PART 11 — THE PROVISION OF REHABILITATION APPLIANCES
11.1 Rehabilitation Appliances Program
11.1.1 The Commission may provide:
(a) surgical appliances; and
(b) appliances for self-help and rehabilitation purposes;
unless those appliances could be provided by the Commission under a Part of the Act other than Part 3 of Chapter 6 of the Act.
Note: appliances 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.
Note: 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;
but should not be an item that is customarily used for domestic purposes and would be used merely for such a purpose by the entitled person.
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” in force on the date in Schedule 1 and the "Rehabilitation Appliances Program (RAP) National Guidelines" in force on the date 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 appliances only to entitled members who have a medically assessed need for these items due to a service injury or service disease:
(a) the supply of electric wheelchairs or electric scooters;
(b) the supply of a guide dog, provided that the Commission will not be responsible for costs associated with keeping the 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.
11.3.2 Subject to this Part, the Commission will provide or accept financial responsibility for the provision of electronic communication equipment only to entitled members who are:
(a) legally blind; or
(b) severely handicapped.
11.3.3 For the purposes of paragraph 11.3.2, a legally blind entitled member means an entitled member:
(a) whose legal blindness is service injury or service disease; and
(b) who has a medically assessed need for the electronic communication equipment; and
(c) who has been assessed by the Commission as being able to benefit from use of the electronic communication equipment.
11.3.4 For the purposes of paragraph 11.3.2, a severely handicapped entitled member means an entitled member:
(a) whose severe handicap was a service injury or service disease; and
(b) who has a medically assessed need for the electronic communication equipment; and
(c) who has been assessed by the Commission as being able to benefit from the use of the equipment because it would substantially improve the member's:
(i) communication skills; and
(ii) quality of life.
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 premises known as a self-care unit.
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 premises known as a self-care unit.
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
(iii) 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 premises known as a self-care unit.
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) an arrangement between the optical dispenser and the Commission or the Department.
11.4.2 Visual aids may be prescribed from the DVA document entitled “Pricing Schedule for Visual Aids”, in force on the date 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”, in force on the date 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”, in force on the date 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.
11.6.3 Subject to this Part, the Commission may:
(a) provide medically suitable footwear as an aid; or
(b) approve the repair of an entitled person’s own footwear as part of medically prescribed alterations to the footwear.
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.
11.9 Provision of aids and appliances for accident prevention and personal safety
11.9.1 The Commission may assist in providing aids and appliances for accident prevention and personal safety for an entitled person by approving, only once in any period of 12 months, financial assistance towards the cost of such aids or appliances to a maximum amount of $200 (maximum amount) — increased annually (if the following formula results in an increase) on 1 January by an amount worked out in accordance with the following formula:
maximum amount (including as indexed) x the movement (expressed as a percentage) in the Wage Cost Index 5 for the previous financial year (as advised to the Department by the Australian Government Treasury), rounded to the nearest dollar = increase.
11.9.1A For the purposes of paragraph 11.9.1:
(a) a period of 12 months commences on the date the Commission approves financial assistance; and
(b) the Commission is not to approve financial assistance for an entitled person if 12 months has not elapsed from and including the date of any previous approval.
11.9.1B Where the Commission approves financial assistance under paragraph 11.9.1 of the Principles before the commencement of the MRCA Treatment Principles (HomeFront - Frequency of Subsidy) Instrument 2009 (commencement date), and on the commencement date a period of 12 months had not expired from and including the date of that approval, the approval is taken to have been granted under the Principles as amended by the MRCA Treatment Principles (HomeFront - Frequency of Subsidy) Instrument 2009 and the period of 12 months commences on the date of the approval.
11.9.2 The Commission may give approval under paragraph 11.9.1 only if it has received a report from a home and safety assessor and the Commission is satisfied that the aid or appliance for which assistance is sought:
(a) is needed by the person for accident prevention or personal safety as part of the person’s preventive health care management; and
(b) is appropriate for its purpose; and
(c) is safe and appropriate for the person’s particular circumstances; and
(d) is customarily used for domestic purposes and would be used for such purposes by the person; and
(e) would be provided or installed efficiently, cost effectively, and on a timely basis.
11.9.3 The Commission may enter into arrangements with a person or persons:
(a) to provide the Commission with reports from home and safety assessors; and
(b) for the provision of aids and appliances for accident prevention and personal safety.
11.9.4 Subject to Principle 3.4, the Commonwealth will not be financially responsible, either partly or wholly, for the purchase, supply, or installation of an aid or appliance for accident prevention and personal safety unless:
(a) financial assistance has been approved under paragraph 11.9.1; and
(b) the appliance is provided under an arrangement entered into under paragraph 11.9.3.
11.9.5 The Commission will not accept financial responsibility, either partly or wholly, for the purchase, supply, or installation of an aid or appliance for accident prevention and personal safety in respect of an entitled person who is in an institution or who has entered a Commonwealth, State or Territory program if, had the appliance been a rehabilitation appliance considered for supply under 11.3.6, the Commission would not, under 11.3.6, have approved its supply in respect of the person.
Note (1): “institution” includes a retirement village, premises the Commission considers have similar functions to a retirement village and premises known as a self-care unit.
Note (2): the intention is that only the “rehabilitation appliance provisions” in respect of institutions/programs apply to “accident prevention and personal safety appliances” in institutions or under programs, not that any other rehabilitation appliance provision applies to accident prevention and personal safety appliances in institutions or under programs.
11.9.7 The Commonwealth will not be financially responsible for the maintenance or repair of any aid or appliance for which the Commission has approved financial assistance under this Principle.
11.9.8 The Commonwealth will not be responsible for any damage caused by:
(a) the installation, operation, non-operation, use, or misuse of an aid or appliance for which the Commission has approved financial assistance under this Principle; or
(b) any delay in installing such an aid or appliance or approving financial assistance under this Principle.