Federal Register of Legislation - Australian Government

Primary content

M1/2011 Determinations/Health as made
This Determination introduces a new service for certain clients of the Department of Veterans' Affairs (DVA). The service is Coordinated Veterans' Care and its aim is to better coordinate treatment services for certain clients with certain chronic conditions so that their hospital admissions may be reduced.
Administered by: Veterans' Affairs
Registered 30 Mar 2011
Tabling HistoryDate
Tabled HR10-May-2011
Tabled Senate10-May-2011
Date of repeal 19 Mar 2014
Repealed by Veterans' Affairs (Spent and Redundant Instruments) Repeal Regulation 2014

 

Australian Government

Military Rehabilitation and Compensation Act 2004

 

MRCA Treatment Principles (Coordinated Veterans' Care Program) Determination 2011

 

Instrument No.M1/2011

 

 

I, Warren Snowdon, Minister for Veterans’ Affairs, pursuant to subsection 286(3) of the Military Rehabilitation and Compensation Act 2004, approve this determination made by the Military Rehabilitation and Compensation Commission.

Dated this       21st     day of              March  2011

Warren Snowdon………………………………….

WARREN SNOWDON

 

The Military Rehabilitation and Compensation Commission, pursuant to subsection 286(2) of the Military Rehabilitation and Compensation Act 2004, varies the MRCA Treatment Principles (Instrument No.M21 of 2004) in accordance with the Schedule.

Dated this       21st     day of              February          2011

 

The Seal of the                                                )

Military Rehabilitation                                    )

and Compensation Commission                   )SEAL

was affixed hereto in the                                )

presence of:                                                     )

Ian Campbell                                        Major General Mark Kelly AO DSC

………………………………………………………………………………………....

IAN CAMPBELL                     Major General Mark Kelly AO DSC

CHAIR                                                                          MEMBER

 

 

 

 

[1]     Name of Instrument

This instrument is the MRCA Treatment Principles (Coordinated Veterans' Care Program) Determination 2011

 

[2]     Commencement

 

        This determination commences on 1 May 2011.

         

[3]     Savings

 

Where, immediately before the commencement of this determination, a community nursing provider had entered into an arrangement with the Repatriation Commission, or the Commission, for the provision of a service by a community nurse, then on the commencement of this determination the determination applies to the community nursing provider as a DVA-contracted community nursing provider and the arrangement is taken to have been made with the provider as a DVA-contracted community nursing provider.

 

Note: terms used in [3] have the same meaning as in the MRCA Treatment Principles.

 

Schedule

 

1.      Paragraph 1.4.1 (definitions)

 

          omit definitions of:

 

          “approved provider”

 

“community nursing provider”

 

          “sub-contractor”

         

          “MRCA Home Care Program”

         

          “MHC assessment agency”

 

“in force on the date in Schedule 1”

 

          insert:

 

“aboriginal health worker” means a person who is qualified as an aboriginal health worker after undertaking a course in Aboriginal and Torres Strait Islander Health, provided by an institution recognised by the Department of Health and Ageing as suitable for providing a course of that nature, and who obtained a Certificate Level III (or higher) under the course.

 

“admission date” means the date on which an LMO records in writing (including in electronic form) that the LMO has decided an entitled person may participate in the Coordinated Veterans' Care Program.

 

“admitting LMO”, in relation to an entitled person in the Coordinated Veterans' Care Program, means the LMO who decided an entitled person may participate in the Coordinated Veterans' Care Program.

 

“Aboriginal Health Worker Care Co-ordination treatment” means treatment provided by an aboriginal health worker to an entitled person under the Coordinated Veterans' Care Program, comprised of:

 

          (a)     implementing the GPMP for the person under the Program — in particular co-ordinating treatment services under the GPMP;

(b)     liaising, in relation to the GPMP, with the LMO who manages the GPMP for the person;

                   (c)      performing such other functions under the program that the aboriginal health worker has under the Notes for Coordinated Veterans' Care Program Providers.

 

"approved provider" means a State, Territory or Local Government, or incorporated organisation, or person, that has entered into an arrangement with the Commission for the provision of:

 

(a)   a Home Care service (category A); or

(b)  a Home Care service (category B); or

(c)    a Home Care service (category C); or

(d)  a limited MHC-type service;

 

to an entitled person, whether by the approved provider or a sub-contractor engaged by it.

 

“community nurse” means a registered nurse or enrolled nurse who works in a community nursing setting and who is employed or engaged by a DVA-contracted community nursing provider.

 

          “Community Nurse Care Co-ordination treatment” means

treatment provided by a community nurse to an entitled person under the Coordinated Veterans' Care Program, comprised of:

 

          (a)     implementing the GPMP for the person under the Program — in particular co-ordinating treatment services under the GPMP; and

(b)     liaising, in relation to the GPMP, with the LMO who manages the GPMP for the person.

                  

“enrolled nurse” means a person who is registered under a law of a State or Territory or of the Commonwealth to practise as an enrolled nurse.

 

“DVA-contracted community nursing provider” means a community nursing provider who has entered into a Deed of Standing Offer with the Commission to provide community nursing services to entitled persons.

 

“GPMP” means the care plan prepared by an LMO, in accordance with the Notes for Coordinated Veterans' Care Program Providers, for an entitled person participating in the Coordinated Veterans' Care Program.

