Email
Hospital Circular 17/1998
Date
Issued: 5 November, 1998
Publication: 17/1998
Contact: Peter Lewis
Distribution: Public Hospitals
Subject:
Revised Arrangements
For Eligible Veterans As A Result Of The New Veterans' Agreement
Purpose:
The purpose
of this circular is to advise hospitals that provide services to Veterans
of revised funding and reporting arrangements.
The Department has entered into interim arrangements with the Department of Veterans' Affairs (DVA), commencing 1 July 1998, which include a move towards full cost recovery for services provided to eligible veterans. As a result, the Department will pay a premium for those services currently purchased on the basis of outputs. A new comprehensive six year Agreement with DVA is being finalised.
Preferential Access
The new arrangements, in accordance with the principles of the Australian Health Care Agreement, allow preferential access for veterans into public hospitals, providing that such access does not impair public patient care.
It is expected that from 1 July 1999, DVA will enter into separate agreements with major private hospital service providers, in direct competition with the public sector.
The new arrangements will allow for the public hospital system, on a fully costed basis, to compete with private hospitals for veterans, on the basis of access and quality.
Eligibility
Payment will only be received for the treatment of eligible veterans as determined by DVA. It is imperative, therefore, that eligibility for treatment is confirmed prior to the commencement of any treatment, or as soon as practicable thereafter. The onus is on hospitals to put in place appropriate procedures to confirm eligibility with DVA. Additional expenditure incurred on a veteran for whom eligibility is not confirmed will not be reimbursed.
Eligible veterans comprise two categories:
- Gold Card Holders: a gold card identifies the holder as being eligible for treatment of all health care conditions at Department of Veterans' Affairs' expense. The card should be presented prior to or upon admission to hospital.
- White Card Holders: a white card confers only limited treatment eligibility on the holder - i.e., for a specific war caused injury or disease, for malignant neoplasia, or for Post Traumatic Stress Disorder (PTSD). This eligibility must be confirmed with DVA (preferably prior to admission) or the service will be included for payment purposes in the hospital's capped non DVA WIES target.
DVA also requires notification of Vietnam veterans and their dependants, who are not otherwise eligible under DVA (and therefore may hold no card), but who are entitled to medically-urgent inpatient treatment in rural public hospitals or the Austin and Repatriation Medical Centre (in such cases a "Hospital Admission Voucher", form D652B, should be completed, endorsed "VIETNAM VETERAN", and a copy faxed to DVA on the number indicated below (in Confirmation of Eligibility). This group of patients will also be included in the Hospital's DVA throughput.
Veterans will not be covered under the arrangement, or the six year comprehensive agreement if they:
- elect to be public patients under the Australian Health Care Agreement
- are compensable patients: or
- elect to use their private health insurance.
DVA will not be responsible for treatment costs incurred by an otherwise eligible person for a compensable incapacity, but does need to be advised if a veteran is being, or is to be, treated. The hospital shall use its best endeavours to ascertain such information, and will convey it to DVA by completing and faxing a "Hospital Admission Voucher", marked "COMPENSABLE" on the numbers referred to in Confirmation of Eligibility below.
Confirmation of Eligibility
Confirmation of eligibility can be obtained by contacting DVA by the following means:
- telephone - the contact number is (03)9284 6336 between 9.00am and 5.00pm, Monday to Friday (an answering service is available after hours); or
- facsimile - the facsimile number is (03)9284 6440 (available 24 hours).
The following information is required by DVA to establish eligibility:
- DVA file number;
- Patient name;
- Patient date of birth;
- Hospital name, contact name, telephone/fax number;
- Date of admission;
- Principal diagnosis.
Reporting
Eligibility for payment will be determined on the basis of information transmitted to the Victorian Inpatient Minimum Database and as agreed with DVA. In order to streamline the reconciliation process new edits will be incorporated into the system that will reject incomplete veterans' patient records. A veteran's record will only be regarded as complete if, in addition to general reporting protocols, the "E1" record contains a "V" code in the account class AND has a matching completed "V1" record that contains additional details of the veteran.
Payment
The Department will pay hospitals a premium to the Casemix price, based on the full fixed and variable rate, for eligible veterans where throughput is currently purchased on an output basis.
The Department will fund hospitals in advance and will reconcile throughput with DVA on a quarterly basis. Reconciliations will take place, following the receipt of completed diagnosis and procedure details. Cashflow adjustments may be made to hospital budgets where there is a significant variance from target (more than 2%) although this will generally not occur without prior consultation with the relevant hospital.
Hospital budgets will be adjusted upwards or downwards, at the premium rate (for Acute WIES this applies to the full fixed and variable rates), based on actual throughput as agreed with DVA. Back payment for those services which currently do not have separate DVA estimates will be made once non-DVA service targets and DVA estimates are agreed.
