4Schedule—Modifications of the Treatment Principles

4 Schedule—Modifications of the Treatment Principles

The Treatment Principles are modified as set out in the Schedule to this instrument for the purposes of the Treatment Benefits (Special Access) Act 2019.

Schedule—Modifications of the Treatment Principles

Treatment Principles

1 Title

Substitute:

Australian Government

REPATRIATION COMMISSION

Treatment Benefits (Special Access) Act 2019

Section 18

Treatment Benefits (Special Access) (Modifications of the Treatment Principles) Instrument 2019

Instrument 2019 No. R17

2 Paragraphs 1.1.1 and 1.1.2

Substitute:

1.1.1 The Treatment Principles set out the circumstances in which, and the conditions subject to which, treatment of a particular kind, or included in a particular class of treatment, may be provided under the Treatment Benefits Act for entitled persons and are to be read subject to the Treatment Benefits Act.

1.1.2 The Treatment Principles state the rules under which the Commission may arrange, or accept financial responsibility for the cost of, treatment for entitled persons.

Note: Consistent with the Treatment Benefits Act, treatment extends beyond medical treatment and also encompasses social and domestic assistance.

3 Paragraph 1.2.1

Omit “The Repatriation Private Patient Principles (the RPPPs), determined by the Commission under section 90A of the Act,”, substitute “The RPPPs”.

4 Paragraph 1.3.1

Omit “under the Act”, substitute “under the Treatment Benefits Act”.

5 Paragraph 1.3.1 (Note)

Omit “section 213 of the Act”, substitute “section 42 of the Treatment Benefits Act”.

6 Paragraph 1.4.1

Omit the following definitions:

(a) definition of “ACPMH treatment”;

(b) definition of “Australian Centre for Posttraumatic Mental Health” and “ACPMH”;

(c) definition of “Authorised Representative”;

(d) definition of “community patient”;

(e) definition of “community services”;

(f) definition of “consumable rehabilitation appliance”.

7 Paragraph 1.4.1 (definition of “contracted private hospital”)

Omit “eligible persons”, substitute “entitled persons”.

8 Paragraph 1.4.1 (paragraph (b) of the definition of “daily care fee”)

Omit “(including a former prisoner of war or a person awarded the Victoria Cross)”.

9 Paragraph 1.4 (Interpretation)

Omit the following definitions:

(a) definition of “data repository”;

(b) definition of “data repository controller”;

(c) definition of “Department of Prime Minister and Cabinet”;

(d) definition of “DVA Telemonitoring Practice Incentive”;

(e) definition of “determined condition”;

(f) definition of “determined residential care condition”;

(g) definition of “eligible person”;

(h) definition of “enrolment day”.

10 Paragraph 1.4.1 (definition of “entitled person”)

Substitute:

“entitled person” means a person who is eligible for treatment under section 7 of the Treatment Benefits Act.

11 Paragraph 1.4.1 (definitions of “entitled veteran”, “entitled widow” and “entitled widower”)

Omit the definitions.

12 Paragraph 1.4.1 (definition of “Gold Card”)

Substitute:

“Gold Card” means an identification card, or written authorisation, provided to an entitled person in relation to treatment for all injuries or diseases.

13 Paragraph 1.4.1

Omit the following definitions:

(a) definition of “home care”;

(b) definition of “in‑home telemonitoring equipment”;

(c) definition of “In‑Home Telemonitoring for Veterans Initiative”;

(d) definition of “internet carriage service”;

(e) definition of “ISP Provider”;

(f) definition of “Level A attendance”;

(g) definition of “limited VHC – type service”;

(h) definition of “National Broadband Network”;

(i) definition of “NBN”;

(j) definition of “NBN wave site”;

(k) definition of “nominated residence”;

(l) definition of “outpatient service”;

(m) definition of “participating LMO”;

(n) definition of “prisioner of war”.

14 Paragraph 1.4.1 (definition of “Principles”)

Substitute:

“Principles” means the Treatment Principles made under section 90 of the Act as modified by the Treatment Benefits (Special Access) (Modifications of the Treatment Principles) Instrument 2019.

15 Paragraph 1.4.1 (definition of “Repatriation Pharmaceutical Benefits Scheme”)

Substitute:

“Repatriation Pharmaceutical Benefits Scheme” means the Repatriation Pharmaceutical Benefits Scheme as modified by the Treatment Benefits (Special Access) (Modifications of the Repatriation Pharmaceutical Benefits Scheme) Instrument 2019.

16 Paragraph 1.4.1 (Note to the definition of “Respite Care”)

Omit the note.

17 Paragraph 1.4.1 (definitions of “revoked Treatment Principles” and “Rural Enhancement Scheme”)

Omit the definitions.

18 Paragraph 1.4.1 (definition of “RPPPs”)

Substitute:

“RPPPs” means the Repatriation Private Patient Principles as modified by the Treatment Benefits (Special Access) (Modifications of the Repatriation Private Patient Principles) Instrument 2019.

