Hospital Circular 19/1996: Hospital Circulars - Department of Health, Victoria, Australia

Hospital Circular 19/1996

Date Issued: 24 October, 1996
Publication: 19/1996
Contact: Regional Office
Distribution: Public Hospitals
Subject:

Same Day Procedures Manual - August 1996
Nursing Home Type Patients (NHTPs) in Recognised Hospitals - changes in fees
Public Hospital Prosthesis Fees
Neo-natal facilities for the treatment of newly born children - approval under the Health Insurance Act 1973
Timely payment of benefits
'Ineligible' patients from whom no payment may be forthcoming
Asylum Seekers - conditions for financial assistance
Medicare Benefits Schedule (MBS) books - distribution

Purpose: To advise public hospitals of the above

1. PROCEDURES MANUAL - AUGUST 1996

This Circular is to advise Victorian public hospitals that the Commonwealth Department of Health and Family Services recently released the Same Day Procedures Manual - August 1996 (3rd edition), hereafter referred to as the Manual. The Manual (a copy of which is attached for public hospitals/State Regional Offices only) replaces the second edition of the previously entitled Day Only Procedures Manual dated November 1993. For those who have access to the Manual, please note the inclusion of more detailed information about the day arrangements at pages 1-5.

The Manual incorporates all changes to the Medicare Benefits Schedule (MBS), including 1 July 1996 amendments (as incorporated in a previous State Department Circular 14/96 dated 4/7/96) that affect Type B professional attention procedures (the day list) and Type C professional attention procedures (the exclusion list).The Commonwealth advises that there have not been further amendments to the MBS since 1 July 1996.

The Medicare Agreement 1993-1998 specifies the minimum criteria for inpatient admission, one of which must be met for a patient to be admitted as a same day or overnight stay patient. Criterion for Admission is an item reported by health care institutions to the Victorian Inpatient Minimum Database (VIMD). The determination of the Criterion for Admission for episodes of care is, in part, guided by the Same Day Procedures Manual - August 1996. This publication is a reference to be used by personnel who are involved in administering same day procedure arrangements.

Hard copy

Due to limited stocks, the State Department is distributing only one copy of the Manual per hospital. However, the Manual=s black binder can be removed for the purpose of photocopying.

Disk copy

The Manual may also be purchased on disk through the Commonwealth Department of Health and Family Services. Please note that the disk has been produced solely for internal hospital/health fund use and its contents will remain the property of the Commonwealth Department of Health and Family Services. An order form for the disk copy is at Attachment A. Formats available are Microsoft Word for Windows Version 2.0a, WordPerfect for Windows 5.2 and Rich text format (standard text format in the Windows environment). All three formats are provided on every disk.

Updates - same day arrangements

Advice of updates to the Manual, how to obtain updates, and related matters will continue to be forwarded to public hospitals via State Departmental Circulars.

Internal distribution

Public hospitals, please ensure a copy of this Circular and its accompanying Manual are made available to the following personnel within your organisation:

Director of Finance
Director of Clinical Services
Manager, Medical Records Services
Admission Office personnel.

State Fees Manual

As a result of these changes, could you please make the following update to the State Fees manual, Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals :

. Same Day Patients - replace page 4 of part 1, Fees for Admitted Patients.

IF YOU REQUIRE ANY FURTHER INFORMATION ABOUT THE CONTENTS OF THE SAME DAY PROCEDURES MANUAL PLEASE TELEPHONE: (06) 289 8786 - 24 HOUR ANSWERING SERVICE - Health Insurance Services Section, Commonwealth Department of Health and Family Services OR E-MAIL THE ENQUIRY TO: kent.penny@a1.cbr.hhcs.gov.au

2. NURSING HOME TYPE PATIENTS (NHTPs) IN RECOGNISED HOSPITALS - CHANGES IN FEES

The Victorian Department of Human Services has increased its NHT patient contribution rate to an amount of $26.30 per day ($184.10 per week), effective 3 October 1996.

As a result of this change, please make the following update to the State Fees manual Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals:

Nursing Home Type Patients - replace page 18 in part 1, Fees for Admitted Patients. This change is effective 3 October 1996.

3. PUBLIC HOSPITAL PROSTHESIS FEES

The Commonwealth Minister's Determination for the purposes of paying benefits from the basic private table for prostheses (hereafter ADetermination@) has been revised effective from 25 September 1996. The Determination incorporates changes to the product range of some of the existing prostheses, and also includes new items. New items appear in bold print.

Deletions

The following items have been deleted from the September 1996 Determination: G942, R794, J414, H921, H837, F247. Health Funds will still be able to pay benefits for these items up to 25 September 1996.

