 3 of Chapter 6 of the Act;
(e) if the Commission’s prior approval is required:
(i) the circumstances in which the Commission may exercise its power to give prior approval; and
(ii) the circumstances in which the Commission may exercise its power to give approval if the treatment was obtained without prior approval.
1.1.3 The MRCA Treatment Principles state the policies under which the Commission may accept financial responsibility for the cost of treatment for persons entitled to treatment under the Act.
Note: Consistent with the Act, treatment extends beyond medical treatment and encompasses social and domestic assistance.
1.1.4 The MRCA Treatment Principles, except the references to “SRCA disability” in paragraph 1.4.1, commences on the day after it is registered on the Federal Register of Legislative Instruments.
1.1.5 The references to “SRCA disability” in paragraph 1.4.1 commence on 10 December 2013.
Note: on 1 July 2013 the Veterans’ Affairs Legislation Amendment (Military Compensation Review and Other Measures) Act 2013 (amending Act) amended, among other Acts, the Safety, Rehabilitation and Compensation Act 1988 (SRCA) to enable certain employees (service personnel) with compensable conditions to obtain treatment for those conditions under the Veterans’ Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004. The amendment made by Schedule 11 of the amending Act commences on 10 December 2013.
1.2 Application of MRCA Private Patient Principles
1.2.1 The MRCA Private Patient Principles (the MPPPs), determined by the Commission under paragraph 286(1)(b) of the Act, apply in all States and Territories
1.2.2 A provision of the MRCA Treatment Principles does not apply if it is inconsistent with the MPPPs.
1.2.3 Nothing in these Principles is to be taken to require prior approval for admission at a public hospital in a State or Territory.
1.3 Delegation
1.3.1 The Commission may delegate all or any of its powers under the Principles (except this power of delegation) in the same manner, and subject to the same conditions, that it may delegate all or any of its powers under the Act.
Note: section 384 of the Actsets out the circumstances in which the Commission may delegate its powers.
1.4 Interpretation
1.4.1 In these Principles, unless a contrary intention appears:
“ABN (Australian Business Number)” has the meaning given by the A New Tax System (Australian Business Number) Act 1999.
“aboriginal health worker” means a person who is qualified as an aboriginal health worker after undertaking a course in Aboriginal and Torres Strait Islander Health, provided by an institution recognised by the Department of Prime Minister and Cabinet as suitable for providing a course of that nature, and who obtained a Certificate Level III (or higher) under the course.
“Aboriginal Health Worker Care Co-ordination treatment” means treatment provided by an aboriginal health worker to an entitled person under the Coordinated Veterans' Care Program, comprised of:
(a) implementing the GPMP for the person under the Program — in particular co-ordinating treatment services under the GPMP;
(b) liaising, in relation to the GPMP, with the LMO who manages the GPMP for the person;
(c) performing such other functions under the program that the aboriginal health worker has under the Notes for Coordinated Veterans' Care Program Providers.
“ACPMH treatment” means action taken with a view to maintaining an entitled member in mental health and includes:
(a) training members of the Defence Force or staff made available under section 382 of the Act, or both, in the mental health care disciplines that could benefit the mental health of an entitled member; and
(b) conducting research into mental injuries or diseases suffered by members of the Defence Force or into the mental state generally of such members with the resulting knowledge being applied to the benefit of the health of an entitled member; and
(c) improving communication on mental injury or disease health care matters between:
(i)members of the Defence Force who are staff-managers; and
(ii)staff made available under section 382 of the Act; and
(iii)an entitled member; and
(d) conducting mental injury or disease health care policy research with the outcomes of that research being applied to the benefit of the health of an entitled member.
Note (1): under section 13 of the Acttreatment can be action taken with a view to maintaining a person in physical or mental health.
Note (2): the term “member” is defined in these Principles so as to include “former member“ and the term “Defence Force” is defined in s.5 of the Act.
“Act” means the Military Rehabilitation and Compensation Act 2004.
“admission date” means the date on which an LMO records in writing (including in electronic form) that the LMO has decided an entitled person may participate in the Coordinated Veterans' Care Program.
“admitting LMO”, in relation to an entitled person in the Coordinated Veterans' Care Program, means the LMO who decided an entitled person may participate in the Coordinated Veterans' Care Program.
“allied health provider” means a category of provider mentioned in the Table in 7.1A.1.
"approved provider" means a State, Territory or Local Government, or incorporated organisation, or person, that has entered into an arrangement with the Commission for the provision of:
(a)a Home Care service (category A); or
(b)a Home Care service (category B); or
(c)a Home Care service (category C); or
(d)a limited MHC-type service;
to an entitled person, whether by the approved provider or a sub-contractor engaged by it.
“Australian Government’s Better Access initiative” means the mental health initiative described in the document entitled “Better Access to Psychiatrists, Psychologists & General Practitioners through the Medical Benefits Schedule Initiative” in force on the date in Schedule 1.
“Australian Centre for Posttraumatic Mental Health” and “ACPMH” mean the Australian Centre for Posttraumatic Mental Health Incorporated.
“authorised nurse practitioner” has the meaning it has in subsection 84(1) of the National Health Act 1953.
“Authorised Representative”, in relation to a medical practice in which a participating LMO is employed, means the person whose name is given as the Authorised Representative for the Practice in the form: “Application for Practice and Provider registration to In-Home Telemonitoring for Veterans Initiative” lodged with the Department of Human Services.
“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.
“approved provider”, in relation to transition care, has the meaning it has in the Aged Care Act 1997.
Note: the Aged Care Act 1997 can be found on COMLAW: 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.
“Centre for Military and Veterans’ Health” means the entity in the University of Queensland, Herston Campus, operated by the Board of Management.
“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.
“CMVH treatment” means action taken with a view to maintaining a member in physical or mental health and includes:
(a) training members of the Defence Force in the health care disciplines that could benefit the health of a member;
(b) conducting research into injuries or diseases suffered by members of the Defence Force or into the state of health generally of such members with the resulting knowledge being applied to the benefit of the health of a member;
(c) improving communication on health care matters between members of the Defence Force who are staff-managers and a member; and
(d) conducting health-care policy research with the outcomes of that research being applied to the benefit of the health of a member.
Note: under section 13 of the Acttreatment can be action taken with a view to maintaining a person in physical or mental health.
“Commission” means the Military Rehabilitation and Compensation 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. See paragraph 423(c) of the Act.
“community nurse” means a registered nurse or enrolled nurse who works in a community nursing setting and who is employed or engaged by a DVA-contracted community nursing provider.
“Community Nurse Care Co-ordination treatment” means
treatment provided by a community nurse to an entitled person under the Coordinated Veterans' Care Program, comprised of:
(a) implementing the GPMP for the person under the Program — in particular co-ordinating treatment services under the GPMP; and
(b) liaising, in relation to the GPMP, with the LMO who manages the GPMP for the person.
"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 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, the Repatriation 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 care and welfare of entitled 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.
“Coordinated Veterans' Care Program” means the treatment program of that name set out in Part 6A of these Principles and in the Notes for Coordinated Veterans' Care Program Providers that aims to reduce the need for hospitalisation among Gold Card members of the veteran and defence force community and improve their social well-being. In particular the program has the following main features:
·assessment - a Local Medical Officer (LMO) will assess a person with complex care needs due to chronic disease to see if the person would benefit from the clinical care services under the program and ascertain if the person meets the program’s eligibility criteria;
·consent – a person needs to consent in writing to participation in the program and the LMO needs to record that consent. As treatment is being provided it is the LMO’s responsibility to ensure a potential participant in the program understands the nature of the program and that the person’s personal details that are relevant to the person’s treatment under the program may be provided to bodies and individuals such as the Department, the Department of Human Services and health care providers, who have a need for the information in connection with the person’s treatment under the program.
·care plan – the LMO will prepare a comprehensive care plan (GPMP) for a person the LMO admits to the program;
·consultation - the person will be consulted in the preparation of the care plan and its review;
·implementation and co-ordination - the LMO’s practice nurse (or a community nurse via a DVA-contracted community nursing provider, or an aboriginal health worker, if more appropriate) will implement the care plan and, in particular, co-ordinate services under the plan.
“Coordinated Veterans' Care Program treatment” means:
(a) LMO Care Leadership treatment; or
(b) Practice Nurse Care Co-ordination treatment; or
(c) Community Nurse Care Co-ordination treatment; or
(d) Aboriginal Health Worker Care Co-ordination treatment.