 

Note: “GPMP” is used in the Repatriation Medical Fee Schedule which is included in the Department of Veterans’ Affairs Fee Schedules for Medical Services (see: paragraph 3.5.1).

 

“Home Care service (category C)” means the provision by an approved provider of a service to an entitled person under the MRCA Home Care Program that is:

 

(a)     pursuant to an LMO Home Care service (category C) Referral and allocated to the provider by a MHC assessment agency; and

(b)     aimed at reducing the person’s social isolation by improving their social networks; and

(c)      provided to an entitled person by an approved provider.

 

“in force on the date in Schedule 1”, in relation to a document, means that on the date in Schedule 1 for the document:

 

(a)     if the document may be approved under the Principles by the Commission, the Repatriation Commission or a member of the Commission or Repatriation Commission or by the Secretary to the Department – the document has been so approved.

 

Note: an example being the Notes for Local Medical Officers (para.1.4.1).

 

(b)     if the document is prepared on behalf of the Commission, the Repatriation Commission or the Department but is not required under the Principles to be approved in a manner in (a) – the document has been approved in a manner in (a).

 

(c)      if the document is not prepared under (b) and is not required under the Principles to be approved in a manner in paragraph (a) – the document exists.

 

“LMO Care Leadership treatment” means treatment provided by an LMO to an entitled person, under the Coordinated Veterans' Care Program, comprised of:

 

          (a)     preparing and managing the GPMP for the person under the Program;

(b)     overseeing a practice nurse in the implementation of the GPMP — where a practice nurse and not a community nurse or aboriginal health worker or the LMO co-ordinates treatment under the GPMP (Practice Nurse Care Co-ordination treatment);

                   (c)      referring the person to a DVA-contracted community nursing provider for Community Nurse Care Co-ordination treatment or to an aboriginal health worker for Aboriginal Health Worker Care Co-ordination treatment, if appropriate;

                   (d)     performing such other functions under the program that the LMO has under the Notes for Coordinated Veterans' Care Program Providers.

 

“LMO Home Care service (category C) Referral” means treatment comprised of an LMO preparing a written document that refers an entitled person, who the LMO has admitted to and is treating under the Coordinated Veterans' Care Program, to a MHC assessment agency for assessment for a Home Care service (category C) under the MRCA Home Care Program and which:

 

(a) is in the form, if any, approved by the Repatriation Commission or Commission; and

 

(b) is sent to the MHC assessment agency, including as a facsimile message.

 

“Notes for Coordinated Veterans' Care Program Providers means the document approved by the Commission, the Repatriation Commission, or a member of the Commission or Repatriation Commission, or by the Secretary to the Department, entitled “Notes for Coordinated Veterans' Care Program”, and in force on the date in Schedule 1, that sets out the terms on which:

 

          (a)     an LMO;

          (b)     a practice nurse;

          (c)      a community nurse (via a DVA-contracted community nursing provider); and

          (d)     an aboriginal health worker;

 

is to provide treatment to an entitled person under the Coordinated Veterans' Care Program in order for the Commission to accept financial responsibility for that treatment.

 

“period of care” in relation to the care provided by:

 

          (a) an LMO; or

          (b) a practice nurse; or

(c) an aboriginal health worker; or

(d) a community nurse (via a DVA-contracted community nursing provider);

 

to an entitled person under the Coordinated Veterans' Care Program (Program), means the period set out in the Notes for Coordinated Veterans' Care Program Providers in relation to the LMO, practice nurse, community nurse or aboriginal health worker, provided that any subsequent period of care by the same LMO is approved by the LMO for the person.

 

Note 1: the period of care is important for billing purposes.  The Notes for Coordinated Veterans' Care Program Providers contain the detail of billing procedures.  Generally, for an LMO the period is 3 months commencing on the patient’s admission to the Program and for a community nurse the period is 28 days commencing on date of service.  Generally previous care periods with different providers must expire before a new provider can claim for a care period except that, with prior approval, a community nurse can claim for a care period although a previous care period in respect of the relevant entitled person has not expired.  A community nurse cannot claim for a period not covered by a period of care provided by an LMO.

 

Note 2: any period of care by an LMO other than the first period of care commencing on the date the entitled person is admitted to the Program (admission date) or the first period of care as a different LMO for the person (commencing on the date worked out under the Notes for Coordinated Veterans' Care Program Providers, is a subsequent period of care by an LMO and the LMO must approve it. By approving it, the periods of care provided by any care co-ordinator (practice nurse, community nurse or aboriginal health worker) during the period of care approved by the LMO are valid periods of care under the Program (sub-periods of care).  A sub-period of care may only be provided under the Program during a period of care under the Program by an LMO. 

 

“practice nurse” means a registered nurse or enrolled nurse employed or engaged by an LMO as a nurse in the LMO’s practice.

 

          “Practice Nurse Care Co-ordination treatment” means

treatment provided by a practice nurse to an entitled person, under the Coordinated Veterans' Care Program, comprised of:

 

          (a)     implementing the GPMP for the person under the Program — in particular co-ordinating treatment services under the GPMP;

(b)     liaising, in relation to the GPMP, with the LMO supervising the practice nurse in relation to the implementation of the GPMP;

                   (c)      performing such other functions under the program that the practice nurse has under the Notes for Coordinated Veterans' Care Program Providers.

