7.1Prior approval and financial responsibility for health services

7.1 Prior approval and financial responsibility for health services

7.1.1 Except where otherwise provided in:

(1) the Principles; or

(2) Notes for Allied Health Providers; or

(3) a Fee Schedule; or

(4) VVCS OPC Provider Notes;

in respect of a particular treatment, the Commission is not to accept financial responsibility for the treatment under this Part unless the Commission’s prior approval for the treatment has been obtained by the entitled person or entitled person’s health care provider.

7.1.1A In relation to any occasion of service to an entitled person under these Principles, except an occasion of service that is a service under the Veterans' Home Care Program, a health provider shall bill only the Department and that bill shall be for full settlement of the account for the service provided to the entitled person but in relation to any occasion of service to an entitled person under these Principles that is the provision of a service under the Veterans' Home Care Program, a health provider shall bill the Department but not for any co-payment payable by an entitled person to the health provider and the bill presented to the Department shall be for full settlement of the account for the service provided to the entitled person.

7.1.2 Subject to these Principles and in addition to services provided under principle 2.6 and paragraph 5.1.3, the Commission may provide, arrange, or accept financial responsibility for the following:

(a) audiology

(aa) diabetes educator services;

(b) dietetics;

(c) chiropractic services;

(d) community nursing;

(dd) exercise physiology;

(e) occupational therapy;

(f) optometry;

(g) orthoptics;

(h) osteopathic services;

(i) Home Care service (category A); Home Care service (category B);

(j) physiotherapy;

Note: Physiotherapy includes hydrotherapy (see paragraph 1.4.1)

(k) podiatry;

(l) psychology;

(m) social work;

(n) speech pathology.

7.1.3 The Commission will not accept financial responsibility for services listed in paragraph 7.1.2 for an entitled person receiving a high level of residential care where the provision of those services is covered by a State or Commonwealth subsidy.

7.1.4 Treatment in an entitled person’s home may be approved where the entitled person is medically unable to attend the relevant facilities or where the entitled person is entitled to treatment at home under the Veterans' Home Care Program.