Federal Register of Legislation - Australian Government

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R30/2006 Principles as made
These Principles set out the circumstances in which the Repatriation Commission may accept financial responsibility for treatment provided to entitled persons for malignant neoplasia.
Administered by: Veterans' Affairs
General Comments: This instrument was approved by the Minister for Veterans' Affairs on 3 January 2007 (see Supporting Material).
Registered 29 Jan 2007
Tabling HistoryDate
Tabled HR06-Feb-2007
Tabled Senate06-Feb-2007
Date of repeal 03 Dec 2013
Repealed by Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (No. R54/2013)
This Legislative Instrument has been subject to a Motion to Disallow:
Motion Date:
08-May-2007
Expiry Date:
14-Aug-2007
House:
Senate
Details:
Full
Resolution:
Withdrawn
Resolution Date:
18-Jun-2007
Resolution Time:
Provisions:

 

 

 

Australian Participants in British Nuclear Tests (Treatment) Act 2006

 

Treatment Principles (Australian Participants in British Nuclear Tests) 2006

 

Instrument 2006 No. R30

 

The Repatriation Commission makes this Instrument for the purposes of subsection 16(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

 

THE REPATRIATION COMMISSION

 

 

 

 

 

 

 

[1]     Definitions

 

In items [1] and [3] of this Instrument:

 

Treatment Principles means the document known as the “Treatment Principles” and prepared by the Repatriation Commission under section 90 of the Veterans’ Entitlements Act 1986 and incorporated in the Australian Participants in British Nuclear Tests (Treatment) Act 2006 by section 16 of that Act.

 

Repatriation Commission means the body corporate known as the Repatriation Commission and continued in existence under section 179 of the Veterans’ Entitlements Act 1986.

 

[2]     Commencement

 

(a)  Subject to paragraph (b), this Instrument commences on the day after it is registered on the Federal Register of Legislative Instruments.

 

(b) The following provisions, substituted by section 5, commence on the commencement of the legislative instrument entitled Veterans’ Entitlements (Treatment Principles - Access to Diabetes Educator Services) Instrument 2006:

 

               (i) definition of “credentialled diabetes educator”;

(ii) definition of “diabetes educator services”;

               (iii) paragraph 3.2.1(na);

(iv) paragraph 3.3.2(da);

(v) paragraph 4.8.1(ga);

(vi) paragraph 7.1.2(aa);

(vii) paragraph 7.6A.

 

[3]     Modifications of the Treatment Principles

 

The Treatment Principles are modified in accordance with Schedule A.

 


SCHEDULE  A

 

[4].    Title (twice occurring)

 

                     at the end, insert:

 

(Australian Participants in British Nuclear Tests) 2006

 

Note: the purpose of this provision is to ensure a part of the Treatment Principles as incorporated in the Act is retained to ensure the Treatment Principles are modified and not substituted.

 

[5].    All provisions other than the title:

 

          substitute:

 

Australian Government

REPATRIATION COMMISSION

 

 

 

 

PART 1 — INTRODUCTION............................................................................................ 5

1.2          Application of Repatriation Private Patient Principles.................................... 5

1.4          Interpretation............................................................................................... 7

PART 2 — ELIGIBILITY FOR TREATMENT................................................................... 21

2.1          Treatment for eligible persons in Australia..................................................... 21

2.2          Treatment for entitled persons travelling overseas......................................... 21

PART 3 — COMMISSION APPROVAL FOR TREATMENT.......................................... 24

3.1          Approval for treatment................................................................................ 24

3.2          Circumstances in which prior approval is required........................................ 24

3.3          Circumstances in which prior approval may not be required.......................... 28

3.4          Other retrospective approval....................................................................... 29

3.5          Financial responsibility................................................................................. 31

PART 4 — MEDICAL PRACTITIONER SERVICES........................................................ 35

4.1          LMO or other GP Scheme.......................................................................... 35

4.2          Providers of services................................................................................... 36

4.3          Financial responsibility................................................................................. 37

4.4          Referrals by LMO or other GPs.................................................................. 40

4.5          Referrals by medical specialists.................................................................... 40

4.6          Referrals to medical specialists in country or Territory areas.......................... 41

4.7          Referrals: prior approval.............................................................................. 41

4.8          Other matters.............................................................................................. 41

PART 5 — DENTAL TREATMENT................................................................................... 43

5.1          Providers of services................................................................................... 43

5.2          Financial responsibility................................................................................. 44

5.3          Eligibility...................................................................................................... 44

5.4          Emergency dental treatment......................................................................... 44

5.6          General anaesthesia..................................................................................... 45

5.7          Prescribing of pharmaceutical benefits by dentists......................................... 45

5.8          Other dental services................................................................................... 45

PART 6 — PHARMACEUTICAL BENEFITS.................................................................... 48

6.1          Repatriation Pharmaceutical Benefits Scheme............................................... 48

6.2          Eligibility under the Repatriation Pharmaceutical Benefits Scheme.................. 48

PART 7 — TREATMENT GENERALLY FROM OTHER HEALTH PROVIDERS........... 49

7.1          Prior approval and financial responsibility for health services......................... 49

7.2          Registration or enrolment  of providers......................................................... 50

7.3          Community nursing...................................................................................... 51

7.4          Optometrical services.................................................................................. 54

7.5          Physiotherapy.............................................................................................. 54

7.6          Podiatry...................................................................................................... 55

7.7          Chiropractic and osteopathic services.......................................................... 58

7.8          Other services............................................................................................. 59

PART 9 — TREATMENT OF ENTITLED PERSONS AT HOSPITALS AND INSTITUTIONS     60

9.1          Admission to a hospital or institution............................................................. 60

9.2          Financial responsibility................................................................................. 61

9.3          Nursing-home-type care.............................................................................. 64

9.5          Convalescent care....................................................................................... 65

9.6          Other matters.............................................................................................. 65

PART 10 — RESIDENTIAL CARE.................................................................................... 67

10.1        Residential care arrangements...................................................................... 67

10.4        Payment of residential care amount for certain entitled persons with dependants           68

PART 11 — THE PROVISION OF REHABILITATION APPLIANCES........................... 73

11.1        Rehabilitation Appliances Program............................................................... 73

11.2        Supply of rehabilitation appliances................................................................ 74

11.3        Restrictions on the supply of certain items..................................................... 74

11.4        Visual aids................................................................................................... 76

11.5        Hearing aids................................................................................................ 78

11.6        Other rehabilitation appliances..................................................................... 79

11.7        Repair and replacement............................................................................... 80

11.8        Treatment aids from hospitals....................................................................... 81

11.9        Provision of aids and appliances for accident prevention and personal safety. 81

PART 12 — OTHER TREATMENT MATTERS................................................................. 86

12.1        Ambulance transport................................................................................... 86

12.2        Treatment under Medicare........................................................................... 87

12.4        Prejudicial or unsafe acts or omissions by patients........................................ 87

12.6        Recovery of moneys.................................................................................... 87

 

 


 

 

 

Australian Government

 

REPATRIATION COMMISSION

 

 

 

Section 16

 

 

 

Instrument No. R30 of 2006

 

PART 1 — INTRODUCTION

1.1.1            The Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (the Treatment Principles), prepared by the Repatriation Commission under section 16 of the Australian Participants in British Nuclear Tests (Treatment) Act 2006 (the Act), set out the circumstances in which, and conditions subject to which, treatment may be provided for eligible persons under Part 2 of the Act and are to be read subject to the Act.

 

1.1.2            The Treatment Principles state the policies under which the Repatriation Commission may accept financial responsibility for the cost of treatment of malignant neoplasia for persons eligible for such treatment under the Act.

 

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

1.2.1  The Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006 (the RPPPs), determined by the Commission under subsection 17(2) of the Act, apply in all States in which a Repatriation General Hospital has been integrated into the State health system and in those States and Territories in which the Commission has declared, under section 90B of the Veterans’ Entitlements Act 1986, that the VEA Repatriation Private Patient Principles, made under section 90A of the Veterans’ Entitlements Act 1986, apply.

 

1.2.2  In those States or Territories where the RPPPs apply, a provision of the Treatment Principles does not apply if it is inconsistent with the RPPPs.

 

1.2.3  Nothing in these Treatment Principles is to be taken to require prior approval for admission at a public hospital in any State or Territory in which the RPPPs apply.

 

 

 

 

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1.4      Interpretation

1.4.1  In these Treatment Principles, unless a contrary intention appears:

 

“Act” means the  Australian Participants in British Nuclear Tests (Treatment) Act 2006

"Access Payment" means:

(a) an amount of $4.20 payable by the Department to an LMO for a medical service (other than a Level A attendance) provided by the LMO to an entitled person ¾ where that service is provided pursuant to the LMO's arrangement with the Commission entered into for the purposes of the VEA Treatment Principles; or

(b) an amount of $5.75 payable by the Department to an LMO for a medical service that is a Level A attendance provided by an LMO to an entitled person ¾ where that service is provided pursuant to the LMO's arrangement with the Commission entered into for the purposes of the VEA Treatment Principles;

being an amount in addition to any amount otherwise payable by the Department to an LMO for a medical service provided to an entitled person by the LMO pursuant to the LMO's arrangement with the Commission entered into for the purposes of the VEA Treatment Principles.

 

“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.

 

“attendant care means assistance with essential daily activities, such as bathing, dressing and eating.

 

“carermeans 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.

 

“Commission” means the Repatriation 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.

 

"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 nursing provider" means a health provider that has a contract with the Commission and, or, the Department, to provide community nursing services to entitled persons.

 

“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).

 

“contracted private hospital means a private hospital with which the Commission has entered into arrangements for the purposes of the VEA Treatment Principles or the VEA Repatriation Private Patient Principles for the care and welfare of eligible 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, associated with malignant neoplasia.

 

“country area” means that part of the State outside the metropolitan area of the capital city of that State, determined by the Commission to be a country area under paragraph 80(2)(b) of the VEA.

 

 

 

 

 

 

 

“credentialled 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.

 

“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 schedules” means the documents known as Dental Schedules A, B and C and the Dental Prosthetist Schedule, prepared by the Commission for the purposes of Part 5 of the VEA Treatment Principles, that list the dental services provided or arranged by the Commission.

 

“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.

 

“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 and the Aged Care Act 1997.

 

“diabetes educator services” means a program of education about diabetes with an emphasis on self-care, provided by a credentialled diabetes educator to a person with diabetes.

 

“elective surgery means any non-urgent surgical procedure performed for diagnostic or therapeutic purposes.

 

“eligible person means a person who is eligible for treatment under 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.

 

“entitled person” means a person who is eligible for treatment under 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 community nursing provider, whether that arrangement was entered into under these Principles or the VEA Treatment Principles.

 

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.

 

"Health Insurance Commission" means Medicare Australia established under the Medicare Australia Act 1973.


