{"id":"F2017L00764","name":"Veterans' Entitlements (Provisional Access to Medical Treatment) Determination 2017","slug":"veterans-entitlements-provisional-access-to-medical-treatment-determination-2017","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":96620,"registerId":"commonwealth-F2017L00764-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Part 1","sectionType":"part","heading":"‑Introduction","content":"## Part 1‑Introduction","sortOrder":0},{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\nThis instrument is the Veterans' Entitlements (Provisional Access to Medical Treatment) Determination 2017.","sortOrder":1},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\nThis instrument is made under paragraphs 88A(1)(a) and (d) of the Veterans’ Entitlements Act 1986.","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Purpose","content":"#### 4 Purpose\n\nThe purpose of this instrument is to enable a person within a class specified in Part 2 to receive treatment (provisional treatment) for a specified condition during the period from the time the person has made a claim for liability under the MRCA, or a defence‑related claim under the SRCA (or if the DRCA is in force, a defence‑related claim under the DRCA) and before liability for that claim has been determined.\n\nProvisional treatment is available in respect of claims made on or after 1 July 2017 and before 1 July 2026.\n\nEntitlement to provisional treatment for a specified condition under this instrument will however cease in the circumstances set out in subsections 9(2),(3),(4) and (5).","sortOrder":3},{"sectionNumber":"5","sectionType":"section","heading":"Definitions","content":"#### 5 Definitions\n\nIn this instrument:\n\nAct means the Veterans’ Entitlements Act 1986.\n\ncadet has the same meaning as it has in section 5 of the MRCA.\n\nCommission means the body corporate known as the Military Rehabilitation and Compensation Commission established under section 361 of the MRCA.\n\ndeclared member has the same meaning as it has in section 5 of the MRCA.\n\nDRCA means the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988 created upon enactment of the Safety, Rehabilitation and Compensation Legislation Amendment (Defence Force) Bill 2016.\n\nformer member has the same meaning as it has in section 5 of the MRCA.\n\nmember has the same meaning as it has in section 5 of the MRCA.\n\nmember of the Defence Force has the same meaning as it has in the MRCA.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\npart‑time Reservist has the same meaning as it has in section 5 of the MRCA.\n\nPharmaceutical Benefits Scheme means the scheme for the provision of pharmaceutical benefits prepared by the Repatriation Commission under section 91 of the Act (the Repatriation Pharmaceutical Benefits Scheme) or the determination made by the Commission under paragraph 286(1)(c) of the MRCA (the MRCA Pharmaceutical Benefits Scheme), as applicable.\n\nPrivate Patient Principles means the principles determined by the Repatriation Commission under section 90A of the Act (the Repatriation Private Patient Principles) or the determination made by the Commission under paragraph 286(1)(b) of the MRCA (the MRCA Private Patient Principles), as applicable.\n\nspecified condition – see section 6.\n\nSRCA means the Safety, Rehabilitation and Compensation Act 1988.\n\nStatement of Principles means a determination made by the Repatriation Medical Authority, for the purposes of the Act and the MRCA, under subsection 196B(3) of the Act.\n\nTreatment Principles means the document prepared by the Repatriation Commission under section 90 of the Act (the Treatment Principles), or the determination made by the Commission under paragraph 286(1)(a) of the MRCA (the MRCA Treatment Principles), as applicable.","sortOrder":4},{"sectionNumber":"6","sectionType":"section","heading":"Meaning of specified condition","content":"#### 6 Meaning of specified condition\n\nIn this instrument, a specified condition means a condition listed in column 1 of the table in this section.\n\nEach specified condition in column 1 has the meaning given in the provision of the Statement of Principles, as in force from time to time, listed in column 2 for the corresponding condition, or the meaning given in any subsequent Statement of Principles, as in force from time to time, for that condition.\n\n```html\n

Column 1

Column 2

1.

Achilles Tendinopathy and Bursitis

subsection 7(2) of the Statement of Principles concerning Achilles Tendinopathy and Bursitis (Balance of Probabilities) (No. 97 of 2015)

2.

