Health
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Hospital Circular 03/1999

Date Issued: 6 April 1999
Publication: 3/1999
Contact: Regional Office
Distribution: Public Hospitals, Bush Nursing Hospitals, Extended Care Centres, Ambulance Services, Regional Offices, Metropolitan Healthcare Networks, Department of Human Services Divisional Directors, Transport Accident Commission (TAC), Victorian WorkCover Authority (VWA), Department of Veterans' Affairs, Health funds, Private Hospitals and Private Day Procedure Centres, Prostheses suppliers
Subject/s:

  1. State's Fees Manual and Acute Health Hospital Circulars related to public hospital fees and charges to be distributed electronically
  2. Australian Health Care Agreement
    1. Delivery of public hospital services
    2. Charges for public hospital services
    3. Proposed reforms/pharmaceutical charging
  3. Department of Veterans' Affairs Patients
  4. Changes to Commonwealth Default Benefits
    1. Public Hospital Prostheses Fees
    2. Patient Classification Schedule
    3. Day Only Arrangements
  5. Approval of neo-natal facility for health benefit purposes
  6. Medicare eligibility for Children from the Chernobyl Region
  7. Compensable non-admitted patients
  8. Nursing Home Type Patients (NHTPs) in public hospitals
  9. Pharmaceutical Fees

(This is part 1 of Circular 3/99 - See below to go to part 2)

1. STATE'S FEES MANUAL AND ACUTE HEALTH HOSPITAL CIRCULARS RELATED TO PUBLIC HOSPITAL FEES AND CHARGES TO BE DISTRIBUTED ELECTRONICALLY

1.1 Background

Circular 21/98 issued 30 November 1998 by the Acute Health Division of the Victorian Department of Human Services (hereafter 'Acute Health Hospital Circulars') indicated that:

  1. the Department's Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals ('State's Fees Manual'); and
  2. Acute Health Hospital Circulars pertaining to public hospital fees and charges

would only available on the Internet/Intranet, provisionally from July 1999.
In February 1999, the State's Fees Manual Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals issued by the Acute Health Division, was launched on Victoria's Department of Human Service's Web and Internet sites.

This undertaking will provide considerable practical benefits to users. Future Acute Health Circulars related to the State's Fees Manual will be in electronic medium. At this stage, only recent Acute Health Hospital Circulars relating to the Fees Manual and only a selection of other Acute Health Hospital Circulars not related to the Fees Manual are on the Internet. It is envisaged that by 1 July 1999 this electronic Circular service will be further developed and you will be informed of progress by electronic Circular.

1.2 Transition to total electronic distribution by 1 July 1999

The electronic Fees Manual has been updated to incorporate the following:

  1. updates in accordance with this Circular advice;
  2. A revised "Foreword"
  3. A new page setting out how to register for notification of updates to the Manual and Acute Health Hospital Circulars.
  4. an expansion of the section on Ineligible patients;
  5. Transfer of various schedules from body of content to new Appendices C and D
  6. Amalgamation of Appendices A and Aa)
  7. Transfer of advice on Day Hospital Patients to Section C;
  8. Various minor changes throughout the Manual eg updated references, websites, department nomenclature, and contact numbers

A hard copy reprint of the Manual is attached. This is the first Manual update since 1993 and avoids the need for lengthy instruction in this Circular on how to update your existing hard copy Manuals for the above amendments. It also ensures those not yet on The Internet or Internet literate, have access to a complete and updated Manual, and which is consistent with the electronic version, as at 20 April 1999.

All Victorian public hospitals, central and regional Department offices, Healthcare Networks and other key internal and external users are encouraged to immediately access the State's Fees Manual and Acute Health Hospital Circulars related to the State's Fees Manual electronically. Distribution of hard copy replacement pages to the State's Fees Manual and Acute Health Hospital Circulars related to the State's Fees Manual, will cease from 1 July 1999. Between now and 1 July 1999 the Acute Health Division will distribute updates to the Manual and related Circulars in both hard copy and electronic format.

In rare instances only, an organisation (eg a remote public hospital) may not have access to the Internet or E-Mail by 1 July 1999. In such cases:

  1. Hospitals seeking hard copy updates of the State's Fees Manual and Acute Health Hospital Circulars related to the State's Fees Manual, should request these from the Regional Office for printing and distributing to you in the interim; and
  2. Regional offices should write to the Assistant Director, Office of the Director, Acute Health, 17th floor, 555 Collins St, Melbourne, stating the hospital(s) that cannot access these electronic services, and why.

1.3 Websites

The State's Fees Manual - Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals

Acute Health Hospital Circulars related to the State's Fees Manual

Acute Health Hospital Circulars not directly related to the Fees Manual are also on the websites above. The Office of the Director, Acute Health, advises you will be notified of any phasing out of those hard copies, by post.

