PART 11 — THE PROVISION OF REHABILITATION APPLIANCES
11.1 Rehabilitation Appliances Program
11.1.1 The Commission may provide:
(a) a surgical appliance; and
(b) an appliance for self‑help and rehabilitation purposes;
to an entitled person, for an injury or disease of the person, unless the appliance could be provided to the person, for that injury or disease, by the Commission under a Part of the Act, other than Part 3 of Chapter 6 of the Act, or under DRCA.
Note (1): an appliance could be provided as part of a rehabilitation program under Chapter 3 of the Act or as a modification to a motor vehicle under Chapter 4 of the Act and could be provided under Part III or s.148 of DRCA (but not under s.16(1) by virtue of s.144B(5) DRCA).
Note (2): the Commission providing an appliance means the Commission arranges for its provision or accepts financial responsibility for the cost of the appliance where its provision is arranged by a third party.
Note (3): the RAP National Schedule of Equipment and the Rehabilitation Appliances Program (RAP) National Guidelines are DVA documents that provide guidance to the Commission and to prescribers and suppliers in relation to the provision of surgical aids and appliances for self‑help and rehabilitation to entitled persons.
11.1.2 The aim of the Rehabilitation Appliances Program is to restore, facilitate or maintain functional independence and/or minimise disability or dysfunction as part of the provision of quality care to entitled persons.
11.1.3 Appliances shall be provided:
(a) according to an assessed clinically indicated need; and
(b) in an efficient manner of delivery; and
(c) towards meeting health care objectives; and
(d) in a cost effective manner; and
(e) on a timely basis.
11.1.4 An appliance that is provided should be:
(a) appropriate for its purpose; and
(b) safe for the particular entitled beneficiary; and
(c) part of the overall management of health care for the entitled person;
and likely to facilitate the independence and/or self‑reliance of the entitled person based on an assessment of clinical need by an appropriately qualified health professional.
11.2 Supply of rehabilitation appliances
11.2.1 Unless otherwise indicated in these Principles, the Commission will arrange the supply of rehabilitation appliances on the condition that these are returned when no longer needed or if the Commission so requests.
Note: an example where the Commission could request the return of a rehabilitation appliance is where it cannot be accommodated in an institution.
11.2A Prior Approval
11.2A.1 If under this Part or under the DVA documents entitled, respectively, the “RAP National Schedule of Equipment” referred to in Schedule 1 and the "Rehabilitation Appliances Program (RAP) National Guidelines" referred to in Schedule 1, the Commission's prior approval is required for the supply of a rehabilitation appliance to an entitled person or the alteration to, replacement or repair of a rehabilitation appliance, then the Commission is not to accept financial liability for the supply, alteration, replacement or repair, as the case may be, unless it has granted that prior approval.
Note: in granting prior approval the Commission must consider the matters in paragraph 3.2.2.
11.2A.2 A grant of prior approval must be recorded in writing by the Department within 7 days after it has been made.
11.2A.3 The record may be maintained in electronic form and must be stored by the Department for a period of at least 12 months commencing on the 8th day after the grant of prior approval was made.
11.3 Restrictions on the supply of certain items
11.3.1 Subject to this Part, the Commission will provide or accept financial responsibility for the following aids or appliances only to entitled members who have a medically assessed need for these items due to a service injury or service disease:
(b) the supply of a guide dog, mobility dog or hearing dog;
(c) the supply of special vehicle driving controls and devices, if the entitled member owns the vehicle and is licensed under relevant State or Territory law to drive a modified vehicle;
(d) a Vertical Platform Lift.
Note: an example of a Vertical Platform Lift may be seen at:
(c) the supply of special vehicle driving controls and devices, if the entitled member owns the vehicle and is licensed under relevant State or Territory law to drive a modified vehicle;
(d) a Vertical Platform Lift.
Note: an example of a Vertical Platform Lift may be seen at:
11.3.2 Subject to paragraph 11.1.3 (clinical need, cost effective etc), the Commission may accept financial responsibility for the provision to an entitled person of an assistive communication device.