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"health provider means a person who provides treatment services.

 

"high level of residential care" has the meaning given in clause 1 of Schedule 1 to the Aged Care Act 1997.

Note (1): Clause 1 of Schedule 1 to the Aged Care Act 1997 provides that: ‘high level of residential care means a level of residential care corresponding to a classification level applicable to residential care (other than a classification level applicable only to respite care) that is not lower than the mid-point of all such classification levels that could apply to residential care.

Note (2): The phrases ‘classification level’ and ‘respite care’ used in this definition are also defined in the Aged Care Act 1997.

Note (3): This definition does not exclude entitled persons in respite care or convalescent care.

 

“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.”.

 

“inpatient” means a person formally admitted for treatment by a hospital.

 

"Level A attendance" means a medical attendance described in an item in Level A, Group A1, Schedule of Services, Category 1-Professional Attendances, General Medical Services, of the Medical Benefits Schedule.

 

“LMO” means a medical practitioner who has a written agreement (that has not expired or been terminated) with the Commission or the Department (on behalf of the Commission), entered into for the purposes of the VEA Treatment Principles, whereby the practitioner has agreed to provide treatment to entitled persons and charge the Commission, the Department or the Health Insurance Commission for the treatment instead of the entitled person.

 

"low level of residential care" means a level of residential care that is not a high level of residential care.

 

"Medicare benefit", in relation to a medical attendance or medical procedure, means the benefit payable in respect of that attendance or procedure under Part II of the Health Insurance Act 1973.

 

“medical practitionerhas 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 Benefits Schedulemeans:

 

(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.

 

“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.

 

"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 provides treatment to an entitled person otherwise than under a written contract with the Commission or the Department (on behalf of the Commission) and who does not, directly or indirectly, impose any charge on the entitled person in relation to that treatment but instead charges the Commission, the Department or the Health Insurance Commission for the treatment.

 

“outpatient service means a health service or procedure provided by a hospital but not involving admission to the hospital.

 

"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.

 

“PBS means the Pharmaceutical Benefits Scheme authorised under the National Health Act 1953.

 

“physiotherapy includes hydrotherapy.

 

“Principles” means the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 made under subsection 16(2) of the Act.

 

“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.

 

“private hospital means premises that have been declared specifically as private hospitals for the purposes of the Health Insurance Act 1973.

 

“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.

 

Repatriation Commission” means the body corporate known as the Repatriation Commission and continued in existence under section 179 of the Veterans’ Entitlements Act 1986.

 

"Repatriation Pharmaceutical Benefits Card" means the identification card entitled 'Repatriation Pharmaceutical Benefits Card' which is provided to a person for the purposes of the person obtaining pharmaceutical benefits pursuant to the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006.

 

“Repatriation Pharmaceutical Benefits Scheme means the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006 made under subsection 18(2) of the Act.

 

“RPPPs. means the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006 determined by the Commission under section 17(2) of the Act.

 

"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 an entitled person in 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 an entitled person who is receiving, or received, residential care — an amount equivalent to the maximum daily amount of resident fees worked out under Division 58 of the Aged Care Act 1997.

Note:‘maximum daily amount of resident fees’ is worked out under section 58-2 of the Aged Care Act 1997.

 

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"residential care (respite)" means residential care provided as respite.

 

"residential care subsidy" means an amount worked out under Chapter 3 of the Aged Care Act 1997 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 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.

 

Repatriation Commission means the body corporate known as the Repatriation Commission and continued in existence under section 179 of the VEA.

 

"Rural Enhancement Scheme" means the scheme established by the Commission under subsection 84(1) of the VEA, 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.

 

“Schedule of Prescribable Itemsmeans the schedule prepared by the Commission under paragraph 7.4.1 of the VEA Treatment Principles that lists the products that may be supplied under these Principles by optometrists and other optical dispensers.

 

“testing” means conducting a recognised medical test to identify malignant neoplasia (whether or not the person being tested has already been tested for, or diagnosed with, malignant neoplasia), but does not include conducting a test that replicates an existing community-wide government screening program.

 

“VEA” means the Veterans’ Entitlements Act 1986.

 

“VEA Repatriation Private Patient Principles” means the principles known as the Repatriation Private Patient Principles determined by the Commission under section 90A of the VEA.

 

VEA Treatment Principles” means the document known as the “Treatment Principles” prepared by the Repatriation Commission under section 90 of the VEA.

 

treatment” means treatment (within the meaning of subsection 80(1) of the Veterans’ Entitlements Act 1986) of malignant neoplasia, and includes testing.

 

"week" means the period from Sunday to Saturday, inclusive.

 

"White Card" means

 

          (a)      the identification card described as the Repatriation Health Card - For Specific Conditions and provided to a person who is eligible under the Act for treatment, subject to these Principles, of malignant neoplasia; or

 

          (b)     a written authorisation issued on behalf of the Commission under subparagraph 2.1.1(a)(ii).

 

1.4.2  In the Principles, if a Note follows a principle, paragraph or subparagraph, the Note is taken to be part of that principle, paragraph or subparagraph, as the case may be.

 

 

 


 

PART 2 — ELIGIBILITY FOR TREATMENT OF MALIGNANT NEOPLASIA

2.1      Treatment for eligible persons in Australia

2.1.1  Subject to these Principles, the Commission may accept financial responsibility for the treatment in Australia of entitled persons who have been issued with:

 

(i)    a White Card; or

 

(ii)   a written authorisation issued on behalf of the Commission.

 

2.2      Treatment for entitled persons travelling overseas

2.2.1  Subject to these Principles, the Commission may accept financial responsibility for the treatment of malignant neoplasia suffered by an entitled person in the situation where the treatment is provided to the person outside Australia and the person is outside Australia temporarily.

 

Note: to be eligible for treatment a person must be an Australian resident.

 

2.2.2  Except where the Commission decides otherwise, the Commission will not accept financial responsibility under paragraph 2.2.1 for costs incurred in the treatment of malignant neoplasia while an entitled person is temporarily absent from Australia unless, prior to departure, an office of the Department has been notified of the person’s intention to travel.

 

2.2.3  Except in an emergency, financial responsibility under paragraph 2.2.1 will be limited to:

 

(a)      except in the cases of residential care or residential care (respite), the cost of treatment provided in accordance with the mode and duration that would have been provided or arranged, under these Principles, in Australia; or

 

(b)     except in the cases of residential care or residential care (respite), the cost of treatment provided by a        health authority or facility nominated by the Commission; or

 

(c)     in the case of residential care or residential care (respite) provided for a period to a an entitled person, whether provided in an emergency or not the lesser of:

 

          (i) the amount charged the person; or

         (ii) the amount of residential care subsidy (at classification level 1 for residential care or at     classification level 3 for residential care (respite)) and the residential care amount (if any) that would have been accepted by the Commission in respect of the person if the person had received residential care or residential care (respite), as the case may be, at the classification level 1 or the classification level 3, respectively, for the same period in Australia;or

            

             Note (1): "classification level 1" and "classification level 3" mean "residential care classification level 1"and "residential care classification level 3", respectively, under the Aged Care Act 1997.  By virtue of Part 10 of the Principles the Commission, in the first instance, rather than the Commonwealth, accepts financial responsibility for the provision of residential care and residential care (respite) under the Aged Care Act 1997 to entitled persons .

            

             Note (2): the "residential care amount", also commonly known as the "basic daily care fee" or "resident fee", is the amount to be worked out under section 58-3, or the amount to be worked out under subsection 58-4(1), of the Aged Care Act 1997 as amended from time to time, depending on which of those provisions applied to the circumstances of the entitled person.

 

(d)     in the case of residential care (respite), the cost of that care (as worked out under paragraph (c)) for only a maximum of 63 days in any Financial year.

 

Note (1):the intention is that the Commission will not accept any further financial responsibility for "a respite admission" in a Financial year where in that year the person had already spent 63 days in residential care as a respite admission.

               

                Note (2): for the purpose of calculating the number of days spent by an entitled person in residential care (respite) in a Financial year, any day spent in residential care (respite) in Australia in that year is also to be taken into account.

 

2.2.5  Notwithstanding paragraphs 2.2.2 or 2.2.3, the Commission will not be responsible for treatment costs incurred by any person who travels outside Australia from Australia where a significant reason for that travel is to obtain treatment or rehabilitation appliances.

 

 

 

 

 


PART 3 — COMMISSION APPROVAL FOR TREATMENT OF MALIGNANT NEOPLASIA

3.1      Approval for treatment

3.1.1 The Commission’s prior approval may be required for treatment.

 

                         Note:      Schedule 3 provides that any approval given for treatment under the VEA Treatment Principles, as brought across by the Act, is deemed to have been given under, and for the purposes of, these Principles.

 

3.2      Circumstances in which prior approval is required

3.2.1  Treatment requiring prior approval includes:

 

(a)   all medical specialist services in metropolitan areas;

Note:      see paragraph 4.7.1.  Prior approval is not required in States or Territories where the RPPPsError! Bookmark not defined. apply — see paragraph 1.2.2.

 

(b)         provision of services that are not made available under the Medicare Benefits Schedule.

 

Note:      see paragraph 4.2.3.

 

(d)        outpatient treatment at a private hospital where the requirement for prior approval for such treatment is specified in a contract entered into by the Commission and, or, the Department, for the purposes of these Principles, the RPPPs or the VEA Repatriation Private Patient Principles.

 

(e)    treatment at a hospital according to the requirements contained in section 4 of the RPPPs.

 

          Note: where the patient is a holder of a White Card and eligibility for the treatment required is uncertain, the Commission will not accept financial responsibility for the cost of care unless the Department has verified eligibility.

 

(f)    admission to a hospital or the provision of hospital treatment not otherwise specified;

 

        Note:      see paragraph 9.1.8.

 

(h)         respite or convalescent admission to an institution;

 

Note:       see paragraph 9.6.1.

 

(j)     in-home respite care;

 

           (ja)   emergency short term home relief (ESTHR) to be provided within 24 hours after a previous      service of ESTHR;

                  

Note: the intention is that 3 days (the max ESTHR per emergency) should be sufficient time for alternative respite care to be arranged and prior approval is required before a further immediately subsequent service of ESTHR may be provided.

 

(k)    provision of residential care in Australia or outside Australia;

 

Note:       see paragraph 2.2.4 and Part 10

 

(n)    dental treatment specified as requiring prior approval in Part 5;

 

(na) diabetes educator services specified in paragraph 7.6A.2;

 

(o)   community nursing services specified as requiring prior approval in Treatment Principle 7.3;

 

(p)   physiotherapy that exceeds the limits specified in paragraph 7.5.1;

 

(q)   podiatry that is not specified in paragraph 7.6.1;

 

(r)    provision of rehabilitation appliances;

 

Note:       see Part 11.

