Health
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Hospital Circular 12/1998

Date Issued: 16 July, 1998
Publication: 12/1998
Contact: Regional Office
Distribution: Distribution: Public Hospitals
Subject/s:

  1. Public Hospital Prostheses Fees - July 1998 Review
  2. Day Only Arrangements - amendments
  3. Patient Classification - amendments
  4. Overnight and Same Day Patients-default benefits
  5. Neonatal Facilities - approval
  6. Fees Manual - housekeeping

1. PUBLIC HOSPITAL PROSTHESES FEES

1.1 July 1998 Review

Please refer to the attached Commonwealth HBF Circular No. 524 entitled Schedule 5, Benefits Payable in Respect of Surgically Implanted Prostheses & Homograft Items - July 1998 Review. It includes date of effect, dates from which items will be removed from the February 1999 Determination, duplicate items, changes to level of benefits, product range changes, new items, the purpose of the next Determination; deadlines for new items and for applications seeking new benefit levels, and information on the Commonwealth Department of Health and Family Services' Review of the Prostheses Arrangements.

1.2 Prostheses Schedule is now available on the Internet

Schedule 5, Benefits Payable in Respect of Surgically Implanted Prostheses & Homograft Items - July 1998 is now available on the Internet.

The July 1998 Schedule is also on disk in Excel 5.0 format; and available for purchase through the Commonwealth Department of Health and Family Services at the cost of $15 per disk. A purchase order form is enclosed.

1.3 Application form for new items

This is available on the Commonwealth Department of Health and Family Services Internet site.

As a result of the above could you please make the following amendment to your copy of the "Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals":

Appendix A: Prostheses Fees - replace with the four pages attached.

2. DAY ONLY ARRANGEMENTS - AMENDMENTS

The Commonwealth advises that the release of the 1 July 1998 Medicare Benefits Schedule (MBS) will affect the day only arrangements. For details please refer to the attached Commonwealth Circular No. HBF 526 which includes:

As a result of these changes, could you please make the following update to the State fees manual Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals:

Same Day Patients - replace page 4, and the Schedule of Type-B Professional attention procedures (Attachment A), and the Schedule of Type-C Professional attention procedures (Attachment B), of part 1, Fees for Admitted Patients. Date of effect 1 July 1998.

If you require further information on prostheses or day only arrangements,please telephone: (02) 6289 8786 - 24 hour answering service - Health Insurance Services, Commonwealth Department of Health and Family Services, or E-mail the enquiry to his@health.gov.au

3. PATIENT CLASSIFICATION - AMENDMENTS

The attached Commonwealth Circular No. HBF 527 advises of changes to the patient classification schedule for fund benefit purposes resulting from amendments to the Medicare Benefits Schedule (MBS) effective 1 July 1998.

It includes a list of all the patient classifications schedule items which have been affected by the MBS amendments including dates of effect for new items, deleted items, item number changes, and the Patient Classification Schedule incorporating these changes.

As a result of the above could you please make the following amendment to your copy of the "Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals":

Patient Classifications- replace page 3 and the Patient Classification Schedule of part 1, Fees for Admitted Patients. Date of effect 1 July 1998.

If you require further information on the patient classification schedule,please telephone: (02) 6289 8786 - 24 hour answering service - Health Insurance Services, Commonwealth Department of Health and Family Services, or E-mail the enquiry to vivien.hinton@health.gov.au

4. OVERNIGHT AND SAME DAY PATIENTS-DEFAULT BENEFITS

The Commonwealth has advised that, as in previous years, it has reviewed the level of benefits for the default table based on yearly CPI levels, March to March. As this year there has been a negative CPI level of -0.2%, the current benefit levels will remain the same for

in recognised hospitals in Victoria.

5. NEONATAL FACILITIES - APPROVAL

The Commonwealth Department of Health and Family Services advises that the Frankston Hospital, Hastings Road, FRANKSTON VIC 3199, Provider No: 030460K, has had its neo-natal facility approved for health benefit purposes for three years effective from 11 June 1998.

6. FEES MANUAL - HOUSEKEEPING

Consistent with the Department of Human Services' Acute Health Division, Hospital Circular 10/98 issued 3 July 1998, could you please make the following amendment to your copy of the "Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals":

Overnight Stay Patients - replace page 2 of part 1, Fees for Admitted Patients.

The amendment merely updates the Circular No. reference (bold text).

DR CHRIS BROOK
DIRECTOR
ACUTE HEALTH

We have had recent advice from the Commonwealth on a number changes concerning drugs on the Highly Specialised Drugs Program. Details of the changes are set out below.

