EXPLANATORY STATEMENT
Veterans’ Entitlements (Treatment Principles – Providers/Treatment in New Guinea/ACPMH Treatment/Incorporated Documents) Instrument 2007
EMPOWERING PROVISION
Section 90 of the Veterans’ Entitlements Act 1986 (the Act).
PURPOSE
The attached instrument (R25/2007) amends the Treatment Principles. The Treatment Principles is a legislative instrument made under section 90 of the Act and sets out the circumstances in which the Repatriation Commission may accept financial liability for treatment provided to veterans or their dependants (entitled persons).
The purpose of the attached instrument is to:
- enable the Department of Veterans’ Affairs (DVA) to decline to pay for treatment provided to an entitled person if the practitioner providing the treatment is disqualified under the Health Insurance Act 1973 from being paid a medicare benefit (“Disqualification Amendment”);
- make it clear that veterans who are residing in Papua New Guinea and have done so on and from the date of independence (16 September 1975) are entitled to treatment for all of their conditions – not just war-caused conditions (“Papua New Guinea Amendment”);
- introduce a new treatment for entitled veterans – ACPMH treatment, being treatment provided under the auspices of the Australian Centre for Posttraumatic Mental Health Incorporated;
- update certain documents incorporated-by-reference into the Treatment Principles (“Incorporated Documents Amendment”).
Disqualification Amendment
The aim here is to maintain the financial integrity of the Repatriation Comprehensive Care Scheme by ensuring that DVA does not pay for treatment services provided by practitioners who have been found by Medicare Australia to have acted in an unprofessional manner e.g. overserviced.
Papua New Guinea Amendment
It is a general rule that DVA will only pay for “overseas treatment” for veterans if the treatment is for a war-caused condition. An exception is where the veteran has resided in Papua New Guinea on and from Independence Day ( 16 September 1975). However the Repatriation Commission considered this exception could be expressed more clearly and the attached instrument ensures this occurs by expressly stating that the treatment may be for any condition, not just a war-caused condition.
ACPMH Treatment
This is a new “strategic treatment” provided by the Australian Centre for Posttraumatic Mental Health Incorporated to entitled veterans and involves, among other things, 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 veteran.
This new treatment does not fall within commonly held views of “treatment” but under the Veterans’ Entitlements Act 1986 treatment is a very broad concept and includes “… action taken, with a view to … maintaining a person in, physical or mental health…” (s.80). It is this component of the treatment-concept that forms the basis for ACPMH treatment.
Incorporated Documents Amendment
The Treatment Principles refer to a number of documents that are not set out in the Principles (external documents). An example of such a document is the Pricing Schedule for Visual Aids in force on
1 May 2007.
It is legally permissible to make external documents part of a legislative instrument but the Legislative Instruments Act 2003 specifies that unless the external document is also legislative then it can only be incorporated into the legislative instrument as it, the external document, exists at the time the legislative instrument takes effect and not as the external document might exist at a future date when it has changed (s.14). In other words, a non-legislative external document is “frozen” in the form it is in when the legislative instrument that incorporates it, takes effect.
Accordingly, if an external document has been changed then it is necessary to amend the legislative instrument that refers to the document so that the reference to the document is made a reference to the updated document.
The attached instrument amends the Treatment Principles so that references to certain external documents are references to those documents in their updated (changed) form as at 1 November 2007.
RETROSPECTIVE
No.
CONSULTATION
In relation to the “Disqualification Amendment”, Medicare Australia was consulted. Practitioners were not consulted because the Rule-Maker considered that consultation was not appropriate because the relevant practitioners were already subject to the same type of provision in the Health Insurance Act 1973 in relation to treating Commonwealth-funded patients and essentially all the attached instrument does is enlarge that group of Commonwealth-funded patients.
In relation to the “Papua New Guinea Amendment”, the Rule-Maker considered that consultation was not appropriate because the amendment was beneficial (clarification that a benefit was available to entitled persons) and did not alter existing arrangements.
In relation to the “ACPMH Amendment”, the Australian Centre for Posttraumatic Mental Health Incorporated was consulted by the Department of Veterans’ Affairs (DVA) in relation to ACPMH treatment. DVA clients were not consulted because the relevant treatment is beneficial and, further, is of an indirect nature (strategic mental health measure) and in these circumstances the Rule-Maker decided that consultation was not appropriate.
In relation to the “Incorporated Documents Amendment”, the Rule-Maker considered that consultation was not appropriate because the amendment was of a machinery nature and did not substantially alter existing arrangements.
Documents Incorporated-by-Reference
Yes.
The following non-legislative documents in force on 1 November 2007 are incorporated into the Treatment Principles by the attached instrument:
- Dental Schedules;
- Fee Schedules for treatment provided by health care providers;
- Notes for Local Medical Officers;
- Notes for Providers of Optometric Services /Dispensers of Optical Appliances;
- Pricing Schedule for Visual Aids;
- American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (commonly known as DSM-IV);
- Notes for Providers (general);
- Notes for Local Dental Officers;
- Notes for Chiropractors;
- Notes for Diabetes Educators;
- Notes for Dietitians;
- Notes for Exercise Physiologists;
- Notes for Occupational Therapists;
- Notes for Osteopaths;
- Notes for Podiatrists;
- Notes for Physiotherapists;
- Notes for Speech Pathologists;
- RAP National Schedule of Equipment;
- Rehabilitation Appliances Program (RAP) National Guidelines.
