This Act has been repealed and is no longer in force. It is retained for historical reference.
Jurisdiction
Commonwealth
Collection
legislative instrument
Plain English Summary
4/10 complexity
This instrument sets rules for when veterans and other MRCA-entitled people can be admitted to hospitals as private patients, using a three-tier preference system (preferred repatriation/public/veteran-partnering hospitals; contracted private; non-contracted private). It restricts when approvals are needed, protects choices like treating doctor and private rooms when clinically necessary, and limits government payments if a person opts for a lower-preference (Tier 3) hospital when a higher-tier option was available.
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Current sections
Direct links to the current provisions in MRCA Private Patient Principles.
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1. Preliminary
1. Preliminary
1. Preliminary
1.1 Principles and commencement
1.1.1 These Principles are the MRCA Private Patient Principles 2004.
1.1.2 The MRCA Private Patient Principles 2004 commence on 1 January 2005 after the commencement of the Military Rehabilitation and Compensation Treatment (Revocation) Determination Instrument No. M20 of 2004.
1.2 Defined terms
For the purposes of these Principles, unless a contrary intention appears:
Act means the Military Rehabilitation and Compensation Act 2004 in force from time to time.
admission means admission for treatment as an in-patient or day-patient upon the referral of a medical specialist or a Local Medical Officer.
Commission means the Military Rehabilitation and Compensation Commission established under section 361 of the Act.
1.1
Principles and commencement
1.1 Principles and commencement
1.1.1 These Principles are the MRCA Private Patient Principles 2004.
1.1.2 The MRCA Private Patient Principles 2004 commence on 1 January 2005 after the commencement of the Military Rehabilitation and Compensation Treatment (Revocation) Determination Instrument No. M20 of 2004.
1.2
Defined terms
1.2 Defined terms
For the purposes of these Principles, unless a contrary intention appears:
Act means the Military Rehabilitation and Compensation Act 2004 in force from time to time.
admission means admission for treatment as an in-patient or day-patient upon the referral of a medical specialist or a Local Medical Officer.
Commission means the Military Rehabilitation and Compensation Commission established under section 361 of the Act.
1.3
Private patient status
1.3 Private patient status
An entitled person is to receive hospital care as a private patient, which entitles the person, as a minimum, to:
(a) the patient’s choice of doctor, subject to the doctor having practising rights at the relevant hospital; and
(b) shared accommodation; and
(c) if medically necessary, private accommodation.
2. Order of preference for admission to
2. Order of preference for admission to hospital
2. Order of preference for admission to hospital
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
Level
Preference
Hospital
Tier 1
first
former Repatriation Hospital, public hospital, or veteran partnering private hospital
Tier 2(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital. The Contracted private hospital must seek prior approval for all other admissions.
Tier 2
second
Contracted private hospital
Tier 3
third
Non-Contracted private hospital
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3.1 Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the MRCA Treatment Principles.
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4. Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5 Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6 Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
4. Prior approval required
4.1 Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2 Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life
(d) in light of the severity of the entitled person’s clinical condition:
(i) the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4 Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
2.1
Order of preference
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
Level
Preference
Hospital
Tier 1
first
former Repatriation Hospital, public hospital, or veteran partnering private hospital
Tier 2(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital. The Contracted private hospital must seek prior approval for all other admissions.
Tier 2
second
Contracted private hospital
Tier 3
third
Non-Contracted private hospital
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3.1 Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the MRCA Treatment Principles.
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4. Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5 Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6 Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
4. Prior approval required
4.1 Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2 Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life
(d) in light of the severity of the entitled person’s clinical condition:
(i) the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4 Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
Preference
Preference
Preference
2.2
Objective
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3. Prior approval not required
2. Order of preference for admission to hospital
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
Level
Preference
Hospital
Tier 1
first
former Repatriation Hospital, public hospital, or veteran partnering private hospital
Tier 2(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital. The Contracted private hospital must seek prior approval for all other admissions.
Tier 2
second
Contracted private hospital
Tier 3
third
Non-Contracted private hospital
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3.1 Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the MRCA Treatment Principles.
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4. Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5 Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6 Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
4. Prior approval required
4.1 Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2 Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life
(d) in light of the severity of the entitled person’s clinical condition:
(i) the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4 Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
3.1
Medical specialist treatment
3.1 Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the MRCA Treatment Principles.
3.2
Non-emergency Tier 1 hospital treatment
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treat
3.3. Non-emergency Tier 2 hospital treatment
3.3. Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4. Emergency hospital treatment
3.4. Emergency hospital treatment
3.4. Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5
Notification of admission
3.5 Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6
Payment of facility fee
3.6 Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
4. Prior approval required
4. Prior approval required
2. Order of preference for admission to hospital
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
Level
Preference
Hospital
Tier 1
first
former Repatriation Hospital, public hospital, or veteran partnering private hospital
Tier 2(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital. The Contracted private hospital must seek prior approval for all other admissions.
Tier 2
second
Contracted private hospital
Tier 3
third
Non-Contracted private hospital
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3.1 Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the MRCA Treatment Principles.
