3. Prior approval not required 3. Prior approval not required
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
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 Treatment Principles.
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.
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.
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.
for in-patient treatment without prior approval if such treatment is certified by a medical practitioner as being urgently required.
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.
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.
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.
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:
(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
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.
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:
5.1.1 The National Treatment Monitoring Committee and the Treatment Monitoring Committees of each State, the Australian Capital Territory, and the Northern Territory that were established under the revoked Repatriation Private Patient Principles are continued in existence by these Principles.
5.2.1 The Commission is to appoint the members of the National Treatment Monitoring Committee and it may appoint those members on such terms as it thinks fit.
(a) at least two members representing the Australian Government, with one of those members being an officer of the Department; and
(a) at least the organisations in subparagraph 5.2.3 (b) (or an associated State or Territory organisation if the relevant organisation is only a national organisation); and
(b) Departmental staff, including the relevant Deputy Commissioner for that State or Territory, who is to be the chair of the Committee for that State or Territory; and
The Treatment Monitoring Committees are to assist the Commission in monitoring the access to, and quality of, treatment arranged for entitled persons as private patients.
5.5.1 The National Treatment Monitoring Committee must consider the reports of the State and Territory Treatment Monitoring Committees and report, in writing, at least annually to the Commission.
5.5.2 The report of the National Treatment Monitoring Committee is to contain, among other relevant details, conclusions regarding the access to, and quality of, treatment, in hospitals or other institutions, provided to entitled persons.
5.5.3 To enable the National Treatment Monitoring Committee to report at least annually, the State and Territory Treatment Monitoring Committees must report at least annually to the National Treatment Monitoring Committee.
The Commission must, within seven days of its receipt, provide a copy of the written report of the National Treatment Monitoring Committee to the Minister.
After receiving a copy of the report of the National Treatment Monitoring Committee, the Minister must cause a copy to be laid before each House of the Parliament within 15 sitting days of that House.
6.1 Subject to paragraph 6.2, the Commission may, and after giving the member an opportunity to be heard, terminate the appointment of a member of a Treatment Monitoring Committee established under Section 5.
Note: this provision is not intended to apply to a situation where a member has not satisfied a term or condition of their appointment.
6.2 In exercising its power under paragraph 6.1, the Commission is to be guided by the grounds on which the appointment of a member of the Repatriation Commission can be terminated under section 188 of the Act.
6.3 The Commission may, and after giving the member an opportunity to be heard, revoke the appointment of a member of a Treatment Monitoring Committee established under Section 5, where the member contravenes, or cannot satisfy, a term or condition of their appointment.
Any approval given, decision or appointment made, or other thing done under the revoked Repatriation Private Patient Principles is taken to have been given, made, or done for the purposes of, and under, these Principles.
From their commencement, these Principles apply to all matters to which these Principles, or the revoked Repatriation Private Patient Principles, relate.
Note: The Repatriation Private Patient Principles 2004 (in force under the Veterans' Entitlements Act 1986) as shown in this compilation comprises the legislative instruments in the Table below:
Year andnumber
Date of FRLIregistration
Date ofcommencement
Application, saving ortransitional provisions
2004/R17
14 March 2005 (see: F2005L00530)
15 March 2005
para.7.2 (see: Table A)
2005/R27
21 December 2005 (see: F2005L04158)
21 December 2005
2006/R32
30 January 2007 (see: F2007L00200)
31 January 2007
2007/R5
19 June 2007 (see: F2007L01223)
19 June 2007
para.4
From their commencement, these Principles apply to all matters to which these Principles, or the revoked Repatriation Private Patient Principles, relate.
The variations made by this instrument to the Repatriation Private Patient Principles 2004 do not apply to a Local Medical Officer who has a current arrangement with the Repatriation Commission or the Department in respect of the provision of treatment to persons entitled to treatment under the 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 Repatriation Commission or the Department expires or is terminated, the provision of treatment under that arrangement is governed by the Repatriation Private Patient Principles 2004 as if those Principles had not been amended by this instrument but when the arrangement ends, the Repatriation Private Patient Principles 2004 apply as amended by this instrument.
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 Treatment Principles.