"co payment", in relation to the MRCA Home Care Program, means an amount of money an approved provider or a sub-contractor is permitted to charge an entitled person, pursuant to an arrangement between the approved provider and the Commission, in respect of a Home Care service (category A).
“country area” means that part of the State outside the metropolitan area of the capital city of that State, determined by the Repatriation Commission to be a country area under paragraph 80(2)(b) of the Veterans' Entitlements Act 1986.
“data repository” means a repository of telemonitoring initiative data controlled by the data repository controller for the purposes of monitoring a telemonitoring initiative participant’s physiological and behavioural data according to the telemonitoring care plan for that participant.
“data repository controller” means a person engaged by the Department to establish and maintain the data repository for the purposes of the In-Home Telemonitoring for Veterans Initiative.
“Day Procedure Centre” means premises that would be Contracted Day Procedure Centre premises if the operator of the premises was contracted to the Commission, the Repatriation Commission or the Department.
“DVA-contracted community nursing provider” means a community nursing provider who has entered into a Deed of Standing Offer with the Commission to provide community nursing services to entitled persons.
“DVA document” means a document prepared in the Department and available on the Internet at:
Telemonitoring Practice Incentive” means the payment of that name referred to in the “Department of Veterans’ Affairs Fee Schedules for Medical Services” and which is payable once only to the Authorised Representative for a medical practice — where, in the Commission’s opinion, all necessary steps have been taken to enable a participating LMO (and any Practice Nurse of the LMO) employed in the Practice to effectively participate in the In-Home Telemonitoring for Veterans Initiative
“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.
“enrolled nurse” means a person who is registered under a law of a State or Territory or of the Commonwealth to practise as an enrolled nurse.
“enrolment day”, in relation to a person, means the date given for a decision by a participating LMO to enrol the person as a participant in the In-Home Telemonitoring for Veterans Initiative.
Note: see 6B.2.4 - 6B.2.6.
“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.
“Department of Human Services” means the Department administered by the Minister administering the Human Services (Medicare) Act 1973.
“Department of Prime Minister and Cabinet” means the Commonwealth Department of State responsible for Commonwealth Aboriginal and Torres Strait Islander policy, programmes and service delivery.
“Department of Social Services” means the Commonwealth Department of State, however named, that from time to time is responsible for the administration of the Aged Care Act 1997.
"dependent eligible young person" has the same meaning as "dependent child" in the Social Security Act 1991.
“diabetes 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 diabetes educator to a person with diabetes.
"Domestic Assistance" means the service under the MRCA Home Care Program consisting of:
(a)assistance with domestic chores, including assistance with cleaning, dishwashing, clothes washing and ironing, shopping and bill paying; and
(b)help with meal preparation where this is not the primary focus of the occasion of the service; and
(c) in remote areas, activities such as collecting firewood.
“elective surgery” means any non-urgent surgical procedure performed for diagnostic or therapeutic purposes.
"eligible young person" has the meaning it has in section 5 of 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.
"emergency short term home relief" means care provided to an entitled person in his or her home on the following conditions:
(a) the person or the person's carer is unable to provide care due to sudden and unforeseen circumstances; and
(b) the period for which the care is provided does not exceed 72 hours (episode) per emergency except that, if the entitled person requires further care within 24 hours after the end of the previous episode in an emergency, and obtains prior approval, a further episode of care (up to 72 hours) may be provided in that emergency; and
(c) the cumulative period of the care provided to the entitled person did not exceed 216 hours in a Financial year.
Note (1): emergency short term home relief is not relevant to the calculation of residential care amounts for residential care or residential care (respite).
“entitled member" means a member or former member as defined in section 5 of the Actwho is or was entitled to treatment under Part 3 of Chapter 6 of the Act and means a person with a SRCA disability.
“entitled person” means a person who is entitled to treatment under Part 3 of Chapter 6 of the Act.
Note: this includes a person with a SRCA disability.
“wholly dependent partner” or “wholly dependent partnerer” means a wholly dependent partner as defined in section 5 of 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 DVA-contracted community nursing provider.
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.
"excluded service" means a service within the scope of the Home and Community Care Program established under the Home and Community Care Act 1985, as amended from time to time, that is commonly known as:
(a) domestic assistance or personal care; or
(b) home maintenance; or
(c) respite care;
Note (1): for the purposes of this definition, "respite care" does not include centre-based day care (also called "day centre respite" or adult day activity centres").
Note (2): the intention is that a Home Care service (category A), Home Care service (category B) and Home Care service (category C) are mutually exclusive.
"exempt amount” means an amount of money not payable by an entitled person in respect of any Home Care service (category A) or Home Care service (category C) provided to the entitled person by an approved provider, because the entitled person is an exempt entitled person.
"exempt entitled person" means, in relation to the provision of any Home Care service (category A) or Home Care service (category C) to an entitled person, an entitled person who:
(a) has a dependent eligible young person; or
Note: under the Acts Interpretation Act 1901 the singular includes the plural meaning a person can have more than one dependent eligible young person.
(b) is a person who, in the opinion of the Commission, is experiencing severe financial hardship or who could experience severe financial hardship if the person was to make a payment in respect of the service; or
(c) is in receipt of an income support payment at the maximum rate and does not earn, derive or receive ordinary income exceeding $40 per fortnight.
Note: the Commission may allow exemption from payment for a period or until the occurrence of an event.
“Fee Schedule” means a DVA document approved by the Repatriation Commission, the Commission, or a member of the Repatriation Commission or of the Commission, 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.
“flexible care” has the meaning it has in section 49‑3 of the Aged Care Act 1997.
“General information about VVCS – Veterans and Veterans Families Counselling Service” means the DVA document of that name in force on the date in Schedule 1 that, among other things, sets out the criteria for eligibility for VVCS.
“Gold Card” means the identification card described as the Repatriation Health Card - For All Conditions and provided to a person who is entitled under the Act to treatment, subject to these Principles, for all injuries or diseases.
“GPMP” means the care plan prepared by an LMO, in accordance with the Notes for Coordinated Veterans' Care Program Providers, for an entitled person participating in the Coordinated Veterans' Care Program.
Note: “GPMP” is used in the Department of Veterans’ Affairs Fee Schedules for Medical Services (see: paragraph 3.5.1).
“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 same meaning it has in the Classification Principles 1997 (excluding paragraph (b) of that definition).
Note (1): the Classification Principles 1997 are made under the Aged Care Act 1997.
Note (2): paragraph (b) of the definition of “high level of residential care” in the Classification Principles 1997 relates to “high level residential respite care” but under the MRCA Treatment Principles “residential care” and “residential care (respite)” are separate treatments
Note (3) the classification of residential care (non respite) as a high or low level of residential care is worked out under section 9.3B of the Classification Principles 1997.
"high level of residential care (respite)" means high level residential respite care described in paragraph (b) of the definition “high level of residential care” in the Classification Principles 1997.
Note (1): the Classification Principles 1997 are made under the Aged Care Act 1997.
Note (2): the classification of residential care that is respite care as a high or low level of residential respite care is worked out under section 9.3C of the Classification Principles 1997.
“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.”.
"Home and Community Care Program service" means a service of Home and Community Care provided under the auspices of the Home and Community Care Act 1985.
"Home and Garden Maintenance" means the service, under the MRCA Home Care Program, of maintaining the home, garden or yard of an entitled person, and includes:
(a)assistance with minor maintenance and minor repair of the home (e.g changing light bulbs, minor carpentry, minor painting, replacing tap washers, but not the supply of replacement items), garden or yard to keep the home, garden or yard safe and habitable;
(b) lawn mowing;
but does not mean:
(c) tree felling or tree removing or other major tasks related to a garden or yard;
(d) provision of materials.
Note: recipients of MRCA Home Care services will be expected to supply materials used in home maintenance, eg replacement light bulbs and tap washers. Service providers will be required to provide any equipment needed, eg garden tools.
“home care” has the meaning given by section 45‑3 of the Aged Care Act 1997.
"Home Care service (category A) " means the provision of Domestic Assistance, Personal Care, Home and Garden Maintenance or Respite Care to an entitled person pursuant to the MRCA Home Care Program.
"Home Care service (category B)" means the provision of treatment, pursuant to the MRCA Home Care Program, that would satisfy the description of a service within the scope of the Home and Community Care Program established under the Home and Community Care Act 1985, as amended from time to time, but does not mean the provision of treatment, pursuant to the MRCA Home Care Program, that would satisfy the description of an excluded service.