 

(s)   provision of visual aids not included under the arrangements entered into between the Commission and suppliers for the purposes of these Principles or the VEA Treatment Principles;

 

Note:       see paragraph 11.4.1.

 

(t)    repair of a rehabilitation appliance;

 

Note:       see paragraph 11.7.2.

 

(u)    chiropractic services that exceed the limits specified in paragraph 7.7.1;

 

(v)    osteopathic services that exceed the limits specified in paragraph 7.7.1; and

 

(w)   ambulance transport, except for that provided by certain ambulance services specified in paragraph 12.1.1;

 

(x)    cosmetic surgery;

 

(y)    medical devices not included on the Department's schedule of 'Benefits Payable in Respect of Surgically Implanted Prostheses, Human Tissue Items and Other Medical Devices;

 

(z)    psychiatric inpatient care or psychiatric day patient program care.

 

3.2.2  In considering whether prior approval will or will not be given and what conditions, if any, will apply, the following will be taken into account:

 

(a)    any specific requirements contained in these Principles or the Act;

 

(c)   the extent of funds that are available;

 

(d)   reasonable control over expenditure;

 

(e)    the clinical need for the proposed treatment; and

 

(f)    the suitability and quality of the proposed treatment.

 


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3.3      Circumstances in which prior approval is not required

3.3.2  Treatment not requiring prior approval includes:

 

(a)    treatment by LMO or other GP except where otherwise indicated in Part 4;

 

(b)   medical specialist consultations in country and Territory areas, except where otherwise indicated in principle 4.7;

Note:      Prior approval is not required for medical specialist consultations in States or Territories where the RPPPsError! Bookmark not defined. apply — see paragraph 1.2.2.

 

(c)   dental treatment specified as not requiring prior approval in Part 5;

 

(d)   dental prosthetic treatment specified as not requiring prior approval in Part 5;

 

(da) diabetes educator services, except where otherwise indicated in Principle 7.6A;

 

(e)    the prescription and supply of pharmaceutical items as set out in Part 6;

 

(f)    subject to paragraph 7.3.5, the provision of community nursing services by a nurse in accordance with paragraph 7.3.3 after the services have been provided;

 

                                Note:see principle 7.3.

 

(g)   optometrical treatment and the dispensing of optical products under the arrangements between optometrists and optical dispensers and the Commission entered into for the VEA Treatment Principles;

Note:      see principle 7.4.

 

(h)   physiotherapy treatment, except where otherwise indicated in principle 7.5.

 

(j)    podiatry treatment, except where otherwise indicated in principle 7.6.

(k)   treatment at a hospital under the conditions set out in paragraph 9.1.8;

 

(m)  ambulance transport in an emergency or where that is the arrangement between ambulance service providers and the Commission entered into for the purposes of the VEA Treatment Principles;

Note:      see paragraph 12.1.5.

 

(n)         referral to the Australian Hearing Service; and

 

(o)        chiropractic or osteopathic treatment, except where otherwise indicated in principle 7.7.

 

3.4      Other retrospective approval

3.4.1  On application, the Commission may approve, and pay the cost of, any treatment for malignant neoplasia that was undertaken in the period between:

 

(a)    the effective date of eligibility under the Act; and

 

(b)   the date on which the person is notified of entitlement.

 

3.4.2  The Commission may provide approval for treatment that has already been given or has commenced to be given in circumstances where:

 

(a)    it would have accepted financial responsibility if prior approval had been sought before the service was provided; and

 

(b)   there are exceptional circumstances justifying the failure to seek prior approval;

 

or where:

 

(c)   a request for prior approval was incorrectly processed or failed to be processed due to an administrative error or processing error on the part of the Department or an officer of the Department.

 

3.4.3  The Commission will accept financial responsibility for emergency treatment of a condition associated with malignant neoplasia, for entitled persons, without prior approval only if approval is sought as soon as possible after the event.

 

Note:this Principle does not to apply to residential care or residential care (respite) provided outside Australia or in Australia.  In such cases the extent of Commission liability is determined under paragraphs 2.2.3 (c) and (d), and Part 10, of the Principles.

 

3.4.4  The Commission’s financial liability under paragraphs 3.4.1 and 3.4.3 is limited to the difference between:

 

(a)    the reasonable cost of treatment; and

 

(b)   the amount that an eligible person has claimed or is entitled to claim from Medicare, a health insurance fund or another third party.

 

3.4.5  The Commission’s financial liability under paragraph 3.4.2 is limited to the difference between:

 

(a)    the cost of treatment for which it is financially responsible under paragraph 3.5.1; and

 

(b)   the amount that an eligible person has claimed or is entitled to claim from Medicare, a health insurance fund or another third party.

 

3.4.6  The Commission will not pay or reimburse taxation levies for Medicare or for health insurance fund payments.

 

3.4.7  The Commission will accept financial responsibility under paragraphs 3.4.1, 3.4.2, and 3.4.3 if an application is supported by accounts, receipts, declarations or other evidence of the condition treated.

 

3.5      Financial responsibility

3.5.1  The extent of the financial responsibility accepted by the Commission for the provision of treatment for malignant neoplasia suffered by entitled persons is, subject to the Act and these Principles, as follows:

 

(a)    in respect of the fee charged by an LMO for a medical attendance or medical procedure, pursuant to the LMO's arrangement with the Commission entered into for the purposes of the VEA Treatment Principles ¾ an amount equal to 115% of the fee listed in the Medicare Benefits Schedule for that attendance or procedure, together with, for each attendance or procedure, an Access Payment.

 

(aa)  in respect of the fee charged by an LMO for a medical attendance or medical procedure where:

          

(i)   the LMO is registered under the Rural Enhancement Scheme;and

 

(ii) the attendance or procedure is, respectively, provided or performed under the Rural Enhancement Scheme and pursuant to the LMO's arrangement with the Commission entered into for the purposes of the VEA Treatment Principles;

 

an amount equal to the sum of the amount of 115% of the fee listed in the Medicare Benefits Schedule for that attendance or procedure and 10% of that amount, together with, for each attendance or procedure, an Access Payment.

 

(b)   in respect of the fees charged by an other GP:

 

(i)      for a medical attendance — an amount equal to the Medicare fee for that attendance plus 60 cents per attendance; and

 

(ii)              for a medical procedure — an amount equal to the fee listed in the Medicare Benefits Schedule for that procedure;

 

(c)   in respect of the fee charged for a medical attendance, or medical procedure, provided by a Medical Specialist who is not a pathologist or a diagnostician — an amount equal to the fee listed in Schedule 2 (Repatriation Medical Fee Schedule) for that attendance or procedure.

 

(cc)  in respect of the fee charged for a medical procedure provided by a Medical Specialist who is a pathologist or diagnostician — an amount equal to the fee listed in the Medicare Benefits Schedule for that procedure.

 

(d)        in respect of the fee charged for a medical procedure by a Medical Specialist who is an anaesthetist:

 

(i)      for a Group T10 procedure, a fee calculated on a unit value equal to $27.65 indexed each year by the Medicare Benefits Schedule index factor.

 

(e)    in respect of the fees payable to dental practitioners and dental prosthetists ¾ the financial liability that may be accepted by the Commission under Part 5 of the Principles;

 

(f)    in all other cases — in accordance with the fees payable under arrangements made by the Commission for the purposes of these Principles or the VEA Treatment Principles;

 

except where the Commission, having regard to the matters specified in paragraph 3.2.2, is satisfied that there are exceptional circumstances justifying payment of a higher fee.

 

3.5.2  The Commission will only accept financial responsibility for treatment:

 

(a)    that is reasonably necessary for the adequate treatment of the eligible person

 

(b)   that is given by an appropriate category of health provider; and

 

(c)         if a claim for payment in respect of treatment:

 

(i)                is in the form, if any, approved by the Commission for the purposes of paragraph 3.5.2 of the VEA Treatment Principles ('approved form'); and

(ii)              contains, or is accompanied by, any information required by any direction in any approved form; and

(iii)            is lodged at an appropriate place or with an appropriate person within the period of 6 months (or such longer period as is allowed in accordance with paragraph 3.5.2A) from the date of rendering the service to which the claim relates.

 

Note 1: a claim is taken to have been lodged on the day it is received.

Note 2: 'appropriate place' means an office of the Department in Australia or a place approved by the Commission for the purpose of lodging claims for the purposes of the VEA Treatment Principles.

Note 3: 'appropriate person' means a person approved by the Commission for the purpose of lodging claims for the purposes of the VEA Treatment Principles.

Note 4: a claim may be lodged by means of an electronic transmission.

 

3.5.2A         Upon application in writing, by a claimant, to the Commission, the Commission may, in its discretion, by notice in writing served on the claimant, allow a longer period for lodging a claim than the period of 6 months referred to in subparagraph 3.5.2(c).

Note: 'claimant' means an appropriate category of health provider seeking payment in respect of treatment provided under the Principles.

 

3.5.2B         In exercising its power under paragraph 3.5.2A to allow a longer period for lodging a claim, the Commission shall have regard to all matters that it considers relevant, including, but without limiting the generality of the foregoing, any hardship that might be caused to the claimant if a longer period is not allowed.

Note: 'claimant' means an appropriate category of health provider seeking payment in respect of treatment provided under the Principles.

 

3.5.3           The Commission will not accept financial responsibility for the cost of the following treatment by health providers, including treatment by dentists, physiotherapists and podiatrists:

 

(a)    services that have been paid for, wholly or partly, by Medicare or a health insurance fund; or

 

(b)   services where the cost is otherwise recoverable, wholly or partly, by way of a legal claim; or

 

(c)   examination for employment purposes; or

 

(d)   examination for a medical certificate for membership of a friendly society.

 

3.5.4   Where the Commission accepts financial responsibility under these Principles, it does so on behalf of the Commonwealth.

 


PART 4 — MEDICAL PRACTITIONER SERVICES FOR MALIGNANT NEOPLASIA

4.1     Local Medical Officers / other General Practitioners

 

4.1.2  Outline

 

4.1.3 The aim of the medical services program is to ensure that as far as practicable entitled persons have access to free, safe and cost-effective treatment for maligant neoplasia.

 

To achieve this objective the Commission or the Department deals with medical practitioners on three levels.

 

At the first level the Commission or the Department enters into agreements with general medical practitioners.  These medical practitioners are called LMOs.  The agreements are those entered into for the purposes of the VEA Treatment Principles or may be agreements entered into for the purposes of these Principles.

 

The second level of engagement is where the Commission or the Department deals with medical practitioners who are willing to treat entitled persons without charging the entitled person but who are not willing to enter into any written agreement with the Commission or the Department in relation to providing the treatment.  These medical practitioners are called other GPs.

 

Because LMOs sign an agreement with the Commission or the Department (on behalf of the Commission) they receive higher rates of remuneration from the Department than do other GPs.