Correction

The Commonwealth Department of Health and Family Services recently advised that a misprint in a Commonwealth Circular (and conveyed in State Department Circular 10/96, page 2) occurred advising that item F379 (Posterior Stabilised $650) had been deleted from the Surgically Implanted Prostheses Determination. The Commonwealth Department apologises for any inconvenience that this may have caused as this item has not been deleted and benefits are payable on this item. F379 can be found in the March 1996 Prosthesis Determination.

Disk

The September 1996 Determination is only available on disk and, consistent with earlier advice (State Departmental Circular 10/96), only available direct from the Commonwealth, at a charge. However, since Circular 10/96, the Commonwealth Department of Health and Family Services has advised that the disk will only be supplied in Excel 5.0 format as from September 1996. To obtain a copy of the disk, please complete the order form at Attachment B.

New Determination

The Commonwealth Department is anticipating a new Determination effective in March 1997 to recognise increases in charges of existing items and to add any new items appropriate to the Schedule. The deadline for application for new items to be included on the March 1997 Determination is Friday 15 November 1996. The deadline for notice of new charges to be considered for updating benefits is Friday 17 January 1997.

IF YOU REQUIRE FURTHER INFORMATION PLEASE TELEPHONE: (06) 289 8786 - 24 HOUR ANSWERING SERVICE - Health Insurance Services Section, Commonwealth Department of Health and Family Services

4. NEO-NATAL FACILITIES FOR THE TREATMENT OF NEWLY BORN CHILDREN - APPROVAL UNDER THE HEALTH INSURANCE ACT 1973

Commonwealth Circular HBF 456 (attached) reiterates the conditions under which basic table health insurance benefits are payable in respect of a newly born child accommodated with his/her mother, and sets out the prerequisites for approval of hospital services with neonatal facilities under 3(2) of the Health Insurance Act. Circular HBF 456 is effective 1 July 1996, will apply until further notice, and replaces State Department circular 37/1994 (issued 14.11.1994) which incorporated Commonwealth Circular HBF 374/PH 207.

It should be noted that Commonwealth Circular 456 does not change the existing criteria for admission of newborns. A newborn infant, within the first nine days of life, may be admitted only if he/she:

is the second or subsequent live born infant of a multiple birth, and the mother is currently an overnight stay patient;
requires treatment which can only be provided in an intensive care facility in a hospital, being a facility approved by the (Commonwealth) Minister for the purpose of special care;
remains in hospital without his/her mother; or
is admitted to the hospital without his/her mother.

State Department Circular 17/1995 provides details regarding the gathering of data on all newborns for the VIMD. It makes the distinction between Qualified newborns, who meet one of the above criteria for admission, and Unqualified newborns, who do not meet any of those criteria, but for whom data are still required to be collected by public hospitals and Bush Nursing Hospitals providing contracted services under the Bush Nursing Hospitals Program, in order to facilitate casemix-based payments. Circular 17/1995 remains current.

Please ensure these details are distributed to relevant personnel as soon as possible.

IF YOU REQUIRE FURTHER INFORMATION ABOUT APPROVALS PLEASE TELEPHONE: (06) 289 8786 - 24 HOUR ANSWERING SERVICE - Health Insurance Services Section, Commonwealth Department of Health and Family Services.

IF YOU REQUIRE FURTHER INFORMATION ABOUT INSPECTIONS PLEASE TELEPHONE: (03) 9616 7786, Nurse Advisor, Acute Health, Victorian Department of Human Services.

5. TIMELY PAYMENT OF BENEFITS

The Commonwealth Department of Health and Family Services advises that it has been drawn to its attention that some health funds are using a variety of tactics to delay or deny the payment of hospital benefits, particularly in relation to Agap@ benefits. AGap@ benefits for professional services are payable once Ahospital treatment@ has been established. For acute patients Ahospital treatment@ essentially means accommodation and nursing care for the provision of professional attention. Once an accommodation account is received (with appropriate certification/s in the case of day Type C and Type B patients) Agap@ benefits are payable for all professional services rendered.

It should be noted that under Schedule 1 (Conditions of Registration) of the National Health Act 1953, claims are to be processed by health funds within 2 months of being lodged unless, upon individual application, the Department=s Secretary approves a longer time period.

