GUIDELINES ON RESPONSIBILITY FOR PAYMENT OF AMBULANCE FEES

General Conditions / Eligibility Criteria

CONCESSIONS

ELIGIBILITY FOR CONCESSIONS

The general principle underlying the provision of Government concessions for ambulance services is to provide low income earners with access to essential health services, including emergency and non-emergency ambulance services.

The following individuals are eligible for free ambulance transport under the State Concession Scheme:

Individuals issued with a Centrelink Pensioner Concession Card except where individual also has a DVA card;

Individuals holding a current Health Care Card, other than Cards with payment types CD and FO (following), and their dependents as listed on the Card;

Children holding a current Child Disability Health care Card (payment type CD) or Foster Care Health Care Card (payment type FO), but not their guardians/families as listed on the Card

Concession entitlements should be read in conjunction with the attached rules relating to responsibility for payment by hospitals or other chargeable authorities. Concession benefits are available only to patients who are not covered by other payment arrangements.

ACCESS TO CONCESSION ENTITLEMENTS

In order to access entitlements through the State Concession Scheme, the Pensioner Concession Card or Health Care Card number must be provided at the time of transport or when an invoice is received. Failure to do so will mean the account remains the responsibility of the relevant individual, hospital or chargeable authority as per these guidelines.

SPECIAL CLIENT GROUPS

NON-CHARGEABLE CLIENTS

No fees will be charged for transports for individuals who are:

Children under Custody to Secretary Orders; and

Children under Guardianship to Secretary Orders.

RECIPROCAL ARRANGEMENTS FOR MEMBERS OF INTERSTATE AMBULANCE SUBSCRIPTION SCHEMES

Inter-state visitors who are members of ambulance subscription schemes in their state of origin may be entitled to the same benefits as Victorian Ambulance Membership Scheme members under reciprocal arrangements. Current reciprocal arrangements should be confirmed with the relevant ambulance service.

DEPARTMENT OF VETERANS' AFFAIRS (DVA) CLIENTS

An eligible DVA client includes holders of a Repatriation Health Card - For All Conditions (Gold Card) and some holders of a Repatriation Health Card - For Specific Conditions (White Card). DVA now purchases a Group Entitlement for ambulance services used by Repatriation White / Gold Card holders. This entitlement will cover all emergency and medically necessary non-emergency ambulance services in Victoria, and interstate trans22 May, 2008

Ambulance fees for prisoners are charged to the responsible prisoner health service.

SPECIAL PROVISIONS RELATING TO MENTAL HEALTH TRANSPORTS

TRANSPORT OF PATIENTS UNDER THE MENTAL HEALTH ACT

Hospitals should note that free transport of patients under the Mental Health Act (sections 9 or 43) is available only for the initial transport to hospital. Patients who are already in the health system at either a public mental health inpatient facility, or who have presented to a hospital receiving non-admitted emergency patient funding (except in the cases discussed below), will be considered to be inter-hospital transfers in the case of any further transports, regardless of classification. Payment for these transfers will rest either with the transferring hospital or, in the case of a public mental health inpatient facility, with the patient's Area Mental Health Service.

STATUS OF MENTAL HEALTH PATIENTS AT HOSPITALS WITH MENTAL HEALTH INPATIENT UNITS AND NON-ADMITTED EMERGENCY PATIENT FUNDING

Responsibility for payment of ambulance charges for mental health patients in hospitals with mental health inpatient units and non-admitted emergency patient funding will be determined by the admission status of the patient. Specifically, ambulance charges for transfer of patients who have not been admitted will be the responsibility of the transferring hospital.

SECTION 9 (RECOMMENDED FOR INVOLUNTARY ADMISSION) PATIENTS

Provisions of these guidelines relating to section 9 (recommended for involuntary admission) patients only come into operation following confirmation of the patient's status at the time of transport by the authorising officer.

MENTAL HEALTH SERVICES CONDUCTING ASSESSMENTS ON HOSPITAL PREMISES

On occasions, public mental health services not attached to a hospital may arrange to meet or take a patient to a hospital for the purposes of making an assessment. In these cases, responsibility for fees is as per the Table, Transports From the Community. Hospitals should note that this does not apply where patients present independently at hospitals receiving non-admitted emergency patient funding. In this case, the hospital will be responsible for any further transport costs, in line with Table 2. Status of the patient in cases where hospitals are claiming exemptions from charges must be confirmed by the treating officer from the mental health service before responsibility for accounts will be reallocated.

AREA MENTAL HEALTH SERVICE RESPONSIBILITY FOR FEES

In cases where fees would be the responsibility of the patient's Area Mental Health Service under these guidelines, transferring agencies should ensure that the Area Mental Health Service is correctly identified in communication with the ambulance services. Failure to do so will result in charges remaining the responsibility of the Area Mental Health Service in the sending area.

ACCESS TO CONCESSION ENTITLEMENTS FOR MENTAL HEALTH PATIENTS

Fees for Section 43 patients with Pension Concession Cards or Health Care Cards will be waived only where card numbers are provided in accordance with the normal provisions of these guidelines. In all other cases fees will remain the responsibility of the sending Area Mental Health Service or hospital.

INFORMATION FOR HOSPITALS

NON-ADMITTED EMERGENCY PATIENT FUNDING

Hospitals receiving non-admitted emergency patient funding are as listed in the current version of Victoria - Public Hospitals Policy and Funding Guidelines.

TRAUMA APPROPRIATENESS PAYMENT

A trauma appropriateness payment (TAP) will be paid to a referring hospital for each trauma patient appropriately referred to a major trauma service. Hospitals should check the Public Hospitals - Policy and Funding Guidelines for further information. Responsibility for ambulance charges for trauma patients transferred under this arrangement will be the same as in other cases.

CLINICIANS IN PRIVATE PRACTICE ON HOSPITAL PREMISE

When ambulances are ordered by clinicians conducting private consultations on hospital premises, who are not directly employed by or under contract to the hospital in that capacity, responsibility for fees is as per the table, Transports From the Community.