4. Department of Veterans' Affairs Patients

4.1 DVA Funding Arrangements

A new six year funding arrangement effective 1 July 2004 - 30 June 2010 is now in operation. Previous funding arrangements will continue.

The Department of Veterans' Affairs (DVA) provides a mixture of output based payments and block grants to the Victorian Department of Health (DH) for the provision of acute health services to veterans.

Acute separations for eligible veterans will be paid at a premium to the full rate (incorporating both the fixed and variable payment) through DH casemix funding arrangements. Hospitals should make every endeavour to ensure DVA status is determined and correctly recorded in the appropriate dataset

Eligibility

There are two types of cards held by entitled veterans

• Gold card which covers all conditions, or
• White card for specific conditions only.

All gold card holders are automatically eligible for public hospital treatment as veterans but a white card holder's eligibility must be established on each admission. If the white card holder does not have the documentation showing DVA prior approval, hospitals will to need to contact DVA to establish eligibility at the time of admission or on the next business day if the patient is admitted over a weekend.

Hospitals can contact the Victorian DVA Office, on ph. (03) 9284 6878 between the hours of 9.00am and 5.00pm, Monday to Friday or facsimile (03) 9284 6440.

If an eligible veteran is also covered under TAC or Workcover arrangements, then those arrangements take priority.

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.

Services

Hospitals currently receive payment at a premium for the following services to eligible veterans:

• WIES
• dialysis and haemodialysis cases
• weighted VACS encounters
• allied health occasions of service
• nursing home type
• rehabilitation
• interim care (in a hospital setting)
• palliative care
• GEM
• mental health admitted patient bed days;
• post acute care patient days, and
• non admitted radiotherapy weighted activity units.

Payments

1. The Victorian State Government is reimbursed for actual work done after confirmation of eligibility by DVA.
2. A loading of 21% will continue to be added to throughput based public health services, and 25% to the published private WIES price.

Where eligibility is confirmed, DVA will pay relevant Medical Practitioners, separately to this Arrangement, for admitted patient medical specialist consultations and services including diagnostic and imaging services, and general practice. Non DVA registered Medical Practitioners will be paid at the Medicare Benefits Schedule rates. Medical Practitioners registered with the DVA Local Medical Officer Scheme will be paid at DVA rates.

In terms of accounts for which DVA has rejected payment because of inadequate or insufficient information during the annual reconciliation, the hospital will be advised by DH and must adjust its records to reflect the appropriate patient election.

Emergency Department treatment

Where a visit of a veteran to an Emergency Department (ED) does not result in an inpatient admission no additional charges should be raised against DVA for services including medical treatment. The funding provided by DVA under the Commonwealth –State Arrangement covers veteran usage of all emergency services including medical and nursing costs.

Where a veteran is admitted from the ED, that admission is classified as commencing from the time of admission and DVA will pay for relevant medical practitioner consultations and services during the inpatient admission.

Prostheses

The cost of surgically implanted prostheses is included in the WIES payment and DVA will not be billed separately by hospitals for surgically implanted prostheses.

Fees

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 6878, or fax (03) 9284 6440, when a POW is reclassified to a Nursing Home Type Patient. A POWs DVA entitlement card has POW embossed in the left hand corner.

Pharmaceuticals

Veterans will not be charged for pharmaceuticals provided while they received services as admitted patients. 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. In addition, those hospitals participating in the Pharmaceutical Reforms may also charge eligible veterans the statutory copayment for drugs on discharge.

Holders to the Repatriation Pharmaceutical Benefits Card (orange card) are entitled to receive pharmaceuticals under the above provisions, but unlike the gold or white card, the orange card does not entitle them to any other form of health care other than pharmacteuticals

For more information, see Pharmaceutical Reform in Victoria's Public Hospitals

Veterans qualify as concessional beneficiaries for pharmaceuticals.
Reference: Circular No.17/1998, Circular No.3/1999 and Circular No.2/2003

5. Compensable (excluding WorkCover and TAC recipients) Patients

The following fees are charged for all compensable patients other than WorkCover and TAC patients.

Accommodation Fees for Compensable (excluding WorkCover and TAC recipients) Inpatients

*Fees only apply for patients admitted to rehabilitation and psychiatric programs/units designated by the Department of Health. The Department's most current PRS/2 Manual as may be amended from time to time lists Designated Rehabilitation Programs - see also specification changes to the manual at http://www.health.vic.gov.au/hdss
**Geriatric fee can only be charged in designated Geriatric Evaluation and Management (GEM) units.
***Hospitals are required to strictly comply with the definition of "Admission" in accordance with the Minimum Criteria for Admission as specified in Circular No. 15/1998 (as may be amended or replaced).

(See section on Patient Classifications for the definitions of advanced surgical, surgical and medical patients).

Reference: Circular No.13/2011
Effective 13 June 2011

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