“Home Care service (category C)” means the provision by an approved provider of a service to an entitled person under the MRCA Home Care Program that is:
(a) pursuant to an LMO Home Care service (category C) Referral and allocated to the provider by a MHC assessment agency; and
(b) aimed at reducing the person’s social isolation by improving their social networks; and
(c) provided to an entitled person by an approved provider.
"income support payment" has the same meaning it has in the Social Security Act 1991, save that it includes an income support supplement under the VEA;
Note: As at 1 January 2001 income support payments were:(a) a social security benefit; (b) a job search allowance; (c) a social security pension; (d) a youth training allowance; (e) a service pension.
“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 may be approved under the Principles by the Commission, the Repatriation Commission or a member of the Commission or Repatriation Commission or by the Secretary to the Department – the document has been so approved.
Note: an example being the Notes for Local Medical Officers (para.1.4.1).
(b) if the document is prepared on behalf of the Commission, the Repatriation Commission or the Department but is not required under the Principles to be approved in a manner in (a) – the document has been approved in a manner in (a).
(c) if the document is not prepared under (b) and is not required under the Principles to be approved in a manner in paragraph (a) – the document exists.
“in-home respite” means care provided to a person in his or her own home for a maximum of 196 hours in a Financial year to provide rest or relief from the role of caring:
(a) to the person; or
(b) to the person’s carer;
Note: in-home respite is not relevant to the calculation of residential care amounts for residential care or residential care (respite).
“in-home telemonitoring equipment”, for a telemonitoring initiative participant, means apparatus (including computer software) that, in conjunction with an internet carriage service provided by an ISP Provider, enables the user of the apparatus to utilise the National Broadband Network so that the user may participate in the In-Home Telemonitoring for Veterans Initiative, and includes a video-conferencing facility.
“In-Home Telemonitoring for Veterans Initiative” means the Initiative of that name established by the Department which has the following features:
(a) telemonitoring initiative participants electronically transmit telemonitoring initiative data to the data repository using in-home telemonitoring equipment that utilises the National Broadband Network; and
(b) participating LMOs (or LMOs Practice Nurses) electronically retrieve telemonitoring initiative data from the data repository and analyse it for the purpose of monitoring the health of telemonitoring initiative participants.
“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.
“internet carriage service” has the meaning it has in Schedule 5 to the Broadcasting Services Act 1992.
“ISP Provider” means “Internet Service Provider” as defined in Schedule 5 to the Broadcasting Services Act 1992.
"limited MHC-type service" means a service identical to Domestic Assistance or Home and Garden Maintenance, provided, or to be provided, by an approved provider to a person eligible to receive a limited MHC-type service.
“Local Medical Officer” or “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.
“LMO Care Leadership treatment” means treatment provided by an LMO to an entitled person, under the Coordinated Veterans' Care Program, comprised of:
(a) preparing and managing the GPMP for the person under the Program;
(b) overseeing a practice nurse in the implementation of the GPMP — where a practice nurse and not a community nurse or aboriginal health worker or the LMO co-ordinates treatment under the GPMP (Practice Nurse Care Co-ordination treatment);
(c) referring the person to a DVA-contracted community nursing provider for Community Nurse Care Co-ordination treatment or to an aboriginal health worker for Aboriginal Health Worker Care Co-ordination treatment, if appropriate;
(d) performing such other functions under the program that the LMO has under the Notes for Coordinated Veterans' Care Program Providers.
“LMO Home Care service (category C) Referral” means treatment comprised of an LMO preparing a written document that refers an entitled person, who the LMO has admitted to and is treating under the Coordinated Veterans' Care Program, to a MHC assessment agency for assessment for a Home Care service (category C) under the MRCA Home Care Program and which:
(a) is in the form, if any, approved by the Repatriation Commission or Commission; and
(b) is sent to the MHC assessment agency, including as a facsimile message.
"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.
“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.
“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.
"member" has the meaning it has in the Act save that it includes former member and a person with a SRCA disability.
"Memorandum of Understanding of 1995" means the Memorandum of Understanding between the Commonwealth of Australia as represented by the Department of Veterans' Affairs, the Repatriation Commission and the Australian Medical Association Ltd, relating to the provision of medical services by Local Medical Officers to entitled persons, dated 10 December 1995.
“MHC assessment agency” means a person to whom the Commission has delegated its power to:
(a) assess whether a person needs:
(i) a Home Care service (category A); or
(ii) a Home Care service (category B); or
(iii) a Home Care service (category C;
under the MRCA Home Care Program; and
(b) allocate a service in (a) to an approved provider.
“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.
“MPPPs” means the MRCA Private Patient Principles determined by the Commission under paragraph 286(1(b) of the Act.
"MRCA 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 “MRCA 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: a MRCA 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.
"MRCA Home Care Program" means:
(a) the treatment program under which the Commission ensures the provision of care and assistance services to entitled persons who are frail, or who have disabilities, with the aim of maintaining the independence of those people, allowing them to remain in their own home for as long as possible, and reducing avoidable illness and injury, and is comprised of paragraphs 7.3A to 7.3A.22 (inclusive) of the Principles, and other relevant paragraphs in the Principles, and the arrangements under section 285 of the Act in support thereof.
(b)the treatment program under which the Commission ensures the provision of social support services to entitled persons referred to the program under a LMO Home Care service (category C) Referral.
"MRCA Pharmaceutical Benefits Scheme" means the scheme determined by the Commission under paragraph 286(1)(c) of the Act.
"MRCA Private Patient Principles" means the principles in the determination made by the Commission under paragraph 286(1)(b) of the Act.
“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:
Broadband Network” has the meaning it has in the National Broadband Network Companies Act 2011.
“NBN” means National Broadband Network.
“NBN wave site” means an area, including part of an area, covered by the NBN.
“neuropsychologist” 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.
“nominated residence” means a residence nominated by an entitled person as the place where the person would participate in the In-Home Telemonitoring for Veterans Initiative.
“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 Coordinated Veterans' Care Program Providers” means the document approved by the Commission, the Repatriation Commission, or a member of the Commission or Repatriation Commission, or by the Secretary to the Department, entitled “Notes for Coordinated Veterans' Care Program”, and in force on the date in Schedule 1, that sets out the terms on which:
(a) an LMO;
(b) a practice nurse;
(c) a community nurse (via a DVA-contracted community nursing provider); and
(d) an aboriginal health worker;
is to provide treatment to an entitled person under the Coordinated Veterans' Care Program 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, the Repatriation 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 Repatriation Commission or the Commission, or a member of either Commission, 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.
“optical dispenser”, in the case of an individual, means a person who:
(a) interprets optical prescriptions and fits and services optical appliances such as spectacle frames and lenses; and
(b) holds a qualification that, in the opinion of the Commission, is appropriate for the skills needed to practise optical dispensing; and
(c) is a member of a body established to supervise the occupation of optical dispenser; and
(d) holds a provider number as an optometrist, ophthalmologist, orthoptist or optical dispenser.
“optical dispenser”, in the case of a company, means a company that:
(a) holds an ABN (Australian Business Number);
(b) carries on a business of optical dispensing;
(c) employs or engages for the optical dispensing aspects of the business — an individual who is an optical dispenser.
“optical dispensing” means interpreting optical prescriptions and fitting and servicing optical appliances such as spectacle frames and lenses.
“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.
“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.
"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.
Note: a provider number may be a number used by the Department and adopted by the Department of Human Services.
“outpatient service” means a health service or procedure provided by a hospital but not involving admission to the hospital.
“outreach program counselling” means the treatment of that name established by paragraph 7.7A.1 of the Principles — comprised of mental health counselling under the Veterans and Veterans Families Counselling Service provided by an outreach program counsellor to an entitled person eligible for the treatment under the Principles.
“outreach program counsellor” means:
(a) a psychologist who:
(i) is registered as a psychologist with the Psychology Board of Australia; and
(ii) has been given a provider number and is eligible to provide psychological services under the Australian Government’s Better Access initiative; and
(iii) in the opinion of the Commission, has an adequate appreciation of veteran and military culture; or
(b) a social worker (mental health) who:
(i) is accredited as a Mental Health Social Worker with the Australian Association of Social Workers; and
(ii) has been given a provider number and is eligible to provide social work services under the Australian Government’s Better Access initiative; and
(iii) in the opinion of the Commission, has an adequate appreciation of veteran and military culture;
being a person who does not have a written contract (described as a Deed of Standing Offer) with the Commission or the Department in respect of the provision of a counselling service to an entitled person under the auspices of the Veterans and Veterans Families Counselling Service.