19 Paragraph 1.4.1

Omit the following definitions:

(a) definition of “short term restorative care”;

(b) definition of “telemonitoring care plan”;

(c) definition of “telemonitoring equipment”;

(d) definition of “telemonitoring initiative data”;

(e) definition of “telemonitoring initiative participant”;

(f) definition of “telemonitoring treatment”;

(g) definition of “TRCP treatment”;

(h) definition of “TRCP provider”.

20 Paragraph 1.4.1

Insert:

“Treatment Benefits Act” means the Treatment Benefits (Special Access) Act 2019.

21 Paragraph 1.4.1

Insert:

“Treatment Principles” means the Treatment Principles made under section 90 of the Act as modified by the Treatment Benefits (Special Access) (Modifications of the Treatment Principles) Instrument 2019.

22 Paragraph 1.4.1 (definition of “veteran”)

Substitute:

“veteran” means an entitled person.

23 Paragraph 1.4.1 (paragraph (a) of the definition of “Veterans’ Home Care Program”)

Omit “made under section 90 of the Act”.

24 Paragraph 1.4.1 (definitions of “Victoria Cross” and “Vietnam veteran”)

Omit the definitions.

25 Paragraph 1.4.1 (definition of “VVCS criterion”)

Omit “eligible for treatment under the Act”, substitute “an entitled person”.

26 Paragraph 1.4.1 (definitions of “war‑caused” and “White Card”)

Omit the definitions.

27 Paragraph 2.1.1

Substitute:

2.1.1 Subject to these Principles, the Commission may provide or arrange for treatment in Australia of entitled persons who have been issued with:

(a) a Gold Card; or

(b) a written authorisation issued on behalf of the Commission.

28 Principles 2.2, 2.3, 2.4, 2.5, 2.5A, 2.7A and 2.7B

Omit the principles.

29 Paragraph 2.8.1

Substitute:

2.8.1 The Commission will not provide, arrange or accept financial responsibility for treatment for a person, as an entitled person, on or from the date of notification from the Department that the person is no longer eligible under section 12 of the Treatment Benefits Act.

30 Subparagraph 3.2.1(e) (Note)

Omit the note.

31 Subparagraph 3.2.2(a)

Omit “Act”, substitute “Treatment Benefits Act”.

32 Subparagraph 3.4.1(a)

Omit “Act”, substitute “Treatment Benefits Act”.

33 Paragraph 3.4.3

Omit “and, subject to principle 2.2, for emergency treatment overseas for a war‑caused injury or disease”.

34 Paragraph 3.4.3 (Note)

Substitute:

Note: this Principle does not apply to residential care or residential care (respite). In such a case, the extent of Commission liability is determined under Part 10 of the Principles.

35 Subparagraphs 3.4.4(b), 3.4.5(b) and 3.5.2(a)

Omit “eligible person”, substitute “entitled person”.

36 Paragraph 4.3.1

Substitute:

4.3.1 Subject to paragraph 3.5.1, and unless otherwise indicated in these Principles, the Commission will accept financial responsibility for treatment costs where a LMO or other GP or specialist provides or arranges for treatment of:

(a) an entitled person who has been issued with a Gold Card; or

(b) a person who has been issued with a written authorisation on behalf of the Commission.

Note: Paragraph 3.5.1 also deals with financial liability for medical practitioner fees.

37 Paragraph 4.8.1 (Note 1)

Substitute:

Note 1: a vaccination is not treatment of an injury or disease. It is preventive treatment. An entitled person is only eligible for treatment of an injury or disease.

38 Paragraph 5.2.5

Omit the paragraph.

39 Paragraph 5.3.1

Omit “, White Card”

40 Paragraph 5.3.2

Substitute

5.3.2 A person who holds a Gold Card will be provided with the following dental services:

(a) the dental services listed in Schedules A, B and C of the DVA document entitled “Fee Schedule of Dental Services for Dentists, Dental Specialists and other Dental Practitioners (excluding Dental Prosthetists)”, referred to in Schedule 1 — on condition the services are provided in accordance with those Schedules;

Note: Schedule C imposes a biennial monetary limit.

(b) the dental services listed in the DVA document entitled “Fee Schedule of Dental Services for Dental Prosthetists”, referred to in Schedule 1 — on condition the services are provided in accordance with that Schedule.

41 Paragraphs 5.3.3, 5.3.4 and 5.4.2

Omit the paragraphs.

42 Principle 5.5

Omit the principle.

43 Paragraphs 5.7.3 and 5.7.4

Substitute:

5.7.3 The Commission will accept financial responsibility for Pharmaceutical Benefits, available under the PBS, that are required as part of dental treatment for entitled persons who hold a Gold Card, other than the amount that would have been payable by the person if the person were a “concessional beneficiary” under the National Health Act 1953.

5.7.4 The Commission will accept financial responsibility for Pharmaceutical Benefits that are not available under the PBS and are required as part of dental treatment for persons who hold a Gold Card, but such a prescription must be written on a private prescription.

44 Paragraph 6.1.1

Omit “(Part I of the Scheme prepared under section 91 of the Act)”.

45 Subparagraph 6.2.1(a)

Omit the subparagraph.

46 Subparagraph 6A.5.1(2)

Substitute:

(2) the person is an entitled person; and.

