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Repatriation Private Patient Principles 2004 Instrument 2004 No. R17
The REPATRIATION COMMISSION revokes the Repatriation Private Patient Principles (Instrument No. 8 of 1992, as amended) and determines the following Repatriation Private Patient Principles under subsection 90A (1) of the Veterans’ Entitlements Act 1986. Dated: 6th December 2004
MARK SULLIVAN
PRESIDENT
IAN CAMPBELL
DEPUTY PRESIDENT
SIMON HARRINGTON
COMMISSIONER
Repatriation Private Patient Principles 2004 Instrument 2004 No. R17 made under section 90A of the Veterans’ Entitlements Act 1986
Contents 1. Preliminary................................................................. 1 1.1 Principles.......................................................... 1 1.2 Defined terms.................................................... 1 Act................................................................. 1 admission........................................................ 1 carerCommission......................................... 1 contracted private hospital............................... 2 country area.................................................... 2 Department..................................................... 2 emergency....................................................... 2 entitled person................................................. 2 facility fee........................................................ 2 Local Medical Officer...................................... 3 medical specialist............................................. 3 prior approval...................................... 2 private hospital................................................ 3 private patient.................................................. 4 veteran partnering private hospital.................... 4 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 3.7 Payment of facility fee........................................ 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 Committees.................... 10 5.1 Continued existence of Committees.................. 10 5.2 Appointments to National Committee............... 11 5.3 Appointments to State Committees.................. 11 5.4 Role of Committees......................................... 12 5.5 National Committee must report to the Commission 12 5.7 Minister must table report in Parliament…………………………………..13 6. Removal of Members……………………………12 7. Transitional provisions......................................... 13 7.1 Past actions..................................................... 13 7.2 Application...................................................... 14
1. Preliminary
1.1 Principles
These Principles are the Repatriation Private Patient Principles.
1.2 Defined terms
For the purposes of these Principles, unless a contrary intention appears:
Act
Act means the Veterans’ Entitlements Act 1986 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 Act.
pensable patient
contracted 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.
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 Act.
Department
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.
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 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.
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 Act. Note: see the Repatriation Institutions (Transfer) Act 1992 Local Medical Officer means a private medical practitioner who provides medical treatment to entitled persons under arrangements entered into with the Commission under paragraph 84(1)(c) of the Act.
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 current Repatriation Private Patient Principles determined by the Commission under subsection 90A(1) of the Act.
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 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 No.8 of 1992 approved by the Minister on 25 June 1992. Treatment Monitoring Committee means: (a) a committee established by the Commission under these Principles to monitor the access to, and quality of, treatment provided in Hospitals or other Institutions to entitled persons; or (b) a committee established by the Repatriation Commission under the revoked Repatriation Private Patient Principles, to monitor the access to, and quality of, treatment provided in Hospitals or other Institutions to persons who were entitled to treatment under the revoked Repatriation Private Patient Principles.
eteran partnering hospital
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, 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.
3.6 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 country area of a State; or (c) a Territory public hospital; for in-patient treatment without prior approval if such treatment is certified by a medical practitioner as being urgently required.
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.
5. Treatment Monitoring Committees
5.1 Continued existence of Committees
5.1.1 The National Treatment Monitoring Committee and the Treatment Monitoring Committees of each State, the Australian Capital Territory, and the Northern Territory that were established under the revoked Repatriation Private Patient Principles are continued in existence by these Principles.
5.2 Appointments to National Committee
5.2.1 The Commission is to appoint the members of the National Treatment Monitoring Committee and it may appoint those members on such terms as it thinks fit. 5.2.3 The National Treatment Monitoring Committee is to comprise: (a) at least two members representing the Australian Government, with one of those members being an officer of the Department; and (b) eight members representing veterans and their dependants, being, a representative of each of: (i) the Returned and Services League of Australia; and (ii) the War Widows’ Guild of Australia; and (iii) the Australian Veterans’ and Defence Services Council; and (iv) the Australian Federation of Totally and Permanently Incapacitated Ex-servicemen and Women; and (v) the Legacy Coordinating Council; and (vi) the Regular Defence Force Welfare Association; and (vii) the Vietnam Veterans Association of Australia.
5.3 Appointments to State Committees
The Commission is to appoint members of State and Territory Treatment Monitoring Committees from: (a) at least the organisations in subparagraph 5.2.3 (b) (or an associated State or Territory organisation if the relevant organisation is only a national organisation); and (b) Departmental staff, including the relevant Deputy Commissioner for that State or Territory, who is to be the chair of the Committee for that State or Territory; and (c) the relevant State or Territory government health authority.
5.4 Role of Committees
The Treatment Monitoring Committees are to assist the Commission in monitoring the access to, and quality of, treatment arranged for entitled persons as private patients.
5.5 The National Treatment Monitoring Committee must report to the Commission
5.5.1 The National Treatment Monitoring Committee must consider the reports of the State and Territory Treatment Monitoring Committees and report, in writing, at least annually to the Commission. 5.5.2 The report of the National Treatment Monitoring Committee is to contain, among other relevant details, conclusions regarding the access to, and quality of, treatment, in hospitals or other institutions, provided to entitled persons. 5.5.3 To enable the National Treatment Monitoring Committee to report at least annually, the State and Territory Treatment Monitoring Committees must report at least annually to the National Treatment Monitoring Committee.
5.6 The Commission must give the report to the Minister
The Commission must, within seven days of its receipt, provide a copy of the written report of the National Treatment Monitoring Committee to the Minister.
5.7 Minister must table report in Parliament
After receiving a copy of the report of the National Treatment Monitoring Committee, the Minister must cause a copy to be laid before each House of the Parliament within 15 sitting days of that House.
6 Removal of Members etc
6.1 Subject to paragraph 6.2, the Commission may, and after giving the member an opportunity to be heard, terminate the appointment of a member of a Treatment Monitoring Committee established under Section 5. Note: this provision is not intended to apply to a situation where a member has not satisfied a term or condition of their appointment. 6.2 In exercising its power under paragraph 6.1, the Commission is to be guided by the grounds on which the appointment of a member of the Repatriation Commission can be terminated under section 188 of the Act. 6.3 The Commission may, and after giving the member an opportunity to be heard, revoke the appointment of a member of a Treatment Monitoring Committee established under Section 5, where the member contravenes, or cannot satisfy, a term or condition of their appointment.
7. Transitional provisions
7.1 Past actions
Any approval given, decision or appointment made, or other thing done under the revoked Repatriation Private Patient Principles is taken to have been given, made, or done for the purposes of, and under, these Principles.
7.2 Application
From their commencement, these Principles apply to all matters to which these Principles, or the revoked Repatriation Private Patient Principles, relate.
