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Fees and Charges for Acute Health Services in Victoria
 
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Section A: Admitted Patients
Section B: Non-Admitted Patients
Section C: Other Services
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Section C: Fees for Other Services

1. Residential Aged Care Service Fees

Public Sector Residential Aged Care Service (RACS) fees (funding and resident contributions) are determined by the Commonwealth under the Aged Care Act 1997.

These fees are issued and available from the Commonwealth only. A current table of fees is listed at:
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-finance-resfees.htm

If public sector RACS require any information on Commonwealth-regulated fees, they should contact the respective Commonwealth officer who administers their RACS's claims.

The State provides additional funding for selected public sector RACS through an Agency's SAM agreement.

2. Community Health Services

Hospitals which provide community health services funded by the Community Health Program are required to comply with the Community Health Program Fees Policy which specifies principles, fee levels, and exemptions. DH Funding for Community Health Services assume revenue from client fees. The Policy and Further Information is available at the Community Health website.

3. Preventive Health Care and Management

The Commonwealth has advised that as from 1 November 1999 (refer Commonwealth Circular HBF 598) and 1 November 2000 (refer Commonwealth Circular HBF 677), new items on the MBS have been created for preventative health care and management. These measures will enhance primary care particularly for older Australians, people with chronic illnesses and those who require a range of services to support them in the community.

A small number of care plans and case conferencing MBS item numbers refer to private admitted privately insured hospital patients (other than nursing home type patients) in respect of hospital treatment provided in hospitals or day hospital facilities. No facility benefit prescribed under the Default Table apply. Full conditions to be met before benefits will be paid and full description details are in he most current MBS book.

Reference: Circular No.12/1999 effective: from 1 November 1999 and
                 Circular No. 2/2003 effective: from 1 November 2002

4. Home Enteral Nutrition (HEN)

Co-payments for Home Enteral Nutrition ceased as of 4 November 2005

Reference Circular 23 2005

5. Transition Care Program

Daily care fees for recipients of the Transition Care Program (TCP) are determined by the Commonwealth under the Aged Care Act 1997.

Maximum care fee charges must not exceed 85% of the basic single age pension for care delivered in a bed based setting and 17.5% of the basic single age pension for care delivered in a home based setting. Such fees may be adjusted twice yearly (March and September) in line with the Consumer Price Index (CPI), which also affects the age pension payment.

On the 20 September 2013, the maximum daily care recipient fees were $45.63 for a bed based service and $9.39 for a home based service.

The basic single age pension was also adjusted on the 20 September 2013 to $751.50 per fortnight and for couples $566.60 each per fortnight. (Please note that the couple rate separated due to ill health is $751.70.)

A care recipient's access to the TCP should not be influenced by their ability to pay the specified fees, but should be decided on the basis of need for care, which includes the capacity of the service provider to meet that need.

Further information regarding the TCP is available at the Australian Government, Department of Health and Ageing Aged and Community Care Transition Care Program Website.

The TCP is jointly funded by the Commonwealth and State/Territory Governments. The Commonwealth Government subsidy component is paid based on occupancy and requires health services to submit a monthly claim form to Medicare Australia. The State subsidy component is paid directly to the health service and is based on full operational capacity. A single national Commonwealth subsidy rate applies to the 4,000 TCP places operational nationally, with 1,000 of these places located in Victoria. 

The single national Commonwealth subsidy for transition care services in 2013-14 is $187.30 per occupied place per day. As part of the Living Longer Living Better aged care reforms announced in April 2013, the dementia and veterans supplements equivalent is $3.68 and has come into effect from the 1 August 2013.  It is payable to all TCP care recipients irrespective of dementia diagnosis or veteran status (can only receive one supplement per care recipient).  This means that the maximum Commonwealth subsidy per occupied place per day is $190.98. The Victorian State Government subsidy component is $50 for home based places and $145 for bed based places. In addition to this bed day support, the Victorian State Government also provides implementation and other operational support, including initiatives to improve and develop the transition care service.

6. Victorian Patient Transport Assistance Scheme

The Victorian Patient Transport Assistance Scheme (VPTAS) aims to improve accessibility of specialist medical and oral health services for rural Victorian residents by reducing the financial disadvantage of patients living in rural areas who require specialist services.

VPTAS provides partial reimbursement to assist with travel and accommodation costs incurred by rural patients and if appropriate, their escorts, when travelling long distances or staying away from home to receive specialist medical treatment.

The VPTAS policy sets out the eligibility criteria, reimbursement rates and conditions under which the scheme operates.

