Hospital Circular 27/2005
Date Issued: 28 December 2005
Distribution: Public Hospitals, Extended Care Centres, Metropolitan Health Services, and Regional Offices
Subject: Revised Arrangements for Public Hospital Services to Asylum Seekers
On Friday 25th November 2005, the then Minister for Health the Honourable Bronwyn Pike announced , that public hospitals are to cease raising charges against asylum seekers for necessary medical care where it is assessed that they have a limited capacity to pay.
In Victoria, as a general rule, public hospitals will provide emergency treatment to anyone, irrespective of their Medicare status. Whilst there is not a Victorian statutory requirement compelling hospitals to provide treatment to Medicare-ineligible persons, there is a common law duty of care, which curtails the refusal to provide emergency treatment when it can otherwise be provided. Ordinarily these services, when provided to ineligible persons, should be provided on a full-cost recovery basis.
Asylum seekers are people who apply to the government for recognition as a refugee. On the Australian mainland claims by asylum seekers for protection are assessed against the criteria set out in the 1951 United Nations Convention and 1967 Protocol relating to the Status of Refugees and Australia's domestic legislation. If they are successful, they are offered protection. This determination can take many years during which time the applicant is classed as an asylum seeker.
The Australian Government provides assistance to some asylum seekers during the period in which their applications for protection are being processed. This can include access to Centrelink payments, work rights and a Medicare card.
However, some asylum seekers, are not provided with a Medicare card, have no Centrelink payments or entitlement to work. This is the group that are of concern.
Please note asylum seeker status is different to humanitarian entrant status and Temporary Protection Visa (TPV) status as both these groups are Medicare eligible. Once an asylum seeker is granted a protection visa they cease to be an asylum seeker.
Medicare ineligible asylum seekers are to be provided full medical care including, pathology, diagnostic, pharmaceutical and other services in Victorian hospitals. Patients in this category are not to be billed. Where appropriate they should be referred to an appropriate support/advocacy agency.
What is an asylum seeker?
An asylum seeker is deemed to be any person who has a current request for protection that is being assessed by the Commonwealth Government or who, being deemed by the Commonwealth not to be a person owed protection is seeking either a judicial review (through courts) or is making a humanitarian claim (to Commonwealth Minister) for residence.
Asylum seekers can be permitted to reside within the Australian community on one of several different visa types. Different visas carry different entitlements including work rights and Medicare eligibility. The visa type held by an asylum seeker can change throughout the process of seeking asylum.
Asylum seekers who are Medicare ineligible are those who:
- have applied for asylum after being in Australia for 45
days (45 day rule);
- have been released from mandatory detention on a bridging
visa whilst determination on refugee status is assessed;
[NOTE: People released from detention who hold a Temporary Protection Visa (TPV) have been assessed as being owed protection and hold full Medicare eligibility]
- have been found not to be owed protection by the Refugee
Review Tribunal and are seeking either a judicial or Ministerial
- are on a bridging visa that carries no work rights and who are not being provided support by the Red Cross under the Commonwealth funded Asylum Seeker Assistance Scheme (ASAS) - General health scheme.
It is these "Medicare ineligible" asylum seekers requiring necessary treatment in Victorian public hospitals who are subject to this circular.
As asylum seekers who are Medicare eligible will hold a Medicare card, their status as an asylum seeker will have no bearing on receiving treatment and they will not be billed. The identification of a Medicare ineligible asylum seeker is slightly more problematic as a person who is Medicare ineligible is not necessarily an asylum seeker.
Those asylum seekers eligible for Commonwealth funding administered by the Red Cross under the Asylum Seeker Assistance Scheme (ASAS) may be provided with income and medical assistance. Payment for medical costs will not be made retrospectively. It is of note that eligibility to access this support may be withdrawn as applicants progress through the determination process.
Indentification of Medicare ineligible asylum seekers - three steps
1. Determine Medicare ineligible status of any sort
- NO WORK clearly stated on visa in passport or on evidence
card (Visa Condition 8101)
- Will not hold a Medicare card
2. Determine asylum seeker status
- Evidence by supporting documentation from asylum seeker
support group, or
- Evidence by receipt/ letter from DIMIA, or
- Evidence by Visa class (bridging Visa E)
Note: it will not always be possible to identify an asylum seeker from official government documentation, some discretion and judgement by hospital staff will be required.
3. Determine eligibility for ASAS or need for referral to specialist agency
- Asylum seekers will generally be aware if they are eligible
[Asylum Seeker Assistance Scheme (ASAS), can support asylum seekers during primary and review stages only. Recipients must; have lodged a valid protective visa application for more than 6 months; hold a bridging visa; demonstrate financial hardship, inability to work; not have been released from detention on an undertaking of support and meet additional criteria. Further details are availiable from the Red Cross.]
- If the patient identifies as receiving ASAS their status
should be confirmed by contacting the Red Cross 'Point of Contact'
for ASAS Tel:8327 7883
- The Red Cross will advise if they should be billed on the
- Assessment staff are encouraged to make appropriate referral of Medicare ineligiable asylum seekers to an asylum seeker support agency. These include: Red Cross ASAS Tel:8327 7883, Asylum Seeker Resource Centre Tel:93266033 and Hotham Mission Asylum Seeker Project Tel: 9326 8343
What to look for on a visa
Identification of Medicare ineligibility by visa
It is recommended that hospital social work staff are involved in the assessment of patients who may seek necessary treatment as Medicare ineligible asylum seekers. This could be achieved by a policy position that permits the Social Work staff to waive all medical, pathology, diagnostic and pharmaceutical fees for patients identified as being Medicare ineligible asylum seekers.
Hospitals admitting ineligible asylum seekers should report these to the Victorian Admitted Episodes Dataset (VAED) with the new Account Class code MF - Ineligible: Asylum Seeker. This Account Class will be valid for relevant admitted episodes from 1 July 2005. Admitted episodes for ineligible asylum seekers already reported to the VAED for 2005-06, where the hospital has not already received payment for the episode from the patient or other source, may be re-sent to the VAED to update the patient's Account Class to the new code. Asylum seekers who are eligible for Medicare must not be reported under this Account Class code. These Account Class code MF episodes will be included in a hospital's current public patient WIES targets and actuals.
Notification of amended VAED business rules and edits will be provided via an HDSS Bulletin and the relevant pages from the VAED Manual 15th Edition will be updated with this information and placed on the HDSS website.
Please note that due to a VAED hardware migration, there will be a delay before the new Account Class code can be accepted into the VAED. It is expected that the VAED will be accepting Account Class code MF - Ineligible: Asylum Seeker early in the new year. Where a related episode fails to meet established data transmission deadlines, the hospital should provide the episode details to the HDSS Helpdesk according to the existing process for requesting exemptions from data deadlines.
Acting Under Secretary, Health