“participating LMO” means an LMO:
(a) whose name is given as a participating GP in the form: “Application for Practice and Provider registration to In-Home Telemonitoring for Veterans Initiative” lodged with the Department of Human Services; and
(b) who is approved in writing by the Commission to be a participating LMO in the In-Home Telemonitoring for Veterans Initiative.
Note: in practice a Commission delegate may grant the approval.
"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.
“period of care” in relation to the care provided by:
(a) an LMO; or
(b) a practice nurse; or
(c) an aboriginal health worker; or
(d) a community nurse (via a DVA-contracted community nursing provider);
to an entitled person under the Coordinated Veterans' Care Program (Program), means the period set out in the Notes for Coordinated Veterans' Care Program Providers in relation to the LMO, practice nurse, community nurse or aboriginal health worker, provided that any subsequent period of care by the same LMO is approved by the LMO for the person.
Note 1: the period of care is important for billing purposes. The Notes for Coordinated Veterans' Care Program Providers contain the detail of billing procedures. Generally, for an LMO the period is 3 months commencing on the patient’s admission to the Program and for a community nurse the period is 28 days commencing on date of service. Generally previous care periods with different providers must expire before a new provider can claim for a care period except that, with prior approval, a community nurse can claim for a care period although a previous care period in respect of the relevant entitled person has not expired. A community nurse cannot claim for a period not covered by a period of care provided by an LMO.
Note 2: any period of care by an LMO other than the first period of care commencing on the date the entitled person is admitted to the Program (admission date) or the first period of care as a different LMO for the person (commencing on the date worked out under the Notes for Coordinated Veterans' Care Program Providers, is a subsequent period of care by an LMO and the LMO must approve it. By approving it, the periods of care provided by any care co-ordinator (practice nurse, community nurse or aboriginal health worker) during the period of care approved by the LMO are valid periods of care under the Program (sub-periods of care). A sub-period of care may only be provided under the Program during a period of care under the Program by an LMO.
"Personal Care" means the service under the MRCA Home Care Program consisting of assistance with daily self care tasks, such as eating, bathing, toileting, dressing, grooming, getting in and out of bed, and moving about the house.
“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.
“practice nurse” means a registered nurse or enrolled nurse employed or engaged by an LMO as a nurse in the LMO’s practice.
“Practice Nurse Care Co-ordination treatment” means
treatment provided by a practice nurse to an entitled person, under the Coordinated Veterans' Care Program, comprised of:
(a) implementing the GPMP for the person under the Program — in particular co-ordinating treatment services under the GPMP;
(b) liaising, in relation to the GPMP, with the LMO supervising the practice nurse in relation to the implementation of the GPMP;
(c) performing such other functions under the program that the practice nurse has under the Notes for Coordinated Veterans' Care Program Providers.
“Principles” means the MRCA Treatment Principles.
“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.
“prisoner of war” means an entitled member who was captured by the enemy (including a terrorist) while rendering defence service.
“private hospital” means premises that have been declared specifically as private hospitals for the purposes of the Health Insurance Act 1973.
"proscribed amount" means, in relation to the MRCA Home Care Program:
(a)subject to paragraph (b), an amount of money that if paid by an entitled person would mean the entitled person has paid in respect of a Home Care service (category A) comprised of Domestic Assistance provided to that entitled person by any approved provider or by any sub-contractor during a week or part thereof, an amount exceeding $5;
Note: for the purpose of ascertaining if an amount of money is a proscribed amount where the amount demanded, received or assigned is in respect of a service (s) provided during two or more weeks, without the service (s) being related to the particular week in which the service(s) was delivered, the amount shall be apportioned pro rata to those weeks.
(aa) subject to paragraph (b), an amount of money that if paid by an entitled person would mean the entitled person has paid in respect of a Home Care service (category A) comprised of Home and Garden Maintenance, provided to that entitled person by any approved provider or by any sub-contractor during the relevant period referred to in paragraph 7.3A.3 (2) of the Principles, an amount exceeding $75;
Note (1): the "relevant period" is a period of 12 months.
Note (2): under paragraph 7.3A.8(a) of the Principles, an entitled person cannot be charged more than $5 per hour of service.
(b)an amount of money that if paid by an entitled person receiving a Home Care service (category A) that was similar to a Home and Community Care Program service provided to the person immediately before 1 January 2001 would mean the entitled person has paid in respect of the Home Care service (category A) provided to that entitled person by any approved provider or by any sub-contractor, an amount exceeding the maximum amount the person could have been required to pay over a particular period in respect of the Home and Community Care Program service formerly provided to the person that was similar to the Home Care service (category A) provided to the entitled person;
Note: for the purpose of ascertaining if an amount of money is a proscribed amount where the amount demanded, received or assigned is in respect of a service (s) provided during two or more weeks, without the service (s) being related to the particular week in which the service(s) was delivered, the amount shall be apportioned pro rata to those weeks.
(c)subject to paragraph (b), an amount of money that if paid by an entitled person would mean the entitled person has paid, in respect of a Home Care service (category A) comprised of Personal Care provided to that entitled person by any approved provider or by any sub-contractor during a week or part thereof, an amount exceeding $10;
Note: for the purpose of ascertaining if an amount of money is a proscribed amount where the amount demanded, received or assigned is in respect of a service (s) provided during two or more weeks, without the service (s) being related to the particular week in which the service(s) was delivered, the amount shall be apportioned pro rata to those weeks.
(d)an amount of money in respect of Respite Care provided, or to be provided, by an approved provider or by a subcontractor, to an entitled person;
Note: the intention is that any amount charged for Respite Care is a proscribed amount regardless of whether it would or would not exceed $5 per hour of service.
(e)an amount of money in respect of a Home Care service (category A) provided or to be provided to an entitled person that was a similar service to a Home and Community Care Program service the entitled person received immediately before 1 January 2001 and in respect of which the entitled person had not been required to pay a charge;
Note: the intention is that any amount charged for a service similar to a free former Home and Community Care Program service previously received is a proscribed amount regardless of whether it would or would not exceed $5 per hour of service.
(f)an amount of money, in respect of a Home Care service (category A) provided or to be provided to an entitled person that was a similar service to a Home and Community Care Program service the entitled person received immediately before 1 January 2001, that exceeds any amount of money the entitled person had been required to pay in respect of the Home and Community Care Program service;
Note: It is the intention that any amount charged for a service similar to a Home and Community Care Program service previously received that is over and above the amount the entitled person previously paid in respect of the Home and Community Care Program service is a proscribed amount notwithstanding that the sum of the amounts that could and could not be charged did not exceed $5 per hour of service. The limitation on the maximum amount a person could be required to pay in (a), (aa) and (b) above applies to this situation (maximum amount payable over a period).
(g)an exempt amount;
Note: the intention is that an exempt amount remains a proscribed amount and therefore not chargeable notwithstanding it would or would not exceed $5 per hour of service.
“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.
"provision of a Home Care service (category A) to an entitled person by an approved provider" includes the situation where an approved provider engages a sub-contractor to provide a Home Care service (category A) to an entitled person.
"provision of a Home Care service (category B) to an entitled person by the Commission" includes the situation where the Commission engages a sub-contractor to provide a Home Care service (category B) to an entitled person.
“provision of a Home Care service (category C) to an entitled person by an approved provider” includes the situation where an approved provider engages a sub-contractor to provide a Home Care service (category C) to an entitled person.
"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.
“MRCA Pharmaceutical Benefits Scheme” means the Scheme determined under paragraph 286(1)(c) of the Act.
“RAP National Schedule of Equipment” means the document of that name approved by the Repatriation Commission or the Commission or by a member of the Repatriation Commission or 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.
“registered nurse” means a person who is registered under a law of a State or Territory or of the Commonwealth to practise as a registered nurse.
"Rehabilitation Appliances Program (RAP) National Guidelines"
means the document of that name approved by the Repatriation Commission or the Commission or by a member of the Repatriation Commission or 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 continued in existence by section 179 of the Veterans' Entitlements Act 1986;
"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 a resident of 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 a person in receipt of a high level of residential care — an amount equivalent to the maximum daily amount of resident fees worked out under Division 58 of the Aged Care Act 1997;or
Note: ‘maximum daily amount of resident fees’ is defined in section 58-2 of the Aged Care Act 1997.