The following table shows the items to be adjusted in the current payment model.
| ACUTE |
|---|
| Acute - casemix funded, WIES6 metro(Major providers) |
| Acute - casemix funded, WIES6 rural B >10,000 |
| Acute - casemix funded, WIES6 rural B <10,000/C |
| Acute - casemix funded, WIES6 rural D and E |
| NHT/Non-Acute |
| Rehabilitation - Level 1 |
| Rehabilitation - Level 2&3 |
| VACS |
| Allied Health Occasions of Service |
| Intermittent Peritoneal Dialysis |
| Continuous Ambulatory Peritoneal Dialysis |
| Home Haemodialysis |
| In Centre Dialysis |
| Satellite Haemodialysis |
| AGED CARE |
| Rehabilitation - Level 1 |
| Rehabilitation Level 2 & 3 |
| Palliative Care |
| Geriatric Evaluation and Management |
| MENTAL HEALTH |
| Psychiatric Services - Adult Acute |
| Psychiatric Services - Aged Acute |
| Psychiatric Services - Psychogeriatric Nursing Home |
| Psychiatric Services - Aged Extended Care |
| Psychiatric Services - Forensic |
Nursing Home Type Patients
If the hospitalisation of a Veteran is likely to exceed a continuous period of 35 days, hospitals shall ensure that the Veteran's status is reviewed and that either:
- a certificate under Section 3B of the Health Insurance Act 1973 is given by a medical practitioner and forwarded to the DVA's Contract Manager forthwith, or
- the Beneficiary is reclassified to a Nursing Home Type patient.
Where an admitted Veteran's length of stay is greater than 35 days and no acute care certificate in accordance with (a) above has been forwarded to DVA, hospitals will only be reimbursed at the Nursing Home Type patient rate.
Advice of Admission
Hospitals are required to complete the DVA "Hospital Admission Voucher" (Form D652B) in respect of each veteran admitted (additional forms may be obtained by telephoning DVA on (03) 9284 6175). The form shall be retained by the hospital on the patient medical record as a means of confirming patient identity, eligibility, and as a record of patient authorisation for disclosure of clinical information.
Targets
Hospitals already have separate DVA WIES included in their model budgets. The new arrangements will require the separate identification of DVA throughput for all services funded on the basis of outputs. Hospitals will be contacted by the end of November 1998 with the aim of agreeing non-DVA targets which will be capped, and DVA estimates which will be uncapped, for those services that do not have agreed separate targets. These estimates will be based on 1997/98 utilisation.
The new arrangements require the Department and DVA to work together in the initial year, to develop an appropriate output based methodology, including appropriate recording and reporting systems, which will allow payment based on entitled veterans' actual usage of non-unit priced outputs. These include:
Acute Outpatient Services
Acute Emergency Services
Acute Radiotherapy Services
Acute Rural Specialist Services
Psychiatric Outpatient and Community Based Services
Non-admitted Aged Care Services
Non- admitted Aged Care Services include:
- Community Rehabilitation Centres (CRCs) and Day Centres: CRC services are rehabilitation services provided to a non-admitted patient or to a group of non-admitted patients such as group therapy classes. Day Centres generally provide programs oriented towards using social activity to assist in rehabilitation.
- Specialist clinics: ambulant services which provide specialist treatment and support in relation to continence, memory and movement disorders as well as pain management.
- Palliative care provided in the non-admitted patient's home or other non-hospital site.
- Assessment services, provided through the extended care components of hospitals that provide assessments for the aged with complex needs and may result in the patient being referred for rehabilitation, specialist treatment in specialist clinics and other appropriate supports such as community care or residential service.
- Post-Acute Care program services
Discharge Arrangements
The hospital will seek to ensure that, within 48 hours of discharge, a copy of the discharge summary, compiled in accordance with the treating hospital's requirements, is sent to the veteran's general practitioner (Local Medical Officer) who will be responsible for the patient's continuity of care.
Hospitals will, in addition, use their best endeavours to comply with the principles and procedures provided in the DVA "Discharge Planners' Resource Kit".
Aids and Equipment on Discharge
Where a veteran
is in receipt of aids or equipment from DVA prior to admission, DVA will
continue to provide those aids and equipment upon discharge.
Victorian Funded
Hospitals are responsible for the provision of aids, equipment, and domiciliary
oxygen free of charge ( no deposits or hire fees) to facilitate safe and
effective discharge for a period of 30 days post discharge, other than
for those already provided by DVA as mentioned above.
After 30 days post discharge the following will apply:
Gold Card holders, and White Card holders whose requirement for aids or equipment relates to a disability accepted by Veterans' Affairs as war caused.
DVA is responsible for providing aids and equipment. The hospital will contact DVA to determine whether DVA will organise alternative provision of these aids and equipment, or whether the current hire arrangements will continue. DVA will be invoiced directly for any hire costs incurred after 30 days post discharge. In the event that equipment provided by, or hired from, the hospital is not returned following written requests, DVA will be invoiced for the replacement cost of the equipment. The hospital will be required to provide proof of effort of recovery;
White Card holders whose requirement for aids or equipment does not relate to a war caused disability.
These veterans
are eligible to access PADP for the provision of aids or equipment for
a certified permanent or long term disability.