 

The feature that distinguishes LMO-treatment or other GP-treatment from treatment provided by other medical practitioners is that LMOs and other GPs do not charge the entitled person for that treatment.  They charge the Commission, the Department or Medicare Australia (hereafter in this Outline these bodies are referred to collectively as DVA).

 

It should be noted that while it is the Commission that accepts financial liability for treatment it is the Department (Commonwealth) that actually pays for the treatment.

 

The third level of interaction between the Commission or the Department and medical practitioners is where the medical practitioner is a specialist. 

 

Unlike LMOs, medical specialists do not have written agreements with the Commission/Department (as at 1 January 2005) but if they are prepared to treat an entitled person at the rate set out in the Principles and charge DVA and not the entitled person, then the relationship between DVA and the specialist is covered by the Principles.

 

4.1.4  Subject to paragraph 3.5.1, the Commission may accept financial liability for medical treatment provided to an entitled person by an LMO, an other GP or a medical specialist but only if the medical treatment was for malignant neoplasia.

 

Note: paragraph 3.5.1 sets out the financial limits on Commission liability for treatment.

4.2      Providers of services

4.2.1  Unless otherwise indicated in these Principles, an entitled person may be provided with only those services included in the Medicare Benefits Schedule.

 

4.2.2  The services referred to in paragraph 4.2.1 may be provided only by:

 

(a)    a LMO or other GP; or

 

(b)   a medical specialist.

 

4.2.3 (1) An entitled person may be provided with services that are not made available under the Medicare Benefits Schedule ("unlisted services"). 

 

(2) Unlisted services are not to be provided to an entitled person if the Commission is satisfied that they are:

 

          (a) a mere improvement on existing Medicare Benefits Schedule listed services; or

(b) experimental and have not been demonstrated to be effective or safe by extensive clinical trials.

 

4.2.4 Subject to paragraph 4.2.3(2), unlisted services are to be provided to an entitled person under paragraph 4.2.3(1) if the Commission is satisfied that the services will provide a substantial benefit to the health of the entitled person.

 

Note 1: the prior approval of the Commission is required before unlisted services may be provided (Paragraph 3.2.1 (b)).

Note 2: the availability of funds and the need to reasonably control expenditure are factors to be considered in granting prior approval (Subparagraphs 3.2.2 (c) and (d)).

   

4.2.5  The services referred to in paragraph 4.2.3 may be provided only by:

 

(a)    a LMO or other GP; or

 

(b)   a medical specialist.

 

4.3      Financial responsibility

4.3.1  Subject to paragraph 3.5.1, and unless otherwise indicated in these Principles, the Commission will accept financial responsibility for treatment costs in respect of malignant neoplasia suffered by an entitled person where an LMO or other GP or specialist provides or arranges for treatment of:

 

(a)         an entitled person who has been issued with a White Card; or

(b)   an entitled person who has been issued with a written authorisation on behalf of the Commission.

 

4.3.2  In relation to any occasion of service to an entitled person under these Principles, a LMO or other GP or specialist shall bill only:

 

(a)    the Department; or

 

(b)   the Commission; or

                  

           (c)    Medicare Australia;

 

and that bill shall be for full settlement of the account for the service provided to the entitled person.

 

 

4.3.3  Any billing method described in paragraph 4.3.2 may be used on each occasion of service.

 

4.3.4  Subject to paragraph 4.7.3, the Commission will accept financial responsibility for any of the services described in paragraph 4.4.1, irrespective of the billing arrangement chosen under paragraph 4.3.2 by the referring LMO or other GP or specialist.


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4.4      Referrals

4.4.1  An LMO or other GP may refer an entitled person for:

 

(a)    treatment of malignant neoplasia from a medical specialist, subject to paragraph 4.7.1, and principles 4.5 to 4.8;or

 

(b)   treatment of malignant neoplasia from a LMO or other GP who has expertise or recognition in a particular field but is not a qualified medical specialist, subject to principles 4.5 to 4.8;or

 

(c)   treatment of malignant neoplasia in a hospital or other institution as indicated in these Principles; or

 

(d)   other health-care services for malignant neoplasia not requiring prior approval, as indicated in principles 7.3, 7.5 and 7.6.

 

4.5      Referrals by medical specialists

4.5.1  In providing treatment for malignant neoplasia, a medical specialist, to whom an entitled person is referred under these Principles, may:

 

(a)    arrange diagnostic tests;or

 

(b)   refer the entitled person to another specialist in the same way as may a LMO or other GP;or

 

(c)   arrange treatment in a hospital or other institution as indicated in these Principles; or

 

(d)   refer the entitled person to a health-care provider in accordance with principles 7.3, 7.5 or 7.6, in the same way as may a LMO or other GP.

 

4.6      Referrals to medical specialists in country or Territory areas

4.6.1  Subject to principles 4.7 and 4.8, the Commission will accept, without the need for prior approval, financial responsibility for treatment of entitled persons for malignant neoplasia upon referral to medical specialists in a country or Territory area, provided that the entitled persons are referred by LMO or other GPs to medical specialists in the local area.

Note:      Prior approval is not required in States or Territories where the RPPPs apply — see paragraph 1.2.2.

 

4.6.2  Referrals under paragraph 4.6.1 shall be valid from the date of the specialist’s or consultant physician’s first service.

 

4.7      Referrals: prior approval

4.7.1  In all instances other than those described in principle 4.6 and paragraph 4.7.3, prior approval is required for the referral of entitled persons to medical specialists.

 

4.7.2  Prior approval is required for the provision of services under paragraph 4.2.3.

 

4.7.3  Prior approval is not required when a LMO or other GP or medical specialist refers an entitled person for radiology services not requiring admission:

 

(a)    if the provider direct bills at 85 per cent or less of the fee set out in the Medicare Benefits Schedule as full settlement of the account for the services rendered; or

 

(b)   if the Commission so determines.

Note:       Prior approval is not required in States or Territories where the RPPPs apply — see paragraph 1.2.2.

 

4.8      Other matters

4.8.1  The Commission will not accept financial responsibility for the cost of:

 

(a)    elective surgery undertaken without prior approval with the exception of minor procedures carried out in a LMO or other GP’s or specialist’s rooms where the only charge is equivalent to the charge that would be applicable under the Medicare Benefits Schedule for that procedure; or

Note:      Prior approval is not required for elective surgery undertaken in public hospitals in States or Territories where the RPPPs apply — see paragraph 1.2.2.

 

(b)   examination for a medical certificate for life assurance purposes; or

 

(c)   examination for a medical certificate for membership of a friendly society; or

 

(d)   examination for employment purposes; or

 

(e)    multi-phasic screening; or

 

(f)    services where the cost is otherwise recoverable wholly or partly, by way of a legal claim; or

 

(g)   services that have been paid for, wholly or partly, by Medicare or a health insurance fund; or

 

(ga)  diabetes educator services that may be provided under Part 7 (Treatment Generally From Other Health Providers); or

 

(h)   treatment for infertility for the partner of an entitled person, unless that partner is personally eligible for treatment for the disability under the Act; or

 

(j)    procedures associated with in-vitro fertilisation programs; or

 

(k)   vaccination or inoculation in connection with overseas travel.


 

PART 5 — DENTAL TREATMENT IN RESPECT OF MALIGNANT NEOPLASIA

5.1      Providers of services

5.1.1  The Local Dental Officer Scheme, prepared by the Commission for the purposes of the VEA Treatment Principles applies under these Principles as if the Commission had prepared the scheme under these Principles.

 

5.1.2 Compliance with the Local Dental Officer Scheme, as in force at 1 June 1993, is a condition of the contract for services with each Local Dental Officer.

 

5.1.3  Dental prosthetic services in respect of a dental condition associated with malignant neoplasia may be provided to entitled persons by dental prosthetists under arrangements entered into with the Commission for the purposes of the VEA Treatment Principles.

 

5.1.4  Subject to prior approval and these Principles, the Commission will accept financial responsibility for dental treatment in respect of a dental condition associated with malignant neoplasia, provided in a hospital.

 

5.1.5  Subject to prior approval, an entitled person may be referred to a dental specialist by a Local Dental Officer, dental prosthetist or a dental specialist for treatment in respect of a dental condition associated with malignant neoplasia.

 

5.2      Financial responsibility

5.2.1  The Dental Schedules A, B and C and the Dental Prosthetist Schedule prepared by the Commission for the purposes of the VEA Treatment Principles list dental services that may be provided or arranged by the Commission for treatment of a dental condition associated with malignant neoplasia and specify the limits of financial responsibility accepted by the Commission.

Note:       Copies of the Local Dental Officer and Dental Prosthetists Fees Bulletins that contain details of these Schedules may be obtained from any office of the Department.

 

5.2.6  Subject to paragraph 5.5.1, the Commission will not accept financial responsibility for dental treatment after a person is no longer eligible.

 

5.3      Eligibility

5.3.1  Subject to these Principles, an entitled person who holds a White Card or written authorisation issued on behalf of the Commission, may be provided with dental services in respect of a dental condition associated with malignant neoplasia at the expense of the Commission.

 

5.3.4  Persons who hold a “White Card" are entitled to dental treatment of a dental condition associated with malignant neoplasia and, subject to prior approval, may be provided with any dental services listed in the Schedules.

 

5.4      Emergency dental treatment

5.4.1  Prior approval is not necessary for emergency dental treatment but the Commission will not accept financial liability for the treatment if approval has not been obtained as soon as possible after treatment. 

 

5.4.2  Financial responsibility for emergency dental treatment for persons who hold a “White Card " will only be accepted for treatment of a dental condition associated with malignant neoplasia for which the person is receiving treatment under principle 2.4.

 

5.6      General anaesthesia

5.6.1  Financial responsibility for a general anaesthetic provided as part of dental treatment for a dental condition associated with malignant neoplasia will be accepted only if:

 

(a)    the anaesthetic is administered by a specialist anaesthetist or approved medical practitioner in a hospital or dental surgery where adequate resuscitation equipment is provided; and

 

(b)   prior approval has been obtained.

 

5.7      Prescribing of pharmaceutical benefits by dentists

5.7.1  Local Dental Officers or dental specialists may prescribe Pharmaceutical Benefits for entitled persons for a dental condition associated with malignant neoplasia.

 

5.7.2  Subject to paragraph 5.7.4, prescriptions prescribed under paragraph 5.7.1 must be in accordance with the PBS.

 

5.7.3  The Commission will accept financial responsibility for Pharmaceutical Benefits, available under the PBS, that are required as part of dental treatment for a dental condition associated with malignant neoplasia, for entitled persons who hold a White Card, other than the amount that would have been payable by the person if the person were a “concessional beneficiary” under the National Health Act 1953.

 

5.7.4  The Commission will accept financial responsibility for Pharmaceutical Benefits that are not available under the PBS and are required as part of dental treatment for a dental condition associated with malignant neoplasia of an entitled person who hold a White Card, but such a prescription must be written on a private prescription.

