7.1Prior approval and financial responsibility for health services

7.1 Prior approval and financial responsibility for health services

7.1.1 Except where provided in:

(1) the Principles;

(2) the Notes for Allied Health Providers; or

(3) a Fee Schedule;

the Commission’s prior approval for a treatment under this Part is not required.

7.1.1A In relation to any occasion of service to an entitled person under these Principles, except an occasion of service that is a service under the MRCA Home Care Program, a health provider shall bill only the Department and that bill shall be for full settlement of the account for the service provided to the entitled person but in relation to any occasion of service to an entitled person under these Principles that is the provision of a service under the MRCA Home Care Program, a health provider shall bill the Department but not for any co‑payment payable by an entitled person to the health provider and the bill presented to the Department shall be for full settlement of the account for the service provided to the entitled person.

7.1.2 Subject to these Principles and in addition to services provided under principle 2.6 and paragraph 5.1.3, the Commission may provide, arrange, or accept financial responsibility for the following:

(a) audiology

(aa) diabetes educator services;

(b) dietetics;

(c) chiropractic services;

(d) community nursing;

(dd) exercise physiology;

(e) occupational therapy;

(f) optometry;

(g) orthoptics;

(ga) orthotic services;

(h) osteopathic services;

(i) Home Care service (category A); Home Care service (category B);

(j) physiotherapy;

Note: Physiotherapy includes hydrotherapy (see paragraph 1.4.1)

(k) podiatry;

(l) psychology;

(m) social work;

(n) speech pathology.

7.1.3 The Commission will not accept financial responsibility for a service listed in paragraph 7.1.2 for an entitled person receiving residential care if the Commission is satisfied that it is more appropriate that the service is provided by the owner or operator of the residential care facility because, due to assistance (financial or otherwise) received by the owner or operator of the residential care facility under Commonwealth, State or Territory legislation, it is fair for the owner or operator of the residential care facility to bear the cost of supplying the service.

Note: For example, if the Commission is taken to have accepted financial responsibility for amounts in respect of the entitled person’s residential care under Part 10 on the basis that those amounts are intended to cover services listed in paragraph 7.1.2, the Commission will not also accept financial responsibility for those services under paragraph 7.1.2.