At the time the attached instrument was made, all the documents, except the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, were available on the Internet (Department of Veterans’ Affairs web page – under Health – Doctors/Health Care Professionals):
http://www.dva.gov.au/
and at the time the attached instrument was made all the documents were available, or could be made available, at:
Department of Veterans’ Affairs (ACT Office), Lovett Tower, 13 Keltie St Woden ACT 2606 / PO Box 21 Woden ACT 2606. Tel.no.(02) 6289 6243.
Any State or Territory Office of the Department of Veterans’ Affairs:
Tel.no: 133 254
FURTHER EXPLANATION
Attachment A.
Attachment A
Clauses Explanation
1. sets out the name of the instrument.
2. provides that the instrument commences when it is registered on the Federal Register of Legislative Instruments.
3. contains definitions.
4. ensures that any action taken, or decision made, under Notes for Providers, before the commencement of the attached instrument, that on the commencement of the instrument had not been completed or implemented, as the case requires, may be completed or implemented under the relevant Notes for Providers as those Notes are incorporated into the Treatment Principles by the attached instrument.
Schedule A – Disqualification of Providers
1. inserts a more accurate definition of “medicare benefit”.
2. inserts a new definition of “practitioner”. This complements the amendments at items 3, 4, 5 and 6.
3. revises the definition of “provider number” in order to incorporate the more comprehensive definition of “practitioner” in the Health Insurance Act 1973 so that a practitioner under that Act (who may also be a provider under the Treatment Principles) is not only a medical practitioner, dentist or optometrist (as was formerly the case) but is also an allied health care provider.
This means that allied health care providers, and not just medical practitioners, dentists and optometrists, need a provider number if DVA is to pay them for treating entitled persons under the Treatment Principles.
4. prohibits the Repatriation Commission from accepting financial responsibility for a medical-service provided to an entitled person by a medical practitioner if, had the medical practioner provided the service as a practitioner under the Health Insurance Act 1973, a medicare benefit would not have been payable in respect of the service because the practitioner had been disqualified under that Act.
It should be noted that the Repatriation Commission may accept financial liability for a treatment-service and DVA may meet the Commission’s liability by paying for the service.
5. prohibits the Repatriation Commission from accepting financial responsibility for a dental-service provided to an entitled person by a dental practitioner if, had the dental practioner provided the service as a practitioner under the Health Insurance Act 1973, a medicare benefit would not have been payable in respect of the service because the practitioner had been disqualified under that Act.
6. prohibits the Repatriation Commission from accepting financial responsibility for a service provided to an entitled person by a health care provider (i.e. a provider covered by Part 7 of the Treatment Principles) if, had the health care provider provided the service as a practitioner under the Health Insurance Act 1973, a medicare benefit would not have been payable in respect of the service because the practitioner had been disqualified under that Act.
Schedule B – Treatment (New Guinea)
1. makes it clear that the Repatriation Commission will accept financial responsibility for the treatment of any injury or disease (not just a war-caused injury or war-caused disease) of an entitled person who has resided in Papua New Guinea on and from Independence Day.
Schedule C – ACPMH Treatment
1/2. insert definitions.
3. enables the Repatriation Commission to accept financial liability for ACPMH treatment. This provision works in conjunction with an “eligibility determination” under s.88A of the Act that gives entitled veterans eligibility for the treatment. This determination was necessary in order to enable the treatment to be provided to entitled veterans without them needing to satisfy the usual grounds of eligibility for treatment e.g the veteran was suffering from a war-caused condition.
Schedule D – Incorporated Documents
1. incorporates the dental schedules in force on 1 November 2007 into the Treatment Principles.
2. incorporates Fee Schedules in force on 1 November 2007 into the Treatment Principles.
3. incorporates Notes for Local Medical Officers in force on 1 November 2007 into the Treatment Principles.
4. incorporates Notes for Providers of Optometric Services/Dispensers of Optical Appliances in force on 1
November 2007 into the Treatment Principles.
5. incorporates the Pricing Schedule for Visual Aids in force on 1 November 2007 into the Treatment Principles.
6. incorporates the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in force on 1 November 2007 into the Treatment Principles.
7. amends the general provisions that incorporate Notes for Providers into the Treatment Principles by providing that Notes for Providers in force on 1 November 2007 are incorporated into the Principles.
8. incorporates the Notes for Local Dental Officers in force on 1 November 2007 into the Treatment Principles.
9. amends the specific provisions that incorporate Notes for Providers into the Treatment Principles by providing that Notes for Providers in force on 1 November 2007 are incorporated into the Treatment Principles.
10. provides that in order for the Repatriation Commission to be able to accept financial liability for exercise physiology treatment provided by an exercise physiologist to an entitled person, the treatment must have been provided in accordance with the Notes for Exercise Physiologists (in force on 1 November 2007).
11. incorporates the RAP National Schedule of Equipment and the Rehabilitation Appliances Program (RAP) National Guidelines, in force on 1 November 2007, into the Treatment Principles.
12. specifies the date on which external documents incorporated into the Treatment Principles are to be regarded as being in force for the purposes of the Treatment Principles.