 

Coordinated Veterans' Care Program” means the treatment program of that name set out in Part 6A of these Principles and in the Notes for Coordinated Veterans' Care Program Providers that aims to reduce the need for hospitalisation among Gold Card members of the veteran and defence force community and improve their social well-being.  In particular the program has the following main features:

 

·        assessment - a Local Medical Officer (LMO) will assess a person with complex care needs due to chronic disease to see if the person would benefit from the clinical care services under the program and ascertain if the person meets the program’s eligibility criteria;

·        consent – a person needs to consent in writing to participation in the program and the LMO needs to record that consent.  As treatment is being provided it is the LMO’s responsibility to ensure a potential participant in the program understands the nature of the program and that the person’s personal details that are relevant to the person’s treatment under the program may be provided to bodies and individuals such as the Department, Medicare Australia and health care providers, who have a need for the information in connection with the person’s treatment under the program.  

·        care plan – the LMO will prepare a comprehensive care plan (GPMP) for a person the LMO admits to the program;

·        consultation - the person will be consulted in the preparation of the care plan and its review;

·        implementation and co-ordination - the LMO’s practice nurse (or a community nurse via a DVA-contracted community nursing provider, or an aboriginal health worker, if more appropriate) will implement the care plan and, in particular, co-ordinate services under the plan.

 

Coordinated Veterans' Care Program treatment” means:

 

(a) LMO Care Leadership treatment; or

              (b) Practice Nurse Care Co-ordination treatment; or

              (c) Community Nurse Care Co-ordination treatment; or

              (d) Aboriginal Health Worker Care Co-ordination    treatment.

 

“provision of a Home Care service (category C) to an entitled person by an approved provider” includes the situation where an approved provider engages a sub-contractor to provide a Home Care service (category C) to an entitled person.

 

“registered nurse” means a person who is registered under a law of a State or Territory or of the Commonwealth to practise as a registered nurse.

 

sub-contractor” means, in relation to the MRCA Home Care Program, a State, Territory or Local Government, or incorporated organisation, or person, engaged by an approved provider or the Commission to provide a Home Care service (category A) or a Home Care service (category B) or a Home Care service (category C) to an entitled person.

 

“subsequent period of care”, in relation to the provision of care by an LMO to an entitled person, means a period of care that may be provided by the LMO after the expiry of a period of care that has already been provided by the LMO to the entitled person.

 

Note: a subsequent period of care must be approved by the LMO (see: 6A.3).  A period of care by an LMO that is not a “subsequent period of care” would be the first period of care provided to a person under the Coordinated Veterans' Care Program (Program) and the first period of care provided to a person under the Program by a new LMO for the person i.e. where the person has changed LMOs.

 

"MRCA Home Care Program" means:

 

(a)     the treatment program under which the Commission ensures the provision of care and assistance services to entitled persons who are frail, or who have disabilities, with the aim of maintaining the independence of those people, allowing them to remain in their own home for as long as possible, and reducing avoidable illness and injury, and is comprised of paragraphs 7.3A to 7.3A.22 (inclusive) of the Principles, and other relevant paragraphs in the Principles, and the arrangements under section 285 of the Act in support thereof.

 

(b)     the treatment program under which the Commission ensures the provision of social support services to entitled persons referred to the program under a LMO Home Care service (category C) Referral.

 

MHC assessment agency” means a person to whom the Commission has delegated its power to:

 

(a) assess whether a person needs:

 

(i) a Home Care service (category A); or

(ii) a Home Care service (category B); or

(iii) a Home Care service (category C;

 

under the MRCA Home Care Program; and

 

(b) allocate a service in (a) to an approved provider.

 

1A.   Paragraph 1.4.1 (Note 2 in definition of “excluded service”)

 

substitute:

Note (2): the intention is that a Home Care service (category A), Home Care service (category B) and Home Care service (category C) are mutually exclusive.

 

1B.   Paragraph 1.4.1 (definition of “exempt amount”)

 

omit:

 

          Home Care service (category A)

 

          substitute:

 

          Home Care service (category A) or Home Care service (category C)

 

1C.   Paragraph 1.4.1 (definition of “exempt entitled person”)

 

omit:

 

          Home Care service (category A)

 

          substitute:

 

          Home Care service (category A) or Home Care service (category C)

 

2.      Paragraphs 1.4.1 (definition of “exceptional case process”; 7.2.1 (the Note); 7.2.2 (the Note); 7.2.3 (the Note); 7.3.3(a) (including the Note); 7.3.3(b); 7.3.4; 7.3.6; 7.3.6A and wherever else occurring in the MRCA Treatment Principles:

 

          omit:

 

          community nursing provider

 

          substitute:

 

          DVA-contracted community nursing provider

 

3.      Part 6

 

          after this Part insert:

 

PART 6A — COORDINATED VETERANS' CARE PROGRAM

         

          6A.1  Outline

 

The “Coordinated Veterans' Care Program” (program) is an initiative that aims to improve the health of a class of entitled persons so they have fewer hospital admissions.

 

The entitled persons are Gold Card holders with complex care needs due to diagnosis of a particular chronic condition (set out in 6A.5).

 

The element of the program intended to reduce hospital admissions is external oversight of a person’s health regimen for a period of care of 3 months (carried over to consecutive periods of 3 months if the treatment is proving positive).

