Australian Government
Veterans’ Entitlements Act 1986
 
Repatriation Private Patient Principles
Instrument 2015 No.R33
 
 
I, Michael Ronaldson, Minister for Veterans’ Affairs, approve this instrument under subsection 90A(4) of the Veterans’ Entitlements Act 1986.
 
Dated this 18th               day of August                      2015
Michael Ronaldson
MICHAEL RONALDSON
 
 
 
The Repatriation Commission makes this instrument under subsection 90A(1) of the Veterans’ Entitlements Act 1986.
 
Dated this                          6th  day of August                                  2015
The Seal of the                                                                )
Repatriation Commission                                                )  SEAL
was affixed hereto in the                                                )
presence of:                                                                      )
 
 
                     Simon Lewis                                                                                                           Craig Orme
...................................................................................................................................................................
                  SIMON LEWIS                                                                                                    CRAIG ORME            
                                                                                                                                                      AM CSC                                                          
                   PRESIDENT                                                                                                   DEPUTY PRESIDENT                             
 
 
 
 
 

 
 
 
 
 
Repatriation Private Patient Principles
 
 
Instrument 2015 No. R33
 
made under the
 
Veterans' Entitlements Act 1986
 
Contents
 
1.           Preliminary. 1
1.1      Principles. 1
1.1A    Commencement
1.2      Defined terms. 1
1.3      Private patient status. 5
2.           Order of preference for admission to hospital 6
2.1      Order of preference. 6
2.2      Objective. 6
3.           Prior approval not required.. 7
3.1      Medical specialist treatment 7
3.2      Non-emergency Tier 1 hospital treatment 7
3.3.     Non-emergency Tier 2 hospital treatment 7
3.4.     Emergency hospital treatment 7
3.5      Notification of admission. 7
3.6      Urgent treatment for Vietnam veterans and their dependants  8
4.           Prior approval required.. 8
4.1      Tier 2 hospital admission and treatment 8
4.2      Tier 3 hospital admission and treatment 8
4.3      Criteria for Tier 2 or Tier 3 hospital admission and treatment 9
4.4      Admission to Tier 3 hospital of choice. 10
4.5      Commonwealth liability if Tier 3 admission by choice  10
5.           Treatment Monitoring 10
5.1      Consultative Forum
 
1.       Preliminary      

1.1       Principles
These Principles are the Repatriation Private Patient Principles.
Commencement
1.1A    These Principles commence on the day after registration.
1.2       Defined terms
For the purposes of these Principles, unless a contrary intention appears:
 
Act means the Veterans’ Entitlements Act 1986 in force from time to time.
 
admission means admission for treatment as an in-patient or day-patient upon the referral of a medical specialist or a Local Medical Officer.
 
Commission means the Repatriation Commission, continued in existence by section 179 of the Act.contracted private hospital
 
consultative forum means the forum in each State established by the Department of Veterans’ Affairs for the purpose of, among other functions, monitoring the treatment of entitled persons and consisting of representatives of the Repatriation Commission, the Military Rehabilitation and Compensation Commission and the ex-service community.
contracted private hospital means a private hospital in respect of which the Commission has entered into arrangements for the treatment of entitled persons.
 
Department means the Australian Government Department of Veterans’ Affairs.
 
dependant of a Vietnam veteran means a person described in subsection 86(5) of the Act.
 
Deputy Commissioner means the person appointed by the Secretary of the Department to manage the affairs of the Department in a State or Territory.
 
emergency means a situation in which a person requires immediate treatment because of a serious threat to the person’s life or health.
 
entitled person means a person eligible for treatment under Part V of the Act but does not include a Vietnam veteran, or a dependant of a Vietnam veteran, who is eligible only under subsection 85(9) or subsection 86(5) of the Act, respectively, for urgent treatment.
 
former Repatriation Hospital means a hospital or other institution that was formerly operated by the Commission under paragraph 89(1)(a) of the Act.
 
  Note:  see the Repatriation Institutions (Transfer) Act 1992
 
Local Medical Officer 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 the Treatment Principles and in the “Notes for Local Medical Officers”; and
 
                                (b) has been given a provider number by Medicare, in respect of being a medical practitioner, that has not been suspended or revoked.
 
medical practitioner means a person registered or licensed as a medical practitioner under a law of a State or Territory that provides for the registration or licensing of medical practitioners but does not include a person so registered or licensed:
 
(a)  whose registration, or licence to practise, as a medical practitioner 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 medical practitioner in that State or Territory.
 
medical specialist means a medical practitioner who is recognised as a consultant physician or specialist in the appropriate specialty for the purposes of the Health Insurance Act 1973.
 