11.3.3 Where the assistive communication device is a computer tablet or smart `phone, the Commission may only accept financial responsibility for the device if:
(a) the entitled person has been clinically assessed by a speech pathologist as having complex communication needs that would be significantly met by a computer tablet or smart `phone; and
(b) in the case of a smart `phone — the entitled person’s communication needs:
(i) could not be reasonably satisfied by the provision of a computer tablet; or
(ii) are not being reasonably satisfied by the use of a computer tablet; and
(c) the computer tablet or smart `phone has been preloaded with a speech pathology application; and
(d) the entitled person is:
(i) a Gold Card holder; or
(ii) a White Card holder whose communication needs arise from a service injury or service disease; and
(e) the Commission considers all relevant guidelines in relation to the provision of an assistive communication device that is a computer tablet or a `smart phone as set out in the RAP National Schedule of Equipment and the Rehabilitation Appliances Program (RAP) National Guidelines.
Note 1: the repair and replacement of rehabilitation appliances is covered by MRCA Treatment Principle 11.7.
Note 2: the holder of a Gold Card is a member or former member, or dependant of a member or former member, eligible under the Act for treatment for any injury suffered, or disease contracted.
Note 3: the holder of a White Card is a member or former member eligible under the Act for treatment for a service injury or service disease.
Note 4: “dependant” is defined in s.15 of the Act; and eligibility of dependants for treatment is set out in s.284 of the Act.
Electric Mobility Aids
11.3.4.1 Subject to this Part, the Commission may provide or accept financial responsibility for the supply of an electric wheelchair, an electric scooter or a power‑assist device to:
(a) an entitled member who has a medically assessed need for the item due to a service injury or a service disease; or
(b) an entitled member who has a medically assessed need for the item and is eligible to be provided with treatment under the Act, subject to these Principles, for all injuries or diseases.
11.3.4.2 For paragraph 11.3.4.1:
power‑assist device means an electrically‑powered device that can be mounted on to a manual wheelchair to provide additional mobility assistance and support independent operation.
Assistance Dogs
11.3.5.1 Subject to this Part, the Commission may accept financial responsibility for the supply of a psychiatric assistance dog to a person if the Commission is satisfied:
(a) the person is an entitled member; and
(b) the person has an accepted condition of post‑traumatic stress disorder or a diagnosis of post‑traumatic stress disorder from a psychiatrist; and
(c) the person is undergoing treatment by a psychiatrist or a psychologist for post‑traumatic stress disorder and has been undergoing such treatment for at least 3 months; and
(d) the person has been assessed as suitable for the supply of a psychiatric assistance dog by a mental health professional having regard to the factors in the RAP Guidelines for this assessment; and
(e) the person is suitable for the supply of a psychiatric assistance dog having regard to the factors in the RAP Guidelines relating to living arrangements, current life circumstances, support networks, and ability to properly care for the dog.
11.3.5.2 In making a decision about the supply of a guide dog, mobility dog or hearing dog for an entitled member under paragraph 11.3.1, the Commission is to have regard to the factors in the RAP Guidelines relating to the supply of a guide dog, mobility dog or hearing dog, as the case requires.
11.3.5.3 If the Commission has accepted financial responsibility for the supply of an assistance dog the Commission will also be responsible for the reasonable costs associated with keeping the dog while the dog remains in the care of the entitled member.
11.3.5.3A The Commission may accept financial responsibility for the reasonable costs, incurred on or after 1 July 2022, associated with a person keeping a psychiatric assistance dog while the dog remains in the care of the person if:
(a) the person is an entitled member; and
(b) the person has an accepted condition of post‑traumatic stress disorder or a diagnosis of post‑traumatic stress disorder from a psychiatrist; and
(c) the person has undergone treatment, or is undergoing treatment, by a psychiatrist or a psychologist for post‑traumatic stress disorder and has accessed such treatment for at least 3 months; and
(d) the Commission is satisfied that:
(i) the dog was supplied to the person before 27 September 2019; or
(ii) the dog was supplied to the person on or after 27 September 2019 in connection with the person commencing training with the dog, or another psychiatric assistance dog, before 27 September 2019; and
(e) the person satisfies any other criteria determined by the RAP Guidelines for the purposes of this subparagraph.
