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Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006

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Australian Participants in British Nuclear Tests (Treatment) Act 2006
 
Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006
 
Instrument 2006 No. R34
 
The Repatriation Commission makes this Instrument for the purposes of subsection 17(2) of the Australian Participants in British Nuclear Tests (Treatment) Act 2006.
 
 
Dated this 13th day of December 2006
 
 
 
 
MARK SULLIVAN
PRESIDENT
ED KILLESTEYN
DEPUTY PRESIDENT
SIMON HARRINGTON
COMMISSIONER
 
 
 
 
 
 
1.      Definitions
 
In sections 1-3 of this instrument:
 
Act means the Australian Participants in British Nuclear Tests (Treatment) Act 2006.
 
Repatriation Private Patient Principles means the instrument referred to in section 17 of the Act as that instrument is incorporated in the Act.
 
2.      Commencement
 
This instrument commences on the day after it is registered on the Federal Register of Legislative Instruments.
 
3.      Modification of the Repatriation Private Patient Principles
 
         The Repatriation Private Patient Principles are modified in accordance with the Schedule.
 
 
 
 
 
 
 
 
 
 
 
SCHEDULE
 
4.      Title (twice occurring)
 
          omit:
2004
substitute:
 
(Australian Participants in British Nuclear Tests) 2006
 
Note: the purpose of this provision is to ensure a part of the Repatriation Private Patient Principles, as that instrument is incorporated in the Act, is retained to ensure the Repatriation Private Patient Principles are modified and not substituted.
 
5.      All provisions other than the title:
 
          substitute:
 
Contents
 
1.           Preliminary................................................................. 5
1.1      Principles.......................................................... 5
1.2      Defined terms.................................................... 5
Act................................................................. 5
admission........................................................ 5
Commission.................................................... 1
contracted private hospital............................... 5
country area.................................................... 6
Department..................................................... 6
emergency....................................................... 6
entitled person................................................. 6
facility fee........................................................ 6
Local Medical Officer...................................... 6
medical specialist............................................. 7
                               prior approval......................................           2
private hospital................................................ 7
private patient.................................................. 7
veteran partnering private hospital.................... 8
1.3      Private patient status.......................................... 9
2.           Order of preference for admission to hospital.. 9
2.1      Order of preference........................................... 9
2.2      Objective........................................................ 10
3.           Prior approval not required................................. 10
3.1      Medical specialist treatment............................. 10
3.2      Non-emergency Tier 1 hospital treatment......... 10
3.3.     Non-emergency Tier 2 hospital treatment......... 10
3.4.     Emergency hospital treatment........................... 10
3.5      Notification of admission.................................. 11
3.7      Payment of facility fee...................................... 11
4.           Prior approval required........................................ 11
4.1      Tier 2 hospital admission and treatment............ 11
4.2      Tier 3 hospital admission and treatment............ 11
4.3      Criteria for Tier 2 or Tier 3 hospital admission and treatment 11
4.4      Admission to Tier 3 hospital of choice.............. 12
4.5      Commonwealth liability if Tier 3 admission by choice 13
 
1.           Preliminary
1.1    Principles
These Principles are the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006.
1.2    Defined terms
For the purposes of these Principles, unless a contrary intention appears:
Act
Act means the Australian Participants in British Nuclear Tests (Treatment) Act 2006 in force from time to time.
admission
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 Veterans’ Entitlements Act 1986.
pensable patientontracted private hospital
contracted private hospital means a private hospital in respect of which the Commission has entered into arrangements, for the treatment of entitled persons, under the Act, or, if no arrangement has been entered into with the hospital under the Act, under the VEA.
 
country area
country area of a State has the meaning given it by the Instrument made by the Commission under paragraph 80 (2) (b) of the VEA.
Department
Department means the Australian Government Department of Veterans’ Affairs.
Emergency
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
entitled person means a person eligible for treatment under the Act.
facility fee
facility fee means a fee relating to accident and emergency services charged by a particular hospital.
Local Medical Officer
former Repatriation Hospital means a hospital or other institution that was formerly operated by the Commission under paragraph 89(1)(a) of the VEA.
          Note: see the Repatriation Institutions (Transfer) Act 1992
 
Local Medical Officer means a private medical practitioner who, under arrangements entered into with the Commission under paragraph 84(1)(c) of the VEA, provides medical treatment to persons entitled to treatment under the VEA.
medical specialist
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.
 
Principles means the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006.
Medicare Benefits Scheduleior approval
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
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 patient
private patient has the meaning given by subsection 17(8) of the Act.
 
public hospital means a hospital operated by a State or Territory or by the Commonwealth.
eteran partnering hospital

Treatment Principles means the document prepared by the Commission under section 16 of the Act that sets out the circumstances in which, and conditions subject to which, treatment may be provided to entitled persons.
 
VEA means the Veterans’ Entitlements Act 1986.
 
VEA Repatriation Private Patient Principles 2004 means the principles determined by the Commission under section 90A of the VEA.
 
VEA Treatment Principles means the document known as the Treatment Principles and prepared by the Commission under section 90 of the VEA.
 
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 section 15 of the Act or subsection 89(1) of the VEA, as the case may be.
Note:      other Tier 1 status hospitals which have similar partnering arrangements are public hospitals and former Repatriation Hospitals.
 
1.3    Private patient status
An entitled person is to receive hospital care as a private patient, which entitles the person, as a minimum, to:
(a)      the patient’s choice of doctor, subject to the doctor having practising rights at the relevant hospital; and
(b)     shared accommodation; and
(c)      if medically necessary, private accommodation.
 
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.
3.7    Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
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.