Medicare means the Chief Executive Medicare under Part IIA of the Human Services (Medicare) Act 1973.
 
Notes for Local Medical Officers has the same meaning it has in the Treatment Principles.
 
Principles means the current Repatriation Private Patient Principles determined by the Commission under subsection 90A(1) of the Act.
 
prior approval means:
  (a)         in relation to treatment—approval by the Commission for treatment before the treatment was given or commenced to be given; and
  (b)         in relation to admission to a hospital—approval by the Commission for admission to that hospital before the person is admitted.
 
private hospital means premises that have been declared to be:
  (a)         a private hospital for the purposes of the Health Insurance Act 1973; or
  (b)         a day hospital facility for the purposes of the National Health Act 1953.
 
private health insurer has the meaning it has in the Private Health Insurance Act 2007.
 
private patient has the meaning given by subsection 90A (8) of the Act.
 
public hospital means a hospital operated by a State or Territory or by the Commonwealth.
 
revoked Repatriation Private Patient Principles means the Repatriation Private Patient Principles 2004 No.R17.
 
Treatment Principles means the document prepared by the Commission under section 90 of the Act that sets out the circumstances in which, and conditions subject to which, treatment may be provided to entitled persons.
 
veteran partnering private hospital means a contracted private hospital that is described as a “veteran partnering private hospital” in its arrangement with the Commission under subsection 89(1) of the Act.
 
Note:      other Tier 1 status hospitals which have similar partnering arrangements are public hospitals and former Repatriation Hospitals.
 
Vietnam veteran means a person described in subsection 85(9) of the Act.
 
1.3       Private patient status
An entitled person is to receive hospital care as a private patient — which entitles the person to:
(a)        the patient’s choice of doctor, subject to the doctor having practising rights at the relevant hospital; and
(b)        shared accommodation; or
(c)        if medically necessary, private accommodation; or
(d)       private accommodation, if available, where the entitled person or the person’s private health insurer agrees to pay the difference between the cost of shared accommodation and the cost of private accommodation for the person; or
(e)        on and after 1 July 2016, private accommodation, if available, in a contracted private hospital.
 

2.       Order of preference for admission to hospital

2.1       Order of preference
Preference for admission is to be in accordance with the following table:
 
Level
Preference
Hospital

Tier 1
first
former Repatriation Hospital, public hospital, or veteran partnering private hospital

Tier 2
(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital.  The Contracted private hospital must seek prior approval for all other admissions.

Tier 2
second
Contracted private hospital

Tier 3
third
Non-Contracted private hospital

2.2       Objective        
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3.       Prior approval not required

3.1       Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the Treatment Principles.
3.2       Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3.      Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4.      Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5         Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6     Urgent treatment for Vietnam veterans and their dependants
A Vietnam veteran or a dependant of a Vietnam veteran may be admitted to:
  (a)      a former Repatriation Hospital; or
  (b)      a public hospital in a State or Territory;
for in-patient treatment without prior approval if such treatment is certified by a medical practitioner as being urgently required.
4.       Prior approval required

4.1       Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2       Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3       Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
  (a)      admission to; or
  (b)      continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
  (c)      advice from the person’s treating medical practitioner concerning:
  (i)       the injury or disease being treated; and
 (ii)       the clinical need for the proposed treatment; and
(iii)       the degree of pain or discomfort; and
(iv)       the effect on the person’s quality of life; and
(d)     in light of the severity of the entitled person’s clinical condition:
  (i)       the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
 (ii)       the distance that the entitled person would have to travel; and
  (e)      reasonable control over Commonwealth expenditure; and
  (f)      the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g)      any other relevant requirement in these Principles or in the Act.
4.4       Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
4.5       Commonwealth liability if Tier 3 admission by choice
If an entitled person, in accordance with paragraph 4.4, elects to be admitted to a Tier 3 hospital, the Commonwealth will be liable only for:
  (a)      accommodation costs; and
  (b)      pharmaceutical fees; and
  (c)      theatre fees; and
  (d)     certain incidental expenses;
 
provided such costs, fees or expenses are, in the Commission’s opinion, reasonable.
5.       Treatment Monitoring

5.1       Consultative Forum
5.1.1    A consultative forum is given the function of monitoring these Principles, especially in respect of access to, and quality of, the care, welfare and treatment provided to entitled persons.  In particular, the consultative forum has the role of receiving and considering comments and concerns, and providing information relating to these issues to the ex-service community.