 

5.8      Other dental services

5.8.1  The Commission will not accept financial responsibility for dental treatment that involves the use of intravenous sedation or relative analgesia technique in a Local Dental Officer’s or dental specialist’s surgery.

 

 

 


 

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PART 6 — PHARMACEUTICAL BENEFITS

6.1     Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006

 

6.1.1      The Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006 prepared under section 18 of the Act relates to the supply of Pharmaceutical Benefits to entitled persons by community pharmacists as defined in that Scheme.

 

6.2     Eligibility under the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006

 

6.2.1 A person is eligible to receive Pharmaceutical Benefits under the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006 if that person holds a White Card.

 


 

PART 7 — TREATMENT FROM ALLIED HEALTH PROVIDERS FOR CONDITIONS ASSOCIATED WITH MALIGNANT NEOPLASIA

7.1      Prior approval and financial responsibility for health services

7.1.1   Subject to the exceptions set out in paragraph 3.3.2 and in this Part, the Commission will accept financial responsibility for treatment services applied to conditions associated with malignant neoplasia and provided by a health provider only if the Commission has given prior approval for those services to be provided.

 

7.1.1A In relation to any occasion of service to an entitled person under this Part, a health provider shall bill only the Department and that bill shall be for full settlement of the account for the service provided to the entitled person.

 

7.1.2  Subject to these Principles and in addition to services provided under paragraph 5.1.3, the Commission may provide, arrange, or accept financial responsibility for, the following services in respect of treatment of a condition associated with malignant neoplasia:

 

(a)    audiology

 

(aa) diabetes educator services;

 

(b)   dietetics;

 

(c)    chiropractic services;

 

(d)   community nursing;

 

(e)    occupational therapy;

 

(f)    optometry;

 

(g)   orthoptics;

 

(h)   osteopathic services;

 

(j)    physiotherapy;

Note:      Physiotherapy includes hydrotherapy (see paragraph 1.4.1)

 

(k)   podiatry;

 

(l)    psychology;

 

(m)  social work;

 

(n)   speech pathology.

 

7.1.3  The Commission will not accept financial responsibility for services listed in paragraph 7.1.2 for an entitled person receiving a high level of residential care where the provision of those services is covered by a State or Commonwealth subsidy.

 

7.1.4  Treatment in an entitled person’s home may be approved where the entitled person is medically unable to attend the relevant facilities.

.

7.2      Registration or enrolment of providers

7.2.1 Where a provider of a service specified in principle 7.1 (other than a service of community nursing) is practising in a State or Territory that has legislation requiring the registration of the occupation, the provider must be registered under that legislation.

 

Note: the occupational registration of community nursing providers is dealt with in the arrangements between the Commission and community nursing providers entered into for the purposes of the VEA Treatment Principles.

 

7.2.2  Where a State or Territory does not have legislation concerning registration, a provider of a service specified in principle 7.1 (other than a service of community nursing) must be registered in another State or possess qualifications that would permit registration in another State or must be registered in another Territory or possess qualifications that would permit registration in another Territory, if that other State or other Territory has legislation requiring the registration of the occupation in question

 

Note: the occupational registration of community nursing providers is dealt with in the arrangements between the Commission and community nursing providers entered into for the purposes of the VEA Treatment Principles.

 

7.2.3    Where the provider of a service specified in principle 7.1 (other than a service of community nursing) is a corporate entity and is practising in a State or Territory that has legislation enabling registration of the corporate entity, both the person actually delivering the service and the corporate entity must be registered under the relevant legislation.

 

Note: the occupational registration of community nursing providers is dealt with in the arrangements between the Commission and community nursing providers entered into for the purposes of the VEA Treatment Principles.

 

7.3      Community nursing

7.3.3  The Commission will accept financial responsibility for community nursing services for an entitled person in respect of a condition associated with malignant neoplasia only if:

 

(a)      the person has been referred to a community nursing provider by a LMO or other GP, treating doctor in a hospital, hospital discharge planner or VHC assessment agency; and

 

Note: paragraph 7.3.6 sets out the community nursing providers to whom an entitled person can be referred under paragraph 7.3.3(a).

 

(b)     a community nursing provider, pursuant to an arrangement with the Commission entered into for the purposes of the VEA Treatment Principles, has undertaken a nursing assessment of the entitled person prior to the commencement of care and assessed that the person has a clinical need or a personal care need, or both, for the community nursing service.

 

7.3.4 All of an entitled person’s care documentation prepared by a community nursing provider shall be provided to the Department upon request by the Department to the community nursing provider.

 

7.3.5 An entitled person whose care needs, due to their complexity and care regime, are significantly outside of the scope of the community nursing classification to which they belong, is treated under the exceptional case process.  Before a person can be treated under the exceptional case process, prior approval must be obtained from the Commission.

 

7.3.6  A referral to a community nursing provider is to be made only to a community nursing provider that has entered into, and is bound by, a contract with the Commission or the Department (being a contract entered into for the purposes of the VEA Treatment Principles) to provide community nursing services during the relevant period of treatment and in the geographical area in which the entitled person resides.

 

7.3.6A If no community nursing provider referred to in paragraph 7.3.6 can provide the relevant community nursing care within a reasonable time, the Commission may approve a referral to another community nursing provider.

 

7.3.7  The Commission will not accept, as part of a community nursing service, financial responsibility for any domestic help services such as cooking, shopping, cleaning, laundry, transport and companionship.

 

 

 

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7.4      Optometrical services

7.4.1  The Commission will accept financial responsibility for optometrical services, in respect of a condition associated with malignant neoplasia, provided to an entitled person who consults an optometrist participating in the arrangements between optometrists and the Commission entered into for the purposes of the VEA Treatment Principles.

 

7.4.2  The Schedule of Prescribable Items prepared by the Commission for the purposes of the VEA Treatment Principles lists the products that may be supplied under these Principles by participating optometrists and other optical dispensers.

Note:      The Schedule of Prescribable Items is available at any office of the Department.

 

7.4.3  A participating optometrist may render the account for services provided to an entitled person either to the Department or to Medicare under the direct billing arrangements.

 

7.4.4  When a participating optometrist direct bills Medicare and visual aids are prescribed, these may be provided under paragraph 7.4.2.

 

7.5      Physiotherapy

7.5.1  The Commission will accept, subject to paragraph 7.5.3, financial responsibility for physiotherapy treatment for a period, in respect of a condition associated with malignant neoplasia, where an LMO or medical practitioner refers an entitled person to a registered physiotherapist to whom the Health Insurance Commission has given a provider number.

Note:      Physiotherapy includes hydrotherapy (see paragraph 1.4.1).

 

7.5.2  The period referred to in paragraph 7.5.1 commences on the date of the LMO or other GP’s, or medical specialist’s, referral.

 

7.5.3  Prior approval is required for physiotherapy treatment:

 

(a)      where those services are to be provided to an entitled person classified as a high care patient in a residential aged care facility; or

 

(b)     where those services are to be provided in a public hospital.

 

7.5.4  The Commission may accept financial responsibility for hydrotherapy treatment, in respect of a condition associated with malignant neoplasia, that does not include recreational water exercises or recreational swimming.

 

7.6               Podiatry

7.6.1  Subject to paragraph 7.6.6, the Commission will accept financial responsibility for podiatry treatment in respect of a condition associated with malignant neoplasia where a LMO or other GP or medical specialist refers an entitled person to a registered podiatrist (to whom the Health Insurance Commission has given a provider number), for an episode of care.

 

7.6.2  Prior approval is required for podiatry treatment:

 

(a)              where those services are to be provided to entitled persons classified as high care patients in a residential aged care facility;

 

(b)              where those services are to be provided in a public hospital;

 

(c)              when prescribing temporary footwear, prescribing more than two pairs of medical grade footwear;

 

(d)             prescribing more than three pairs for entitled persons living in remote areas;

 

(e)               repairing depth and custom footwear if the cost is over $100;

 

(f)               modifying depth and custom footwear if the cost is over $100;

 

(g)              providing an Electrodynographic Analysis and Report;

 

(h)              providing a Video Gait Analysis and/or Treadmill Analysis and Report;

 

(i)                delivering services valued at over $60 under the Miscellaneous Items listed in the Deed of Agreement between the Commission and the podiatrist entered into for the purposes of the VEA Treatment Principles.

 

7.6.3  The Commission will accept financial responsibility for surgical removal of the toenail plate (either partial or total) by a registered podiatrist (to whom the Health Insurance Commission has given a provider number), with or without sterilisation of the matrix, only if the procedure is for a condition associated with malignant neoplasia and prior approval has been obtained.

 

7.6.4    The Commission may use an approved contracted supplier for the provision of footwear — being a supplier who entered into an arrangement with the Commission or the Department, in respect of the provision of footwear, for the purposes of the VEA Treatment Principles.

 

7.6.5  The Commission will accept financial responsibility for footwear, and footwear repairs, only if the footwear is:

 

          (a)      medical grade footwear;

 

(b)     prescribed by a registered podiatrist, or a medical specialist who is a rehabilitation specialist, orthopaedic surgeon or rheumatologist; and

 

(c)     supplied by a contractor or other supplier approved by the Commission for the purposes of paragraph 7.6.5(c) of the VEA Treatment Principles.

 

7.6.6  Except where the Commission decides otherwise, financial responsibility will not be accepted for routine toenail cutting.

 

 

 

 


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7.6A           Diabetes Educator services

 

7.6A.1          Subject to paragraph 7.6A.2 the Commission may accept financial responsibility for diabetes educator services provided to an entitled person with diabetes where:

 

(a)  a referer, being a LMO, other GP, medical specialist, discharge planner, a treating doctor in a hospital or another credentialled diabetes educator with a current referral, refers the entitled person to a credentialled diabetes educator for diabetes educator services; and

 

(b) except where the referer is of the opinion that the entitled person suffers from chronic diabetes that needs ongoing treatment, twelve months has not elapsed from the date of the referral or, where an entitled is referred by a credentialled diabetes educator to another credentialled diabetes educator, twelve months has not elapsed from the date of the original referral; and

 

(c)  the credentialled diabetes educator is participating in arrangements between the diabetes educator and the Commission; and

 

(d) the credentialled diabetes educator has a provider number issued by Medicare Australia.

 

7.6A.2                  Prior approval is required for diabetes educator services where:

 

(a)  those services are to be provided to an entitled person classified as a high care patient in a residential aged care facility; or

 

(b) those services are to be provided to an entitled person in a public hospital.

 

7.7               Chiropractic and osteopathic services

 

7.7.1    The Commission will accept financial responsibility for chiropractic or osteopathic services, in respect of a condition associated with malignant neoplasia, where a LMO or other GP or medical specialist refers an entitled person to a registered chiropractor or osteopath to whom the Health Insurance Commission has given a provider number.