Chondromalacia Patella

paragraph 3(b) of the Statement of Principles concerning Chondromalacia Patella (Balance of Probabilities) (No. 80 of 2010)

3.

Cut, Stab, Abrasion and Laceration

subsection 7(2) of the Statement of Principles concerning Cut, Stab, Abrasion and Laceration (Balance of Probabilities) (No. 54 of 2016)

4.

Dislocation

paragraph 3(b) of the Statement of Principles concerning Dislocation (Balance of Probabilities) (No. 25 of 2010)

5.

Fracture

subsection 7(2) of the Statement of Principles concerning Fracture (Balance of Probabilities) (No. 95 of 2015)

6.

Internal Derangement of the Knee

paragraph 3(b) of the Statement of Principles concerning Internal Derangement of the Knee (Balance of Probabilities) (No. 52 of 2010)

7.

Intervertebral Disc Prolapse

subsection 7(2) of the Statement of Principles concerning Intervertebral Disc Prolapse (Balance of Probabilities)

(No. 44 of 2016)

8.

Joint Instability

paragraph 3(b) of the Statement of Principles concerning Joint Instability (Balance of Probabilities) (No. 33 of 2010)

9.

Labral Tear

paragraph 3(b) of the Statement of Principles concerning Labral Tear (Balance of Probabilities) (No. 95 of 2010)

10.

Lumbar Spondylosis

paragraph 3(b) of the Statement of Principles concerning Lumbar Spondylosis (Balance of Probabilities) (No. 63 of 2014)

11.

Non‑melanotic Malignant Neoplasm of the Skin

subsection 7(2) of the Statement of Principles concerning Non‑melanotic Malignant Neoplasm of the Skin (Balance of Probabilities) (No. 8 of 2016)

12.

Osteoarthritis

paragraph 3(b) of the Statement of Principles concerning Osteoarthritis (Balance of Probabilities) (No. 14 of 2010)

13.

Plantar Fasciitis

paragraph 3(b) of the Statement of Principles concerning Plantar Fasciitis (Balance of Probabilities) (No. 52 of 2015)

14.

Rotator Cuff Syndrome

paragraph 3(b) of the Statement of Principles concerning Rotator Cuff Syndrome (Balance of Probabilities)

(No. 101 of 2014)

15.

Sensorineural Hearing Loss

paragraph 3(b) of the Statement of Principles concerning Sensorineural Hearing Loss (Balance of Probabilities) (No. 6 of 2011)

16.

Shin Splints

paragraph 3(b) of the Statement of Principles concerning Shin Splints (Balance of Probabilities) (No. 10 of 2015)

17.

Solar Keratosis

paragraph 3(b) of the Statement of Principles concerning Solar Keratosis (Balance of Probabilities) (No. 74 of 2012)

18.

Sprain and Strain

paragraph 3(b) of the Statement of Principles concerning Sprain and Strain (Balance of Probabilities) (No. 95 of 2011)

19.

Thoracic Spondylosis

paragraph 3(b) of the Statement of Principles concerning Thoracic Spondylosis (Balance of Probabilities) (No. 65 of 2014)

20.

Tinnitus

paragraph 3(b) of the Statement of Principles concerning Tinnitus (Balance of Probabilities) (No. 34 of 2012)