7. Provision of Aids and Equipment and Domiciliary Oxygen

This information is provided to clarify responsibilities of public hospitals in the provision of aids, equipment and domiciliary oxygen for patients being discharged from hospital.        NOTE: This supersedes and replaces circular 24/1995.

Public Hospital responsibility

  1. Hospitals have a responsibility to provide aids and equipment including domiciliary oxygen and continence aids required by patients for safe and effective discharge. The aids, equipment and domiciliary oxygen may be defined as that equipment which is necessary for recuperation and if not provided would result in either continued hospitalisation or readmission to hospital.
  2. For patients being discharged including from an emergency department who do not have a certifiable permanent or long term disability, hospitals must provide any aids or equipment necessary to enable discharge for as long as these are required. This shall be at no cost to the patient for a period of 30 days unless, at the hospital discretion, a refundable deposit is required. However hospitals may charge fees for these aids and equipment after the expiry of the 30 day post discharge period. Alternatively patients may choose to make their own arrangements.
  3. For patients discharged including from an emergency department who have or are likely to have a certifiable permanent or long term disability, hospitals must provide any aids and equipment necessary to enable discharge for a period of 30 days post discharge at no cost to the patient.
  4. The exception to paragraph 3 is where the Victorian Aids and Equipment Program (A&EP) will continue to provide equipment including domiciliary oxygen to a patient on discharge if they are a pre-existing A&EP client prior to admission to hospital, and require equipment related to the same condition.
  5. Hospitals are responsible for assessment of the patient’s needs and consideration of appropriate discharge options including services and supports available within the community. As part of the discharge planning process, hospitals should identify ongoing equipment requirements and discuss options with patients.
  6. Hospitals can make referrals to appropriate health and community services for follow up assessment of the patient’s ongoing equipment needs. Alternatively hospitals may wish to complete an equipment assessment/prescription and submit these to the relevant community equipment program which includes the Victorian A&EP, Compensable providers (where applicable) and Commonwealth programs noting that equipment provision during the 30 day post discharge period remains the responsibility of the discharging hospital.
  7. The exception to No. 6 is where patient’s require oxygen equipment, whereby the discharging public hospital is responsible for arranging relevant testing 30 days post discharge prior to lodgement of prescription form.

Victorian Aids and Equipment Program

  1. The Victorian A&EP is a suite of programs funded by the Department of Human Services to provide subsidised aids and equipment for people with a permanent or long term disability to enhance independence in their home, facilitate community participation and support families and carers in their role.
  2. To ensure a smooth transition of the client from hospital, applications for the Victorian A&EP may be lodged during the 30-day post discharge period for clients who meet the eligibility criteria.
  3. There is high demand for the Victorian A&EP and every effort is made to provide equipment as soon as possible. Applications are processed in date order of receipt and in accordance with priority of urgency criteria. However, when the number of applications exceeds the funds available, applications will be waitlisted for all programs except the Domiciliary Oxygen Program.

State-wide equipment Program (SWEP)

  1. The State-wide equipment program (SWEP) managed by Ballarat Health Services is the main service provider for the Department of Human Services Victorian A&EP. SWEP administers the following Victorian aids and equipment programs and schemes:
    • Aids and Equipment Program
    • Supported Accommodation Equipment Assistance Scheme
    • Domiciliary Oxygen Program
    • Continence Aids
    • Vehicle Modification Subsidy Scheme
    • Top-up Fund for Children
  2. SWEP can be contacted on 1300 PH SWEP or (1300 74 7937) website http://swep.bhs.org.au

Domiciliary Oxygen

  1. Domiciliary oxygen therapy includes the provision of oxygen gas through equipment which is necessary for recuperation and, if not provided, would result in either continued hospitalisation or readmission.
  2. Hospitals are responsible for the provision of oxygen gas and associated equipment (oxygen therapy) for a period of 30 days post discharge to new patients requiring domiciliary oxygen equipment.
  3. Where a patient may require ongoing oxygen therapy, hospitals should arrange the appropriate tests, completion and submission of an application to the SWEP Domiciliary Oxygen Program so that there is no disruption to the supply of the patient’s oxygen equipment.  Please note that the subsidy through the SWEP Domiciliary Oxygen Program will only be approved if the test results meet with the Thoracic Society Australia & New Zealand (TSANZ) guidelines for domiciliary oxygen.
  4. Current clients of the SWEP Domiciliary Oxygen Program will continue to have their oxygen therapy funded on discharge by the SWEP Domiciliary Oxygen Program (ie: the 30 day rule does not apply).