The State's Fees Manual and Acute Health Hospital Circulars related to the State's Fees Manual, contain electronic links to Commonwealth and State Circulars. State Circulars issued by Acute Health are denoted by a Circular Number and date of issue. Circulars issued by the Commonwealth Department of Health and Aged, Insurance & Hospital Services Section, Private Health Industry Branch (formerly Health Insurance Services Section) are prefixed HBF.

The Commonwealth Department's Private Health Industry Branch provides items (eg the latest Schedule of Surgically Implanted Prostheses, and Day Only Procedures Manual - Type B (Day Only) and Type C (Exclusions) lists) and HBF Circulars in electronic medium. For expediency, you may wish to access these at the location below. You should note however that not all Commonwealth HBF circular advice is relevant to each hospital, For examples, advice about the opening of a private hospital; benefits applicable to other States; and information directed to Health Funds (private health insurers). The State Department therefore will continue to advise public hospitals direct via Acute Health Circulars, of any relevant Commonwealth HBF Circular advice (eg Day Only Arrangements) and how to purchase or access it (eg Prosthesis schedule).

You can choose to receive all HBF Circulars direct from the Commonwealth Department by E-mail. To subscribe, mail your subscription details to Private Health Industry Branch at HIS@health.gov.au.

1.4 Notification of updates to the State's Fees Manual, and Acute Health Hospital Circulars related to the Fees Manual

Everyone including public hospitals with access to E-Mail can be automatically notified of each change to the State's Fees Manual and Acute Health Hospital Circulars related to the Fees Manual. If you wish to be so notified you need to take the following action:

  1. If you are located within Department offices (Head Offices, Regional Offices) please ring Ms Kellie Postlethwaite, Office of the Director, Acute Health on telephone (03) 9616- 8073.
  2. Everyone else (eg public hospital staff): please forward your name, title, organisation, work address and E-Mail address to lyn.macfarlane@dhs.vic.gov.au

These two separate mailing lists above are for technical capacity reasons only. The service is the same.

1.5 Registration responsibility

As the Department needs to ensure updates to the State's Fees Manual, and Acute Health Hospital Circulars related to the Fees Manual are communicated to the field, the following (or their delegates) are responsible to:

Public Hospitals CEOs Bush Nursing Hospitals CEOs Public Extended Care Centres CEOs Departmental Regional Office Directors Department Regional Mangers, Provider Management Metropolitan Healthcare Network CEOs CEOs of third parties regulated by the Victorian Government (eg TAC, VWA) responsible for ensuring payment of eligible claims for acute health and related services provided by a public hospitals Ambulance Service CEOs Any other internal or external organisations for whom notification of Departmental advice regarding the State's Fees Manual is pertinent to their responsibilities.

1.6 Notification of select default benefits, to sections of the private sector

The Commonwealth Department of Health and Aged Care continues to be responsible for the distribution of Circular advice relating to the default benefits (as may be amended from time to time) below.

  1. overnight stay benefits
  2. same day benefits
  3. prosthesis benefits
  4. homograft item benefits
  5. Nursing Home Type Patients benefits and patient contributions; and
  6. any changes to the 2nd tier default benefits

Accordingly, notification of advice to the following sections of the private sector in regard to the above default benefits, is not a State Department responsibility:

  1. prostheses suppliers (prostheses table only);
  2. private hospitals;
  3. private day hospital facilities; and
  4. health funds

For your information, the website (as may be amended from time to time) for Circulars issued by the Commonwealth Department of Health and Aged, Insurance & Hospital Services Section, Private Health Industry Branch is http://www.health.gov.au/pubs/circfinl/index.htm

If you require further information, please telephone: (02) 6289 8786 - 24 hour answering service or E-Mail the enquiry to: his@health.gov.au

1.7 Tender documents

Where the State's Fees Manual and Acute Health Hospital Circulars related to the State's Fees Manual form part of tender documents, it is the responsibility of the officer managing the tender process to ensure tenderers know how to access these.

1.8 Enquiries

Enquiries about how to use the Internet should be directed in-house. Technical enquiries may be directed to the Manager, Electronic Service Delivery, Acute Health, Department of Human Services on E-Mail warwick.bullen@dhs.vic.gov.au, Fax: 03 96168980, Ph: 03 96168425

1.9 Printing pages

The electronic version of future Acute Health Hospital Circulars relating to the State's Fees Manual, including any attachments, will be attached to registrants' E-Mail message in the form of MS Word files. This allows users preferring to have a hard copy of the State's Fees Manual to print updated sections for insertion into their hard copy version of the Manual; and to distribute hard copies of these and the related Circulars internally to users who do not yet have net access.

1.10 Different format

You may notice that the electronic and updated hard copy version of the State's Fees Manual is formatted a little differently from the 1993 hard copy edition. Eg they do not contain page numbers, and headings and subheadings are numbered. Also, the electronic version has the capacity to advise if a section in the Manual is in the process of being updated.