Note: ‘standard resident contribution’ is defined in sections 58-3 and 58-4 of the Aged Care Act 1997 and does not include the ‘daily income tested reduction’ (defined in sections 44-21 to 44-23 of the Aged Care Act 1997. The effect of this is that for the purposes of determining the Commonwealth’s liability under the Act the income testing provisions of the Aged Care Act 1997 do not apply.
(d) in relation to an entitled person awarded the Victoria Cross who is receiving or received a high level of residential care — an amount equivalent to the sum of:
(i) the standard resident contribution worked out under Division 58 of the Aged Care Act 1997, as that amount forms part of the maximum daily amount of resident fees; and
(ii) any care fee payable by the entitled person, in respect of the residential care, that is calculated by reference to the person's income.
Note: if a standard resident contribution is payable daily because it forms part of the maximum daily amount of resident fees a person is to pay, then the Commission's financial responsibility for the standard resident contribution is for that contribution as it is incurred daily.
"residential care (respite)" means residential care provided as respite and includes residential care (28 day respite).
"residential care (28 day respite)" means residential care provided as respite for up to 28 days in a Financial year pursuant to the MRCA Home Care Program.
"residential care subsidy" means an amount worked out under Chapter 3 of the Aged Care Act 1997 (including any amount of veterans’ supplement) 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 Care" means the service under the MRCA Home Care Program consisting of in-home respite, residential care (28 day respite) or emergency short term home relief.
“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.
“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.
“revoked MRCA Treatment Principles” means the MRCA Treatment Principles (Instrument 2004 No. M21).
"Rural Enhancement Scheme" means the scheme jointly established by the Commission (under section 285 of the Act) and the Repatriation Commission, 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.
"service injury" has the meaning it has in section 5 of the Act.
"service disease" has the meaning it has in section 5 of the Act.
“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.
“SRCA” means the Safety, Rehabilitation and Compensation Act 1988.
“SRCA disability” means an injury (within the meaning of the Safety, Rehabilitation and Compensation Act 1988):
(a) for which the Military Rehabilitation and Compensation Commission has accepted liability to pay compensation under that Act; and
(b) for which the person with the injury is eligible to be provided with treatment under Part 3 of Chapter 6 of the Act.
Note 1: In the Safety, Rehabilitation and Compensation Act 1988 the definition of injury includes a disease (see section 5A of that Act).
Note 2: Section 85(2A) of the Actprovides eligibility for treatment of a person with an injury under the Safety, Rehabilitation and Compensation Act 1988.
“sub-contractor” means, in relation to the MRCA Home Care Program, a State, Territory or Local Government, or incorporated organisation, or person, engaged by an approved provider or the Commission to provide a Home Care service (category A) or a Home Care service (category B) or a Home Care service (category C) to an entitled person.
“subsequent period of care”, in relation to the provision of care by an LMO to an entitled person, means a period of care that may be provided by the LMO after the expiry of a period of care that has already been provided by the LMO to the entitled person.
Note: a subsequent period of care must be approved by the LMO (see: 6A.3). A period of care by an LMO that is not a “subsequent period of care” would be the first period of care provided to a person under the Coordinated Veterans' Care Program (Program) and the first period of care provided to a person under the Program by a new LMO for the person i.e. where the person has changed LMOs.
“telemonitoring care plan” means a care plan prepared by a participating LMO in conjunction with a telemonitoring initiative participant that:
(a) is based on the electronic transmission of telemonitoring initiative data and;
(b) satisfies the minimum requirements for a GPMP (General Practitioner Management Plan), as if the telemonitoring care plan is to be a GPMP, as set out in the Notes for Coordinated Veterans' Care Program Providers.
“telemonitoring equipment”, for a participating LMO, means computer software and similar tools that will enable the participating LMO (or the LMOs Practice Nurse) to participate in the In-Home Telemonitoring for Veterans Initiative.
“telemonitoring initiative data” means physiological and behavioural data about a telemonitoring initiative participant (participant), assembled with reference to the telemonitoring care plan for the participant, and transmitted by the participant, or by a person on the participant’s behalf, to the data repository via the participant’s in-home telemonitoring equipment where it may be electronically retrieved by the participating LMO for the participant or the LMOs Practice Nurse.
“telemonitoring initiative participant” means an entitled person who has in-home telemonitoring equipment installed in the person’s nominated residence and who has been enrolled in the In-Home Telemonitoring for Veterans Initiative by a participating LMO.
“telemonitoring treatment” means treatment provided by a participating LMO (or the LMO’s Practice Nurse), a data repository controller, a contractor or an ISP provider, as the case may be, under Part 6A.
“transition care” has the meaning it has in section 15.28 of the Flexible Care Subsidy Principles 1997.
Note: the Flexible Care Subsidy Principles 1997 can be found on COMLAW: 1 Hospital” means a hospital in the category described as Tier 1 in 2.1 of the MPPPs.
“Treatment Principles” means the legislative instrument entitled ‘Treatment Principles’ made by the Repatriation Commission under section 90 of the VEA.
"VEA" means the Veterans' Entitlements Act 1986.
“Veterans and Veterans Families Counselling Service” or “VVCS” means the service funded by the Department of Veterans’ Affairs that provides free, confidential and Australia-wide mental health counselling and group programs to Australian veterans, peacekeepers, their families, eligible current serving Australian Defence Force members and F-111 workers and their families.
“VVCS criterion” means a criterion in the DVA document “ General information about VVCS – Veterans and Veterans Families Counselling Service” under the heading “Who can use VVCS?”, being a criterion that relates to a person who is eligible for treatment under the Act.
“VVCS OPC Provider Notes” means the document approved by the Commission, the Repatriation Commission, a member of the Commission or Repatriation Commission or by the Secretary to the Department, entitled “ Veterans and Veterans Families Counselling Services (VVCS) Outreach Program Counsellors (OPC) Provider Notes”, and in force on the date in Schedule 1, that sets out the terms on which an outreach program counsellor is to provide outreach program counselling to an eligible entitled person.
“service injury” and “service disease” are defined in section 5 of the Act; and in relation to a person with a SRCA disability mean the person’s injury (within the meaning of the Safety, Rehabilitation and Compensation Act 1988) that was caused by, or arose out of, the person’s employment in the Defence Force that is covered by the Safety, Rehabilitation and Compensation Act 1988.
Part C — respite admissions not involving residential care (respite)
Note (1): this heading is intended to be an aid in interpretation.
Note (2): an example of a respite admission not involving residential care (respite) would be an admission to a hospital. The definition of residential care does not include hospital care.
10.4 The Commission may accept, in whole or in part, financial responsibility for respite for a maximum period of 28 days in a Financial year in an institution in respect of which a residential care subsidy is not payable if, in the opinion of the Commission, it is a cost-effective and appropriate alternative to residential care (respite) under paragraph 10.3.1 and to Respite Care under the MRCA Home Care Program.
Part D – HOME CARE
Definition:
“co-payment” means an amount a person must pay for home care but does not include an amount payable to the provider of the home care as subsidy under the Aged Care Act 1997.
10.5 The Commission may accept financial responsibility for the co-payment a former prisoner of war, or an entitled member awarded the Victoria Cross for Australia (VC veteran), paid, or is to pay, for home care for the person pursuant to an agreement with the provider of the home care — to the extent the co-payment does not exceed any limit under:
(a)the Aged Care Act 1997;
(b)instruments under the Aged Care Act 1997; or
(c)any agreement between the provider of the care and the Secretary of the Department that administers the Aged Care Act 1997.
10.6 In deciding whether to accept financial responsibility for a co-payment for home care provided to a former prisoner of war or VC recipient the Commission should take into account:
(a) whether the care was provided in accordance with the relevant provisions of the Aged Care Act 1997 and the relevant instruments thereunder;
(b) whether the care complies with the requirements of any agreement between the provider of the care and the Secretary of the Department that administers the Aged Care Act 1997; and
(c) whether the care essentially duplicates treatment the former prisoner of war or VC recipient is receiving under other provisions of the Principles (double-dipping).
10.7 Billing
10.7.1The provider of a service of home care should bill the Department of Human Services for the co-payment rather than the former prisoner of war or VC recipient (client) but if the client is billed, the Commission may, subject to paragraph 10.5 and 10.6, accept financial responsibility for the co-payment.