 

7.7.2   The Commission will only accept financial responsibility for chiropractic and osteopathic services involving treatment of the musculo-skeletal system in relation to a condition associated with malignant neoplasia.  No other treatment will be accepted.

 

7.7.3   The Commission will only accept financial responsibility for x-rays taken by a registered chiropractor who is licensed to take x-rays under relevant State or Territory legislation.

 

7.7.5    The Commission will not accept financial responsibility for the provision of concurrent courses of physiotherapy and chiropractic services or physiotherapy and osteopathic services for the same condition to any entitled person.

 

7.8      Other services

 

7.8.1  The Commission will not accept financial responsibility for certain services, including:

 

(a)    herbalist services;

 

(b)   homeopathy;

 

(c)   iridology;

 

(d)   massage that is not performed as part of authorised physiotherapy, chiropractic or osteopathy services; and

 

(e)    naturopathy.

 

 

 


 

PART 9 — TREATMENT OF ENTITLED PERSONS AT HOSPITALS AND OTHER INSTITUTIONS FOR MALIGNANT NEOPLASIA

9.1      Admission to a hospital or institution

9.1.1  Subject to these Principles, the Commission will accept financial responsibility for the provision of treatment to entitled persons, for malignant neoplasia, at a hospital or an institution.

 

9.1.2  The Commission will not approve, or accept financial responsibility for, admission to a hospital or an institution if:

 

(b)   the person could have been provided with suitable outpatient treatment; or

 

(c)   the person could have been suitably cared for at home, with or without supporting community health care services, unless the admission would provide respite for a carer of an entitled person.

 

9.1.3  Notwithstanding other provisions of these Principles, the Commission will accept financial responsibility for the emergency admission to the nearest hospital of an eligible person for treatment if an office of the Department is notified on the first working day after the admission, or as soon thereafter as is reasonably practicable, if that admission is to a private hospital requiring prior approval as set out in Part 3 of these Principles.

 

9.1.4  Where hospital treatment of an entitled person has been arranged under these Principles, and the person’s partner is an inpatient at another hospital within reasonable proximity, the Commission may arrange the admission or transfer of the person to the hospital at which the person’s partner is an inpatient.

 

9.1.5  If such arrangements are made under paragraph 9.1.4, the Commission will accept financial responsibility for the hospital treatment of the entitled person.

 

9.1.6  The Commission will accept financial responsibility for the admission of an entitled person to a Tier 2 or Tier 3 hospital, as set out in Principle 2 of the RPPPs, only if prior approval for the admission is obtained.

 

9.1.7  When giving consideration of prior approval under paragraph 9.1.6, the Commission will have regard to the matters set out in paragraph 3.2.2 and in Principle 2 of the RPPPs.

 

9.1.8  Subject to this Part, the Commission will accept financial responsibility for inpatient treatment of an entitled person in a country or a Territory public hospital or in a private hospital with which arrangements have been previously agreed with the Commission, for the purposes of Part V VEA, and according to the preferences and requirements set out in Part 3 of these Principles and in Principle 2 of the RPPPs.

 

9.1.9  The Commission’s approval is required before it will accept financial responsibility for the admission to hospital, or for hospital treatment, of entitled persons in all other circumstances.

 

9.1.10         Where prior approval is required, the Commission will not accept financial responsibility for any additional charges where an admission for treatment is arranged according to these Principles and then non-Medicare Benefits Schedule surgery or cosmetic surgery is performed subsequently without the Commission's approval.

 

9.2      Financial Responsibility For Treatment In Hospital

9.2.1  Subject to paragraph 9.2.5, the Commission will accept financial responsibility for any usual and reasonable hospital treatment, for malignant neoplasia, that takes place at the hospital for persons admitted in accordance with these Principles.

 

9.2.2  The Commission may accept financial responsibility for any usual and reasonable treatment, for malignant neoplasia, that takes place outside the hospital if it is prescribed as a necessary part of inpatient treatment.

 

 

 


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9.2.4  Subject to paragraph 9.2.5, the Commission will accept financial responsibility for hospital charges on the basis of:

 

(a)    for a public hospital — an amount in accordance with arrangements made by the Commission with the appropriate State/Territory authority, or, in the absence of such arrangements, an amount in accordance with arrangements made by the Commission under Part V VEA with the appropriate State/Territory authority, for the purposes of the VEA; or

 

(b)   for a contracted private hospital — the rate agreed between the Commission and the hospital or, in the absence of such an agreement, the rate agreed between the Commission and the hospital under Part V VEA for the purposes of the VEA;

 

(c)   for a non-contracted private hospital, when neither a public nor a contracted private hospital can provide the treatment required — the rate agreed from time to time between the Commission and the hospital or, in the absence of such an agreement, the rate agreed between the Commission and the hospital under Part V VEA for the purposes of the VEA; or

 

(d)   for a non-contracted hospital, when chosen by an entitled person in preference to a contracted private hospital — the rate agreed from time to time between the Commission and the hospital or, in the absence of such an agreement, the rate agreed between the Commission and the hospital under Part V VEA for the purposes of the VEA.

 

9.2.5  The Commission will not accept financial responsibility for the whole, or that portion, of:

(a)    hospital charges; or

 

(b)   charges for any surgically implanted prostheses; or

 

(c)   charges paid by health fund benefits;or

 

in circumstances where the entitled person:

 

(d)   is insured by private health insurance for hospital charges, or surgically implanted prostheses, and

 

(e)    agrees to assign to the hospital or other institution the benefits available from private health insurance in respect of all or part of the hospital charges or surgically implanted prostheses.

 

9.3      Nursing-home-type care for entitled persons with malignant neoplasia

9.3.1  Where:

 

(a)    an entitled person remains an inpatient in excess of 35 consecutive days and there is no acute care certificate under section 3B of the Health Insurance Act 1973 in force stating reasons approved by the Commission for the continuing need for acute care for the condition of malignant neoplasia; or

 

(b)   the medical practitioner responsible for treating the entitled person agrees at any time after admission that the entitled person no longer requires acute care;

 

the person will be regarded as receiving nursing-home-type care if the person is suffering from the effects of malignant neoplasia.

 

9.3.2  If an entitled person:

 

(a)      is eligible for a residential care subsidy under the Aged Care Act 1997; and

         (b)     is receiving nursing-home-type care as defined in paragraph 9.3.1;

 

the Commission will accept financial responsibility for the standard hospital fee for nursing-home-type patients under the National Health Act 1973, or other agreed fee, less the residential care amount.

 

9.3.3  Nothing in this Part is to be taken to permit payments to be made by the Commonwealth under both the Australian Participants in British Nuclear Tests (Treatment) Act 2006 and either the Veterans’ Entitlements Act 1986, the Aged Care Act 1997 or the National Health Act 1953 in respect of the same amount for which the Commonwealth has become liable in respect of nursing-home-type care under these Principles, the Veterans’ Entitlements Act 1986, the Aged Care Act 1997 or the National Health Act 1953.

 

9.5      Convalescent care

9.5.1  Subject to prior approval and subject to paragraph 9.2.5, the Commission will accept financial responsibility for the costs of convalescent care for an entitled person, as a consequence of treatment of the entitled person for a condition associated with malignant neoplasia, at an institution for a maximum of 21 days during any financial year.

 

9.6      Other matters

9.6.1  The Commission may withdraw its approval, at any time, for an entitled person’s continued inpatient treatment in a hospital or other institution.

 


 

PART 10 — RESIDENTIAL CARE FOR ENTITLED PERSONS

                     SUFFERING FROM MALIGNANT NEOPLASIA

Part A — residential care not involving residential care (respite)

 

Note: this heading is intended to be an aid in interpretation.

 

10.1    Residential care arrangements

 

10.1.1  Residential care may be provided in accordance with this Part to                 a person who has a current valid White Card.

 

Note (1)‘residential care is defined in paragraph 1.4.1.

 

10.1.2  Subject to paragraph 10.1.3 and paragraph 10.1.5, a person referred to in paragraph 10.1.1 may be provided with residential care under the Aged Care Act 1997and the Principles if the person suffers from a condition associated with malignant neoplasia.

 

10.1.3  Upon the Commonwealth becoming liable to pay an amount under the Aged Care Act 1997 in respect of residential care for a person referred to in paragraph 10.1.1, the Commission is taken to have:

 

(a)      arranged for the provision of that residential care in accordance with this Part; and

 

(b)     accepted financial responsibility for that amount.

Note:       The effect of paragraph 10.1.3 is to provide for payment to be made under the Australian Participants in British Nuclear Tests (Treatment) Act 2006 instead of the Aged Care Act 1997.  

 

10.1.4  Paragraph 10.1.3 does not permit payments to be made by the Commonwealth under both the Australian Participants in British Nuclear Tests (Treatment) Act 2006 and the Aged Care Act 1997 in respect of the same amount for which the Commonwealth has become liable.

 

10.1.5                   Despite paragraph 10.1.3, where residential care is provided to an entitled person under the Aged Care Act 1997 and the Commonwealth is not liable to pay an amount under that Act in respect of an amount incurred by the entitled person in relation to that care, the Commission may accept financial liability for any such amount incurred by the entitled person where the Principles so provide.

 

Note:under the Aged Care Act 1997 the Commonwealth is not necessarily liable to pay resident fees such as the residential care amount.  Liability to pay that amount may be accepted by the Commission where the Principles so provide.

 

10.4    Payment of residential care amount for certain entitled persons

10.4.1  The Commission may, in exceptional circumstances, accept financial responsibility for the residential care amount for an entitled person who:

 

(a)      has a dependant; and

 

(b)     is receiving a high level of residential care because of a condition associated with malignant neoplasia.

 

Part B — residential care involving residential care (respite)

 

Note (1): this heading is intended to be an aid in interpretation.

Note (2): in Part B respite admission and residential care (respite) are interchangeable terms.

 

10.6        Residential care (respite) arrangements

 

10.6.1     residential care (respite) may be provided to an entitled person in accordance with this Part.

 

10.6.2     The Commission may, in accordance with the following Table and subject to this Part, accept financial liability for the provision of residential care (respite) to an entitled person, suffering from a condition associated with malignant neoplasia, for a period not exceeding 63 days in a Financial year or not exceeding such further period in a Financial year for which residential care provided as respite to the person is permitted under the Residential Care Subsidy Principles.

 

Note (1): in Part B respite admission and residential care (respite) are interchangeable terms.

 

Note (2): the Residential Care Subsidy Principles (Principles) are made under subsection 96-1 (1) of the Aged Care Act 1997.  Under Part 7 of the Principles the Secretary may increase the number of days a person may be provided with residential care as respite care by 21.