6. 'INELIGIBLE' PATIENTS FROM WHOM NO PAYMENT MAY BE FORTHCOMING

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. Where a hospital attempts to recover the cost for the provision of emergency treatment, this may require action through the courts or reaching an agreement with the patient or the patient's relatives to pay the debt in instalments. However, where hospitals' attempts to recover debts prove futile, there may be no alternative but to write off debts. The 1996/97 Health Service Agreements between Victoria's public hospitals and Department of Human Services provide a set allowance for bad debts at 0.5% of revenue collected by the hospital. (Ref: p28, 1996/97 Health Service Agreement Pro-Forma.)

7. ASYLUM SEEKERS - CONDITIONS FOR FINANCIAL ASSISTANCE

7.1 Access to Medicare under certain conditions.

Since 29 May 1996, applicants for a protection visa, with a valid temporary entry visa that have either work rights or a spouse, parent or child who is a permanent Australian resident, are eligible to apply for a Medicare card. Their eligibility will continue until their protection visa application is finalised, their temporary entry visa expires or their work rights are revoked. You may find some of your previously ineligible patients may have been covered by or are currently eligible for Medicare. Due to the complexities of such Medicare eligibility, evidence of a Medicare card is the best indicator of such eligibility.

7.2 Asylum Seekers Assistance (ASA) Scheme

The Asylum Seekers Assistance (ASA) Scheme provides financial and Limited Health Care assistance to asylum seekers (non-residents) who are unable to meet their most basic needs (food, clothing, accommodation and health care). The ASA Scheme is administered by the Australian Red Cross Society and funded by the Commonwealth Department of Immigration and Multicultural Affairs (DIMA).

All ASA recipients who have a protection visa application before DIMA, subject to meeting certain eligibility criteria, will remain eligible to receive ASA until DIMA makes its decision. From 1 October 1996, the government will not provide ASA to those asylum seekers who wish to seek a review of DIMA's decision with the Refugee Review Tribunal (RRT).

The health care provided by the ASA Scheme includes hospital admission for urgent and/or life threatening conditions and also maternity care. Limited Health Care is available from a network of medical service providers and hospitals that have negotiated with the Red Cross and agreed to provide services for the Medicare bed rate in each state.

For further information regarding the Limited Health Care component of the ASA Scheme you may wish to contact:

Mr David Fair
ASA Officer
National Office, Australian Red Cross
206 Clarendon Street
East Melbourne VIC 3002
Ph: (03) 9418 5224
Fax: (03) 9419 0404

8. MEDICARE BENEFITS SCHEDULE BOOKS - DISTRIBUTION

The Commonwealth advises that the Commonwealth Minister for Health and Family Services recently approved a change in the arrangements for the distribution of the Medicare Benefits Schedule (MBS) books. The new arrangements which will take effect from the November 1996 reprint are:

all active medical practitioners on the Medicare Provider File will be able to receive one free copy of the Schedule in either book or disk format, however, these copies will now have to be ordered in advance rather than just being sent them automatically.
non-medical and commercial users will need to purchase copies from Australian Government Information Shops (AGPS bookshops - Ph: 132447) at $24.95 each or $40.00 for both the book and disk.

Network versions (5 users and above) of the disk will be available. Please contact Andrea at the AGPS on (06) 295 4676 for more information regarding the disk or to register your specific network requirements.

DR MICHAEL WALSH
DIRECTOR
ACUTE HEALTH SERVICES

ATTACHMENT A

ORDER FORM FOR THE SAME DAY PROCEDURES MANUAL (DISK FORMAT) - AUGUST 1996 (3RD EDITION)

Forward cheque to:
Ms Lydia Mills - Health Insurance Services Section (DP 2)
Commonwealth Department of Health and Family Services
GPO Box 9848
CANBERRA ACT 2601

Please forward me ....... copy/ies of the *Same Day Procedures Manual on disk at $10 each. I enclose a cheque made payable to the Department of Health and Family Services for $...... (total amount)

Name: ...........................................................................

Organisation: ............................................................................

Address: ............................................................................

............................................................................

Contact Ph Number: ............................................................................

Signature: ............................................................................

ATTACHMENT B

ORDER FORM FOR THE SCHEDULE OF BENEFITS FOR SURGICALLY INSERTED PROSTHESES

Please forward cheque to:
Mr Kent Penny (MDP 2)
Health Insurance Section
Commonwealth Department of Health and Family Services
GPO Box 9848
CANBERRA CITY ACT 2601

Please forward me ...... copy/ies of the September 1996 listing of the Schedule of Benefits for Surgically Inserted Prostheses on disk at $15 each. I enclose a cheque made payable to the Commonwealth=s Department of Health and Family Services for $ ...... (total amount).

Available in Excel 5.0 version only on a 3.5" IBM formatted disk.