Part E – TRANSITION CARE CO-PAYMENT
“co-payment” means an amount a person must pay for transition care but does not include an amount payable to the provider of the transition care as subsidy under the Aged Care Act 1997.
10.8 Financial Responsibility for Co-Payment
10.8.1 The Commission may accept financial responsibility for the co-payment an entitled member who is former prisoner of war (POW), or an entitled member awarded the Victoria Cross for Australia (VC recipient), paid, or is to pay, to an approved provider for transition care provided to the person:
(a) on condition that the care is provided on a day in respect of which flexible care subsidy is payable for the care under the Flexible Care Subsidy Principles 1997, in force from time to time; and
Note (1): as at December 2010 the maximum number of days for which flexible care subsidy was payable for transition care was 126 days.
Note (2): as at 1 July 2013 there was a proposal to consolidate the various legislative instruments under the Aged Care Act 1997 in one set of Subsidy Principles. If that occurs, the intention is that the new Subsidy Principles as they relate to flexible care will be the Flexible Care Subsidy Principles 1997 as in force from time to time.
(b) to the extent:
(i) the co-payment does not exceed the amount the approved provider is permitted to charge the POW or VC recipient under section 56-3 of the Aged Care Act 1997; and
(ii) the co-payment does not exceed the amount the approved provider is permitted to charge the POW or VC recipient under any agreement between the Secretary of the Department that administers the Aged Care Act 1997 and the approved provider pursuant to section 15.33 of the Flexible Care Subsidy Principles 1997.
10.8.2In deciding whether to accept financial responsibility for a co-payment for transition care (care) provided to a POW or VC recipient the Commission should take into account:
(a) whether the care was provided in accordance with the relevant provisions of the Aged Care Act 1997 and the relevant instruments thereunder;
Note 1: Part 3.3 of Chapter 3 of the Aged Care Act 1997 deals with transition care (flexible care)
Note 2:The Approval of Care Recipients Principles 1997, the Flexible Care Subsidy Principles 1997 and the User Rights Principles 1997 are relevant to transition care (flexible care).
(b) whether the care complies with:
(i) any agreement between the approved provider of the care and the Secretary of the Department that administers the Aged Care Act 1997 — under the Aged Care Act 1997 and under 15.33 of the Flexible Care Subsidy Principles 1997; and
(c) whether, if there is an agreement mentioned in (b)(i) and the agreement (Provider/Secretary Agreement) sets out requirements for agreements (client agreement) between an approved provider and a recipient of flexible care or flexible care that is transition care:
(i) the client agreement satisfies any requirements in respect of it in the Provider/Secretary Agreement; and
(ii) the provision of care complies with the client agreement.
(d) whether the care essentially duplicates treatment the POW or VC recipient is receiving under other provisions of the Principles (double-dipping).
10.9 Billing
10.9.1An approved provider should bill the Department of Human Services for the co-payment for transition care, rather than the POW or VC recipient (client) but if the client is billed, the Commission may, subject to 10.8.1 and 10.8.2, accept financial responsibility for the amount.
PART 11 — THE PROVISION OF REHABILITATION APPLIANCES
11.1 Rehabilitation Appliances Program
11.1.1 The Commission may provide:
(a) a surgical appliance; and
(b) an appliance for self-help and rehabilitation purposes;
to an entitled person, for an injury or disease of the person, unless the appliance could be provided to the person, for that injury or disease, by the Commission under a Part of the Act, other than Part 3 of Chapter 6 of the Act, or under SRCA.
Note (1): an appliance could be provided as part of a rehabilitation program under Chapter 3 of the Actor as a modification to a motor vehicle under Chapter 4 of the Actand could be provided under Part III or s.148 of SRCA (but not under s.16(1) by virtue of s.144B(5) SRCA).
Note (2): the Commission providing an appliance means the Commission arranges for its provision or accepts financial responsibility for the cost of the appliance where its provision is arranged by a third party.
Note (3): the RAP National Schedule of Equipment and the Rehabilitation Appliances Program (RAP) National Guidelines are DVA documents that provide guidance to the Commission and to prescribers and suppliers in relation to the provision of surgical aids and appliances for self-help and rehabilitation to entitled persons.
11.1.2 The aim of the Rehabilitation Appliances Program is to restore, facilitate or maintain functional independence and/or minimise disability or dysfunction as part of the provision of quality care to entitled persons.
11.1.3 Appliances shall be provided:
(a) according to an assessed clinically indicated need; and
(b) in an efficient manner of delivery; and
(c) towards meeting health care objectives; and
(d) in a cost effective manner; and
(e) on a timely basis.
11.1.4 An appliance that is provided should be:
(a) appropriate for its purpose; and
(b) safe for the particular entitled beneficiary; and
(c) part of the overall management of health care for the entitled person;
but should not be an item that is customarily used for domestic purposes and would be used merely for such a purpose by the entitled person.
11.2 Supply of rehabilitation appliances
11.2.1 Unless otherwise indicated in these Principles, the Commission will arrange the supply of rehabilitation appliances on the condition that these are returned when no longer needed or if the Commission so requests.
Note: an example where the Commission could request the return of a rehabilitation appliance is where it cannot be accommodated in an institution.
11.2A Prior Approval
11.2A.1 If under this Part or under the DVA documents entitled, respectively, the “RAP National Schedule of Equipment” in force on the date in Schedule 1 and the "Rehabilitation Appliances Program (RAP) National Guidelines" in force on the date in Schedule 1, the Commission's prior approval is required for the supply of a rehabilitation appliance to an entitled person or the alteration to, replacement or repair of a rehabilitation appliance, then the Commission is not to accept financial liability for the supply, alteration, replacement or repair, as the case may be, unless it has granted that prior approval.
Note: in granting prior approval the Commission must consider the matters in paragraph 3.2.2.
11.2A.2 A grant of prior approval must be recorded in writing by the Department within 7 days after it has been made.
11.2A.3 The record may be maintained in electronic form and must be stored by the Department for a period of at least 12 months commencing on the 8th day after the grant of prior approval was made.
11.3 Restrictions on the supply of certain items
11.3.1 Subject to this Part, the Commission will provide or accept financial responsibility for the following appliances only to entitled members who have a medically assessed need for these items due to a service injury or service disease:
(a) the supply of electric wheelchairs or electric scooters;
(b) the supply of a guide dog, provided that the Commission will not be responsible for costs associated with keeping the dog;
(c) the supply of special vehicle driving controls and devices, if the entitled member owns the vehicle and is licensed under relevant State or Territory law to drive a modified vehicle.
11.3.2 Subject to this Part, the Commission will provide or accept financial responsibility for the provision of electronic communication equipment only to entitled members who are:
(a) legally blind; or
(b) severely handicapped.
11.3.3 For the purposes of paragraph 11.3.2, a legally blind entitled member means an entitled member:
(a) whose legal blindness is service injury or service disease; and
(b) who has a medically assessed need for the electronic communication equipment; and
(c) who has been assessed by the Commission as being able to benefit from use of the electronic communication equipment.
11.3.4 For the purposes of paragraph 11.3.2, a severely handicapped entitled member means an entitled member:
(a) whose severe handicap was a service injury or service disease; and
(b) who has a medically assessed need for the electronic communication equipment; and
(c) who has been assessed by the Commission as being able to benefit from the use of the equipment because it would substantially improve the member's:
(i) communication skills; and
(ii) quality of life.
11.3.6 Subject to 11.3.6A and 11.3.7, the Commission will not approve the supply of a rehabilitation appliance to an entitled person who is in an institution or who has entered a Commonwealth, State or Territory program if the Commission is satisfied that:
(a) for an institution, the appliance should be supplied by the owner or operator of the institution because:
(i) any Commonwealth, State or Territory legislation under which the institution (or owner or operator) is registered, licensed or otherwise authorised enables the appliance to be supplied; or
(ii) due to charges made by or subsidies received by the owner or operator of the institution under Commonwealth, State or Territory legislation, it is fair for the owner or operator of the institution to bear the cost of supplying the appliance; or
Note: the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
installing the appliance would involve an alteration to the structure of part of the institution; or
(iv) it is otherwise appropriate for the appliance to be supplied by the owner or operator.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village, and a cluster of self-care units.
Note (2): the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
for an institution, where the appliance is a hand rail, ramp, non-slip surface or similar appliance, the appliance should be supplied by the entitled person or the owner or operator of the institution because the entitled person should have known, by reason of the person’s state of health or frailty at the time the person arranged to enter the institution, that such an appliance would have been likely to have been needed by the person upon being admitted to the institution or a short time thereafter.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village, and a cluster of self-care units.