Continence Aids

  1. Hospitals are responsible for a period of 30 days post discharge to new patients for the provision of continence equipment. This equipment includes catheters, condoms and associated drainage systems which are necessary to facilitate discharge and if not provided, would result in either continued hospitalisation or readmission.
  2. Where a patient may require ongoing continence equipment, hospitals should consider arranging submission of an application to the Continence Aids Payment Scheme (Australian Government) if their patient is eligible, and/or the SWEP Continence Aids program pre-discharge.
  3. Current clients of the SWEP Continence Aids program will continue to have their continence equipment funded on discharge by the SWEP Continence Aids program  (ie: the 30 day rule does not apply).

Compensable Patients (including TAC, Workcover and DVA)

  1. During the hospital stay, compensable patients are treated the same as public patients. Hospitals have a responsibility to provide aids and equipment including domiciliary oxygen therapy required by compensable patients for safe discharge up to 30 days post hospital stay. Hospitals should liaise with the compensable provider to arrange on going services following the 30 days post discharge.
  2. Hospitals should invoice the compensable provider for any aids or equipment, including domiciliary oxygen therapy, for any hire fee after the 30 day discharge period and for any equipment which is not returned. Hospitals may be required to provide proof of effort of recovery.
  3. Hospitals have a responsibility to provide aids and equipment, including domiciliary oxygen, for Department of Veterans Affairs (DVA) patients, who hold a Gold Card, or a White Card where the aid is required for a related accepted condition. Hospitals should liaise with DVA for entitled persons who hold a Gold Card, or a White Card where the aid is required for a related accepted condition to determine if DVA will arrange alternative provision or continuation of current hire arrangements of these aids. Hospital should invoice DVA for any hire fee charged after the 30 day post discharge period expires and for the replacement cost of any equipment not returned. Hospitals may be required to provide proof of effort of recovery.
  4. Where the patient has been in receipt of aids or equipment from their compensable provider prior to the hospital stay, the supply of these items should re-commence on discharge.
  5. Where compensable patients have been using customised aids or equipment prior to admission, these should continue to be used during the hospital stay. Where customised aids or equipment will be required post discharge for ongoing use (e.g. wheelchairs), hospitals should contact the compensable provider to commence the process of providing these post discharge to the patient. These customised items are not subject to the 30 day rule.
  6. Compensable providers are responsible for approving and funding appropriate home modifications for their clients. Where the hospital arranges a home assessment for a compensable patient and the need for a home modification is identified for more than 30 days post discharge, the hospital should liaise with the compensable provider.

Non-compensable spinal cord patients

  1. Patients who have a spinal cord injury with a diagnosis of any form of quadriplegia or paraplegia and are non-compensable, may submit an application to the A&EP, prior to being discharged from the hospital/ rehabilitation service.
  2.  In order for an application for subsidy assistance through the A&EP to be approved the patient will need to have a completed discharge plan including an expected date of discharge and meet the eligibility requirements of the A&EP. To facilitate the application process hospitals/rehabilitation services will need to provide as much advance notice of the patient’s discharge date as possible.
  3. Submitting an application to the A&EP does not necessarily guarantee availability of equipment or subsidy. Applications may also be waitlisted should there be insufficient funds available at the time the application is submitted.

Home Renovation Service and Home Renovation Loan Scheme

  1. In addition to the Victorian A&EP, the Department of Human Services also provides advice and assistance for home modifications through the Home Renovation Service and the Home Renovation Loan Scheme.
  2. Home Renovation loans can be provided for renovations or modifications to a person’s principle place of residence. Loans can be used in conjunction with the Victorian A&EP subsidy
  3. For more information please contact the Department of Human Services Home Modifications Loan assistance on 03 9096 9821 or 1800 134 872 (free call) or DHS Home Renovation Loan.

8. Prisoners

Admitted Services
Prisoners should be coded in accordance with the PRS manual to receive payment.

Medical specialist, diagnostic fees etc should be billed to the prison administrator.

Non Admitted (including Emergency) Services
Prisoners should be billed at full cost recovery to the prison administrator.

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Last updated: 16 January, 2014

For information relating to this site, contact: Peter Lewis Ph: (03) 9096 9050

This website is managed and authorised by the Finance, Policy and Operations Unit, Chief Finance Officer Branch of the Finance and Corporate Services Division of the Department of Health, Victorian State Government, Australia

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