Hospital Circular 07/2001: Hospital Circulars - Department of Health, Victoria, Australia

Hospital Circular 07/2001

Date Issued: 23 May 2001

Publication: 7/2001

Distribution: Subscribers (Acute Health Circular 7/2001 refers)

Enquiries: Regional Office

Subject: Public Hospital Fees & Charges

Public hospital fees and charges - changes
Guidelines for individual health funds for the purposes of approving private patient hospital -based psychiatric care programs for the purpose of health insurance benefits.
Medicare eligibility
Administrative Items

1. Public Hospital Fees

Accessing changes-agency responsibilities

The Department of Human Services Victoria (DHS) seeks to ensure changes to public hospitals fees and charges are accessible by the field as soon as possible as this helps agencies implement any changes by their date of effect. Accordingly CEOs or their delegate(s) of all Victorian public hospitals, Bush Nursing Hospitals, Public Extended Care Centres, Regional Offices, Metropolitan Health Services, and Ambulance Service are to ensure access to that information by relevant staff.

Key sources of Government and Department advice of changes to public hospital fees and charges currently include:

Commonwealth HBF Circulars

These are produced by the Private Heath Industry Branch, Commonwealth Department of Health and Aged Care (DHAC). They include information relating specifically to regulations, default benefit changes and other specific policy issues. To receive these direct by email within around 24 hours of publication, email subscription details to Private Health Industry Branch at HIS@health.gov.au. Details should include Nature of Business, Company Name, Contact Name, Position, Postal Address, Phone, Fax and if possible Email address. See also Commonwealth Circular HBF 680 regarding Distribution Arrangements.

Victorian Acute Health Circulars

These are produced by the Acute Health Division of the Department of Human Services and include Departmental policy on fees and charges for services provided by public hospitals. To receive automatic notification of these by E-mail, E-mail your name, title, organisation, work address and E-mail address to Ms Lyn MacFarlane, Office of the Director, Acute Health at lyn.mcfarlane@dhs.vic.gov.au.

Fees manual

Public hospitals are encouraged in conjunction with the above advice, to access the State's Fees Manual Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals for a user friendly "one stop shop". Please note that from time to time Manual updates lag behind Circular advice.
Patient classification for fund benefit purposes

The Commonwealth has advised that the patient classification schedule for fund benefit purposes has changed as a result of amendments to the Medicare Benefits Schedule (MBS) with effect from 1 November 2000. It should be noted that the 1 November 2000 MBS amendments included a 1.2% fee increase for all MBS items except for Pathology and Diagnostic Imaging. As a consequence of this increase, the dollar threshold for the classification of patients in all private and public hospitals in Victoria for default benefit purposes has increased. See Commonwealth Circular HBF 675.

Following a review of the those changes, amendments were made effective 1 December 2000. See Commonwealth Circular HBF 682.

In accordance with the 1 May 2001 supplement to the MBS 1 November 2000, adjustments have been made to the patient classification schedule effective 1 May 2001. See Commonwealth Circular HBF 707.
Day only arrangements -Type B (Day Only) and Type C (exclusion) Lists