 

The oversight will be performed by a Local Medical Officer (LMO) and the LMO’s practice nurse (or a community nurse (via a DVA-contracted community nursing provider) or an aboriginal health worker, if more appropriate).

 

Essentially the LMO will prepare a comprehensive care plan (GPMP) for the entitled person and the LMO’s practice nurse (or a community nurse or aboriginal health worker) will co-ordinate health care services under the plan.  The LMO will provide oversight throughout.  In cases where an LMO is unable to obtain the services of a nurse or aboriginal health worker as a care co-ordinator, the LMO may provide that care co-ordination.

 

In addition to having their health care services overseen and co-ordinated, some entitled persons in the program who the LMO considers are socially isolated and would benefit from a service under a particular community care program aimed at providing the person with more social contact, may be referred by the LMO to a MHC assessment agency (an agency under the MRCA Home Care Program) for an assessment as to the suitability of the person for a social support service under that Program. 

 

Accordingly, two main treatments are provided under the program:

 

·        LMO Care Leadership treatment

·        practice nurse/community nurse/aboriginal health worker/care co-ordination treatment

 

An ancillary treatment under the program is:

 

·        LMO referral for social support service assessment

 

The main treatments relate to the oversight and co-ordination of health care services under the entitled person’s comprehensive care plan (GPMP) and are in addition to existing treatments available to the entitled person under the Medicare Benefits Schedule and the MRCA Treatment Principles.

 

The ancillary treatment may be provided by an approved provider of MRCA Home Care services following a request for social support services from a MHC assessment agency.  The LMO will have decided the person is socially isolated and that a social support service might prevent the person from being admitted or re-admitted to hospital.  The MHC assessment agency will assess the person’s suitability for a social support service.

                  

                   Note: an identical program for veterans exists under the Treatment Principles made under the Veterans’ Entitlements Act 1986.

 

6A.2 Treatments under the Coordinated Veterans' Care Program

 

6A.2.1    LMO Care Leadership treatment/LMO Home Care service (category C) Referral

 

6A.2.2    An LMO may, under the Coordinated Veterans' Care Program, provide:

         

          (a) LMO Care Leadership treatment; and/or

(b) an LMO Home Care service (category C) Referral;

 

for an entitled person.

 

          6A.2.3                  Practice Nurse Care Co-ordination treatment

 

                             6A.2.4 A practice nurse may, under the Coordinated Veterans' Care Program, provide Practice Nurse Care Co-ordination treatment to an entitled person.

         

6A.2.5 Community Nurse Care Co-ordination treatment

 

                             6A.2.6 A DVA-contracted community nursing provider may, under the Coordinated Veterans' Care Program, provide Community Nurse Care Co-ordination treatment to an entitled person.

         

6A.2.7 Aboriginal Health Worker Care Co-ordination treatment

 

6A.2.8 An aboriginal health worker may, under the Coordinated Veterans' Care Program, provide Aboriginal Health Worker Care Co-ordination treatment to an entitled person.

 

6A.3    LMO Approval of Subsequent Period of Care

 

6A.3.1        Before any subsequent period of care of an entitled person by an LMO commences, being an LMO who is treating the person under the Coordinated Veterans' Care Program (Program), the LMO is to decide if the person’s continued participation in the Program would meet the aims of the Program (i.e. reduce hospitalisation of the person/avoid duplication of services/provide cost-effective treatment).

 

Note 1: the first period of care by an LMO commences on the date the LMO decides to admit the entitled person to the Program (admission date).  Any following period of care by the same LMO is a subsequent period of care.  The first period of care by an LMO may also occur where the LMO is a different LMO for the person.  Any following period of care by the same LMO is a subsequent period of care.

 

Note 2: the period of care by an LMO is set out in the Notes for Coordinated Veterans' Care Program Providers and is a period of 3 months.

 

6A.3.2        For making the decision in 6A.3.1, the LMO is to:

 

(a)   review the entitled person’s file maintained by the LMO and any other information the LMO considers relevant; and

           

(b)   ascertain if the person is eligible for a subsequent period of care by the LMO.

 

Note: see 6A.6.2

 

6A.3.3.                 If the LMO decides the entitled person should continue to participate in the Program, because the person meets the aims of the Program and is eligible for a subsequent period of care by the LMO, the LMO is to:

 

(a)   approve a subsequent period of care by the LMO of the entitled person before the period commences (approval);

(b)   make a record of the approval (which may be in electronic form), containing the date of the approval;

(c)   store the approval in a readily retrievable form; and

(d)   take any necessary steps to facilitate the provision of the subsequent period of care by the LMO to the entitled person.

 

6A.3.4.                 Where an LMO approves a subsequent period of care by the LMO for an entitled person, before the expiry of a current period of care by the LMO for the person, the subsequent period of care commences on the day following the day on which the current period of care expired.

 

6A.3.5.       Where an LMO approves a subsequent period of care by the LMO for an entitled person (approval), after the expiry of a current period of care by the LMO for the person, the subsequent period of care commences on the date of the approval.