Note (2): The policy is that entitled persons entering institutions should ensure the institution caters to their needs before they take up residence.
Note (3): A guide to a “short time” is a period within 6 months after entering the institution.
Note (4): the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
for a program, it is more appropriate that the appliance is provided under the program because:
(i)the Commonwealth financially contributed to the program, if the case; or
(ii)the program’s budget appears sufficient to reasonably absorb the cost of the appliance; or
(iii)the Department is under a short-term financial constraint; or
(iii) it is otherwise appropriate for the appliance to be supplied under the program.
Note: the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
The Commission will approve the supply of a rehabilitation appliance to an entitled person in an institution or participating in a Commonwealth, State or Territory program, if:
(a) the Commission approved the appliance for the person before the person entered the institution or the program and that approval has not been revoked; and
(b) for a person in an institution, any alteration to the structure of part of the institution necessary to install or attach the appliance satisfies the requirements in (a) and (b) of 11.3.7; and
Note: (a) and (b) deal with compliance with relevant laws and approval by owner of property to installation/attachment together with an undertaking by the owner not to seek compensation if the appliance is removed.
(c) the rehabilitation appliance is not a consumable
rehabilitation appliance.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village, and a cluster of self-care units.
Note (2): 11.3.6A is relevant in relation to the maintenance or repair of the appliance. Generally, only an approved appliance may be maintained or repaired at Commission expense.
11.3.7 Subject to other conditions specified in this Part, the Commission may approve the installation or the attachment of a rehabilitation appliance to property when:
(a) the installation or the attachment conforms to Commonwealth, State or Territory laws relating to alterations to property; and
(b) the property owner has given approval and an undertaking not to seek compensation for restoration of the property when the appliance is no longer required by the entitled person to whom the aid was supplied.
11.3.8 Subject to this Part, the Commission may provide or accept financial responsibility for the installation of a telephone deaf aid and/or touch phone and the rental of the aid for the first year, in the workplace of an entitled member who has a medically assessed need for these items because of a service injury or service disease.
11.4 Visual aids
11.4.1 The Commission may accept financial liability for visual aids dispensed by an optical dispenser (who may be an optometrist) to an entitled person on the prescription of an ophthalmologist or an optometrist (with a current provider number) where the visual aids have been provided in accordance with:
(a) the Principles; and
(b) Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optometrists and optical dispensers)); and
(c) the DVA document entitled “Pricing Schedule for Visual Aids”, in force on the date in Schedule 1.
11.4.2 Visual aids may be prescribed from the DVA document entitled “Pricing Schedule for Visual Aids”, in force on the date in Schedule 1.
11.4.3 The Commission’s prior approval is required for the prescription of items not listed in the DVA document entitled “Pricing Schedule for Visual Aids”, in force on the date in Schedule 1, except in the circumstances referred to in paragraph 11.4.6.
11.4.4 Subject to paragraph 11.4.5, in any two year period, the Commission shall not provide an entitled person with:
(a) more than one pair of distance spectacles and one pair of readers; or
(b) more than one pair of bifocals, trifocals or progressive power lenses.
11.4.5 The Commission will provide an entitled person with renewed lenses before the expiration of two years if:
(a) in the opinion of the treating practitioner, there has been a change in;
(i) the person’s refraction; or
(ii) the condition of the person’s eyes,
that necessitates new lenses; or
(b) there has been accidental loss or breakage.
11.4.6 If an entitled person chooses spectacle frames or lenses that differ from those listed in the DVA document entitled “Pricing Schedule for Visual Aids”, in force on the date in Schedule 1, or that have not been medically prescribed, the Commission will accept financial responsibility only to the financial limits set out in the schedule.
11.5 Hearing aids
11.5.1 The Commission will approve the supply of a spectacle hearing aid when it is the only type of hearing aid appropriate and the person is entitled to the treatment:
(a) of all injuries or diseases; or
(b) of deafness that is a service injury or service disease; or
(c) of a visual defect that is a service injury or service disease and the need for a spectacle hearing aid arises from the person’s inability to accommodate spectacles and a separate hearing aid.
11.5.2 Where a person who has a hearing defect that is a service injury or service disease is provided with a spectacle hearing aid under paragraph 11.5.1:
(a) new lenses will be provided; or
(b) the existing spectacle lenses will be fitted as part of the aid.
11.5.3 The Commission will not be responsible, under paragraph 11.5.2, for the further supply or the fitting of lenses if the person is not entitled to the supply of spectacles.
11.5.4 Subject to prior approval, the Commission may accept financial responsibility for the supply of a hearing aid from an audiology provider if the hearing aid is unable to be supplied to the entitled person under the Hearing Services Administration Act 1997 or the Hearing Services Act 1991.
11.5.5 The Commission may accept financial responsibility for service charges in respect of a hearing aid that has been supplied under paragraph 11.5.4.
11.5.6 The Commission may accept financial responsibility for service charges in respect of a hearing aid following the supply of that hearing aid under paragraph 11.5.4 or 11.5.5.
11.6 Other rehabilitation appliances
11.6.1 Subject to this Part, the Commission may arrange for a wig to be supplied to an entitled person who:
(a) became bald as a result of a service injury or service disease or as a result of the treatment of a service injury or service disease; or
(b) requires a wig as part of medical treatment for disfigurement.
11.6.2 The Commission will not accept financial responsibility for the cleaning and setting of a wig.
11.6.3 Subject to this Part, the Commission may:
(a) provide medically suitable footwear as an aid; or
(b) approve the repair of an entitled person’s own footwear as part of medically prescribed alterations to the footwear.
11.6.4 Where the Commission approves the provision of stoma appliances and consumables, the provision will be through:
(a) a stoma association; or
(b) the Pharmaceutical Benefits Scheme; or
(c) the MRCA Pharmaceutical Benefits Scheme.
11.6.5 The Commission will accept financial responsibility for the cost of membership of a stoma association and for the cost of postage of stoma supplies.
11.7 Repair and replacement
11.7.1 The Commission may approve the provision of more than one of the same rehabilitation appliance if the entitled person depends completely on the appliance, and:
(a) it is necessary to maintain the appliance in a hygienic condition because of domestic or occupational circumstances; or
(b) the entitled person lives in an isolated country area and would be handicapped by loss or breakage; or
(c) there are other circumstances where the Commission considers it reasonable to do so.
11.7.2 Subject to paragraphs 11.7.6 and 11.7.7, the Commission will not be financially responsible for the alteration to, or the repair of, a treatment aid without prior approval.
11.7.3 The Commission will not be financially responsible for, or reimburse, the cost of an alteration to, or a repair of, a rehabilitation appliance for which it has not accepted financial responsibility, unless there are circumstances where the Commission considers it reasonable to accept financial responsibility.
11.7.4 The Commission will not be financially responsible for repair or replacement of a rehabilitation appliance for a non service injury or disease injury or disease while an entitled person is travelling overseas.
11.7.5 Prior approval will be given for the repair or replacement of an appliance where repair or renewal is necessary because:
(a) the appliance was damaged by normal wear and tear;
(b) the appliance inadvertently was damaged or lost; or
(c) the health-care practitioner treating the entitled person considers that a replacement is required because the person’s condition has changed.
11.7.6 The Commission will not give approval for the repair or replacement of an appliance if repair or renewal is necessary as the result of:
(a) a wilful act of the entitled person using or wearing the appliance; or
(b) a negligent act of the entitled person using or wearing the appliance and the person has damaged or lost a similar appliance in the past as a result of negligence or wilfulness.
11.7.7 Prior approval is not required for repairs to spectacles.
11.8 Treatment aids from hospitals
11.8.1 The Commission may provide, or accept financial responsibility for, treatment aids as part of inpatient treatment where the aids expedite discharge from hospital.
11.8.2 The conditions for the supply of treatment aids are the same as those normally applied by the hospitals for patients not covered by these Principles.
11.8.3 The Commission will not provide, or accept financial responsibility for, a treatment aid as part of inpatient or outpatient treatment where the treatment solely comprises the provision of the treatment aid.