\n```","sortOrder":5},{"sectionNumber":"Part 2","sectionType":"part","heading":"‑ Specified classes of person","content":"## Part 2 ‑ Specified classes of person","sortOrder":6},{"sectionNumber":"7","sectionType":"section","heading":"Former members, part‑time reservists etc.","content":"#### 7 Former members, part‑time reservists etc.\n\nFor paragraphs 88A(1)(a) and (d) of the Act, the following class of people is specified:\n\n(1) A person who:\n\n(a) on or after 1 July 2017 and before 1 July 2026, makes:\n\n(i) a defence‑related claim within the meaning of section 141 of the SRCA, or, if the DRCA is in force, a defence‑related claim within the meaning of section 141 of the DRCA; or\n\n(ii) a claim under paragraph 319(1)(a) of the MRCA; and\n\n(b) that claim relates to one or more specified conditions; and\n\n(c) prior to making the claim, the person had rendered defence service within the meaning of paragraph 6(1)(d) of the MRCA; and\n\n(d) at the time of making the claim, the person is either:\n\n(i) a former member, part‑time Reservist, cadet or declared member; or\n\n(ii) a member of the Defence Force who, after the claim is made and before 1 July 2026, becomes a former member.\n\n(2) A person specified in subparagraph (1)(d)(ii) is included in the class only from the time that person becomes a former member.","sortOrder":7},{"sectionNumber":"8","sectionType":"section","heading":"Current full‑time ADF members","content":"#### 8 Current full‑time ADF members\n\nFor paragraphs 88A(1)(a) and (d) of the Act, the following class of person is specified:\n\nA person who:\n\n(a) on or after 1 July 2017 and before 1 July 2026 makes a claim under paragraph 319(1)(a) of the MRCA; and\n\n(b) that claim relates to one or more specified conditions; and\n\n(c) at the time of making the claim, the person is a member who is entitled to medical and dental treatment under section 49 of the Defence Regulation 2016; and\n\n(d) in respect of whom, the Commission has made a determination under paragraph 279(d) of the MRCA that it is more appropriate to provide treatment for the person’s injury or disease under Part 3 of Chapter 6 of the MRCA than to provide treatment under section 49 of the Defence Regulation 2016.","sortOrder":8},{"sectionNumber":"Part 3","sectionType":"part","heading":"‑ Specified treatment","content":"## Part 3 ‑ Specified treatment","sortOrder":9},{"sectionNumber":"9","sectionType":"section","heading":"Treatment","content":"#### 9 Treatment\n\nFor the classes of persons specified in Part 2 of this instrument, the following kind of treatment is specified:\n\n(1) Treatment that:\n\n(a) can be applied to a specified condition, under, and subject to:\n\n1. the Treatment Principles; or\n2. the Pharmaceutical Benefits Scheme; or\n3. the Private Patient Principles; or\n4. an arrangement between the Repatriation Commission and a health care provider pursuant to Part V of the Act; and\n\n(b) is appropriate having regard to the nature of the claim and the specified conditions involved in that claim; and\n\n(c) is provided within the period between 1 July 2017 and 31 December 2026.\n\n(2) Entitlement of a person to treatment for a specified condition under this instrument ceases on the making of a determination at primary level to accept liability in respect of the specified condition.\n\n(3) Subject to subsection (4), entitlement of a person to treatment for a specified condition under this instrument ceases on the making of a determination at primary level to refuse liability in respect of the specified condition.\n\n(4) Subsection (3) does not apply if an application for review or appeal is made in relation to the determination at primary level to refuse liability in respect of the specified condition.\n\n(5) However, entitlement to treatment for a specified condition under this instrument ceases on the making of a decision on review or appeal referred to in subsection (4) if the decision, or the effect of the decision, is to accept or refuse liability in respect of the specified condition.","sortOrder":10}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The legislation appears tightly scoped to its original purpose of providing provisional medical treatment during the claims determination period. The 20 specified conditions, the two distinct beneficiary classes, and the multiple sunset dates suggest careful targeting rather than scope creep. The scheme is explicitly temporary (2017–2026) and limited to specific physical conditions, indicating it has not expanded beyond its original intent."