 

6A.3.6.       If the LMO decides not to approve a subsequent period of care by the LMO of the entitled person, because the person does not meet the aims of the Program or is ineligible for a subsequent period of care by the LMO, the LMO is to:

 

(a)     notify (including by telephone) any DVA-contracted community nursing provider who may have co-ordinated care for the entitled person under the Program immediately before the potential subsequent period of care by the LMO, of the decision;

 

(b)     if the entitled person was receiving a Home Care service (category C) immediately before the potential subsequent period of care by the LMO, notify (including by telephone) the MHC assessment agency for the person, of the decision;

 

(c)      notify the entitled person, in a manner the LMO considers appropriate, of the decision.

 

6A.4    Commission Financial Responsibility for Treatment under the Coordinated Veterans' Care Program

 

                             6A.4.1    The Commission will accept financial responsibility for:

                            

                                      (a) LMO Care Leadership treatment;

                                      (b) Practice Nurse Care Co-ordination treatment;

                                      (c) Community Nurse Care Co-ordination treatment;

                                      (d) Aboriginal Health Worker Care Co-ordination treatment;

                                     

                             provided to an entitled person, during a period of care of the person by the LMO, the practice nurse, the community nurse or the  aboriginal health worker, as the case may be, if the treatment is provided:

 

                                      (a) in accordance with the Principles and the Notes for Coordinated Veterans' Care Program Providers; and

(b) during a period of care provided to the entitled person by the LMO under the Coordinated Veterans' Care Program (Program).

 

                             6A.4.2    The financial amounts the Department will pay for:

 

                                  (a) LMO Care Leadership treatment, Practice Nurse Care Co-ordination treatment and Aboriginal Health Worker Care Co-ordination treatment — are set out in the Repatriation Medical Fee Schedule in the DVA document entitled: “Department of Veterans’ Affairs Fee Schedules for Medical Services”, in force on the date in Schedule 1;

 

                                  (b) Community Nurse Care Co-ordination treatment — are set out in the DVA document entitled: “Australian Government Department of Veterans’ Affairs Classification System and Schedule of Item Numbers and Fees — Community Nursing Services”, in force on the date in Schedule 1.

                            

                            Note: Medicare Australia will pay fees on behalf of the Department under a Services Agreement.

 

                             6A.4.3    Subject to 6A.4.4, the Commission is only to accept financial responsibility for a period of care provided to an entitled person by an LMO, practice nurse, community nurse or aboriginal health worker under the Coordinated Veterans' Care Program (Program) if any previous period of care provided by, respectively, an LMO, practice nurse, community nurse or aboriginal health worker under the Program in respect of the entitled person has expired.

 

                             Note: Under the Coordinated Veterans' Care Program a period of care provided by an LMO, practice nurse, community nurse or aboriginal health worker must be in respect of the Coordinated Veterans' Care Program treatment the health care provider may provide under the Program.

 

                             6A.4.4    A practice nurse or community nurse (collectively called “nurse 2”) may provide a period of care comprised of, respectively, Practice Nurse Care Co-ordination treatment or Community Nurse Care Co-ordination treatment, to an entitled person under the Program, where a period of care comprised of, respectively, Practice Nurse Care Co-ordination treatment or Community Nurse Care Co-ordination treatment being provided in respect of the entitled person by another practice nurse or community nurse, as the case requires, (collectively called “nurse 1”) under the Program has not expired — if the LMO or DVA-contracted community nursing provider, as the case requires, for nurse 2, has obtained prior approval.

 

Note 1: Where a period of care provided by nurse 2 and nurse 1 overlaps, and prior approval has been obtained for nurse 2’s period of care, the Commission may accept financial responsibility for the two simultaneous periods of care.

 

Note 2: “prior approval” is defined in 1.4.1 and 3.2.2 is also relevant.  The grant of prior approval is discretionary and for 6A.4.4 will be considered on a case-by-case basis.

 

 

6A.4.5    The payment of a fee for Practice Nurse Care Co-ordination treatment and Aboriginal Health Worker Care Co-ordination treatment will be made by the Department to the LMO who employed or engaged the practice nurse or aboriginal health worker, as the case may be, at the time the treatment was provided.

 

                             6A.4.6    The payment of a fee for Community Nurse Care Co-ordination treatment provided by a community nurse will be made by the Department to the DVA-contracted community nursing provider who employed or engaged the nurse at the time the treatment was provided.

 

6A.5       Entitlement to Participation in the Coordinated Veterans' Care Program and to Coordinated Veterans' Care Program Treatment under the program

                            

6A.5.1    Subject to 6A.3 and 6A.6, an entitled person is entitled to participation in the Coordinated Veterans' Care Program (program) and to Coordinated Veterans' Care Program treatment under the program if:

 

                             (1) in the opinion of an LMO treating the person:

 

(a)     the entitled person has one or more of the following conditions:

 

          (i)      congestive heart failure; or

          (ii)     coronary artery disease; or

          (iii)    pneumonia; or

          (iv)    chronic obstructive pulmonary disease; or

          (v)     diabetes; or

                                                          (vi)    some other chronic condition; and

 

                                      (b)     the condition in (1)(a) has resulted in the person being admitted frequently to hospital or could reasonably result in the person being admitted frequently to hospital; and

 

                                      (c)      the entitled person has complex care needs for the condition in (1)(a), being:

 

(i)                one or more of:

 

(aa)                                 multiple co-morbidities that complicate the treatment regimen for the person;

(bb)                                the person’s condition is unstable with a high risk of acute exacerbation;

(cc)                                  the condition is contributed to by frailty, age and/or social isolation factors;

(dd)                                there are limitations in self management and monitoring;

and:

 

(ii)     needs which require a treatment regimen that involves one or more of the following complexities of ongoing care:

 

(aa)        multiple care providers;

(bb)         complex medication regimen;

(cc)         frequent monitoring and          review;

(dd)        support with self management and self monitoring.