The Commonwealth has advised with respect to Day Only Arrangements Type B and Type C Lists, that:
1. amendments to the MBS affected the day only arrangements effective 1 November 2000. See Commonwealth Circular HBF 676;
2. following a review of the those changes, amendments were made effective 1 December 2000. See Commonwealth Circular HBF 682; and
3. in accordance with the 1 May 2001 supplement to the MBS 1 November 2000, adjustments have been made effective 1 May 2001 See Commonwealth Circular HBF 706.
Schedule 5 - Benefits Payable in respect of Surgically Implanted Prostheses and Human Tissue Items
1. The Commonwealth Minister's Determination in respect of Schedule 5 of the Default Benefit, for the purpose of paying benefits for surgically implanted prostheses, has been revised effective from 28 February 2001. See Commonwealth HBF Circular 692 and all attachments (Commonwealth Circulars HBF 589, 651, 656, 667, 678, 684 and 687 outlined full deregulation of the benefit for Appendix A effective 28 February 2001. Acute Health Circulars 2/2000 and 12/2000 also referred.). Amendments to the February 2001 Schedule 5 Determination of Benefits Payable in Respect of Surgically Implanted Prostheses and Human Tissue Item List, effective from 18 April 200, are detailed in Commonwealth Circular HBF 704 and all its attachments. For your information that Circular also provides reports from Private Health Industry Medical Devised Expert Committee Meetings.
2. The deadline for applications for new items to be considered for listing on the August 2001 schedule is 15 June 2001. See Commonwealth HBF Circular 709 and attachments for details and application forms.
3. Commonwealth Circular HBF 692 is to be read in its entirety. However select items are summarised below for emphasis:
  1. there is no price field in the new database; the benefit level is to be negotiated and agreed to between the health fund and the supplier/manufacturer/hospital;
  2. there can be no inadvertent introduction of a patient gap;
  3. clinical choice remains with the clinician in consultation with the patient;
  4. where the supply charge has been incurred it must be paid;
  5. health funds have been advised by the Commonwealth to negotiate only one benefit for each item listed;
  6. health funds and manufacturers/suppliers must advise hospitals of the agreed fee or charge payable for prostheses within two weeks of the effective date;
  7. hospitals will need to check their stock against specific billing codes to ensure they are correctly listed against the new codes as a significant number of items may have been deleted from the list and this will have obvious implications for hospitals outlays;
  8. the legal implications of inaccurate use of billing codes could be significant. As hospitals are the agent that generally bill health funds, hospitals will need to ensure their staff ensure correct billing codes are used. The Commonwealth notes that all of the industry would be aware of the recent advice to the industry advising them of the serious nature of purposeful code misuse;
  9. billing codes are tied specifically to the TGA sponsor identified in the code and are not for use by other companies. Where the code identifier is different from the company supplying the good it is advisable that hospitals request evidence that they are authorised to do so by the identified sponsor;
  10. hospitals and industry groups will need to ensure arrangements are in place to download Schedule 5 from the Commonwealth internet site. The Schedule will be in Microsoft Access database format only. Copies of Schedule 5 are no longer available on disc or in hard copy;
  11. Final Report on the New Database Model for Schedule 5 - Benefits Payable in Respect of Surgically Implanted Prostheses, Human Tissue and Other Medical Devises List (The List): Refer Commonwealth Circular HBF 678;
  12. Human Tissue item arrangements are unchanged. The benefit payable for all items is specified in Schedule 5 - Appendix B
For enquiries regarding prosthesis list: please contact the Private Health Industry Branch, Commonwealth Department of Health and Aged Care via their 24 hour answering machine service (02) 6289 9853 or E-Mail the enquiry to his@health.gov.au or contact the Commonwealth Department's Prostheses Team who manage the list, and have established an electronic mailbox with the e-mail address: Prostheses@health.gov.au This mailbox address is directly accessed by the prostheses team and aims to ensure that your enquiries will be answered promptly.
Schedule 7 - Care Plans and Case Conferencing - Default Table

Commonwealth Circular HBF 598 referred. See Commonwealth Circular HBF 677 for additional MBS item numbers effective 1 November 2000.
Nursing Home Type Patients (NHTPs) in public hospitals-change in patient contribution

The Commonwealth Government has advised of a recent increase in the pension. As a result the Victorian Department of Human Services has increased its NHT patient contribution from $28.10 per day effective 20 September 2000, to $29.20 effective 28 March 2001.

2. Guidelines for Individual Health Funds

The Commonwealth Department of Health and Aged Care advises that the document Guidelines for determining benefits for health insurance purposes for private patient hospital -based psychiatric care is available. The Guidelines should assist individual health funds when approving psychiatric care programs for privately insured private patients, for the purpose of health insurance benefits. For details and a copy of the Guidelines, refer Commonwealth Circulars HBF 694 and HBF 694 Attachment A.

The Guidelines were not developed for the purpose of public patient hospital based psychiatric care programs

3. Medicare Eligibility

Medicare eligibility for children and their carers from the Chernobyl region

The Commonwealth advises that a group of some 34 sponsored children and two adult carers from the Chernobyl region will be visiting Melbourne from 18 May to 9 July 2001.

