PART 4 — MEDICAL PRACTITIONER SERVICES

4.1 Medical Practitioner Services

4.1.2 Outline

4.1.3 The aim of the medical services program is to ensure that as far as practicable entitled persons have access to free, safe and cost-effective treatment.

To achieve this objective the Commission or the Department deals with medical practitioners on three levels.

At the first level the Commission or the Department deals with medical practitioners called LMOs. Services provided by these medical practitioners must be in accordance with these Principles and the Notes for Local Medical Officers if the Department is to pay for the services.

The second level of engagement is where the Commission or the Department deals with medical practitioners who are willing to treat entitled persons under these Principles eg without charging the entitled person, but who are not prepared to provide their services in accordance with the Notes for Local Medical Officers. These medical practitioners are called other GPs.

Because LMOs provide services in accordance with the Notes for Local Medical Officers, which impose various requirements, some of which are exacting but which are aimed at maintaining a high quality of service and ensuring accountability, they receive higher rates of remuneration from the Department than do other GPs.

The feature that distinguishes LMO-treatment or other GP-treatment from treatment provided by medical practitioners not included in these categories is that LMOs and other GPs do not charge the entitled person for that treatment. They charge the Commission, the Department or Department of Human Services (hereafter in this Outline these bodies are referred to collectively as DVA).

It should be noted that while it is the Commission that accepts financial liability for treatment it is the Department (Commonwealth) that actually pays for the treatment.

The third level of interaction between the Commission or the Department and medical practitioners is where the medical practitioner is a specialist.

Unlike LMOs, medical specialists (as at 1 April 2006) are not prepared to submit to the same level of regulation as LMOs regarding services to entitled persons (at DVA expense) but if they are prepared to treat an entitled person at the rate set out in the Principles and charge DVA and not the entitled person, then the relationship between DVA and the specialist is covered by the Principles.

4.1.4 Subject to paragraph 3.5.1, the Commission may accept financial liability for medical treatment provided to an entitled person by an LMO, an other GP or a medical specialist.

Note: paragraph 3.5.1 sets out the financial limits on Commission liability for treatment.