 


LIMITS OF FINANCIAL RESPONSIBILITY ACCEPTED BY THE REPATRIATION COMMISSION FOR RESPITE ADMISSION

category of patient

 

type of care; max.period of care permitted; type of care costs accepted

 

type of care; max.period of care permitted; type of care costs accepted

 

 

 

 

 

 

 

residential care (respite)

 

up to 28 days (inclusive) in a Financial year

 

residential care (respite)

 

upon an entitled person exhausting 28 days of residential care (respite) in a Financial yearbetween and including 29 to 63 days* in that Financial year

entitled person

RCS + RCA

RCS

 

For the purposes of this table:

 

‘RCA’ means the Commission will accept financial responsibility for the residential care amount.

 

‘RCS’ means the Commission will accept financial responsibility for the residential care subsidy.

 

‘RCS + RCA’ means the Commission will accept financial responsibility for the residential care subsidy  and the residential care amount.

 

* or for such further period permitted under the Residential Care Subsidy Principles.

 

 

 

10.6.3   Where the Commission could accept financial liability for a residential care amount otherwise payable by an entitled person in respect of a day in residential care, but does not accept liability because the entitled person chooses to accept that liability, then that day is not to be taken into account in calculating if the person has been a respite admission for 63 days or such further period permitted under the Residential Care Subsidy Principles.

 

10.6.7 (1)    For the purposes of paragraphs 10.6.1 to 10.6.3 (inclusive), a day means, in relation to residential care (respite) a period of 24 hours.

 

Note: the "limit of days" for residential care (respite) means the maximum number of days for which the Commission may accept financial liability for - in the case of residential care (respite), the residential care subsidy or the residential care subsidy and the residential care amount.

 

         10.6.8         Upon the Commonwealth or an entitled person becoming liable to pay an amount under the Aged Care Act 1997 in respect of residential care (respite) provided to that person and the Commission assuming financial responsibility for that amount, the Commission is taken to have arranged for the provision of that residential care (respite) to that entitled person in accordance with this Part.

         Note (1): the effect of paragraph 10.6.8 is to provide for payment to be made under the Australian Participants in British Nuclear Tests (Treatment) Act 2006 instead of the Aged Care Act 1997.

 

Note (2): the amount an entitled person could be liable to pay for residential care (respite) is the residential care amount, being a resident's contribution to his or her care.

 

         10.6.9  Nothing in this Part is to be taken to permit payments to be made by the Commonwealth under both the Australian Participants in British Nuclear Tests (Treatment) Act 2006 and the Aged Care Act 1997 in respect of the same amount for which the Commonwealth has become liable in respect of residential care (respite)  under these Principles or the Aged Care Act 1997.

 

                 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 or to a residential care facility not governed by the Aged Care Act 1997.  The definition of residential care does not include hospital care.

 

           10.8  The Commission may accept, in whole or in part, financial responsibility for respite provided to an entitled person who suffers from malignant neoplasia, for a maximum period of 28 days in a Financial year, where such respite is provided 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 10.6.1.

 

 


 

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PART 11 — THE PROVISION OF REHABILITATION APPLIANCES TO ENTITLED PERSONS SUFFERING FROM MALIGNANT NEOPLASIA

11.1  Rehabilitation Appliances Program

11.1.1         The Commission may accept financial responsibility for:

 

(a)    surgical appliances; and

 

(b)   appliances for self-help and rehabilitation purposes;

 

provided to an entitled person for use by that entitled person in relation to a condition associated with malignant neoplasia.

 

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.

 

11.2.2         Subject to principle 3.4 and paragraph 11.4.1, the Commission will not be financially responsible for the supply of an appliance without prior approval.

 

11.3    Restrictions on the supply of certain items

11.3.1                   Subject to this Part, the Commission will accept financial responsibility for the following appliances only where they are provided to entitled persons who have a medically assessed need for these items due to malignant neoplasia:

 

(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 person 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 accept financial responsibility for the provision of electronic communication equipment to an entitled person only where such equipment is provided to an entitled persons who, due to suffering from malignant neoplasia, is:

 

(a)    legally blind; or

 

(b)   severely handicapped.

 

11.3.3                   For the purposes of paragraph 11.3.2, a legally blind person means a person:

 

(a)    whose legal blindness is caused by a condition associated with malignant neoplasia; 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 person means a person:

 

(a)   whose severe handicap is caused by a condition associated with malignant neoplasia; 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 person’s:

 

(i)    communication skills; and

 

(ii)   quality of life.

 

11.3.6                   The Commission will not approve the supply of a rehabilitation appliance to an entitled person in an institution where:

 

(a)    the Commission is satisfied that the appliance should be supplied by the institution because of Commonwealth, State or Territory legislation under which the institution is registered;or

 

(b)   the Commission is satisfied that the appliance should be supplied by the institution as the result of charges made or subsidies received by the institution under Commonwealth, State or Territory legislation; or

 

(c)   installation of the appliance necessitates structural alteration to any part of the institution.

 

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 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 person who has a medically assessed need for these items because of a condition associated with malignant neoplasia.

 

 

 

 

 

 

11.4    Visual aids

11.4.1                   The Commission will accept financial responsibility for visual aids dispensed on a prescription of an ophthalmologist or an optometrist in accordance with arrangements entered into between the Commission and suppliers for the purposes of the VEA Treatment Principles where the aids are for a condition associated with malignant neoplasia.

 

11.4.2                   Visual aids may be prescribed from the Schedule of Prescribable Items.

Note:      The Schedule of Prescribable Items is made by the Commission under paragraph 7.4.2 of the VEA Treatment Principles.

 

11.4.3                   Prior approval is required for the prescription of non-Schedule items 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 Schedule of Prescribable Items, 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 aid is for a condition associated with malignant neoplasia.

 

11.5.2                   Where a person who has a condition associated with malignant neoplasia 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.

 

 

 

 

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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 malignant neoplasia or as a result of treatment of malignant neoplasia; or

 

(b)   requires a wig as part of medical treatment for disfigurement due to a condition associated with malignant neoplasia.

 

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, for a condition of an entitled person that is associated with malignant neoplasia:

 

(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, for a condition of an entitled person that is associated with malignant neoplasia, the provision will be through:

 

(a)    a stoma association; or

 

(b)   the Pharmaceutical Benefits Scheme; or

 

(c)   the Repatriation Pharmaceutical Benefits Scheme (Australian Participants in British Nuclear Tests) 2006.

 

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 may accept financial responsibility for the repair or replacement of a rehabilitation appliance while an entitled person is temporarily outside Australia.

 

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 accept financial responsibility for treatment aids as part of inpatient treatment for a condition associated with malignant neoplasia 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 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 financial assistance towards the cost of such aids or appliances for the entitled person to a maximum amount of $187 (maximum amount) in a Calendar year  — 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.

 

11.9.2                   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 in relation to a condition associated with malignant neoplasia; 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 arrangements entered into by the Commission with any person, for the purposes of paragraph 11.9.3 of the VEA Treatment Principles, whereby the person:

 

(a)     is to provide the Commission with reports from home and safety assessors; or

 

(b)     provide aids and appliances for accident prevention and personal safety;

 

apply for the purposes of this Part as if entered into by the Commission under this Part.

 

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 referred to in paragraph 11.9.3.

 

11.9.5                   The Commission cannot accept financial responsibility, either partly or wholly, for the purchase, supply, or installation of an aid or appliance for accident prevention and personal safety if it is satisfied that:

 

(a)     the appliance can reasonably be obtained under another Commonwealth, State, or Territory program; or

 

(b)     the appliance should be provided by the owner of a self-care unit, or retirement village, or institution in which the entitled person resides; or

 

(c)     the installation of the appliance would result in structural alteration to any part of the institution in which the person resides.

 

11.9.6                   If the relevant aid or appliance requires attachment to real property in such manner that it becomes a fixture or involves alteration to the structure of the property, the Commission may give approval under paragraph 11.9.1 only if it is satisfied that:

 

(a)    such attachment or alteration will not breach, and  will be in accordance with, relevant Commonwealth, State, or Territory laws; and

 

(b)   the owner of the property has:

 

(i)      given approval for the attachment; and

 

(ii)      undertaken not to seek compensation for restoration of the property.

 

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                   Neither the Commonwealth nor the Commission will 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.


 

[Leave one page space as an amendment divider]

PART 12 — OTHER MATTERS RELATING TO TREATMENT OF MALIGNANT NEOPLASIA

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 for transport for a condition associated with malignant neoplasia.

 

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 entered into for the purposes of paragraph 12.1.5 of the VEA Treatment Principles.

 

12.2    Treatment under Medicare

12.2.1                   Entitled persons may choose to have their treatment arranged through the Department or under Medicare.

 

12.2.2                   Subject to these Principles, entitled persons who are treated under Medicare arrangements may also receive services that are not covered by Medicare 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 eligible 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                  Subject to the Act, 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.

 

Note: Division 3 of Part 5 of the Act applies to payments induced by false statements etc

 

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 48 of the Act, by offsetting moneys for any excess amounts against any later claims for payment by that person or body; or

Note:      Section 48 provides, in effect, that where amounts have been overpaid, the Commission may, if the person agrees, offset moneys owed against later claims.

 

(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.

 


 

Schedule 2  Repatriation Medical Fee Schedule

 

 

 

 

                            Repatriation Medical Fee Schedule

 

 

Repatriation Medical Fees can be claimed by medical specialists who provide services to an entitled person.  Where a specialist agrees to claim the Repatriation Medical Fee for a service provided, no further claim can be levied against that entitled person.

 

Repatriation Medical Fee assessments and calculations are based on Medicare assessment rules.