         

                                  (2)     the person is eligible for treatment under the Act for any injury suffered, or disease contracted, by the person (i.e. person has been granted a Gold Card); and

                            

                             (3)     the person is an Australian resident and living in Australia; and

                            

(4)     the person has consented to participation in the program and the admitting LMO has recorded the consent (which may be an electronic record); and

 

                                      Note: under the Notes for Coordinated Veterans' Care Program Providers the LMO is to store the consent.

                            

                             (5)     the LMO treating the person has prepared, in consultation with the person, a comprehensive care plan (GPMP); and

 

                             (6)     the LMO admits the person to the program by making a decision to that effect and keeping a record of it.

 

6A.6  Ineligibility for participation in the Coordinated Veterans' Care Program (program) and for Coordinated Veterans' Care Program Treatment and LMO Home Care service (category C) Referral under the program

         

                             6A.6.1 An entitled person is ineligible to be admitted to the Coordinated Veterans' Care Program (Program) by an LMO for the person if any one of the following applies to the person:

 

                                                (a) the person is receiving residential care; or

                                                     Note: receiving residential care (respite) does not disentitle a person to participation in the program.

                                                (b) the person has been diagnosed by a medical practitioner as having a condition that, in the opinion of the LMO, would be likely to be terminal within 12 months after the person is admitted to the program, if the person were to be admitted; or

                                                (c) the person is participating in a health care program provided by the Department of Health and Ageing (Cth) known as:

                                          

                                                (i) “Coordinated Care for Patients with Diabetes” (including as a pilot program); or

(ii) “Extended Aged Care at Home program”; or

(iii) “Community Aged Care Program”; or

(iv) “Transition Care”;

                                     

                                                or in a program provided by that Department that is essentially the same as one in (i) –(iv) but with a different name.

 

                             6A.6.2    An entitled person is not eligible for a subsequent period of care by an LMO under the Program if immediately before the commencement of the potential period of care the matters in (a) or (c) of 6A.6.1 apply to the person.

 

                                      Note: the period of a period of care by an LMO is set out in the Notes for Coordinated Veterans' Care Program Providers and is a period of 3 months.

 

6A.7  Date of Admission for Participation in the Coordinated Veterans' Care Program

 

                             6A.7.1 Subject to 6A.3 and 6A.6, treatment of an entitled person under the Coordinated Veterans' Care Program (program) commences on the admission day for the person and continues throughout any period of care provided by an LMO to the entitled person under the program.

 

Note: treatment under the program provided by a practice nurse, community nurse or aboriginal health worker can only occur during a period of care provided by an LMO under the program. 

 

                             6A.8  LMO Home Care service (category C) Referral

 

6A.8.1    An LMO treating an entitled person under the Coordinated Veterans' Care Program may decide the person would benefit from a Home Care service (category C) and may refer the person to a MHC assessment agency for an assessment as to the person’s suitability for the service and, depending on the outcome, the agency may allocate responsibility for providing the Home Care service (category C) to an approved provider.  The referral is treatment known as: LMO Home Care service (category C) Referral.

 

Note: for the purposes of 7.3A.1(1)(a)(iii) the referral to a MHC assessment agency is also taken to be a referral to the Commission. 

 

6A.8.2    The LMO may provide an LMO Home Care service (category C) Referral for an entitled person if:

 

(1) the person is admitted to the Coordinated Veterans' Care Program; and

                                     

(2) in the opinion of the LMO:

 

(a) the person has a limited or inadequate social support network and could reasonably be at risk of hospitalisation for a condition in 6A.5.1(1)(a) because of that social situation; and

    

     (b) the risk of the person being hospitalised for a condition in 6A.5.1(1)(a) may be significantly reduced if the person received a Home Care service (category C).

         

Note: a referral must comply with the requirements in the definition of Home Care service (category C) Referral.

                                          

                             6A.9  Procedures under the Coordinated Veterans' Care Program.

 

                             6A.9.1 An LMO may medically assess an entitled person the LMO is treating to determine if the person would benefit from participation in the Coordinated Veterans' Care Program (program).

 

                             6A.9.2 If the LMO decides the entitled person would benefit from participation in the program, and the person is entitled to participate in the program, then the LMO is to inform the entitled person that the person’s participation in the program is conditional upon the person consenting to personal information about the person that is relevant to the person’s treatment under the program being provided to bodies such as:

 

·        the Department;

·        Contractors to the Department who provide services related to the administration of the Program or who would provide a Home Care service (category C) (social support service) to the person;

·        Medicare Australia (which pays treatment costs for the Department);

·        health care providers associated with the person’s treatment under the program.

 

The LMO is to obtain the person’s consent, if the person is to participate in the program, and record it and store it in a readily retrievable form.

                            

                             Note: consent may be recorded and stored in electronic form.