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4. Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5 Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6 Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
4. Prior approval required
4.1 Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2 Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life
(d) in light of the severity of the entitled person’s clinical condition:
(i) the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4 Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
4.1
Tier 2 hospital admission and treatment
4.1 Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2
Tier 3 hospital admission and treatment
4.2 Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3
Criteria for Tier 2 or Tier 3 hospital admission and treatment
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life
(d) in light of the severity of the entitled person’s clinical condition:
(i) the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4
Admission to Tier 3 hospital of choice
4.4 Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
4.5
Commonwealth liability if Tier 3 admission by choice
4.5 Commonwealth liability if Tier 3 admission by choice
If an entitled person, in accordance with paragraph 4.4, elects to be admitted to a Tier 3 hospital, the Commonwealth will be liable only for:
(a) accommodation costs; and
(b) pharmaceutical fees; and
(c) theatre fees; and
(d) certain incidental expenses;
provided such costs, fees or expenses are, in the Commission’s opinion, reasonable.
5. Transitional provisions
5. Transitional provisions
4.5 Commonwealth liability if Tier 3 admission by choice
If an entitled person, in accordance with paragraph 4.4, elects to be admitted to a Tier 3 hospital, the Commonwealth will be liable only for:
(a) accommodation costs; and
(b) pharmaceutical fees; and
(c) theatre fees; and
(d) certain incidental expenses;
provided such costs, fees or expenses are, in the Commission’s opinion, reasonable.
5. Transitional provisions
5.1 Past actions
5.1.1 Any approval given, decision or appointment made, or other thing done under the Repatriation Private Patient Principles applied by the Determination for Providing Treatment (MRCA Instrument No.3 of 2004) is taken to have been given, made, or done for the purposes of, and under, these Principles.
5.2. Application
5.2.1 From their commencement, these Principles apply to all matters to which the Repatriation Private Patient Principles applied by the Determination for Providing Treatment (MRCA Instrument No.3 of 2004) related.
Notes to the MRCA Private Patient Principles 2004
Note 1
Note: The MRCA Private Patient Principles 2004 (in force under the Military Rehabilitation and Compensation Act 2004) as shown in this compilation comprises the legislative instruments in the Table below:
Table A Application, saving or transitional provisions
Legislative Instrument 2004/M17
5. Transitional provisions
5.1 Past actions
5.1.1 Any approval given, decision or appointment made, or other thing done under the Repatriation Private Patient Principles applied by the Determination for Providing Treatment (MRCA Instrument No.3 of 2004) is taken to have been given, made, or done for the purposes of, and under, these Principles.
5.2. Application
5.2.1 From their commencement, these Principles apply to all matters to which the Repatriation Private Patient Principles applied by the Determination for Providing Treatment (MRCA Instrument No.3 of 2004) related.
Legislative Instrument 2007/M7
Application
The variations made by this instrument to the MRCA Private Patient Principles 2004 do not apply to a Local Medical Officer who has a current arrangement with the Military Rehabilitation and Compensation Commission or the Department in respect of the provision of treatment to persons entitled to treatment under the MRCA Treatment Principles — being an arrangement entered into before the commencement of this instrument.
Note: the intention is that until any arrangement between a Local Medical Officer and the Military Rehabilitation and Compensation Commission or the Department expires or is terminated, the provision of treatment under that arrangement is governed by the MRCA Private Patient Principles 2004 as if those Principles had not been amended by this instrument but when the arrangement ends, the MRCA Private Patient Principles 2004 apply as amended by this instrument.
5.1
Past actions
5.1 Past actions
5.1.1 Any approval given, decision or appointment made, or other thing done under the Repatriation Private Patient Principles applied by the Determination for Providing Treatment (MRCA Instrument No.3 of 2004) is taken to have been given, made, or done for the purposes of, and under, these Principles.
5.2. Application
5.2. Application
5.2. Application
5.2.1 From their commencement, these Principles apply to all matters to which the Repatriation Private Patient Principles applied by the Determination for Providing Treatment (MRCA Instrument No.3 of 2004) related.
Notes to the MRCA Private Patient Principles 2004
Note 1
Note: The MRCA Private Patient Principles 2004 (in force under the Military Rehabilitation and Compensation Act 2004) as shown in this compilation comprises the legislative instruments in the Table below:
Table A Application, saving or transitional provisions
Legislative Instrument 2004/M17
Source text: opening excerpt
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
1. Preliminary 1. Preliminary
1. Preliminary
1.1 Principles and commencement
1.1.1 These Principles are the MRCA Private Patient Principles 2004.
1.1.2 The MRCA Private Patient Principles 2004 commence on 1 January 2005 after the commencement of the Military Rehabilitation and Compensation Treatment (Revocation) Determination Instrument No. M20 of 2004.
1.2 Defined terms
For the purposes of these Principles, unless a contrary intention appears:
Act means the Military Rehabilitation and Compensation Act 2004 in force from time to time.
admission means admission for treatment as an in-patient or day-patient upon the referral of a medical specialist or a Local Medical Officer.