2. AUSTRALIAN HEALTH CARE AGREEMENT (AHCA)

This Circular provides advice on the new Australian Health Care Agreement (AHCA). The AHCA is an agreement between the Commonwealth of Australia and the State of Victoria, to provide and jointly fund health care for eligible persons who choose to use State funded health services.

2.1 Delivery of public hospital services

The new 5 year AHCA provides for the Commonwealth's funding contribution to public hospital services for the five years from 1 July 1998 to 30 June 2003; and outlines the principles that are to guide the delivery of public hospital services for that period. An electronic version of the AHCA between Victoria and the Commonwealth is available on the Internet.

The AHCA commits the Commonwealth and Victoria to the following principles:

  1. Eligible persons must be given the choice to receive public hospital services free of charge as public patients;
  2. Access to public hospital services by public patients is to be on the basis of clinical need and within a clinically appropriate period; and
  3. Eligible persons should have equitable access to public hospital services, regardless of their geographical location.

The Commonwealth and Victoria agree that principles 2 and 3 are met if Victoria is using its best endeavours to achieve the outcomes sought in those principles to the greatest extent practicable.

It should be noted that under Principle (2), it is Victorian Government policy that both public and private patients should receive access to public hospital services on the basis of clinical need. This includes public and private patients regardless of their private health insurance status, compensable patients (other than under Veterans' Affairs legislation) including TAC and VWA patients, and Reciprocal Health Care Agreement patients.

Public hospitals in Victoria must ensure that public hospital services are provided in accordance with the terms of the AHCA and that eligible persons are able to access public hospital services as public patients. Public hospital services means services including admitted patient services and non-admitted patient services that were provided on 1 July 1998 by hospitals that are wholly or partly funded by a State or Territory (whether those services are provided directly or via one or more intermediate persons or bodies).

The Victorian Government will allow preferential access for eligible veterans to public hospitals, but only so long as care of public patients is not impaired, consistent with principle (2). Department of Human Services Victoria Hospital Circular 17/1998, issued 5 November 1998 provides that the new Veterans' Hospital Services Arrangement, in accordance with the principles of the Australian Health Care Agreement, allows preferential access for eligible veterans into public hospitals, providing that such access does not impair public patient care. The new Arrangement allows for the public hospital system, on a fully costed basis, to compete with private hospitals for veterans, on the basis of access and quality.

Payment will only be received for the treatment of eligible veterans as determined by DVA. Eligible veterans will not be covered under the Arrangement if they:

2.2 Charges for public hospital services

2.2.1 Patients other than public patients

The AHCA provides that admitted and non admitted patients other than public patients (private patients, compensable patients and ineligible persons) may be charged an amount as determined by Victoria. However pharmaceutical services provided to private admitted patients for public hospital services are provided free of charge and cannot be claimed against the PBS.

Funding for admitted and non-admitted Department of Veterans' Affairs patients is subject to an agreement between the State and the Commonwealth 1 July 1998 to 30 June 2004. That agreement is separate from the AHCA.

The Department of Human Services, Victoria, negotiates fees for admitted and non admitted TAC and VWA patients. Non TAC and non VWA compensable patient fees are set by the Department.

2.2.2 Admitted public patients

The AHCA and Commonwealth legislation provide that where an eligible person receives public hospital services as a public admitted patient, no charges will be raised for medical or hospital services unless they are classified as nursing home type patients.

2.2.3 Non-admitted public patients

The AHCA allows Victoria, if it chooses, to raise charges against public patients for the non-admitted patient services listed below, for services provided to non-admitted patients and admitted patients upon discharge. State Government policy in this respect is provided in the State's Fees Manual Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals.

The Fees Manual stipulates that public hospitals in Victoria are permitted to raise fees for the following non-admitted patient services; but are not permitted to raise fees for the following services provided to admitted patients upon discharge:

MBS arrangements for funding of MRI apply to public and private non-admitted patients (eligibility conditions apply) effective 1 September 1998, as detailed in Acute Health Hospital Circular No.20/1998, issued 10 December 1998.

To access this advice in the Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals, please go to the Fees Manual website.

and refer to:

Section B: Fees for Non-Admitted Patients
1. Fees and Charges for Non-Admitted Patients

2.3 Proposed reforms/pharmaceutical charging for admitted patients upon discharge and non-admitted patients.

Victoria and the Commonwealth are working in partnership to achieve agreed service delivery reform in these areas. Victoria is actively working with the Commonwealth towards an agreed proposal which, in the future, would allow public hospitals to access the PBS for admitted patients upon discharge and for non-admitted patients.

Currently public hospitals are not able to charge against the PBS for these patients. Hospitals will be advised of any changes following agreement with the Commonwealth. In the meantime, hospitals should follow the current charging policy for outpatient pharmaceuticals.

All pharmaceutical services to public and private patients, while they receive services as admitted patients must continue to: be provided by public hospitals free of charge; and cannot be claimed against the Pharmaceutical Benefits Scheme.

Continued Go to Part 2

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