                            

6A.9.3 Once an entitled person’s consent is obtained the LMO is to admit the person to the program.  This takes the form of the LMO recording in writing (including in electronic form) that the person has been admitted to the program.  Participation in the program commences on and from the admission date.

 

6A.9.4 The LMO is to prepare, in consultation with the person, a comprehensive care plan for the person (GPMP).

 

                             6A.9.5 A practice nurse (nurse working for the LMO) or, if appropriate, a community nurse (nurse working for a DVA-contracted community nursing provider) or an aboriginal health worker (working for the LMO) will co-ordinate care services under the GPMP (care co-ordinator).  The LMO may need to refer co-ordination of the GPMP to a DVA-contracted community nursing provider if, for example, the LMO does not employ a practice nurse.  In some cases the LMO may not be able to secure the services of a care co-ordinator and may need to provide the service themselves but the main role of the LMO is to provide oversight of the care co-ordination under the GPMP.

 

6A.9.6 Part of the monitoring mechanism for the program involves the LMO assessing the progress an entitled person is making (progress assessment).  This is to occur toward the end of a period of care by the LMO and before the LMO provides a further period of care to the person.  More details of the procedure is at 6A.3.  A progress assessment is not a prerequisite to the commencement of an initial period of care.

 

                             6A.9.7 If the LMO decides that the entitled person is socially isolated and that because of that situation the person could be reasonably at risk of being hospitalised for a condition in 6A.5.1(1)(a) and that the risk of hospitalisation may be significantly reduced by the provision of a Home Care service (category C) to the person — then the LMO may refer the person to a MHC assessment agency for an assessment as to the person’s suitability for the service.  The referral is called: LMO Home Care service (category C) Referral.

 

                             6A.9.8 The MHC assessment agency is to assess a person pursuant to a LMO Home Care service (category C) Referral and is to determine if the person is suitable for a Home Care service (category C), using the standard assessment process that the agency applies to all assessments for services under the MRCA Home Care Program, and is to determine the type, duration and frequency of any Home Care service (category C) to be provided to a person.

 

                                  6A.9.9 When providing treatment under the Coordinated Veterans' Care Program an LMO, a practice nurse, a DVA-contracted community nursing provider (for a community nurse), and an aboriginal health worker are to comply with the requirements in these Principles and any requirements in the Notes for Coordinated Veterans' Care Program Providers that relate to them.

 

                   4.      Part 7.3A MRCA Home Care Program

 

5.      Paragraph 7.3A.1(1)

 

omit, substitute:

 

           7.3A.1 (1) The Commission may:

 

                 (a)   examine the circumstances of an entitled person and assess the suitability of the person for:

 

                        (i)    a Home Care service (category A); or

(ii)   a Home Care service (category B); or

(iii) pursuant to a LMO Home Care service (category C) Referral, a Home Care service (category C).

                            

                               Note: the Commission has delegated its assessment power to a contractor known as a VHC assessment agency.

                                                                  

                   6.      Paragraph 7.3A.4

                                   

omit, substitute:

 

7.3A.4        Outcome of Assessment

 

(1)     Where under 7.3A.1(1) the Commission decides that an entitled person is not suitable for a relevant service, it shall inform the entitled person accordingly and give reasons for its decision.

 

(2)     Where under 7.3A.1(1) the Commission decides that an entitled person is suitable for a relevant service, it shall:

 

(a)        determine the type, duration and frequency of the service;

(b)        in the case of a Home Care service (category A) or a Home Care service (category C) — allocate responsibility for providing the service to an appropriate approved provider; and

(c )       in the case of a Home Care service (category B) provide the service.

 

Note (1): in practice the Commission may delegate its power to assess a person’s suitability for a service to contractors (called MHC assessment agency). 

 

Note (2): The Commission may also delegate its power to allocate the task of providing any “category A or C service” to contractors (called a MHC assessment agency).

 

Note (3): The Commission may delegate its power to provide a Home Care service (category B) to a contractor (e.g. an instrumentality of a State or Territory). 

 

Note (4): Contractors may, in turn, sub-contract the responsibility to provide a relevant service.

 

6A.   Paragraph 7.3A.4 (as substituted)

 

                             after the paragraph, insert:

 

                             7.3A.4A An approved provider may provide a Home Care service (category A), a Home Care service (category B) or a Home Care service (category C) to an entitled person.

 

6B.   Paragraph 7.3A.5(ii)

 

omit:

 

the entitled person needed the service

 

substitute:

 

the entitled person is suitable for the service

 

                   7.      Paragraph 7.3A.6

 

                             after the paragraph, insert:

 

7.3A.6B      The Commission may accept financial responsibility for the provision of a Home Care service (category C) to an entitled person by an approved provider, for a period of care provided by an LMO to the entitled person under the Coordinated Veterans' Care Program, if:

 

         (1)       the approved provider has an arrangement with the Commission or the Department to provide a Home Care service (category A) or Home Care service (category B) to an entitled person; and

        

         (2)       the service has been requested for the person by a MHC assessment agency pursuant to a LMO Home Care service (category C) Referral and pursuant to an assessment by the agency of the person’s suitability for the service; and

 

         (3)       the service is in accordance with the request from the MHC assessment agency; and

        

                      Note: it will be the MHC assessment agency’s responsibility to inform the approved provider of the terms on which the service is to be provided e.g. frequency of service.