11.9 Provision of aids and appliances for accident prevention and personal safety
11.9.1 The Commission may assist in providing aids and appliances for accident prevention and personal safety for an entitled person by approving, only once in any period of 12 months, financial assistance towards the cost of such aids or appliances to a maximum amount of $200 (maximum amount) — increased annually (if the following formula results in an increase) on 1 January by an amount worked out in accordance with the following formula:
maximum amount (including as indexed) x the movement (expressed as a percentage) in the Wage Cost Index 5 for the previous financial year (as advised to the Department by the Australian Government Treasury), rounded to the nearest dollar = increase.
11.9.1A For the purposes of paragraph 11.9.1:
(a) a period of 12 months commences on the date the Commission approves financial assistance; and
(b) the Commission is not to approve financial assistance for an entitled person if 12 months has not elapsed from and including the date of any previous approval.
11.9.1B Where the Commission approves financial assistance under paragraph 11.9.1 of the revoked MRCA Treatment Principles before the commencement of the MRCA Treatment Principles (Instrument 2013 No. MRCC 53) (commencement date), and on the commencement date a period of 12 months had not expired from and including the date of that approval, the approval is taken to have been granted under the MRCA Treatment Principles (Instrument 2013 No. MRCC 53) and the period of 12 months commences on the date of the approval.
11.9.2 The Commission may give approval under paragraph 11.9.1 only if it has received a report from a home and safety assessor and the Commission is satisfied that the aid or appliance for which assistance is sought:
(a) is needed by the person for accident prevention or personal safety as part of the person’s preventive health care management; and
(b) is appropriate for its purpose; and
(c) is safe and appropriate for the person’s particular circumstances; and
(d) is customarily used for domestic purposes and would be used for such purposes by the person; and
(e) would be provided or installed efficiently, cost effectively, and on a timely basis.
11.9.3 The Commission may enter into arrangements with a person or persons:
(a) to provide the Commission with reports from home and safety assessors; and
(b) for the provision of aids and appliances for accident prevention and personal safety.
11.9.4 Subject to Principle 3.4, the Commonwealth will not be financially responsible, either partly or wholly, for the purchase, supply, or installation of an aid or appliance for accident prevention and personal safety unless:
(a) financial assistance has been approved under paragraph 11.9.1; and
(b) the appliance is provided under an arrangement entered into under paragraph 11.9.3.
11.9.5 The Commission will not accept financial responsibility, either partly or wholly, for the purchase, supply, or installation of an aid or appliance for accident prevention and personal safety in respect of an entitled person who is in an institution or who has entered a Commonwealth, State or Territory program if, had the appliance been a rehabilitation appliance considered for supply under 11.3.6, the Commission would not, under 11.3.6, have approved its supply in respect of the person.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village, and a cluster of self-care units.
Note (2): the intention is that only the “rehabilitation appliance provisions” in respect of institutions/programs apply to “accident prevention and personal safety appliances” in institutions or under programs, not that any other rehabilitation appliance provision applies to accident prevention and personal safety appliances in institutions or under programs.
11.9.7 The Commonwealth will not be financially responsible for the maintenance or repair of any aid or appliance for which the Commission has approved financial assistance under this Principle.
11.9.8 The Commonwealth will not be responsible for any damage caused by:
(a) the installation, operation, non-operation, use, or misuse of an aid or appliance for which the Commission has approved financial assistance under this Principle; or
(b) any delay in installing such an aid or appliance or approving financial assistance under this Principle.
PART 12 — OTHER TREATMENT MATTERS
12.1 Ambulance transport
12.1.1 With the exception of arrangements for medical emergency under paragraph 12.1.4 and special arrangements under paragraph 12.1.5, prior approval must be obtained in all cases before ambulance transport is used by an entitled person.
12.1.2 Approval for ambulance transport normally will be given where the entitled person:
(a) is a stretcher case;or
(b) requires treatment during transport;or
(c) is grossly disfigured; or
(d) is incontinent to a degree that precludes the use of other forms of transport.
12.1.3 Other than in exceptional circumstances, air ambulance will be approved only to transport an entitled person with acute medical and surgical complaints for admission to, or discharge from, a hospital.
12.1.4 The Commission will accept financial responsibility for the use of ambulance transport in a medical emergency for an entitled person if an office of the Department is notified on the first working day after the ambulance transport is used or as soon thereafter as is reasonably practicable.
12.1.5 Prior approval for ambulance transport for entitled persons is not required where the transport is provided under arrangements between the ambulance service provider and the Commission.
12.2 Treatment under Medicare Program
12.2.1 Entitled persons may choose to have their treatment arranged through the Department or under a medicare program.
12.2.2 Subject to these Principles, entitled persons who are treated under a medicare program may also receive services that are not covered by the MBS at the Commission’s expense.
12.2.3 When part or all of the cost of a treatment item has been paid as a medicare benefit, the Commission will not pay for the same professional or ancillary service regardless of the person’s entitlement under the Act.
12.4 Prejudicial or unsafe acts or omissions by patients
12.4.1 The Commission may refuse to be financially responsible for, or provide treatment to, or any further treatment to, an entitled person who, by an act or omission, deliberately prejudices his or her own, or a fellow patient’s, treatment or the safety of persons providing treatment.
12.6 Recovery of moneys
12.6.1 Where a payment has been made to any person or body, purportedly as payment for treatment, the Commission may recover (up to the extent that the payment exceeds the amount, if any, that should have been paid to that person or body) any moneys, the payment of which was induced or affected at all by:
(a) any misrepresentation; or
(b) any mistake of fact; or
(c) any mistake of law; or
(d) any other cause.
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 317 of the Act, by offsetting moneys for any excess amounts against any later claims for payment by that person or body; or
Note: Section 317 provides, in effect, that where amounts have been overpaid, the Commission may, if the person agrees, offset money owed against later payments.
(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.
Transitional Provisions
(1) MRCA Treatment Principles (2013 No. MRCC 53)
(a) any arrangement entered into, or taken to have been entered into, by the Commission or the Department (on behalf of the Commission) with a health provider, under the revoked MRCA Treatment Principles, being an arrangement that is in force immediately before the commencement of these Principles ¾ is taken to have been entered into under these Principles.
(b) any action taken (e.g. issue of a notice, grant of approval, giving of a receipt), and any document produced in the course of that action, by the Commission, the Department (on behalf of the Commission), a health provider or an entitled person, under the revoked MRCA Treatment Principles, being action or a document that is in effect or in force immediately before the commencement of these Principles ¾ is deemed, respectively, to have been taken or produced under these Principles.
(c) a Scheme (eg Local Medical Officer Scheme, Local Dental Officer Scheme) prepared by the Repatriation Commission under the Treatment Principles under section 90 of the Veterans' Entitlements Act 1986, that is in force immediately before the commencement of these Principles and is referred to in these Principles, is taken to have been made by the Commission under these Principles.
(d) a person who was receiving care under a Community Aged Care Package or Extended Aged Care at Home Package under the revoked MRCA Treatment Principles immediately before the commencement of these Principles, is, on the commencement of these Principles, entitled to a continuation of that care as if it is home care under these Principles.
(e) a requirement in a provision under the Principles for a person to hold a qualification (current qualification), being a different qualification required by the provision in the revoked MRCA Treatment Principles (former qualification) in the state the revoked MRCA Treatment Principles existed immediately before the commencement of these Principles under 1.1.4, is satisfied where a person holds a former qualification.
Note: under the revoked MRCA Treatment Principles an aboriginal health worker needed to have undertaken an “aboriginal health care course” at an institution recognised by the Department of Health and Ageing but under these Principles the institution must be recognised by the Department of Prime Minister and Cabinet. The qualification of an aboriginal health worker obtained at an institution recognised by the former Department of Health and Ageing is recognised under these Principles as if the institution had been recognised by the Department of Prime Minister and Cabinet.
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. ...
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 (paragraph 6A.4.2(b));
23. Notes for Coordinated Veterans' Care Program Providers (Part 6A);
24. Rehabilitation Appliances Program (RAP) National Guidelines (paragraph 11.2A.1);
25. RAP National Schedule of Equipment (paragraph 11.2A.1);
26. Veterans and Veterans Families Counselling Services (VVCS) Outreach Program Counsellors (OPC) Provider Notes (paragraph 1.4.1 and 7.1A.1);
27. Veterans and Veterans Families Counselling Service (VVCS) Outreach Program Counsellors (OPC) Schedule of Fees (paragraph 3.5.1);
28. General information about VVCS – Veterans and Veterans Families Counselling Service (paragraph 1.4.1);
29. Better Access to Psychiatrists, Psychologists & General Practitioners through the Medical Benefits Schedule Initiative
1 November 2013.
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