Get a plain-English read of 4. Prior approval required
Turn the raw legal text into a practical explanation grounded in Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006.
Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006
Instrument 2006 No. R34 as amended
made under the
Australian Participants in British Nuclear Tests (Treatment) Act 2006
This compilation was prepared on 11 July 2007
taking into account amendments up to LI 2007 No. R9
Prepared by the Legal Services Group,
Department of Veterans' Affairs, Canberra
Definitions
In sections 1-3 of this instrument:
Act means the Australian Participants in British Nuclear Tests (Treatment) Act 2006.
Repatriation Private Patient Principles means the instrument referred to in section 17 of the Act as that instrument is incorporated in the Act.
Commencement
This instrument commences on the day after it is registered on the Federal Register of Legislative Instruments.
Modification of the Repatriation Private Patient Principles
The Repatriation Private Patient Principles are modified in accordance with the Schedule.
SCHEDULE
Title (twice occurring)
omit:
2004
substitute:
(Australian Participants in British Nuclear Tests) 2006
Note: the purpose of this provision is to ensure a part of the Repatriation Private Patient Principles, as that instrument is incorporated in the Act, is retained to ensure the Repatriation Private Patient Principles are modified and not substituted.
All provisions other than the title:
substitute:
Contents
Preliminary
1.1 Principles
1.2 Defined terms
Act
admission
Commission
contracted private hospital
country area of a State
Department
Deputy Commissioner
emergency
entitled person
facility fee
former Repatriation Hospital
Local Medical Officer
medical practitioner
Notes for Local Medical Officer
medical specialist
Principles
prior approval
private hospital
private patient
public hospital
Treatment Principles
VEA
VEA Repatriation Private Patient Principles 2004
VEA Treatment Principles
veteran partnering private hospital
1.3 Private patient status
Order of preference for admission to hospital
2.1 Order of preference
2.2 Objective
Prior approval not required
3.1 Medical specialist treatment
3.2 Non-emergency Tier 1 hospital treatment
3.3. Non-emergency Tier 2 hospital treatment
3.4. Emergency hospital treatment
3.5 Notification of admission
3.7 Payment of facility fee
Prior approval required
4.1 Tier 2 hospital admission and treatment
4.2 Tier 3 hospital admission and treatment
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
4.4 Admission to Tier 3 hospital of choice
4.5 Commonwealth liability if Tier 3 admission by choice
Preliminary
1.1 Principles
These Principles are the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006.
1.2 Defined terms
For the purposes of these Principles, unless a contrary intention appears:
Act means the Australian Participants in British Nuclear Tests (Treatment) Act 2006 in force from time to time.
admission means admission for treatment as an in-patient or day-patient upon the referral of a medical specialist or a Local Medical Officer.
Commission means the Repatriation Commission, continued in existence by section 179 of the Veterans’ Entitlements Act 1986.
contracted private hospital means a private hospital in respect of which the Commission has entered into arrangements, for the treatment of entitled persons, under the Act, or, if no arrangement has been entered into with the hospital under the Act, under the VEA.
country area of a State has the meaning given it by the Instrument made by the Commission under paragraph 80 (2) (b) of the VEA.
Department means the Australian Government Department of Veterans’ Affairs.
Deputy Commissioner means the person appointed by the Secretary of the Department to manage the affairs of the Department in a State or Territory.
emergency means a situation in which a person requires immediate treatment because of a serious threat to the person’s life or health.
entitled person means a person eligible for treatment under the Act.
facility fee means a fee relating to accident and emergency services charged by a particular hospital.
former Repatriation Hospital means a hospital or other institution that was formerly operated by the Commission under paragraph 89(1)(a) of the VEA.
Note: see the Repatriation Institutions (Transfer) Act 1992
Local Medical Officer means a medical practitioner who:
(a) is registered under the Notes for Local Medical officers as a Local Medical Officer and who treats an entitled person in accordance with the terms, and subject to the conditions, in the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 and in the “Notes for Local Medical Officers”; and
(b) has been given a provider number by Medicare Australia, in respect of being a medical practitioner, that has not been suspended or revoked.
medical practitioner means a person registered or licensed as a medical practitioner under a law of a State or Territory that provides for the registration or licensing of medical practitioners but does not include a person so registered or licensed:
(a) whose registration, or licence to practise, as a medical practitioner in any State or Territory has been suspended, or cancelled, following an inquiry relating to his or her conduct; and
(b) who has not, after that suspension or cancellation, again been authorised to register or practise as a medical practitioner in that State or Territory.