 

 


 

Item

Scheduled

Increase

Item

Scheduled

Increase

Item

Scheduled

Increase

Item

Scheduled

Increase

number

fee

%

number

fee

%

number

fee

%

number

fee

%

 

 

 

 

 

 

 

 

 

 

 

 

00104

83.50

 

00338

243.45

 

00534

635.65

 

11204

110.20

 

00105

41.85

 

00342

48.15

 

00536

706.35

 

11205

110.20

 

00106

69.30

 

00344

63.95

 

00820

135.70

 

11210

110.20

 

00107

122.40

 

00346

94.45

 

00822

203.60

 

11211

110.20

 

00108

77.45

 

00348

51.05

 

00823

271.40

 

11212

71.40

 

00110

147.25

 

00350

114.85

 

00825

97.50

 

11215

125.20

 

00116

73.70

 

00352

51.05

 

00826

155.50

 

11218

154.70

 

00119

41.85

 

00353

48.60

 

00828

213.45

 

11221

69.00

 

00122

178.70

 

00355

97.05

 

00830

135.70

 

11222

69.00

 

00128

108.05

 

00356

142.30

 

00832

203.60

 

11224

41.60

 

00131

77.80

 

00357

196.40

 

00834

271.40

 

11225

41.60

 

00160

211.90

 

00358

239.25

 

00835

97.50

 

11235

124.90

 

00161

353.10

 

00364

42.25

 

00837

155.50

 

11237

82.85

 

00162

494.25

 

00366

84.40

 

00838

213.45

 

11240

82.85

 

00163

635.65

 

00367

123.70

 

00855

135.70

 

11241

105.55

 

00164

706.35

 

00369

170.80

 

00857

203.60

 

11242

81.60

 

00170

112.45

 

00370

208.00

 

00858

271.40

 

11243

81.60

 

00171

118.50

 

00385

83.50

 

00861

135.70

 

11300

195.95

 

00172

144.20

 

00386

41.85

 

00864

203.60

 

11303

195.95

 

00173

24.90

 

00387

122.40

 

00866

271.40

 

11304

322.70

 

00193

35.50

 

00388

77.45

 

10801

118.75

 

11306

22.40

 

00195

 

15.00

00410

16.20

 

10802

118.75

 

11309

26.75

 

00197

67.35

 

00411

35.50

 

10803

118.75

 

11312

37.80

 

00199

99.15

 

00412

67.35

 

10804

118.75

 

11315

50.10

 

00300

42.25

 

00413

99.15

 

10805

118.75

 

11318

61.80

 

00302

84.40

 

00414

 

15.00

10806

118.75

 

11321

117.50

 

00304

123.70

 

00415

 

15.00

10807

118.75

 

11324

33.40

 

00306

170.80

 

00416

 

15.00

10808

118.75

 

11327

20.10

 

00308

208.00

 

00417

 

15.00

10809

118.75

 

11330

8.05

 

00310

21.15

 

00444

16.20

 

10816

118.75

 

11332

59.60

 

00312

42.25

 

00445

35.50

 

11000

125.35

 

11333

45.40

 

00314

61.85

 

00446

67.35

 

11003

331.70

 

11336

45.40

 

00316

85.50

 

00447

99.15

 

11004

331.70

 

11339

45.40

 

00318

104.10

 

00448

112.75

 

11005

331.70

 

11500

170.05

 

00319

170.80

 

00449

134.85

 

11006

170.05

 

11503

141.20

 

00320

42.25

 

00501

16.20

 

11009

231.85

 

11506

20.90

 

00322

84.40

 

00503

35.50

 

11012

113.95

 

11509

36.30

 

00324

123.70

 

00507

67.35

 

11015

152.65

 

11512

62.90

 

00326

170.80

 

00511

99.15

 

11018

228.05

 

11600

70.50

 

00328

208.00

 

00515

158.65

 

11021

152.65

 

11602

58.75

 

00330

77.55

 

00519

105.90

 

11024

116.00

 

11604

77.10

 

00332

121.75

 

00520

211.90

 

11027

171.95

 

11605

77.10

 

00334

168.75

 

00530

353.10

 

11200

41.50

 

11610

64.85

 

00336

204.25

 

00532

494.25

 

11203

70.20

 

11611

64.85

 

 

 


 

Item

Scheduled

Increase

Item

Scheduled

Increase

Item

Scheduled

Increase

Item

Scheduled

Increase

number

fee

%

number

fee

%

number

fee

%

number

fee

%

 

 

 

 

 

 

 

 

 

 

 

 

11612

114.40

 

12215

714.60

 

13312

28.90

 

14050

53.70

 

11614

77.10

 

12217

643.75

 

13318

231.60

 

14053

53.70

 

11615

77.20

 

12306

104.20

 

13319

231.60

 

14100

155.30

 

11627

232.80

 

12309

104.20

 

13400

98.60

 

14106

155.30

 

11700

31.80

 

12312

104.20

 

13500

183.60

 

14109

190.70

 

11701

15.85

 

12315

104.20

 

13503

367.25

 

14112

225.85

 

11702

15.85

 

12318

104.20

 

13506

187.80

 

14115

261.10

 

11708

130.25

 

12321

104.20

 

13700

339.35

 

14118

331.75

 

11709

170.50

 

12500

220.55

 

13703

121.60

 

14124

155.30

 

11710

52.80

 

12503

432.55

 

13706

84.95

 

14200

60.95

 

11711

28.75

 

12506

308.80

 

13709

49.30

 

14203

52.10

 

11712

154.85

 

12509

220.55

 

13750

139.15

 

14206

36.25

 

11713

71.00

 

12512

106.90

 

13755

139.15

 

14209

90.35

 

11715

123.00

 

12515

234.05

 

13757

74.30

 

14212

188.70

 

11718

35.35

 

12518

106.90

 

13760

776.50

 

14215

99.65

 

11721

71.00

 

12521

128.95

 

13815

86.80

 

14218

99.65

 

11722

35.35

 

12524

161.15

 

13818

115.80

 

14221

53.45

 

11724

171.95

 

12527

86.45

 

13830

76.75

 

14224

71.65

 

11800

177.70

 

12530

128.95

 

13839

23.40

 

15000

43.40

 

11810

177.70

 

12533

86.10

 

13842

70.50

 

15003

 

20.00

11820

2076.30

 

13015

259.40

 

13845

550.80

 

15006

96.10

 

11830

190.15

 

13020

263.45

 

13848

133.45

 

15009

 

20.00

11833

254.30

 

13025

117.85

 

13851

502.60

 

15012

54.40

 

11900

28.10

 

13030

166.45

 

13854

116.90

 

15100

48.60

 

11903

113.15

 

13100

139.15

 

13857

149.05

 

15103

 

20.00

11906

113.15

 

13103

72.50

 

13870

310.60

 

15106

57.35

 

11909

168.05

 

13106

123.60

 

13873

231.30

 

15109

 

20.00

11912

168.05

 

13109

231.85

 

13876

70.50

 

15112

122.40

 

11915

168.05

 

13110

232.60

 

13879

225.40

 

15115

 

20.00

11917

436.10

 

13112

139.15

 

13882

76.75

 

15211

55.70

 

11919

436.10

 

13200

2035.60

 

13885

138.80

 

15214

 

20.00

11921

76.40

 

13203

508.90

 

13888

72.30

 

15215

60.80

 

12000

39.65

 

13206

872.35

 

13915

66.25

 

15218

60.80

 

12003

59.95

 

13209

87.10

 

13918

99.65

 

15221

60.80

 

12012

21.10

 

13212

370.80

 

13921

112.80

 

15224

60.80

 

12015

63.60

 

13215

116.35

 

13924

66.50

 

15227

60.80

 

12018

81.90

 

13218

872.35

 

13927

85.90

 

15230

 

20.00

12021

120.00

 

13221

53.10

 

13930

119.95

 

15233

 

20.00

12200

37.85

 

13290

208.00

 

13933

133.10

 

15236

 

20.00

12201

2436.50

 

13292

416.10

 

13936

86.70

 

15239

 

20.00

12203

598.70

 

13300

58.00

 

13939

99.65

 

15242

 

20.00

12207

598.70

 

13303

85.90

 

13942

66.50

 

15245

60.80

 

12210

714.60

 

13306

340.15

 

13945

53.45

 

15248

60.80

 

12213

643.75

 

13309

290.00

 

13948

66.50

 

15251

60.80

 

 

 


 

Item

Scheduled

Increase

Item

Scheduled

Increase

Item

Scheduled

Increase

Item

Scheduled

Increase

 

number

fee

%

number

fee

%

number

fee

%

number

fee

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15254

60.80

 

15524

648.90

 

16624

304.50

 

18292

127.15

 

 

15257

60.80

 

15527

80.35

 

16627

620.05

 

18294

179.15

 

 

15260

 

20.00

15530

358.50

 

16633

 

20.00

18296

153.25

 

 

15263

 

20.00

15533

679.80

 

16636

 

20.00

18298

179.15

 

 

15266

 

20.00

15536

271.70

 

18213

90.30

 

18350

127.15

 

 

15269

 

20.00

15539

638.70

 

18216

193.30

 

18352

254.30

 

 

15272

 

20.00

15541

271.70

 

18219

 

20.00

18354

127.15

 

 

15303

363.55

 

15600

1733.30

 

18222

38.30

 

18356

127.15

 

 

15304

363.55

 

15999

132.00

 

18225

51.00

 

18358

127.15

 

 

15307

689.15

 

16003

662.40

 

18226

289.90

 

18360

127.15

 

 

15308

689.15

 

16006

509.00

 

18227

 

20.00

18362

251.15

 

 

15311

339.30

 

16009

347.35

 

18228

63.65

 

18364

127.15

 

 

15312

336.85

 

16012

300.55

 

18230

242.75

 

18366

159.30

 

 

15315

666.10

 

16015

4160.05

 

18232

193.30

 

18368

271.85

 

 

15316

666.10

 

16018

2486.80

 

18233

193.30

 

18370

45.90

 

 

15319

413.40

 

16500

37.00

 

18234

127.15

 

30001

 

20.00

 

15320

413.40

 

16501

143.10

 

18236

63.65

 

30003

37.00

 

 

15323

735.10

 

16502

37.00

 

18238

38.30

 

30006

47.35

 

 

15324

735.10

 

16504

37.00

 

18240

95.30

 

30010

75.25

 

 

15327

799.75

 

16505

37.00

 

18242

38.30

 

30014

158.20

 

 

15328

799.75

 

16508

37.00

 

18244

102.60

 

30017

331.90

 

 

15331

759.35

 

16509

37.00

 

18246

102.60

 

30020

646.50

 

 

15332

759.35

 

16511

223.90

 

18248

90.30

 

30023

331.90

 

 

15335

689.15

 

16512

64.60

 

18250

63.65

 

30026

53.15

 

 

15336

689.15

 

16514

37.40

 

18252

102.60

 

30029

91.55

 

 

15338

952.55

 

16515

352.90

 

18254

102.60

 

30032

84.00

 

 

15339

77.60

 

16518

352.90

 

18256

63.65

 

30035

119.65

 

 

15342

193.75

 

16519

543.50

 

18258

63.65

 

30038

91.55

 

 

15345

517.10

 

16520

635.15

 

18260

90.30

 

30042

189.05

 

 

15348

59.45

 

16522

1276.15

 

18262

63.65

 

30045

119.65

 

 

15351

118.75

 

16525

301.10

 

18264

102.60

 

30049

189.05

 

 

15354

144.10

 

16564

221.95

 

18266

63.65

 

30052

258.60

 

 

15357

40.70

 

16567

324.65

 

18268

90.30

 

30055

75.25

 

 

15360

367.55

 

16570

423.60

 

18270

90.30

 

30058

146.65

 

 

15363

367.55

 

16571

324.65

 

18272

63.65

 

30061

23.90

 

 

15500

247.15

 

16573

264.60

 

18274

90.30

 

30064

111.90

 

 

15503

317.30

 

16600

64.60

 

18276

127.15

 

30068

281.75

 

 

15506

473.75

 

16603

124.15

 

18278

90.30

 

30071

53.15

 

 

15509

214.20

 

16606