1. New Drugs on Program

Doxorubicin hydrochloride peglated liposomal (Caelyx) Code No.: 6294X

Suspension for I.V. infusion 20mg in 10ml vial Pack size: 1 Price: $522.72

Indication: Treatment of AIDS-related Kaposi’s sarcoma in patients with CD4 cell counts of less than 200 per mm3 and extensive mucocutaneous or visceral involvement.

Effective Subsidy Date: 1 January, 1999

Stavudine Code No.: 6250Y

Powder for oral solution 1mg per ml, 200mg Pack size: 1 Price $55.56

Indication: Treatment of HIV infection in patients with CD4 cell counts of less than 500 per mm3, or viral load of greater than 10,000 copies per mL.

Effective Subsidy Date: 1 January, 1999

2. Changes to Indications

DORNASE ALPHA

The requirement to provide the additional reporting for dornase alpha is no longer applicable, so the following information is no longer required:

- Number of patients who commenced in a 4 week trial within quarter
- Number of patients who qualified for ongoing therapy within quarter
- Number of patients receiving ongoing therapy at end of quarter

Please Note: the price for Dornase alpha has decreased as follows

Dornase alpha
Soln. for inhalation, 2.5mg/ml Pack size:30 Price: $1110.00

Effective Subsidy Date: 1 January, 1999

FILGRASTIM (Neupogen)

Change to indication: These criteria now specify in more detail the action of Filgrastim and extend the incation to include treatment of patients undergoing myeloablative as well as myelosuppressive therapy. The revised indication will now specify Filgrastim’s use for:

 

Mobilisation of peripheral blood progenitor cells to facilitate harvest of such cells for reinfusion into patients with non-myeloid malignancies who have had myeloablative or myelosuppressive therapy.

Effective Subsidy Date: 1 January 1999

LENOGRASTIM (Granocyte)

Change to indication: Addition of patients with non-myeloid malignancies receiving peripheral blood progenitor cells following marrow ablative chemotherapy. The revised indication will read:

For use in patients with non-myeloid malignancies receiving marrow ablative chemotherapy and subsequent peripheral blood progenitor cell or bone marrow transplantation.

 

3 ADDITIONS TO INDICATIONS

LENOGRASTIM (Granocyte)

Addition to indication: The following has been added to the list of indications:

Mobilisation of peripheral blood progenitor cells to facilitate harvest of such cells for reinfusion into patients with non-myeloid malignancies who have had myeloablative or myelosuppressive therapy

Effective Subsidy Date: 1 January 1999

OCTREOTIDE (Sandostatin)

Addition to indication: The following has been added to the list of indications:

9.29.3 Patients with a histologically-confirmed diagnosis of a functional carcinoid tumour or vasoactive intestinal peptide secreting tumour (VIPoma) experiencing on average over one a week, three or more episodes per day of diarrhoea and /or flushing, which persists despite the use of anti-histamines, anti-serotonin agents and anti-diarrhoea agents, and for whom surgery or anti neoplastic therapy has failed or is inappropriate.

Treatment should cease if there is failure to produce a clinically significant reduction in the frequency and severity of symptoms after two months’ therapy. Dosage and tolerance to the drug should be assessed regularly and the dosage should be titrated slowly downwards to determine the minimum effective dose.

PRIVATE HOSPITALS:

Please Note: There is now an additional indication for Disodium Pamidronate. The following has been included:

Multiple myeloma; bone metastases from breast cancer

 

4 ADDITIONAL INFORMATION

RIBAVIRIN

In relation to Circular No.18/1998 dated 30 September,1998 the TGA inclusion criteria for Ribavirin use have been amended to include:

adult male or female,18 to 65 years of age non-responder or relapsed CHC patients following an initial course of interferon therapy, or those not previously treated with interferon (ie naïve patients)

Please note to be subsidised through the highly specialised drugs program, patients using Ribavirin in combination with Interferon Alpha must fit the TGA inclusion criteria for both drugs.


Note 1: Please note that certified statements of Hospital Audits 1997/98 for the HSD Program were due by 30 September 1998. There are a number of hospitals who have not yet submitted these. Could you please ensure that this is done immediately to secure your continued access to the program.

Please send Audit Certifications to:

Jane Evans or Robyn Rennick, Acute Health, Level 17, Collins Street, Melbourne, VIC 3095. If you have any questions please phone Robyn on 9616 8673.


Note 2: Please ensure that the most current claim form is used when submitting claims. Additional claim forms for Interferon Alpha 2B and Filgrastim are attached.

Updates to the relevant pages in Appendices 2, 3 and 8 of the Commonwealth/State Highly Specialised Drugs Program Guidelines, August 1997 can be found on the internet either through the Department of Human Services Home page (Acute Health), or directly on Commonwealth/State Highly Specialised Drugs Program Guidelines. Any changes notified by hospital circular will be immediately updated in the Guidelines on the internet.

DR C W BROOK
DIRECTOR ACUTE HEALTH

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