|Title:||Direct Billing Arrangements For Selected Services Provided To The Department Of Veteransí Affairs Entitled Persons|
|Document ID:||Operational Circular OP 2082/06|
|Date of issue:||Friday, 14 July 2006|
|Status:||NO LONGER APPLICABLE|
|Description:||This circular outlines the direct billing arrangement between WA Funded Hospitals and The Department Of Veteransí Affairs for high-cost prostheses, pharmaceuticals, nursing home type patient contribution for ex-Prisoners of War (POW) and post discharge services provided to Entitled Persons.|
|Legal requirements:||WA-DVA Hospital Services Arrangement 2005-10
|Applicable to:||WA Funded Hospitals|
|Period of effect:||from 14 July 2006|
|Authorised by:||Dr Neale Fong, Director General, DEPARTMENT OF HEALTH, 14-Jul-2006|
|Print version:||View print version|
Direct Billing Arrangements For Selected Services Provided To The Department Of Veteransí Affairs Entitled Persons
This circular outlines the direct billing arrangement between WA Funded Hospitals and DVA for high-cost prostheses, pharmaceuticals, nursing home type patient (NHTP) contribution for ex-Prisoners of War (POW) and post discharge services provided to Entitled Persons.
The Hospital Services Arrangement for 2005-10 (HSA) between the Commonwealth DVA and Western Australia (WA) is in place. The HSA ensures that Entitled Persons receive a range of admitted and non-admitted hospital services in WA Funded Hospitals. Relevant details of the HSA can be accessed via http://dev.intranet.health.wa.gov.au/hss/divisions/dva.cfm.
Entitled persons are veterans with a Gold or White Repatriation Health ealth HealtCard. The process of identifying Entitled Persons is detailed in Technical Bulletin 33/5 or as amended from time to time.
Entitled Persons will have the same access to pharmaceuticals as other admitted and non-admitted patients. Where an Entitled Person requires access to Highly Specialised Drugs, pharmaceuticals under the Special Access Scheme (not registered for use in Australia) or which are not normally provided to other patients, the hospital should first seek financial authorisation from the DVA by calling 1800 552 580. If approval for supply of these pharmaceuticals is granted, the hospital should invoice the DVA directly for the cost.
An Entitled Person will not be charged for pharmaceuticals while receiving services as an admitted patient. For pharmaceuticals provided as a non-admitted patient, charges will be levied consistent with that provided under the WA Hospital Services Charges Regulations 1984 or as amended from time to time.
Entitled Persons are covered for prostheses costing more than $25,000. Hospitals should seek DVA approval before implantation by calling 1300 550 456. If the prosthesis is clinically required after hours, weekends or public holidays, hospitals may provide the prosthesis and advise DVA within two business days of the procedure. Upon approval, the hospital should bill DVA directly for the cost of the item.
NHTP Contribution for ex-POWs
Entitled Persons who are admitted as or reclassified to NHTP would be charged a patient contribution in line with the provisions of the Health Insurance Act 1973. If the patient is an ex-POW, the patient contribution will be met by the DVA and hospitals should send the invoice directly to DVA. The POW status is shown on the gold card. NHTP contributions for non ex-POWs should be billed directly to the patients and they cannot recover the cost from the DVA.
Post Discharge Services
Where an admitted Entitled Person requires post discharge care, hospitals are encouraged to refer them to DVA-contracted health service providers. A list of providers for the relevant area can be obtained by contacting DVA on 133 254 or 1800 555 254. If DVA advised that there are no DVA-contracted providers in the area, hospitals should seek approval to provide the service themselves or arrange for it to be provided by their subcontractors. Upon approval, the hospital or their subcontractors should provide the required service and invoice DVA directly for the cost.
The DVA Discharge Planning Resource Kit, which provides more information about post discharge services for Entitled Persons can be accessed via the DVA website on http://www.dva.gov.au/media/publicat/2003/dprk/index.htm.
D. DATA REQUIREMENTS
Each hospital or their subcontractors (for discharge services only) should forward a tax invoice directly to the DVA for the selected items and services as described above. The tax invoice must be accompanied by the relevant Tax Invoice Attachment (attached) providing details of the patient, health service provider and products or services rendered to Entitled Persons. DVA will make payment directly to the hospital or their subcontractors against the tax invoice.
At the end of each quarter the hospital or health service is to provide the DVA Management Unit, Department of Health with a summary of the charges raised during the quarter including the amounts that are outstanding. Form B (attached) should be used for this purpose.
All hospitals are required to directly bill DVA for the services described above. Tax invoices and attachments should be posted to:
The Contract Manager
Dr Neale Fong
This circular last updated: Friday, 14 July 2006 at 9:35am