},"complexity_factors":["Multiple overlapping legislative schemes referenced (Veterans' Entitlements Act 1986, MRCA, SRCA, DRCA, Defence Regulation 2016) requiring knowledge of which Act applies when","20 defined conditions each referencing separate Statement of Principles documents with their own legal definitions","Complex eligibility criteria with nested conditions – section 7 has four cumulative requirements plus a temporal limitation, section 8 requires a separate administrative determination under MRCA s.279(d)","Sunset clauses and date restrictions at multiple levels (claim must be made 1 July 2017–1 July 2026, treatment must occur by 31 December 2026, person in s.7(1)(d)(ii) only covered after becoming former member)","Cessation triggers in section 9 create a conditional logic chain: automatic cessation on acceptance, conditional cessation on refusal (suspended by review), final cessation on review outcome","Cross-references to external documents (Treatment Principles, Pharmaceutical Benefits Scheme, Private Patient Principles) that are themselves complex statutory instruments"],"plain_english_summary":"This Determination creates a temporary scheme letting certain current and former Defence Force members receive free medical treatment while their compensation claims (lodged between 1 July 2017 and 1 July 2026) are decided, avoiding waits for claim acceptance. It covers 20 specified physical conditions (common military injuries like fractures, back/knee problems, hearing loss, skin cancers) and runs until 31 December 2026, stopping if a claim is accepted or finally rejected."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"This Determination is narrowly focused and time‑limited: it authorises provisional access to treatment for a defined list of conditions for specified classes of Defence‑related claimants during set date windows. It implements a specific procedural measure (early access to treatment pending liability decisions) and does not expand entitlements beyond that purpose. It therefore does not appear to have grown significantly beyond its original, instrument‑level purpose of enabling provisional treatment while claims are decided (see Purpose, s4; Parts 2–3)."},"complexity_factors":["Cross‑references to multiple Acts and instruments: Veterans’ Entitlements Act 1986, MRCA, SRCA, DRCA, Defence Regulation 2016, and Statements of Principles (s3, s5, s6, s8).","Numerous defined terms that pull meaning from external sources (Act, MRCA, MRCA Pharmaceutical Benefits Scheme, Treatment Principles, Private Patient Principles, Statement of Principles) (s5).","A list of 20 specified conditions with meanings tied to particular Statements of Principles entries (s6 and table).","Time‑limited windows and differing date cutoffs (claims from 1 July 2017 to 1 July 2026; treatment allowed up to 31 December 2026) (s4, s9(1)(c)).","Two overlapping classes of persons with conditional eligibility rules and a transitional clause for serving members who become former members (s7–s8).","Conditional cessation rules dependent on primary decisions and the procedural status of reviews/appeals (s9(2)–(5)).","Administrative discretion required by the Commission (paragraph 279(d) MRCA determinations and Part V provider arrangements) (s8(d), s9(1)(a)(4)).","Dependence on evolving external medical instruments (Statements of Principles and Treatment Principles) which change the substantive scope without amending the Determination (s6, s9(1)(a))."],"plain_english_summary":"**What this instrument does, simply stated**\n\n- Mechanically, the Determination creates a limited, time‑bound entitlement to \"provisional treatment\" (medical treatment provided before liability for a claim is finally decided) for people who make certain Defence‑related compensation or MRCA claims between 1 July 2017 and 1 July 2026. (See Purpose, s4 and Parts 2–3.)\n\n- The provisional treatment applies only for the specified conditions listed in section 6 (20 musculoskeletal, skin and hearing conditions, tinnitus, some cancers, etc.), and only where the treatment is the sort set out in the Repatriation Treatment Principles, the relevant Pharmaceutical Benefits Scheme, the Repatriation Private Patient Principles, or an arrangement between the Repatriation Commission and a health provider. (See s6 and s9(1).)\n\n**Who is covered**\n\n- Former members, part‑time Reservists, cadets, declared members, and ordinary members who become former members after making a qualifying claim. The person must have rendered defence service and have a claim that relates to one or more of the listed specified conditions. (See s7.)\n\n- Current full‑time ADF members are covered only where they make an MRCA claim (paragraph 319(1)(a)), the claim relates to a listed condition, the person is entitled to medical/dental treatment under Defence Regulation section 49 at the time of claim, and the Military Rehabilitation and Compensation Commission (the Commission) determines it is more appropriate to provide treatment under the MRCA than under Defence Regulation 2016. (See s8.)\n\n**When the provisional treatment runs and when it stops**\n\n- Provisional treatment is available for claims made from 1 July 2017 up to 1 July 2026. Eligible treatment must be provided between 1 July 2017 and 31 December 2026. (See s4 and s9(1)(c).)\n\n- The provisional entitlement ends if a primary‑level decision accepts liability for the specified condition (treatment ceases because the normal entitlements then apply). (See s9(2).)