47 PART 6B

Omit the Part.

48 The heading “Transitional” before paragraph 7.3A.14

Omit the heading.

49 Paragraphs 7.3A.14 to 7.3A.22

Omit the paragraphs.

50 Paragraph 9.1.1

Omit “as well as urgent treatment for Vietnam veterans, not otherwise entitled, and their dependants as indicated in principle 2.5,”.

51 Paragraph 9.1.1 (Note)

Omit “93 of the Act”, substitute “59 of the Treatment Benefits Act”.

52 Paragraph 9.1.3

Omit “eligible person”, substitute “entitled person”.

53 Paragraph 9.3.2

Substitute

9.3.2 If an entitled person:

(a) is eligible for care from a registered provider for which the registered provider is eligible for a residential care subsidy; and

(b) is receiving nursing‑home‑type care as defined in paragraph 9.3.1;

the Commission will accept financial responsibility for the standard hospital fee for nursing‑home‑type patients under the National Health Act 1973, or other agreed fee, less the daily care fee.

54 Paragraph 9.3.3

Omit “the Veterans’ Entitlements Act 1986”, substitute “the Treatment Benefits Act”.

55 Paragraph 10.1.1

Substitute:

10.1.1 Residential care may be provided in accordance with this Part to a person who has a current valid Gold Card.

Note: ‘residential care is defined in paragraph 1.4.1.

56 Paragraph 10.1.3 (Note)

Substitute

Note: The effect of paragraph 10.1.3 is to provide for payment to be made under the Treatment Benefits Act instead of the Aged Care Act 2024. Subsidies payable under Part 2 of Chapter 4 of the Aged Care Act 2024 in respect of treatment under certain Acts, including the Treatment Benefits Act, are not payable as an automatic appropriation out of the Consolidated Revenue Fund under the Aged Care Act 2024 (see section 598 of that Act). See section 62 of the Treatment Benefits Act for how payments are appropriated.

57 Paragraph 10.1.4

Omit “the Veterans’ Entitlements Act 1986”, substitute “the Treatment Benefits Act”.

58 Principles 10.2, 10.3 and 10.4

Omit the principles.

59 Paragraph 10.6.2 (Note (3)

Omit the note.

60 Paragraph 10.6.2 (Table and definitions)

Substitute:

LIMITS OF FINANCIAL RESPONSIBILITY ACCEPTED BY THE REPATRIATION COMMISSION FOR RESIDENTIAL CARE (RESPITE)

For the purposes of this table:

‘DCF’ means the Commission will accept financial responsibility for the daily care fee.

‘RCS’ means the Commission will accept financial responsibility for the residential care subsidy.

‘RCS + DCF’ means the Commission will accept financial responsibility for the residential care subsidy and the daily care fee.

* or for such further period permitted under the Aged Care Rules.

61 Paragraph 10.6.8 (Note (1))

Substitute

Note (1): The effect of paragraph 10.6.8 is to provide for payment to be made under the Treatment Benefits Act instead of the Aged Care Act 2024. Subsidies payable under Part 2 of Chapter 4 of the Aged Care Act 2024 in respect of treatment under certain Acts, including the Treatment Benefits Act, are not payable as an automatic appropriation out of the Consolidated Revenue Fund under the Aged Care Act 2024 (see section 598 of that Act). See section 62 of the Treatment Benefits Act for how payments are appropriated.

62 Paragraph 10.6.9

Omit “the Veterans’ Entitlements Act 1986”, substitute “the Treatment Benefits Act”.

63 Parts D and E of Part 10

Omit Parts D and E.

64 Paragraph 11.3.1

Omit the paragraph.

65 Subparagraph 11.3.3(d)

Substitue:

(d) the entitled person is a Gold Card holder; and

66 Paragraph 11.3.3 (Note 2)

Omit “, or dependant of a veteran, eligible under the Act”, substitute “eligible under the Treatment Benefits Act”.

67 Paragraph 11.3.3 (Note 3)

Omit the note.

68 Paragraph 11.3.8

Omit the paragraph.

69 Paragraph 11.5.1

Substitute

11.5.1 The Commission will approve the supply of a spectacle hearing aid to an entitled person who is a Gold Card holder if it is the only type of hearing aid that is appropriate.

70 Paragraph 11.5.2

Omit the paragraph.

71 Paragraph 11.5.4

Omit “eligible person”, substitute “entitled person”.

72 Paragraph 11.6.1

Substitute

11.6.1 Subject to this Part, the Commission may arrange for a wig to be supplied to an entitled person who requires a wig as part of medical treatment for disfigurement.

73 Paragraph 11.7.4

Substitute

11.7.4 The Commission will not be financially responsible for repair or replacement of a rehabilitation appliance for any injury or disease while an entitled person is travelling overseas.

74 Paragraph 12.2.3

Omit “the Act”, substitute “the Treatment Benefits Act”.

75 Paragraph 12.3.1 (the Note)

Omit “93 or 93A of the Act”, substitute “59 of the Treatment Benefits Act”.

76 Paragraph 12.4.1

Omit “eligible person”, substitute “entitled person”.

77 Principle 12.5

Omit the principle.