PART 12 — OTHER TREATMENT MATTERS

12.1 Ambulance transport

12.1.1 With the exception of arrangements for medical emergency under paragraph 12.1.4 and special arrangements under paragraph 12.1.5, prior approval must be obtained in all cases before ambulance transport is used by an entitled person.

12.1.2 Approval for ambulance transport normally will be given where the entitled person:

(a) is a stretcher case;or

(b) requires treatment during transport;or

(c) is grossly disfigured; or

(d) is incontinent to a degree that precludes the use of other forms of transport.

12.1.3 Other than in exceptional circumstances, air ambulance will be approved only to transport an entitled person with acute medical and surgical complaints for admission to, or discharge from, a hospital.

12.1.4 The Commission will accept financial responsibility for the use of ambulance transport in a medical emergency for an entitled person if an office of the Department is notified on the first working day after the ambulance transport is used or as soon thereafter as is reasonably practicable.

12.1.5 Prior approval for ambulance transport for entitled persons is not required where the transport is provided under arrangements between the ambulance service provider and the Commission.

12.2 Treatment under Medicare Program

12.2.1 Entitled persons may choose to have their treatment arranged through the Department or under a medicare program.

12.2.2 Subject to these Principles, entitled persons who are treated under a medicare program may also receive services that are not covered by the MBS at the Commission’s expense.

12.2.3 When part or all of the cost of a treatment item has been paid as a medicare benefit, the Commission will not pay for the same professional or ancillary service regardless of the person’s entitlement under the Act.

12.3 Compensable patients

12.3.1 Unless otherwise indicated in these Principles, the Commission will not accept financial responsibility for the cost of treating a compensable patient.

Note: Where expenses have been incurred in relation to the treatment of a compensable patient, costs will be recovered from the patient or the person or authority responsible for compensation in accordance with section 93 or 93A of the Act.

12.4 Prejudicial or unsafe acts or omissions by patients

12.4.1 The Commission may refuse to be financially responsible for, or provide treatment to, or any further treatment to, an eligible person who, by an act or omission, deliberately prejudices his or her own, or a fellow patient’s, treatment or the safety of persons providing treatment.