 

(4)     the service is in accordance with any requirements in the Notes for Coordinated Veterans' Care Program Providers (Notes) that relate to an approved provider delivering a Home Care service (category C) to an entitled person; and

 

(5)       the entitled person is otherwise entitled to the service and is not, at the time of the service, receiving residential care; and

                                     

(6)       the service is not essentially the same as a Home Care service (category A) or Home Care service (category B)

         the person is entitled to receive.

 

8.      Paragraph 7.3A.7

 

                             omit:

 

                             health provider

 

                             substitute:

 

                             health care provider

 

9.      Paragraph 7.3A.8

 

omit, wherever occurring:

 

          Home Care service (category A)

 

          substitute:

 

          Home Care service (category A) or Home Care service (category C)

 

10.    Paragraph 7.3A.10 (the Note)

 

omit:

 

          Home Care service (category A)

 

          substitute:

 

          Home Care service (category A) or Home Care service (category C)

 

11.    Paragraph 7.3A.11

 

omit:

 

          Home Care service (category A)

 

          substitute:

 

          Home Care service (category A) or Home Care service (category C)

 

12.    Paragraph 7.3A.13

 

omit, substitute:

 

7.3A.13  The prior approval of the Commission for:

 

(a)          the provision of a Home Care service (category A) to an entitled person by an approved provider;

(b)          the provision of a Home Care service (category B) to an    

              entitled person by an approved provider; or

(c)          the provision of a Home Care service (category C) to an entitled person by an approved provider;

 

is not required except that in the case of the provision of a Home Care service (category A) to an entitled person by an approved provider that is emergency short term home relief (ESTHR), the prior approval of the Commission is required for the provision of ESTHR within 24 hours after a previous service of ESTHR.

 

Note: the fact that the Commission's prior approval for treatment is not required does not mean an assessment is not required.

 

13.    Schedule 1 (Dates for Incorporated Documents)

 

                             omit, substitute:

 

         

SCHEDULE 1 DATES FOR INCORPORATED DOCUMENTS

 

PART 1

 

The date for :

 

         

1.       Notes for Local Medical Officers (paragraph 1.4.1);

 

2.       Department of Veterans’ Affairs Fee Schedules for Medical Services (paragraph 3.5.1);

 

3.       Notes for Providers of Optometric Services/Dispensers of Optical Appliances (paragraphs 1.4.1 and 7.1A.1);

 

4.       Optometrist Fees for Consultation (paragraph 3.5.1);

 

5.       DVA Schedule of Fees Orthoptists (paragraph 3.5.1);

 

6.       Pricing Schedule for visual aids (paragraph 3.5.1);

 

 

          7.       Notes for Local Dental Officers (paragraphs 1.4.1 and 5.1.1);

 

8.       Fee Schedule of Dental Services for Dentists and Dental Specialists (paragraph 3.5.1);

 

9.       Fee Schedule of Dental Services for Dental Prosthetists (paragraph 3.5.1);

 

10.     Notes for Chiropractors (paragraphs 1.4.1 and 7.1A.1);

 

          11.     Chiropractors Schedule of Fees (paragraph 3.5.1);

 

12.     Notes for Diabetes Educators (paragraphs 1.4.1 and 7.1A.1);

 

13.     Diabetes Educators Schedule of Fees (paragraph 3.5.1);

 

14.     Notes for Dietitians (paragraphs 1.4.1 and 7.1A.1);

 

15.     Dietitians Schedule of Fees (paragraph 3.5.1);

 

16.     Notes for Exercise Physiologists (paragraphs 1.4.1 and 7.1A.1);

 

17.     Exercise Physiologists Schedule of Fees (paragraph 3.5.1);

 

18.     Notes for Occupational Therapists (paragraphs 1.4.1 and 7.1A.1);

 

19.     Occupational Therapists Schedule of Fees (paragraph 3.5.1);

 

20.     Notes for Osteopaths (paragraphs 1.4.1 and 7.1A.1);

 

21.     Osteopaths Schedule of Fees (paragraph 3.5.1);

 

22.     Notes for Physiotherapists (paragraphs 1.4.1 and 7.1A.1);

 

23.     Physiotherapists Schedule of Fees (paragraph 3.5.1);

 

24.     Notes for Psychologists (paragraphs 1.4.1 and 7.1A.1);

 

25.     Psychologists Schedule of Fees (paragraph 3.5.1);

 

26.     Notes for Podiatrists (paragraphs 1.4.1 and 7.1A.1);

 

27.     Podiatrists Schedule of Fees (paragraph 3.5.1);

 

28.     Social Workers Schedule of Fees (paragraph 3.5.1);

 

29.     Clinical Counsellors Schedule of Fees (paragraph 3.5.1);

 

30.     Notes for Speech Pathologists (paragraphs 1.4.1 and 7.1A.1);

 

31.     Speech Pathologists Schedule of Fees (paragraph 3.5.1).

 

32.     Australian Government Department of Veterans’ Affairs      Classification System and Schedule of Item Numbers and Fees — Community Nursing Services;

 

33.     RAP National Schedule of Equipment (paragraph 11.2A.1);

 

34.     Rehabilitation Appliances Program (RAP) National Guidelines (paragraph 11.2A.1);

 

35.     Notes for Coordinated Veterans' Care Program Providers;

 

is 1 May 2011.