DVA will be responsible for the provision of home modifications for eligible veterans. Where a Victorian Funded Hospital arranges a home assessment for a veteran that identifies a requirement for home modifications, the hospital will organise supply under DVA's Rehabilitation Appliances Program (RAP) as follows:
- for minor modifications (i.e., under $350 per item), such as minor hand rails and hand held showers, the hospital will complete a "RAP Supplier Form" and send it directly to their usual local supplier (when completed, the supplier will submit this form and an invoice to DVA for payment);
- for major modifications (i.e., over $350 per item), the hospital will contact DVA as soon as practicable who will arrange supply.
Any requests
or queries relating to the provision of aids or equipment under the Rehabilitation
Appliances Program should be directed to DVA by the following means:
- telephone - the contact number is (03) 9284 6870 between 9.00am and 5.00pm Monday to Friday (an answering machine is available after hours); or
- facsimile - the facsimile number is (03) 9284 6217 (available 24 hours).
Supplies of the "RAP Supplier Form", and of the "RAP Schedule of Equipment" which sets out the Program guidelines, can be obtained by calling DVA on (03) 9284 6175.
Surgically Implanted Prostheses
Unlike in the previous arrangement DVA will not be billed separately for surgically implanted prostheses. The cost of surgically implanted prostheses is included in the WIES payment for relevant DRGs and hospitals will provide these to eligible veterans free of charge.
Patient Charging Arrangements
Hospitals shall not raise any charges directly on a Veteran except where provided for under Commonwealth legislation. This provision shall not prevent the Hospital providing personal services including television and/or telephone services to Veterans, with any cost to be borne by the Veteran.
Veterans who are reclassified to nursing home type patients may be charged a patient contribution, in line with the provisions of the Health Insurance Act 1973, except for Prisoners of War (POWs) for whom DVA will directly meet the cost of the Resident's Contribution. DVA should be notified on (03) 9284 6336, or fax (03) 9284 6440, when a POW is reclassified to a Nursing Home Type Patient.
Veterans will not be charged for pharmaceuticals provided while they receive services as inpatients. However under the National Health Act 1953 Veterans may be charged at a level consistent with the Pharmaceutical Benefits Scheme statutory copayments for pharmaceuticals provided to them as non-admitted patients.
Inter Hospital Transfers
The following table sets out the circumstances in which DVA will accept financial responsibility for inter hospital transfers effected by a State Ambulance Service. This table is included for information only as arrangements for the payment of ambulance services is not in the new Arrangement:
| Inpatient, with No Pensioner Concession Card entitlement. | Public to Public Public to Private- with prior DVA approval
* Public to Private - with no prior DVA approval. Public to Nursing Home |
Transferring Hospital bears cost. DVA bears cost. Transferring Hospital bears cost DVA bears cost |
| Inpatient, with Pensioner Concession Card entitlement # | Public to Public Public to Private Public to Nursing Home |
Transferring Hospital bears cost. Transferring Hospital bears cost. DVA bears cost |
| Non-inpatient, with No
Pensioner Concession Card entitlement card |
Public to Public Public to Private- with prior DVA approval
* Public to Private- with no prior DVA approval * |
DVA bears cost. DVA bears cost.
|
| Non-Inpatient, with Pensioner Concession Card entitlement # | Public to Public Public to Private |
Transferring Hospital bears cost. Transferring Hospital bears cost. |
The ambulance service providing the inter-hospital transfer will bill the referring hospital or DVA accordingly.
DVA will bear no financial responsibility for an inter hospital transfer -
- to a private hospital, where financial authorisation for the private admission has not been obtained from DVA prior to the transfer occurring (approval for admitting to a private hospital can be obtained by contacting the numbers shown in Confirmation of Eligibility above); or
- that is carried out by a taxi or private ambulance service engaged by a hospital, unless authorised by the Manager Repatriation transport Unit on (03) 9284 6500.
Access to Patient Records
Hospitals will ensure that the DVA is given prompt access to discharge summaries and related documentation in respect of eligible veterans' medical records, provided that the eligible persons have consented to such access (e.g., by signing the Patient Declaration on the "Hospital Admission Voucher" described in Advice of Admission above), or access is authorised pursuant to the terms of section 141 of the Health Services Act 1988.
Artificial Limbs Program
The new agreement
will not impact on the current arrangements for the supply and fitting
of artificial limbs and accessories to eligible veterans under the Artificial
Limbs Program
DR
C W BROOK
DIRECTOR
ACUTE HEALTH
MARKETING OF SERVICES
In
marketing a hospital's services to the veteran community, the Department
of Veterans' Affairs advises that over time ex-service organisations have
indicated that the following features are of significance to their members:
- effective discharge planning arrangements for veterans and war widows, particularly ensuring adequate carer support in the home, and the seamless provision of aids and equipment;
- availability of a nominated patient representative or designated Veterans Liaison officer at a hospital; one who is familiar with veteran culture and able to liaise with ex-service organisations;
- maintenance of Unit/Battalion lists derived from admission details, and access by ex-service organisation Welfare Officers to visit patients identified as veterans (with patient consent);
- familiarisation training by the hospital for accredited ex-service representatives;
- single gender ward accommodation;
- reserved parking for veteran and war widow patients;
- minimum waiting times in outpatient and emergency departments;
- access to bedside telephones.