11.3.5.4 For paragraphs 11.3.5.1 to 11.3.5.4:
assistance dog means a guide dog, a mobility dog, a hearing dog or a psychiatric assistance dog;
mental health professional means:
(a) a psychiatrist; or
(b) a psychologist; or
(c) a mental health occupational therapist; or
(d) a mental health social worker;
mental health occupational therapist means a person who is registered with AHPRA to practise as an occupational therapist and eligible to provide focussed psychological strategies under Medicare;
mental health social worker means a social worker who is a member of the Australian Association of Social Workers and certified by that association as eligible to provide focussed psychological strategies under Medicare;
psychiatrist means a medical practitioner who is registered with AHPRA and holds specialist registration as a psychiatrist;
psychologist means a person who is registered with AHPRA to practise as a psychologist;
RAP Guidelines means the Rehabilitation Appliances Program (RAP) National Guidelines defined in paragraph 1.4.1 of these Principles.
11.3.6 Subject to 11.3.6A and 11.3.7, the Commission will not approve the supply of a rehabilitation appliance to an entitled person who is in an institution or who has entered a Commonwealth, State or Territory program if the Commission is satisfied that:
(a) for an institution, the appliance should be supplied by the owner or operator of the institution because:
(i) any Commonwealth, State or Territory legislation under which the institution (or owner or operator) is registered, licensed or otherwise authorised enables the appliance to be supplied; or
(ii) due to charges made by or subsidies received by the owner or operator of the institution under Commonwealth, State or Territory legislation, it is fair for the owner or operator of the institution to bear the cost of supplying the appliance; or
Note: the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
(iii) installing the appliance would involve an alteration to the structure of part of the institution; or
(iv) it is otherwise appropriate for the appliance to be supplied by the owner or operator.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village, and a cluster of self‑care units.
Note (2): the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
(b) for an institution, where the appliance is a hand rail, ramp, non‑slip surface or similar appliance, the appliance should be supplied by the entitled person or the owner or operator of the institution because the entitled person should have known, by reason of the person’s state of health or frailty at the time the person arranged to enter the institution, that such an appliance would have been likely to have been needed by the person upon being admitted to the institution or a short time thereafter.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village, and a cluster of self‑care units.
Note (2): The policy is that entitled persons entering institutions should ensure the institution caters to their needs before they take up residence.
Note (3): A guide to a “short time” is a period within 6 months after entering the institution.
Note (4): the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
(c) for a program, it is more appropriate that the appliance is provided under the program because:
(i) the Commonwealth financially contributed to the program, if the case; or
(ii) the program’s budget appears sufficient to reasonably absorb the cost of the appliance; or
(iii) the Department is under a short‑term financial constraint; or
(iv) it is otherwise appropriate for the appliance to be supplied under the program.
Note: the DVA document known as “RAP Business Rules” provides a guide to decision making in respect of the supply of appliances and is contained in the RAP Schedule of Equipment at:
11.3.6A The Commission will approve the supply of a rehabilitation appliance to an entitled person in an institution or participating in a Commonwealth, State or Territory program, if:
(a) the Commission approved the appliance for the person before the person entered the institution or the program and that approval has not been revoked; and
(b) for a person in an institution, any alteration to the structure of part of the institution necessary to install or attach the appliance satisfies the requirements in (a) and (b) of 11.3.7; and
Note: (a) and (b) deal with compliance with relevant laws and approval by owner of property to installation/attachment together with an undertaking by the owner not to seek compensation if the appliance is removed.
(c) the rehabilitation appliance is not a consumable
rehabilitation appliance.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village, and a cluster of self‑care units.
Note (2): 11.3.6A is relevant in relation to the maintenance or repair of the appliance. Generally, only an approved appliance may be maintained or repaired at Commission expense.
11.3.7 Subject to other conditions specified in this Part, the Commission may approve the installation or the attachment of a rehabilitation appliance to property when:
(a) the installation or the attachment conforms to Commonwealth, State or Territory laws relating to alterations to property; and
(b) the property owner has given approval and an undertaking not to seek compensation for restoration of the property when the appliance is no longer required by the entitled person to whom the aid was supplied.
11.3.8 Subject to this Part, the Commission may provide or accept financial responsibility for the installation of a telephone deaf aid and/or touch phone and the rental of the aid for the first year, in the workplace of an entitled member who has a medically assessed need for these items because of a service injury or service disease.