Public hospitals are advised that that during the period of the visit, these children, and the carers accompanying them from Chernobyl, are entitled under Medicare to immediately necessary medical and public hospital treatment for any ill health or injury they have while in Australia which requires treatment before returning home.

A child/carer will probably not be carrying any type of identification other than his/her passport. As the benefits available to these children/carers are not widely known, it is reasonable to assume that those persons presenting at a hospital requesting treatment as a child/carer from Chernobyl are genuine.

If a situation arises where clarification is sought regarding the eligibility of a patient then it is recommended that the Commonwealth Department of Health and Aged Care be contacted on (02) 6289 8607. Where the situation arises over a weekend and the Department cannot be contacted, an account may be raised if necessary pending confirmation of a patient's identity. Once clarification is received, the account is not to be pursued. Under NO circumstances are the children from Chernobyl to receive an account for any treatment that is considered to be clinically necessary.

Hospitals should admit the child/carer as an eligible patient who is entitled to receive treatment in a public hospital as a public patient (ie without cost). If the hospital has a problem with declaring the child/carer as eligible, the Commonwealth Department of Health and Aged Care should be contacted.

For a child/carer visiting a general practitioner, the procedure in the past has been that the host family takes the child/carer to the GP, who is then presented with an invoice, or the account is paid on the spot. The family then sends the receipt/invoice to the Victims of Chernobyl Fund, who forward it on to the Department. The Department then issues a Ministerial Order, and the Health Insurance Commission issues a temporary Medicare number which is relevant ONLY to the invoice/account received. This information is then sent back to the Victims of Chernobyl Fund, who relay it on to the family who make the claims as appropriate.

If you have any enquiries, please contact Ms Bronwen Collin, Ph: (02) 6289 8624 or Mr Craig Rayner Ph: (02) 6289 7312, Medicare Eligibility Section, Commonwealth Department of Health and Aged Care.
Changes to Medicare eligibility: applicants for parent visas

The Commonwealth Government has advised that from 1 January 2001 most applicants for a parent visa who are currently enrolled in Medicare will not be able to claim, or assign, Medicare benefits. Eg they will have to meet any costs associated with a hospital admission, unless they have appropriate insurance. For the effect of these arrangements on applicants from countries with Reciprocal Health Care Agreements and other details see Commonwealth Circular HBF 685.
New Interim Medicare Card

The Health Insurance Commission (HIC) has introduced a new type of interim Medicare card to identify people who have been given full Medicare cover but only for a limited time. Holders of these new cards include those who have been granted a temporary visa by the Department of Immigration and Multicultural Affairs for a conditional period of time. This new interim card is blue (rather than green) and the date when Medicare eligibility expires is shown on the card (at the bottom). This expiry date can be extended until a final decision on whether permanent residency is granted. If granted, a green Medicare card is issued. HIC notified hospitals of the new arrangements in letters dated 29 November 2000, addressed to hospital managers (enquiries to 132-011 local call rate).

If the card has expired, the patient is ineligible and should be billed for services See Health Data Standards & Systems (HDSS) Bulletin Issue 20 item 20.7.

4. Administrative Items

Contact number-change
DHAC's Private Health Industry Branch new 24 hour contact phone number is (02) 6289 9853.
Fees Manual Updates
1. Access
  To access the updates to the Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals ('State's Fees Manual') in accordance with this Circular advice, please go to:
  Fees Manual website and refer to:
  
  Enquiries and Registration
  
  Section A: Fees for Admitted Patients
  
  3. Private Admitted Patients
  
  3.1 Overnight Stay Patients
  
  3.2 Same Day Patients
  
  8. Eligible & Ineligible Patients
  
  9. Nursing Home Type Patients
  
  Section C: Fees
  
  5. Preventative Health Care and Management
  
  Appendices
  
  Appendix A: Surgically Implanted Prostheses and Human Tissue Items Fees
  
  Appendix C: Patient Classification Schedule
  
  Appendix D: Type-B (day only) and Type C (exclusion) Lists:
2. Printing pages - change in arrangements
  Effective immediately, revised relevant sections of the State's Fees Manual will no longer accompany e-mailed Acute Health Circulars. Revised sections of the Fees Manual, however, can be printed from the internet.

CHRIS BROOK
DIRECTOR
ACUTE HEALTH

Hospital Circulars