Notes for Local Medical Officers has the same meaning it has in the Treatment Principles (Australian Participants in British Nuclear Tests) 2006.
medical specialist means a medical practitioner who is recognised as a consultant physician or specialist in the appropriate specialty for the purposes of the Health Insurance Act 1973.
Principles means the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006.
prior approval means:
(a) in relation to treatment—approval by the Commission for treatment before the treatment was given or commenced to be given; and
(b) in relation to admission to a hospital—approval by the Commission for admission to that hospital before the person is admitted.
private hospital means premises that have been declared to be:
(a) a private hospital for the purposes of the Health Insurance Act 1973; or
(b) a day hospital facility for the purposes of the National Health Act 1953.
private patient has the meaning given by subsection 17(8) of the Act.
public hospital means a hospital operated by a State or Territory or by the Commonwealth.
Treatment Principles means the document prepared by the Commission under section 16 of the Act that sets out the circumstances in which, and conditions subject to which, treatment may be provided to entitled persons.
VEA means the Veterans’ Entitlements Act 1986.
VEA Repatriation Private Patient Principles 2004 means the principles determined by the Commission under section 90A of the VEA.
VEA Treatment Principles means the document known as the Treatment Principles and prepared by the Commission under section 90 of the VEA.
veteran partnering private hospital means a contracted private hospital that is described as a “veteran partnering private hospital” in its arrangement with the Commission under section 15 of the Act or subsection 89(1) of the VEA, as the case may be.
Note: other Tier 1 status hospitals which have similar partnering arrangements are public hospitals and former Repatriation Hospitals.
1.3 Private patient status
An entitled person is to receive hospital care as a private patient, which entitles the person, as a minimum, to:
(a) the patient’s choice of doctor, subject to the doctor having practising rights at the relevant hospital; and
(b) shared accommodation; and
(c) if medically necessary, private accommodation.
2. Order of preference for admission to hospital
2.1 Order of preference
Preference for admission is to be in accordance with the following table:
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
2.2 Objective
The main objective of these Principles is to provide an entitled person with access to the nearest suitable hospital.
3. Prior approval not required
3.1 Medical specialist treatment
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.
3.2 Non-emergency Tier 1 hospital treatment
An entitled person may be admitted to a Tier 1 hospital for non-emergency treatment without prior approval.
3.3. Non-emergency Tier 2 hospital treatment
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.
3.4. Emergency hospital treatment
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.
3.5 Notification of admission
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.
3.7 Payment of facility fee
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.
4. Prior approval required
4.1 Tier 2 hospital admission and treatment
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.
4.2 Tier 3 hospital admission and treatment
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.
4.3 Criteria for Tier 2 or Tier 3 hospital admission and treatment
In deciding whether prior approval will be given under paragraph 4.1 or 4.2 for:
(a) admission to; or
(b) continued, non-emergency, treatment in;
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:
(c) advice from the person’s treating medical practitioner concerning:
(i) the injury or disease being treated; and
(ii) the clinical need for the proposed treatment; and
(iii) the degree of pain or discomfort; and
(iv) the effect on the person’s quality of life; and
(d) in light of the severity of the entitled person’s clinical condition:
(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
(ii) the distance that the entitled person would have to travel; and
(e) reasonable control over Commonwealth expenditure; and
(f) the extent of a clinical need for continuity of care by a particular medical practitioner; and
(g) any other relevant requirement in these Principles or in the Act.
4.4 Admission to Tier 3 hospital of choice
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.
4.5 Commonwealth liability if Tier 3 admission by choice
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:
(a) accommodation costs; and
(b) pharmaceutical fees; and
(c) theatre fees; and
(d) certain incidental expenses;
provided such costs, fees or expenses are, in the Commission’s opinion, reasonable.
Notes to the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006
Note 1
The Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006 (in force under the Australian Participants in British Nuclear Tests (Treatment) Act 2006) as shown in this compilation comprises the legislative instruments in the Table below:
Table A Application, saving or transitional provisions
Legislative Instrument 2007/R9
Application
The variations made by this instrument to the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006 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 (Australian Participants in British Nuclear Tests) 2006 — 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 (Australian Participants in British Nuclear Tests) 2006 as if those Principles had not been amended by this instrument but when the arrangement ends, the Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006 apply as amended by this instrument.
Part 4. Prior approval required - Repatriation Private Patient Principles (Australian Participants in British Nuclear Tests) 2006 - 4. Prior approval required | Zoe