11.4 Visual aids
11.4.1 The Commission may accept financial liability for visual aids dispensed by an optical dispenser (who may be an optometrist) to an entitled person on the prescription of an ophthalmologist or an optometrist (with a current provider number) where the visual aids have been provided in accordance with:
(a) the Principles; and
(b) Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optometrists and optical dispensers)); and
(c) the DVA document entitled “Pricing Schedule for Visual Aids”, referred to in Schedule 1.
11.4.2 Visual aids may be prescribed from the DVA document entitled “Pricing Schedule for Visual Aids”, referred to in Schedule 1.
11.4.3 The Commission’s prior approval is required for the prescription of items not listed in the DVA document entitled “Pricing Schedule for Visual Aids”, referred to in Schedule 1, except in the circumstances referred to in paragraph 11.4.6.
11.4.4 Subject to paragraph 11.4.5, in any two year period, the Commission shall not provide an entitled person with:
(a) more than one pair of distance spectacles and one pair of readers; or
(b) more than one pair of bifocals, trifocals or progressive power lenses.
11.4.5 The Commission will provide an entitled person with renewed lenses before the expiration of two years if:
(a) in the opinion of the treating practitioner, there has been a change in;
(i) the person’s refraction; or
(ii) the condition of the person’s eyes,
that necessitates new lenses; or
(b) there has been accidental loss or breakage.
11.4.6 If an entitled person chooses spectacle frames or lenses that differ from those listed in the DVA document entitled “Pricing Schedule for Visual Aids”, referred to in Schedule 1, or that have not been medically prescribed, the Commission will accept financial responsibility only to the financial limits set out in the schedule.
11.5 Hearing aids
11.5.1 The Commission will approve the supply of a spectacle hearing aid when it is the only type of hearing aid appropriate and the person is entitled to the treatment:
(a) of all injuries or diseases; or
(b) of deafness that is a service injury or service disease; or
(c) of a visual defect that is a service injury or service disease and the need for a spectacle hearing aid arises from the person’s inability to accommodate spectacles and a separate hearing aid.
11.5.2 Where a person who has a hearing defect that is a service injury or service disease is provided with a spectacle hearing aid under paragraph 11.5.1:
(a) new lenses will be provided; or
(b) the existing spectacle lenses will be fitted as part of the aid.
11.5.3 The Commission will not be responsible, under paragraph 11.5.2, for the further supply or the fitting of lenses if the person is not entitled to the supply of spectacles.
11.5.4 Subject to prior approval, the Commission may accept financial responsibility for the supply of a hearing aid from an audiology provider if the hearing aid is unable to be supplied to the entitled person under the Hearing Services Administration Act 1997 or the Hearing Services Act 1991.
11.5.5 The Commission may accept financial responsibility for service charges in respect of a hearing aid that has been supplied under paragraph 11.5.4.
11.5.6 The Commission may accept financial responsibility for service charges in respect of a hearing aid following the supply of that hearing aid under paragraph 11.5.4 or 11.5.5.
11.6 Other rehabilitation appliances
11.6.1 Subject to this Part, the Commission may arrange for a wig to be supplied to an entitled person who:
(a) became bald as a result of a service injury or service disease or as a result of the treatment of a service injury or service disease; or
(b) requires a wig as part of medical treatment for disfigurement.
11.6.2 The Commission will not accept financial responsibility for the cleaning and setting of a wig.
11.6.4 Where the Commission approves the provision of stoma appliances and consumables, the provision will be through:
(a) a stoma association; or
(b) the Pharmaceutical Benefits Scheme; or
(c) the MRCA Pharmaceutical Benefits Scheme.
11.6.5 The Commission will accept financial responsibility for the cost of membership of a stoma association and for the cost of postage of stoma supplies.
11.7 Repair and replacement
11.7.1 The Commission may approve the provision of more than one of the same rehabilitation appliance if the entitled person depends completely on the appliance, and:
(a) it is necessary to maintain the appliance in a hygienic condition because of domestic or occupational circumstances; or
(b) the entitled person lives in an isolated country area and would be handicapped by loss or breakage; or
(c) there are other circumstances where the Commission considers it reasonable to do so.
11.7.2 Subject to paragraphs 11.7.6 and 11.7.7, the Commission will not be financially responsible for the alteration to, or the repair of, a treatment aid without prior approval.