\n\n- If a primary decision refuses liability, provisional treatment generally stops, but it continues if the claimant lodges an application for review or appeal; provisional treatment then ends when that review or appeal itself results in a decision that accepts or refuses liability. (See s9(3)–(5).)\n\n**Why the Government says it exists (official purpose) and what that implies mechanically**\n\n- The instrument is described as enabling early access to treatment while liability for a claim is undecided (s4). Mechanically, that means public treatment resources (the Repatriation Commission under the Act/MRCA, or its contracted providers) may be used before a compensation/entitlement decision is final.\n\n**Practical costs, incentives and trade‑offs (mechanisms, not judgments)**\n\n- Who pays: the Repatriation Commission (the statutory body implementing MRCA/Act entitlements) funds treatment under the Treatment Principles, PBS subsidies where applicable, private patient rules or specific Commission provider arrangements (s9 and definitions in s5). That is public expenditure funded through the Commission’s budget lines.\n\n- Administrative discretion and implementation tasks: the Commission must (a) determine when it is more appropriate for treatment to be delivered under MRCA rather than Defence Regulation for some current members (s8(d)); and (b) manage arrangements with providers under Part V of the Act (s9(1)(a)(4)). Staff must also track and apply Statements of Principles and other medical determinations that are updated over time (s6). These are administrative actions that carry implementation risk and require record‑keeping and operational policies.\n\n- Incentives for claimants: knowing treatment can start before a liability decision may encourage earlier claim lodgement and earlier use of medical services for listed conditions. That will shift demand forward for medical services covered by the Commission or contracted providers.\n\n- Effects on private providers and markets: the measure creates predictable demand for providers willing to treat under the Commission’s arrangements or under Repatriation private patient rules. It may direct some patients away from Defence‑provided care (for current members in cases where the Commission determines MRCA treatment is appropriate) and toward Commission‑funded pathways. The instrument does not itself set provider payment rates, but expanding access may increase volume for contracted providers and for providers supplying PBS medicines.\n\n- Fiscal trade‑off / opportunity cost: providing treatment before liability is determined requires public funds to be spent earlier. That increases short‑term expenditure and administrative processing; there is potential for recoveries or offsets if a claim is later refused, but the Determination does not itself establish a recovery mechanism here — that is governed by the Act and MRCA processes.\n\n- Compliance burden and complexity for claimants and providers: eligibility depends on (a) the date of claim, (b) listed conditions as defined by Statements of Principles (which can be updated), (c) the claimant’s service status, and (d) Commission decisions for some current members (s6–s8). Providers must confirm eligibility against those cross‑referenced rules before treating as provisional‑treatment cases.\n\n**Key risks and operational notes**\n\n- Reliance on external medical determinations (Statements of Principles, Treatment Principles, PBS, Private Patient Principles) means meaning and eligibility can change over time without amending this Determination — administrators must track those instruments. (See s6 and s9(1)(a)–(c).)\n\n- The Commission’s discretion under paragraph 279(d) MRCA to choose the appropriate treatment pathway for some current members (s8(d)) concentrates decision‑making and creates potential for case‑by‑case inconsistency unless clear policy is applied.\n\n**Net effect, in plain terms**\n\n- The instrument gives certain Defence‑connected people early access to specifically listed medical treatments while their compensation/entitlement claims for those conditions are being decided. It shifts the timing of publicly funded treatment earlier in the claims process, is tightly limited by condition lists and date windows, and relies on existing Repatriation treatment and pharmaceutical rules and Commission provider arrangements to deliver care. (See ss4,6–9.)"},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/veterans-entitlements-provisional-access-to-medical-treatment-determination-2017","history":"/api/acts/veterans-entitlements-provisional-access-to-medical-treatment-determination-2017/history","analysis":"/api/acts/veterans-entitlements-provisional-access-to-medical-treatment-determination-2017/analysis","conflicts":"/api/acts/veterans-entitlements-provisional-access-to-medical-treatment-determination-2017/conflicts","importantCases":"/api/acts/veterans-entitlements-provisional-access-to-medical-treatment-determination-2017/important-cases","documents":"/api/acts/veterans-entitlements-provisional-access-to-medical-treatment-determination-2017/documents"}}