Commission means the Military Rehabilitation and Compensation Commission established under section 361 of the Act.
1.1 Principles and commencement
1.1 Principles and commencement
1.1.1 These Principles are the MRCA Private Patient Principles 2004.
1.1.2 The MRCA Private Patient Principles 2004 commence on 1 January 2005 after the commencement of the Military Rehabilitation and Compensation Treatment (Revocation) Determination Instrument No. M20 of 2004.
1.2 Defined terms
1.2 Defined terms
For the purposes of these Principles, unless a contrary intention appears:
Act means the Military Rehabilitation and Compensation Act 2004 in force from time to time.
admission means admission for treatment as an in-patient or day-patient upon the referral of a medical specialist or a Local Medical Officer.
Commission means the Military Rehabilitation and Compensation Commission established under section 361 of the Act.
1.3 Private patient status
1.3 Private patient status
An entitled person is to receive hospital care as a private patient, which entitles the person, as a minimum, to:
(a) the patient’s choice of doctor, subject to the doctor having practising rights at the relevant hospital; and
(b) shared accommodation; and
(c) if medically necessary, private accommodation.
2. Order of preference for admission to 2. Order of preference for admission to hospital
2. Order of preference for admission to hospital
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
former Repatriation Hospital, public hospital, or veteran partnering private hospital
Tier 2(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital. The Contracted private hospital must seek prior approval for all other admissions.
Tier 2
second
Contracted private hospital
Tier 3
third
Non-Contracted private hospital
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3.1 Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the MRCA Treatment Principles.
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4. Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5 Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6 Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
4. Prior approval required
4.1 Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2 Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life
(d) in light of the severity of the entitled person’s clinical condition:
(i) the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4 Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
2.1 Order of preference
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
Level
Preference
Hospital
Tier 1
first
former Repatriation Hospital, public hospital, or veteran partnering private hospital
Tier 2(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital. The Contracted private hospital must seek prior approval for all other admissions.
Tier 2
second
Contracted private hospital
Tier 3
third
Non-Contracted private hospital
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3.1 Medical specialist treatment
A medical specialist or Local Medical Officer may, without prior approval, refer an entitled person to a medical specialist for treatment as a private patient (whether that medical specialist works at a hospital or at consulting room facilities) only if the fee to be charged by that medical specialist for that treatment is no greater than the fee the medical specialist could charge for the treatment pursuant to the MRCA Treatment Principles.
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treatment
An entitled person may be admitted to a Tier 2 hospital for non-emergency treatment without prior approval only in those circumstances where the arrangements relating to that hospital specifically exclude the need for prior approval.
3.4. Emergency hospital treatment
An entitled person may be treated at, and admitted through, the accident and emergency centre of a Tier 1, 2, or 3 hospital for emergency treatment without prior approval.
3.5 Notification of admission
If an entitled person is admitted to a Tier 2 or Tier 3 hospital under paragraph 3.4, the hospital must notify the Department of that admission the next working day in the State or Territory in which the admission occurred, or as soon as practicable afterwards.
3.6 Payment of facility fee
The Commonwealth will pay a facility fee relating to treatment of an entitled person at an accident and emergency centre only if the person was not subsequently admitted to the hospital.
4. Prior approval required
4.1 Tier 2 hospital admission and treatment
Subject to Principle 3, an entitled person may be admitted to, and have continuing treatment in, a Tier 2 hospital only if a suitable Tier 1 hospital is unavailable and prior approval has been obtained for the admission.
4.2 Tier 3 hospital admission and treatment
Subject to paragraph 3.4, an entitled person may be admitted to, and have continuing treatment in, a Tier 3 hospital only if no suitable Tier 1 or Tier 2 hospital is available and prior approval has been obtained.
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
a Tier 2 or Tier 3 hospital, the Commission must consider where the person’s needs can most appropriately be met within a reasonable time, having regard to:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life
(d) in light of the severity of the entitled person’s clinical condition:
(i) the waiting time, if any, at that hospital compared with waiting times, if any, at relevant Tier 1 or Tier 2 hospitals, as the case may be; and
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4 Admission to Tier 3 hospital of choice
If prior approval has been given for an entitled person to be admitted to a Tier 2 hospital for the purpose of particular treatment, or an entitled person has been admitted for treatment to a Tier 2 hospital in accordance with paragraph 3.3, the person may elect to be admitted to a Tier 3 hospital of his or her choice for that treatment.
Preference Preference
Preference
2.2 Objective
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required 3. Prior approval not required
2. Order of preference for admission to hospital
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
Level
Preference
Hospital
Tier 1
first
former Repatriation Hospital, public hospital, or veteran partnering private hospital
Tier 2(special authorisation)
second
The Contracted private hospital is not required to seek prior approval for a referral for services specified in the contract, chargeable to DVA, from a Tier 1 hospital. The Contracted private hospital must seek prior approval for all other admissions.
Tier 2
second
Contracted private hospital
Tier 3
third
Non-Contracted private hospital
This is an opening excerpt, not the complete document.