Program Management Circulars Index <

Accessing services across regions & areas - December 1999 (Reviewed December 2010)

• Purpose
• Background
• Key Principle
• Definitions
• Assessment and Treatment
• Transferring Case Management Responsibility
• Financial Responibility Principles
• Financial Responibility Guidelines
• Exceptions to Financial Responsibility

Purpose

To outline the service provision and financial responsibilities of Area Mental Health Services (AMHS) when out-of-area services are provided to a client.

Background

It is essential that clients receive prompt and appropriate clinical care at the time of contact with a public mental health service. Some mental health service clients are mobile and use services from several areas or regions. This raises potential problems in identifying which AMHS is responsible for:

• Service provision.
• Service funding.
• Case management.

Service providers will normally cooperate in the best interests of clients to ensure that they receive the services they require. Accordingly these guidelines need only be followed if other suitable arrangements cannot be mutually agreed.

These guidelines are effective immediately and will be monitored over the next 12 months with their effectiveness reviewed prior to 1996-97.

Key Principle

People who present to a mental health service seeking assistance have a right to an immediate assessment of their needs. If the person receives treatment from an "out of area" service, the AMHS in the person’s area-of-origin is responsible for ensuring service provision, service funding and continuity of care.

Definitions

Area-of-origin is defined as the AMHS to which the client is currently registered except as follows:

• The area for a new client is defined by their residential address.
• The area for a new client who has no permanent residential address, is defined as the AMHS with which the client has first contact.
• A former client who has had no contact with a public mental health service for three months is deemed to be a new client.

An out-of-area client is one who receives assistance from an AMHS which is different to the AMHS for that client’s area-of-origin (as defined above).

Assessment and Treatment

All AMHS are responsible for assessing persons who present with, or are at risk of developing a serious mental illness or a severely disabling psychiatric condition. If a client requiring community-based treatment or admission is known to be from out-of-area, the staff-member assessing the client must ensure that appropriate services are provided to the client and is to determine whether to:

• Provide community-based treatment in the current area;
• Refer the client to the appropriate service in the client’s area-of-origin;
• Admit the client to the inpatient service in the area in which the client is being assessed; or
• Locate a bed in an alternative inpatient facility.

Where a client is treated in an out-of-area service:

• The clinical staff-member responsible for their care must within 24 hours notify the Authorised Psychiatrist in the client’s area-of-origin that the client is receiving treatment.
• The Authorised Psychiatrist in the client’s area-of-origin must notify their AMHS Manager of any clients being treated out-of-area in inpatient services for more than 24 hours, so that financial responsibility can be assessed and managed.
• The clinical staff-member responsible for their care must also discuss coordination of service provision for the client with the client’s case manager. The duty worker in the AMHS in the client’s area-of-origin will perform the function of case manager if one has not been assigned.
• The client’s case manager (or the duty worker) must ensure that the client’s clinical history and other relevant information is provided to the out-of-area service.
• The Authorised Psychiatrist in the out-of-area AMHS currently providing treatment has the primary responsibility for the treatment and care of the client, including assessing the appropriateness of transfer back to the AMHS in the client’s area-of-origin. They must make decisions on any appropriate arrangements for transfer in consultation with the relevant clinical staff in the client’s area-of-origin, and where appropriate with the client’s carers.
• Should a conflict arise about whether or not to transfer a client, the relevant Authorised Psychiatrists and AMHS management must reach an agreement on a course of action that is in the best interests of the client.
• When transferring clients from one inpatient facility to another, the transferring service must determine the mode of transport.
• The transfer of an involuntary patient to another psychiatric inpatient service must comply with Section 39 of the Mental Health Act.

Transferring Case Management Responsibility

Transfer of case management responsibility may occur as follows:

• The client’s case manager will decide, in consultation with the client and their carers, whether or not to formally transfer case management responsibility for the client to an alternative AMHS.
• The AMHS in the client’s area-of-origin retains case management responsibility for the client’s inpatient admissions until formal transfer has been completed.

Financial Responsibility Principles

Victoria is adopting a needs-based purchaser-provider funding framework, which means that:

• Each region's share of the mental health budget is determined by its weighted population.
• Regional Directors and Psychiatric Services Managers determine and "purchase" the most appropriate mix and structure of services in each area.
• AMHS are responsible for the resources for services provided to residents of their areas, even when those services are provided by another area or region.

This approach means that a person’s area-of-origin is responsible for meeting the cost of the direct or indirect provision of mental health services for that person.

Financial Responsibility Guidelines

Unless otherwise agreed between the relevant AMHS, financial reimbursement for out-of-area services only applies to inpatient services after the first 24 hours and excludes extended care provided in a nursing home.

The guidelines for reimbursement are:

• When a transferring AMHS gives prior notification to the receiving AMHS in writing that a client is to relocate, the transferring AMHS is only financially responsible for the cost of further inpatient services which occur within three months of the date of the client’s last discharge from an inpatient service. This means that if the client has not received inpatient services in the three months prior to formal transfer, the transferring AMHS has no further financial responsibility.
• When an AMHS provides services to an out-of-area client about whom they have not received prior notification, the AMHS in the client’s area-of-origin has financial responsibility for the cost of all inpatient services for three months from the client’s date of contact with the new AMHS.
• Charges for inpatient services may be levied at up to the standard daily bed rate for the service type for the duration of the inpatient episode beyond the first 24 hours, provided the Authorised Psychiatrist in the client’s area-of-origin has been notified.
• Where exceptional costs are incurred by the treating service related to one-to-one nursing care ("specialling" ), the fee will be negotiated on the standard daily bed rate plus the hourly salary rate for a Registered Psychiatric Nurse Level 1. This additional charge only applies for one-to-one nursing care provided in excess of 24 hours.

Exceptions to Financial Responsibility

Financial responsibility does not apply in the following circumstances:

• A Statewide Service providing treatment to clients within its target group.
• The transfer of clients as part of the redevelopment of stand-alone inpatient facilities (such as NEMPS and Lakeside), where replacement services are separately funded.
• Treatment of mentally ill people in other than a specialist psychiatric ward in a general hospital. For example, this may arise in response to a person’s need for specialist services such as transport accident rehabilitation or intensive care services. During such admissions a patient may receive concurrent treatment for their mental illness, but the financial responsibility for this treatment remains with the general hospital and its associated AMHS.