11.7.3 The Commission will not be financially responsible for, or reimburse, the cost of an alteration to, or a repair of, a rehabilitation appliance for which it has not accepted financial responsibility, unless there are circumstances where the Commission considers it reasonable to accept financial responsibility.
11.7.4 The Commission will not be financially responsible for repair or replacement of a rehabilitation appliance for a non service injury or disease injury or disease while an entitled person is travelling overseas.
11.7.5 Prior approval will be given for the repair or replacement of an appliance where repair or renewal is necessary because:
(a) the appliance was damaged by normal wear and tear;
(b) the appliance inadvertently was damaged or lost; or
(c) the health‑care practitioner treating the entitled person considers that a replacement is required because the person’s condition has changed.
11.7.6 The Commission will not give approval for the repair or replacement of an appliance if repair or renewal is necessary as the result of:
(a) a wilful act of the entitled person using or wearing the appliance; or
(b) a negligent act of the entitled person using or wearing the appliance and the person has damaged or lost a similar appliance in the past as a result of negligence or wilfulness.
11.7.7 Prior approval is not required for repairs to spectacles.
11.8 Treatment aids from hospitals
11.8.1 The Commission may provide, or accept financial responsibility for, treatment aids as part of inpatient treatment where the aids expedite discharge from hospital.
11.8.2 The conditions for the supply of treatment aids are the same as those normally applied by the hospitals for patients not covered by these Principles.
11.8.3 The Commission will not provide, or accept financial responsibility for, a treatment aid as part of inpatient or outpatient treatment where the treatment solely comprises the provision of the treatment aid.
PART 12 — OTHER TREATMENT MATTERS
12.1 Ambulance transport
12.1.1 With the exception of arrangements for medical emergency under paragraph 12.1.4 and special arrangements under paragraph 12.1.5, prior approval must be obtained in all cases before ambulance transport is used by an entitled person.
12.1.2 Approval for ambulance transport normally will be given where the entitled person:
(a) is a stretcher case; or
(b) requires treatment during transport; or
(c) is grossly disfigured; or
(d) is incontinent to a degree that precludes the use of other forms of transport.
12.1.3 Other than in exceptional circumstances, air ambulance will be approved only to transport an entitled person with acute medical and surgical complaints for admission to, or discharge from, a hospital.
12.1.4 The Commission will accept financial responsibility for the use of ambulance transport in a medical emergency for an entitled person if an office of the Department is notified on the first working day after the ambulance transport is used or as soon thereafter as is reasonably practicable.
12.1.5 Prior approval for ambulance transport for entitled persons is not required where the transport is provided under arrangements between the ambulance service provider and the Commission.
12.2 Treatment under Medicare Program
12.2.1 Entitled persons may choose to have their treatment arranged through the Department or under a medicare program.
12.2.2 Subject to these Principles, entitled persons who are treated under a medicare program may also receive services that are not covered by the MBS at the Commission’s expense.
12.2.3 When part or all of the cost of a treatment item has been paid as a medicare benefit, the Commission will not pay for the same professional or ancillary service regardless of the person’s entitlement under the Act.
12.4 Prejudicial or unsafe acts or omissions by patients
12.4.1 The Commission may refuse to be financially responsible for, or provide treatment to, or any further treatment to, an entitled person who, by an act or omission, deliberately prejudices his or her own, or a fellow patient’s, treatment or the safety of persons providing treatment.
12.6 Recovery of moneys
12.6.1 Where a payment has been made to any person or body, purportedly as payment for treatment, the Commission may recover (up to the extent that the payment exceeds the amount, if any, that should have been paid to that person or body) any moneys, the payment of which was induced or affected at all by:
(a) any misrepresentation; or
(b) any mistake of fact; or
(c) any mistake of law; or
(d) any other cause.
12.6.2 Further to paragraph 12.6.1, the Commission may recover moneys for any excess amounts that should not have been paid to that person or body:
(a) in a single demand; or
(b) by instalments; or
(c) subject to section 317 of the Act, by offsetting moneys for any excess amounts against any later claims for payment by that person or body; or
Note: Section 317 provides, in effect, that where amounts have been overpaid, the Commission may, if the person agrees, offset money owed against later payments.
(d) by a combination of any of these methods of recovery.
12.6.3 Nothing in this principle is to be taken to restrict any other right or action for recovery of moneys.